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Tag: obesity

  • High Caffeine Levels Linked to Lower Body Fat, Diabetes Risk

    High Caffeine Levels Linked to Lower Body Fat, Diabetes Risk

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    March 17, 2023 — Having a higher level of caffeine in your blood could reduce body fat and the risk of type 2 diabetes, according to a new study published in BMJ Medicine. 

    Although additional research is needed, the findings open possibilities about the role that calorie-free caffeinated drinks could play in lowering the risks for obesity, diabetes, and other conditions.

    “Caffeine has been implicated in affecting metabolism and is commonly consumed in drinks. It is therefore important to better understand what causal effect it might have on metabolism,” said senior study author Dipender Gill, PhD, professor of epidemiology at Imperial College London.

    “However, we would like to emphasize that individuals should not change their dietary preferences or lifestyle based on the findings of our study alone,” he said. “Further validation in the form of clinical trials is warranted first. Furthermore, too much caffeine can also have harmful effects, so a balance is necessary.”

    Previous studies have found that drinking 3-5 cups of coffee per day is associated with a lower risk of type 2 diabetes and heart disease and drinking 100 milligrams of caffeine per day can increase energy expenditure by about 100 calories per day. An average cup of coffee contains about 70-150 milligrams of caffeine.

    However, most of the published research has focused on observational studies, which don’t prove cause and effect. Plenty of other factors could be involved, including other ingredients in caffeinated drinks and foods, according to lead author Susanna C. Larsson, PhD, of the Karolinska Institute in Stockholm, Sweden, and colleagues.

    Katarina Kos, MD, PhD, a senior lecturer in diabetes and obesity at the University of Exeter, UK, agrees. She said that this genetic study “shows links and potential health benefits for people with certain genes attributed to a faster [caffeine] … metabolism as a hereditary trait and potentially a better metabolism.”

    “It does not study or recommend drinking more coffee, which was not the purpose of this research,” she told the U.K. Science Media Centre. Kos wasn’t involved with this study.

    In the new analysis, the researchers examined data from 10,000 people mainly of European ancestry who participated in six long-term studies. 

    They examined two specific genetic mutations that have been linked to a slower speed of caffeine metabolism. In general, people with these two common genetic variants will have higher levels of caffeine in their blood after consuming coffee, or other caffeinated drinks, than those with faster caffeine metabolism.

    They then looked at how caffeine levels tracked with body fat, risk of type 2 diabetes, and risk of major heart conditions such as coronary artery disease, stroke, heart failure, and irregular heart rhythm.   

    The two gene variants resulted in “genetically predicted, lifelong, higher plasma caffeine concentrations,” the researchers note “and were associated with lower body mass index and fat mass, as well as a lower risk of type 2 diabetes.”

    There weren’t any strong associations in this study with a lower risk of developing any of the major heart conditions.

    They found that weight loss contributed to about 43% of the effect of caffeine on type 2 diabetes risk.

    “The finding that higher plasma caffeine levels may reduce bodyweight and risk of type 2 diabetes seems to fit with what is known about its effects on metabolism,” Gill said. “We are now exploring the broader effects of caffeine on health outcomes and potential mechanisms that may be mediating this.”

    The researchers noted several limitations, including that they only studied two genetic variants and that the study participants had predominantly European ancestry. They also emphasized caution about drawing strong conclusions or changing behaviors.

    Kos agrees. “When considering coffee consumption and caffeine-containing energy drinks, one must be mindful of the potential negative offset by surplus calories in the form of sugar and fat in many of these drinks,” she noted. 

    “Even for the option of increasing the use of calorie-free caffeine drinks, a benefit has yet to be proven,” Kos said. 

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  • World Obesity Day – March 4, 2023 – What Really Works for Weight Loss?

    World Obesity Day – March 4, 2023 – What Really Works for Weight Loss?

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    Newswise — As a popular diabetes drug takes social media by storm as a quick fix for weight loss, experts warn, not only is there no magic pill when it comes to losing weight, but this off-label use can actually backfire, possibly doubling the weight that was lost, once the medication is stopped. 

    According to the National Institute of Health, more than 2 in 5 adults are obese. With obesity linked to a number of diseases, including diabetes, heart disease, stroke, and cancers including breast and colorectal, these statistics are a major cause for concern. 

    But there is hope according to a new study published in the journal Obesity that found people with severe obesity, who underwent bariatric surgery, were significantly less likely to die from heart disease, diabetes, or cancer, compared with people with severe obesity who didn’t have the surgery.

    “Bariatric surgery alters the digestive system to help people lose weight,” explains Dr. Hans Schmidt, chief, Bariatric Surgery at Hackensack University Medical Center. “The benefits of bariatric surgery can far outweigh the possibility of any complications.”

    Dr. Schmidt says when multiple attempts at weight loss fail, bariatric surgery is often the best option because it actually reduces the stomach’s storage capacity, limiting food intake to help people feel full, faster. 

    Nobody knows this better than 38 year old Alex Monteleone, a detective with the Palisades Park Police Department, who underwent bariatric surgery in 2018. Alex not only lost nearly 100 pounds, he’s also no longer on the verge of diabetes or high blood pressure.

    Alex Monteleone

    For more information on this life saving procedure or to book interviews with Dr. Schmidt and his patients, contact . 

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    Hackensack Meridian Health

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  • Ozempic-like weight loss drug Wegovy coming to the U.K. market, and it will cost a fraction of what Americans pay

    Ozempic-like weight loss drug Wegovy coming to the U.K. market, and it will cost a fraction of what Americans pay

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    London — Major drug store chains in the United Kingdom plan to start selling the weight loss drug Wegovy, a different version of its hugely popular Ozempic brand, this year, as the company that makes both says it’s working to expand supplies of the popular semaglutide medications to Europe.

    Semaglutide works by mimicking the action of a hormone that makes people feel full, blunting their appetites so they eat less. Ozempic is marketed and prescribed to treat Type 2 diabetes, but its side effect of dramatic weight loss has made it popular among celebrities for that purpose. Wegovy, made by the same Denmark-based pharmaceutical company Novo Nordisk, is marketed specifically for weight loss and comes in higher doses. 

    The spike in popularity of semaglutide caused a surge in demand, leading to shortages in the U.S. earlier this year.


    The weight loss and type 2 diabetes drugs facing shortages | 60 Minutes

    01:54

    Britain’s National Institute for Health and Care Excellence (NICE) has issued draft guidance recommending Wegovy for people living with obesity, and its final guidance is expected on March 8. That guidance will serve as a formal instruction to Britain’s National Health Service to start providing the drug to patients who need it, a NICE spokesperson told CBS News.

    “We know that management of overweight and obesity is one of the biggest challenges our health service is facing with nearly two thirds of adults either overweight or obese. It is a lifelong condition that needs medical intervention, has psychological and physical effects, and can affect quality of life,” Helen Knight, program director at the center for health technology evaluation at NICE, said in a statement.

    Jo Dent, an NHS worker who visited a private doctor to obtain a prescription for Ozempic late last year after struggling to lose weight, told CBS News that semaglutide has helped her reshape her relationship with food. She said making it more readily available would be a good thing for the country’s health service.

    “I do think it would support people to be less of a burden on the NHS, in terms of the challenges of obesity and what that means for other health conditions,” she said. “It’s not a quick fix and it’s not the only answer, but actually it will help you if you’re serious about wanting to lose weight.”

    Wegovy injection pens
    Wegovy, an injectable prescription medicine, can help obese or overweight adults with weight-related medical problems lose weight.

    Novo Nordisk


    At least one major drug store chain in the U.K. plans to start prescribing and selling Wegovy privately through its online doctor service this year. Boots, the biggest national pharmacy chain, is already offering an online prescription service for the medication, while competitor Superdrug has set up a waiting list.

    Declining to offer specific countries or timings, a spokesperson for Novo Nordisk said the company was “really looking to make sure that we only launch if we can provide the product. So obviously, we have ramped up our supply chain. We’ve invested quite a lot, where our manufacturing is now running 24-hours, seven days a week.”

    The spokesperson said even after the NICE guidelines in the U.K. are published next week, Wegovy will only be available to the NHS once the company has sufficient supplies to offer it to the market.

    “We don’t have concrete launch timings,” the spokesperson told CBS News. “We’re just looking to make it available as soon as possible.”


    New guidelines for treating childhood obesity include medication and surgery

    05:20

    Novo Nordisk launched Wegovy in Norway and Denmark at the end of last year, and the spokesperson said the company expects to launch in a number of additional European countries in 2023.

    “We’re just focused on, obviously, production for Europe and continuing to supply the U.S.,” the spokesperson told CBS News.

    NICE said the list price of Wegovy in 0.25 mg, 0.5 mg and 1.0 mg doses was 73.25 pounds (about $88) per pack of four pre-filled injection pens, but that if it becomes available on the NHS, it will either be free or cost patients the standard prescription fee of about $10 per order, depending on the cost structure.

    In the U.S. the same pack of four Wegovy injection pens has a list price of $1,349, but some health insurance plans will cover at least some of that cost.

    In the U.K., Wegovy will only be available to obese adults who have at least one additional condition, such as heart disease or high blood pressure. It must be prescribed by a doctor or someone with specialist qualifications.

    Haley Ott

    Haley Ott is a digital reporter/producer for CBS News based in London.

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  • Q&A: Maybe Kids Don’t Need to Lose Weight

    Q&A: Maybe Kids Don’t Need to Lose Weight

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    Feb. 22, 2023 — After the American Academy of Pediatrics’ new guidelines for treating obese kids came out, I wrote “What Parents Should Know” for WebMD. It included insights from several experts and two moms of overweight children. The guidelines have proven controversial due to the recommendations of medication and bariatric surgery for older kids — but also because a growing number of people question whether telling a child to lose weight is ever a good idea. 

    One of the most prominent voices reaching parents about kids and weight belongs to Virginia Sole-Smith. A journalist and creator of a newsletter and podcast focused on fatphobia, diet culture, and parenting called Burnt Toast, she’s also the author of a forthcoming book on the subject. Fat Talk: Parenting in the Age of Diet Culture will be published in April. I spoke with her about the AAP guidelines and how to parent a fat — or thin — child in our seemingly inescapable diet culture.

    This interview has been edited for length and clarity.

    Q: This is probably due to my own history as a fat kid, but when I read the new AAP guidelines, they struck me as thoughtful and empathetic, though the idea of medicating or operating on teens made me uneasy. But you point out that encouraging weight loss in the first place is likely to cause more problems than it solves.

    A: We don’t have a ton of evidence that high body weight itself is the problem. There are reasons to be concerned about weight-linked health conditions, but pathologizing body size brings with it a whole other set of complications. When you do that, you start telling kids their bodies are problems to solve, you start focusing on food in ways that can raise their risk for disordered eating and eating disorders. There’s a whole ripple effect to this that the guidelines aren’t reckoning with. 

    Underpinning this whole conversation is anti-fat bias. We live in a culture that believes fat bodies are less valuable, less lovable, and less attractive than thin bodies. Our whole world is built to celebrate and welcome thin bodies and push out larger ones. This is just another way we’re doing that.

    Q: People may wonder why the AAP would put out guidelines that might be harmful for kids since this is an organization that clearly cares about children’s health. 

    A: It’s really tricky. Officially, in their paper, they say, “We have no financial disclosures to reveal, everything’s on the up and up.” But the AAP itself receives donations from pharmaceutical companies, including Novo Nordisk, which is the manufacturer of two of the biggest weight loss drugs. A lot of the authors on this paper have received research funds, speaking fees, consulting fees, etc., or they’re employed by centers that do bariatric surgery. That doesn’t need to get disclosed because it’s just their job. They’re considered an expert because of it, but they’re financially entangled with weight loss being a thing we push for. (Editor’s note: WebMD reached out to the AAP for comment. This is their reply: The AAP has a strict conflict-of-interest disclosure policy and process for all authors of policy statements, clinical reports and clinical practice guidelines. The authors include medical experts with a wide range of perspectives, medical specialties and professional experiences, including some who have conducted research on weight and obesity and others who have devoted their careers to this aspect of medicine. Their knowledge and expertise was important in the development of these evidence-based guidelines. The guidelines also underwent an extensive peer-review process among many other groups of pediatricians and pediatric specialists, and ultimately were approved by the AAP Board of Directors.)

    Q: Is trying to lose weight always bad? The moms I interviewed for that article, both of whom use the new injectable weight loss drugs, said they found it reassuring to have a medical solution to their weight problems. It removed a lot of the shame to know it was a physiological thing. And doctors point out that if your child had diabetes you wouldn’t hesitate to give them drugs. So why is this different?

    A: Why is because body size in and of itself isn’t a medical condition. Doctors have pathologized it and made obesity a diagnosis, but there’s a lot of evidence to suggest it shouldn’t be. So it’s not the same as giving your kid an inhaler for asthma or insulin for diabetes. That’s what I want — I want doctors to medicate the actual medical conditions. 

    The moms you spoke to are being told over and over that their kid’s body is a problem, and they are to blame. Parents in general, but moms especially, get so much judgment if they have a fat kid. And if you’re a fat parent with a fat kid, doubly so. They’re being told if you don’t get this problem under control, your child will have lifelong health consequences. Your child will be bullied. Your child will be unpopular, unlovable, less employable, and so on. All of that is driven by bias. That’s not medical. 

    I empathize with parents — they’re terrified for their kids so making kids smaller feels like the answer. But when we choose that, we reinforce anti-fat bias and we make it more powerful. And we say to these kids, yup, the bullies are right, your body is the problem, you are the problem. We need to change you. We don’t need to change this whole system.

    Q: The AAP guidelines say that the treatments they’re recommending statistically don’t lead to eating disorders. You argue that in reality, they do. 

    A: Eating disorders are really underdiagnosed in fat people because we assume they only happen to thin white girls. But we know they happen to people of every age, every gender, every race. There’s a lot of evidence to show that fat folks, by the time they do get treated, are much sicker because doctors have been reinforcing that disordered behavior along the way. They’re so happy to see weight loss, they don’t question how the loss was achieved. But you absolutely can have an eating disorder, you can be experiencing the physical complications of eating disorders, the heart issues, the fainting, all of that, in a larger body. You don’t have to be emaciated to deserve treatment.

    As for the AAP saying these programs don’t cause eating disorders, the research they used to determine that didn’t follow kids long enough. Often studies only follow people for 1 to 2 years. If you put a 10-year-old on a diet and follow them until they’re 11 or 12, that eating disorder may not onset until age 14 or 15. 

    And then when they did check for eating disorder symptoms, they looked for things like binge eating, overeating, purging. They looked for the symptoms they expect fat people to show, but they did not look for restriction, skipping meals, cutting out food groups, because No. 1, they don’t think fat people do that, and No. 2, that is exactly what they’re teaching the kids to do: to restrict. 

    Q: There are diseases with clear correlations to excess weight. I was just diagnosed with arthritis in my hip, and I suspect it has to do with the fact that I was 100 pounds overweight for years. How should we be talking about that?

    A: We often rush to say weight is legitimately an issue without investigating. Might a thin person with the same habits have the same risk for the condition? Just focusing on making body size smaller won’t necessarily affect whatever lifestyle factors are at play. 

    There’s also the fact that people in larger bodies receive significantly worse medical care, so a thin person reporting symptoms might get treatment faster than a fat person. I remember interviewing a weight-inclusive doctor, and I asked about knee issues. I’m fat and I have knee problems. And she said, “I have knee problems, too. I get physical therapy, I’ve gotten surgery, I’ve been prescribed all these different treatments.” But fat people get told to lose weight to take pressure off your knees. They don’t get referrals to physical therapy and things that might help these issues. The bias becomes a self-fulfilling prophecy.

    Of course, there are conditions where weight may play a causal role. I’m not disputing that. I don’t think anyone is disputing that. What we’re disputing is treating fat people like it’s their fault — if only they’d had more willpower, they wouldn’t be in this situation. Denying them care in a punitive way. That’s the harder thing for the medical community to wrap their heads around. Even if you’re fat and unhealthy, your body is still worthy of dignity and respect and health care. 

    The last piece is that sustainable weight loss doesn’t work most of the time. Dieting has a huge failure rate. Medications and surgery may be starting to change that, but they come with significant side effects. The surgery is going to be lifelong, and the medication you have to stay on for life to sustain the weight loss. You’re looking at a lifetime of consequences.

    Q: Let’s talk about the more positive side of things. In your book, you write about fat positivity and how to instill it, telling your child, “Your body is never the problem.” What does a kid get out of hearing that?

    A: It’s not the doctor’s fault, but doctors always see bodies as problems to solve — why is this symptom or behavior happening? For a kid sitting under the microscope, what a gross feeling that is, knowing someone has to invest time and money into fixing them. And with weight, it reinforces this whole larger bias. 

    But you can’t necessarily control what the doctor says in an appointment. You can ask not to discuss BMI or weight, you can try to set boundaries, but you can’t guarantee how the conversation will go. The only thing you can control is what your child hears you say. If you say to the doctor, “I don’t view their body as a problem,” at least your child comes away with the knowledge that my body is safe in my home, with my family. My parents don’t see me this way. It feels like an important foundation that so many fat kids don’t get. 

    Q: What about parents of thin kids? What should they be doing?

    A: I really want parents of thin kids to be talking about this, for two reasons. One, thin kids aren’t immune to the harms of anti-fat bias. Not every thin kid will grow up to be a thin adult. I say this as a former thin kid who’s a fat adult. It’s really important that thinness not be so interwoven with their identity, that if they can’t maintain that thinness, they feel like they’re failing.

    Thing two is, parents of thin kids need to talk about anti-fat bias the same way parents of white kids need to talk about racism. If we don’t have these hard conversations, if we don’t teach our kids to name and unlearn this bias, the rest of the culture is going to teach them instead. 

    It’s not that I want parents to try to keep their kids in a fat-positive bubble with no exposure to diet culture. I want parents to be naming these things, to be learning alongside their kids, to be having conversations so that we can help kids develop critical thinking skills. Then they can start to point out diet culture to us, they can say, “Hey, this is a really messed up way to talk about bodies in this TV show or this book I’m reading or this person I’m following on TikTok.” That is going to do more to buffer kids against these influences because we’re giving them the option to disagree with it. We’re giving them the option to think about going a different way. 

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  • TRANSCRIPT AND VIDEO AVAILABLE: Newswise Live Event: Do No-Calorie Sweeteners Affect Health?

    TRANSCRIPT AND VIDEO AVAILABLE: Newswise Live Event: Do No-Calorie Sweeteners Affect Health?

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    What: Virtual Press Briefing on New Study of Low- and No-Calorie Sweeteners and Glycemic Response.

    When: Tuesday, February 21 2022 at 1:00 PM EST

    Who: Dr. Tauseef Khan, Research Associate in Epidemiology at the University of Toronto

    Details:

    Public health organizations that are working to reduce intake levels of sugars have suggested that sweetness in the diet be reduced (including from both sugars and low-calorie sweeteners), hypothesizing that consumption of sweet-tasting foods leads to a desire for more sweets. 

    This Newswise Live Event will discuss the effects of dietary sweeteners and overall diet quality on metabolic and endocrine health.

    Dr. Khan from the University of Toronto will participate in the expert panel and discuss the different aspects of these effects, with questions prepared by Newswise editors and submissions from media attendees.

    TRANSCRIPT

    Thom: Okay, welcome to today’s Newswise live event. We’re here to talk about no-calorie sweeteners and their effect on health. We have with us today, Dr. Tauseef Khan. He’s a research associate in epidemiology at the University of Toronto. And he’s also affiliated with IAFNS. 

    We’ll get started with Dr. Khan and please Dr. Khan, if you would, tell us a little bit about the study that you’re working on and the results here relating to these no-calorie sweeteners. And how is this different from other papers and studies about these sorts of topics? 

    Dr. Khan: So, as we know that sugars have emerged as a dominant nutrient of concern and the call for its reduction is presented by all health agencies and nutrition organizations, and dietary guidelines. And the focus has been – so one thing that can replace those excess calories or excess sugars is low-calorie sweeteners. However, low-calorie sweeteners have been –  in the media, there has been a certain amount of information given which might hint at harm. So that attention needs to be addressed. Is there harm with the low-calorie sweeteners? And some proposed mechanisms are that they affect sweet taste receptors, which impair your glucose response, and insulin response, or if you eat them with carbohydrates, then there is another acute response leading to glucose intolerance. So, we wanted to answer these concerns actually. 

    First of all, many of these papers or studies did not consider that these low-calorie sweeteners are distinct compounds. So, an effect of one was attributed to all others. Plus, also there are methodological design issues with many of these studies. So how they are taken, what are they taken with, and what are they compared to? So, we want to address that question. 

    So, we undertook a systematic review and meta-analysis to compare non-nutritional sweetened beverages to water and also to caloric sweeteners. 

    So, recent evidence shows that low-calorie sweeteners can replace those calories. However, the question is there is some concern regarding low-calorie sweeteners – Or I would call them non-nutritive sweeteners over here because that’s the name that we have used, the term we have used in the paper. 

    So, eight had been approved by the FDA and the attention has been, as I described, that these non-nutritive sweeteners may affect sweet taste receptors or glucose intolerance, or they might lead to glucose intolerance and then the results are usually given. So, one study is done and it’s attributed to all others. 

    So, we want to address those concerns. 

    So, what we did was- we did a systematic review and network meta-analysis. So, it’s a kind of a review of all acute studies, all studies which looked at the intake of non-nutritive sweeteners in the beverage form in which the non-nutritive sweetener was either single or blend, compared them to water and sugary beverages. And the outcomes we looked at were glucose, insulin, and all other endocrine responses that are related to sweet taste or weight gain or appetite. 

    We looked at three different kinds of studies and one was uncoupling intervention. So where non-nutritive sweetened beverages are consumed without any calories. So, you consume them in water compared to a sugary beverage or compared to water. So, they’re not consumed with any calories. 

    Then the second one was coupling interventions with non-nutritive sweetened beverages consumed with calories. And that can answer the specific question that we want to ask. 

    And another one was the delayed coupling where intervention with non-nutritive sweetened beverages is taken first and within 15 minutes, or there’s a delay of up to 15 minutes and then a meal is taken afterwards. So this answers the question – so if non-nutritive – do they affect these various responses or outcomes of these endocrine hormonal factors and can they then affect your meal response afterwards? This is a result which is a network meta-analysis. So, the advantage of – I’ll just explain what it is. 

    So, these are individual – so this is a big network plot where we have compared the individual sweeteners are here on the axis that is coming down and their individual non-nutritive sweeteners, then blends are here, then water, and these are caloric sweeteners which mean either glucose, sucrose or fructose. 

    So, what’s happening is every bar shows you a comparison. So, aspartame over here is compared to glucose or sucralose is compared to ASK and aspartame or saccharin is compared to over here to water. So, network meta-analysis allows us to compare each non-nutritive sweetener to another. So, every comparison can be compared to another, even if in the original studies they haven’t been compared with each other. And what we see is – anything that is bold is significant effect or anything that is blue is in a significant effect that is non-trivial. So, meaning that they are significant and that response actually needs attention. So, what we see is between the individual non-nutritive sweeteners and water, there’s no difference. They’re actually acting similarly. There is slight deviations here but those are non-trivial or unimportant. However, we see a large difference between the sweeteners and the non-nutritive sweeteners and caloric sweeteners. What it shows is compared to caloric sweeteners and non-nutritive sweeteners are acting similar to water and only caloric sweeteners are increasing glucose response. And this was in 14 trials. And if we see a coupling intervention where non-nutritive sweetener was given with calories, there is no difference between the control arm and the non-nutritive sweetener arm. And this is just one for glucose but we have this for all outcomes. I’m just showing you for glucose but we have all these outcomes, more than 11 outcomes that we have compared. 

    Delayed coupling where the non-nutritive sweetener is given slightly before the calories and calories are taken afterwards. We see no difference between all these non-nutritive sweeteners and sweetener blends and water. So, they’re very similar to water. They’re inert. They have no effect on the subsequent glucose response at all with meals.

     So, what do we find? 

    So, we found that non-nutritive sweetener beverages had no effect on acute glucose, insulin or other endocrine response markers like GLP-1, GIP, PYY, ghrelin, or glucose. These are all appetite or food-related endocrine factors or hormonal factors. 

    Non-nutritive sweeteners were similar to water. The findings are similar to previous reviews looking at this topic, ghrelin, Nicole and Tucker. So, these studies looked at either glucose or insulin but we have looked at all the other outcomes too. The results are similar to recently published systematic reviews in which rigorous methods were used. These were from our group also last year, Lee 2022, which was cohort studies and Maglin 2022, which was RCTs. And we show a similar difference of caloric versus non-nutritive sweeteners. 

    Non-nutritive sweeteners will be similar to water. 

    Our results differ from select narrative reviews, in vitro studies and human studies as they failed to consider key methodological and design issues, which I have described earlier like – a pattern of intake. So, these are three patterns we are looking at, plus the type of non-nutritive sweeteners and the comparator. Are you comparing it to another non-nutritive sweetener? Are you comparing it to blend? Are you comparing it to glucose? Are you comparing it to sucrose? So, all this actually matters. 

    This paper actually answers these two very important questions that are raised for acute studies, especially acute responses. One is that there’s uncoupling a sweet taste from caloric content because of non-nutritive sweeteners that disrupt metabolic consequences of sweet taste – through hormonal changes. 

    So, what it says is, that when you take non-nutritive sweeteners there are no calories involved. The body actually acts differently, and in that uncoupling, then the body then has to have a different response and it actually eats – there’s a different glucose or hormonal response because of that sweet taste disruption. However, when we looked at non-nutritive sweeteners uncoupled from calories, they did not elicit any different response. It was similar to water and I haven’t shown this but we also had a subset of people with type two diabetes and they showed the same result. 

    So, this actually answers this sweet and coupling hypothesis. 

    Another hypothesis that is presented in the literature is the non-nutritive sweeteners might alter metabolism when consumed along with carbohydrates. So, on their own they are fine but if you eat them with carbohydrates they have a different response and that is why they might be harmful. However, when we looked at that question – when we looked at the coupled and the delayed coupling studies, delayed coupling was a preload and non-nutritive sweeteners had taken preload. They did not produce any alteration in acute glucose or other metabolic responses and the effect was similar to water. 

    So, we answered these two very important questions that are being raised in literature. 

    In conclusion, that is my final slide, no differences in acute metabolic and endocrine responses were shown. These metabolic responses were glucose. These are the ones that regulate glucose of food intake. When we compared non-nutritious sweeteners, singles or blends with water – across three patterns of intake. Our study actually supports the use of non-nutritious sweetened beverages and an alternative replacement strategy for sugar-sweetened beverages similar to water. 

    That ends my presentation and thank you, and I’m open to questions now. 

    Thom: We’ve got a couple of questions from Marlene at Medscape. You addressed some of them already a little bit, but just to recap, if you could, in a few words. Even these sweeteners, these low-calorie sweeteners and things like soft drinks, your study is showing that they do not increase appetite or cause weight gain, and that’s one of Marlene’s questions from Medscape. 

    Dr. Khan: Yeah. We can talk about appetite and weight gain related to many of these hormonal factors that we study. These are acute trials, so they’re not looking at your weight gain three months down the line or your appetite changes over a long term. We’ll be looking at acute responses within two hours. Does it affect GLP, GIP, which affect appetite? Your glucose-insulin response might affect how your calories are stored as fat or not or if they are burned up. When we look at those short-term studies, there is no effect of the non-calorie sweeteners. The results are limited to short-term responses. However, these short-term responses can be considered to inform a long-term effect also, because if anything is happening long-term, it should then show something in the short-term also. 

    Thom: In light of that, another question from Marlene, that’s a good follow-up to that is, what should then doctors advise patients who want to follow a healthy way of eating and lose weight? The suggestion of substituting these kinds of sweeteners versus others – and as you said, looking at the more long-term patterns versus these acute ones, what would you say in response to that question? 

    Dr. Khan: So Long-term cohort studies – there is some literature published which shows that in the long term when you take low-calorie sweeteners or sweetened beverages, there is an increased risk of weight gain, diabetes, or mortality. However, those studies suffer from major methodological issues, and we addressed them in another paper we published recently in Diabetes Care. What those studies do is a lot of people when they’re taking excess calories, so they’re already at high risk of disease. As soon as either the doctor tells them or consciously, they decide to change and then switch to low-calorie sweeteners. When the study is done, actually they are recorded as taking low-calorie sweeteners, but it actually is that risk – so those who switch to low-calorie sweeteners are actually the ones who are at higher risk of disease already because of the excess intake over a lifetime of intake previously, like over decades. That is something, a phenomenon called reverse causality. 

    The high risk itself makes them switch to low-calorie sweeteners. When we look at those studies, we see that effect. 

    When you actually control for that, and we have done that in the previous paper in Diabetes Care where we looked at people who actually switched from sugar-sweetened beverages to low-calorie sweeteners. Actual switching and adjusting for their weight, and second, those who actually increase their intake of low-calorie sweeteners. In both situations, we found that low-calorie sweeteners actually reduced the risk of type 2 diabetes and mortality, and also was associated with a reduction in weight. Both in the long-term and the acute term, if rigorous methods are used and properly controlled methods are used, then low-calorie sweeteners show that they can be a viable replacement for excess calories.

    Thom:  Another question from Kristy Adams relating to oral health and these non-nutritive sweeteners. She references that the World Health Organization has mentioned that dental caries is the single most common health condition globally. Do these low and non-nutritive sweeteners play a role in reducing sugar consumption to support oral health around the world? 

    Dr. Khan: Thank you for this question. It’s very interesting. The WHO sugar guidelines for adults and children are actually based on oral health. Excess sugars or sugars that you take actually affect your oral health. So a reduction in sugar intake is recommended because of its benefits to oral health, and oral health then has association with chronic disease also. 

    If anything, that can reduce the consistent intake of sugary substances will be beneficial for oral health. So, this is not my area of research, I haven’t seen literature on how low-calorie sweeteners benefit oral health. However, if they are associated with the reduction in replacing those sugar intake, it most likely will affect or benefit oral health also. 

    Thom: What, if any, gaps are there still in this research that you’d like further studies to address? 

    Dr. Khan: Yeah, there are still some gaps. In acute studies, we had very few studies for blends. The majority of trials looked at single non-nutritive sweeteners. However, in industry, the majority of foods have blends in them. 

    More studies or more trials need to be done on blends. That’s one issue. 

    Then there has to be consistency between what we see in human studies and what is seen in animal studies. In animal studies, they give very high dosages, and then they show some effect. However, with humans, the amount is so small, it doesn’t. More studies need to be done regarding those specific non-nutritive sweeteners which have shown some effect in animal studies. But in our study, we show that they are also inert in their effect on humans. 

    Thom: If we don’t have any others coming in the chat, I wanted to ask Dr. Khan about this sweet uncoupling that you referred to. Could you just summarize that for us as best you can, this separation between the taste of sweetness versus actual calories, and help us make a little bit of sense of that for maybe a takeaway here? 

    Dr. Khan: Sweet uncoupling hypothesis is just a hypothesis. It’s not been proven yet. This was presented a few years ago in the literature which says that when there’s uncoupling of sweet taste from calories. When you eat sweet food or caloric sugars, it has sweetness. 

    However, non-nutritive sweeteners are sweet, but they have no calories. 

    The hypothesis was when there is an uncoupling or separation between that, our body becomes confused and it disrupts the metabolic consequences of sweet taste. When you eat non-nutritive sweeteners, you feel the sweetness, but your gut then is expecting calories, but those calories do not arrive. It then starts responding through some acute hormonal changes. These factors GLP, GIP1, or glucose or insulin response actually then is disrupted. That is the hypothesis. 

    Thom: Your feeling is that this study is evidence to disprove that hypothesis? 

    Dr. Khan: Yes. Our study is uniquely placed to answer that question because we looked at studies where non-nutritive sweeteners were separated from calories. It did not elicit any acute hormonal response and they were very similar to water. It was both in healthy people and also in people with type 2 diabetes. 

    I believe our study actually answers that very well. 

    Thom: Fascinating. Thank you so much, Dr. Khan. I think that’s all the questions we have for today. With that, I will say thank you to Steve Gibb from the IAFNS for helping to arrange this and thank you, Dr. Tauseef Khan from the University of Toronto. Really fascinating stuff and good luck with your next studies. Thanks very much. 

    Dr. Khan: Thank you. Thanks for having me.

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  • UCLA Health tip sheet: Pesticides & Parkinson’s symptoms; Gender-affirming hormones improve mental health; Body composition & cardiovascular disease

    UCLA Health tip sheet: Pesticides & Parkinson’s symptoms; Gender-affirming hormones improve mental health; Body composition & cardiovascular disease

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    UCLA Health Tip Sheet Feb. 21, 2023

    Below is a brief roundup of news and story ideas from the experts at UCLA Health. For more information on these stories or for help on other stories, please contact us at [email protected].

    Body composition, not BMI, may signal risk for cardiovascular disease  Body mass index has long been a measure of a person’s risk of developing cardiovascular disease, but body composition and its role in the disease have not been well studied. In a new study, UCLA researchers predicted higher fat mass would be linked to higher levels of coronary artery calcification (CAC) — a marker of subclinical cardiovascular disease – and higher fat-free mass would be linked to lower levels of CAC. Using computed tomography scans and bioelectrical impedance analysis to study CAC and body composition in 3,129 non‐Hispanic Whites, Blacks, Hispanics, and Chinese patients, the researchers unexpectedly found that higher fat-free mass and, to a lesser extent, higher fat mass were linked to high levels of CAC. The researchers cautioned that bioelectrical impedance analysis could not identify the quality of fat or fat-free mass. Given these findings, the researchers say measuring body composition rather than using BMI to assess obesity may be a better approach to evaluating cardiovascular disease risk. Read the study published Feb. 8, 2023 in the Journal of the American Heart Association.

    Bariatric surgery reduces risks of hospitalization for heart failure Bariatric surgery has been found to reverse the ill effects of diabetes and may be protective against obesity-related cancers. Because obesity rates are on the rise across the globe, UCLA researchers set out to study other health benefits weight loss surgeries confer, in particular the link between the procedures and acute heart failure hospitalizations. After analyzing data from the Nationwide Readmissions Database from 2016 to 2019, the researchers found bariatric surgery was associated with lower odds of being hospitalized with acute heart failure. Among patients hospitalized with acute heart failure, prior bariatric surgery was associated with lower risks of death, prolonged ventilation, and acute renal failure. Beyond the health benefits, those who had undergone surgery stayed one fewer day in the hospital and incurred about $1,200 less in hospital costs compared to age matched cohorts. Read the study in Surgery for Obesity and Related Diseases. 

    Pesticides may also worsen Parkinson’s symptoms: While researchers have consistently found an association between pesticide exposure and higher risk of developing Parkinson’s disease, there has been little study of whether such exposure can accelerate the course of the disease. In a new study of 53 pesticides associated with Parkinson’s onset, researchers led by UCLA assistant professor of neurology Kimberly Paul, PhD, identified 10 pesticides that are associated with faster progression of motor and non-motor symptoms. Furthermore, exposure to six of those pesticides was associated with worsening of multiple endpoints researchers measured. Two pesticides, copper sulfate (pentahydrate) and MCPA (dimethylamine salt), were associated with all three endpoints measured: motor function, cognitive function, and depressive symptoms. Read the study in the journal Science of the Total Environment.

    Repurposing an old drug for a rare disease: A drug used to treat epilepsy, retigabine, may help manage episodic attacks of paralysis in patients with the rare inherited muscle disease Hypokalemic Periodic Paralysis (HypoPP), according to a new study that tested retigabine in genetically engineered mice. There’s a strong need to identify new HypoPP treatments since existing ones only improve symptoms in about half of patients and have considerable side effects. HypoPP is often marked by reduced potassium levels in the blood during episodes of muscle weakness. While it was known that retigabine affects a potassium channel that plays an important role in the heart and brain, the channel wasn’t previously known to exist in skeletal muscle. However, the new study led by Dr. Stephen C. Cannon, chair of the physiology department at the UCLA David Geffen School of Medicine, found that retigabine helps stabilize the membrane potential of skeletal muscle, thereby protecting against attacks of muscle weakness. Read the study, published online Jan. 30, in the journal Brain.

    Women treated with thrombectomy for pulmonary embolism fare worse A new study led by UCLA researchers analyzed the different outcomes in men and women with a pulmonary embolism who are treated by a percutaneous pulmonary artery thrombectomy- a procedure in which a catheter is placed in a patient’s lung to dissolve or remove a blood clot. After analysis of a national cohort of US patients from an inpatient claims-based database, researchers reported that women had higher rates of procedural bleeding, vascular complications, and needed more blood transfusions compared to men. They also found that women had higher in-hospital death rates and were more likely to go a nursing home or an assisted living facility instead of returning home after discharge. Given these disparities in outcomes, study authors are calling for more sex-based research. Read the study in the January 1, 2023 issue of CHEST. 

    A new clue about Parkinson’s progression The transmission of misfolded proteins in the brain is a key mechanism for the progression of various neurodegenerative diseases including Parkinson’s disease and Alzheimer’s disease. Chao Peng, PhD, an assistant professor of neurology, found a novel mechanism that regulates the transmission of one of these pathological proteins, misfolded alpha-synuclein, which leads to disease progression in Parkinson’s. This mechanism is the discovery that many modifications that a cell makes in these proteins alter their ability for transmission in the brain and disease progression. This discovery not only provides critical insights into disease mechanism but also facilitates the development of novel therapy for neurodegenerative diseases. Read the study, published Jan. 23, in Nature Neuroscience.

    Urban heat islands, redlining and kidney stones The persistent rise in kidney stone prevalence in recent decades has prompted much speculation as to the causes. There has been some discussion about the effect of heat on nephrolithiasis. A review of recent data suggests that heat may play a role in stone formation on a large scale and among African-Americans in particular. A new UCLA-led study led by Dr. Kymora B. Scotland states that African-Americans are the race/ancestry group with faster rates of increasing incidence and prevalence of kidney stones. Researchers also found that urban heat islands in the United States have resulted in part from the effects of redlining, a practice of systematic segregation and racism in housing that led to the development of neighborhoods with substantial disparities in environmental conditions. Dr. Scotland and her team hypothesize that the increased temperatures experienced by residents in redlined communities, many of whom are African American may contribute to the 150% increase in the prevalence of kidney stones in African Americans in recent decades. Read the study in the January 1, 2023 issue of Current Opinion in Nephrology and Hypertension.

    Gender-affirming hormones tied to mental health for transgender youth Transgender and nonbinary teens who receive gender-affirming hormones experience improvement in body satisfaction, life satisfaction and less depression and anxiety than before treatment. These findings are according to newly-published research by a four-site prospective, observational study and co-authored by Marco A. Hidalgo, PhD. Dr. Hidalgo is a clinical psychologist and Associate Clinical Professor of Medicine at the David Geffen School of Medicine at UCLA. Read the study published January 19, 2023 in the New England Journal of Medicine.

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  • Community Gardening Could Boost Your Lifestyle and Your Health

    Community Gardening Could Boost Your Lifestyle and Your Health

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    Feb. 3, 2023 — Despite the boom in wellness culture seen in recent years, Americans continue to struggle with maintaining a healthy lifestyle in the long term. We’ve had more options than ever before, but something still isn’t working. 

    According to the CDC, 6 in 10 Americans have diet-related chronic illnesses — heart disease, strokes, certain cancers, and type 2 diabetes — most of which are preventable through eating well and getting regular exercise. 

    So it might be time to think creatively and get our hands dirty.   

    For years, leaders of the Denver Urban Gardens (DUG) took notice of how many health benefits were brought about by planting seeds and tending crops, but they had no real way of scientifically measuring it. From 2017 to 2019, environmental health expert Jill Litt, PhD, and her colleagues at the University of Colorado Boulder, studied 37 DUG-run community gardens in Colorado to see if gardening could reduce the common health risks associated with diet-related chronic illnesses. 

    The randomized, controlled trial — the gold standard for measuring how effective new interventions are — found that these beginner-level gardeners saw significant increases in their fiber intake and time spent doing moderate-to-vigorous physical activity. Researchers also saw an overall decrease in anxiety among gardeners, especially in those who started the program with higher stress levels. 

    The garden, Litt says, is a solution that’s an intentional departure from medicine. 

    “It gets you away from the doctor wagging his or her finger at you and telling you that you need to lose weight and eat better because we know that doesn’t change behavior,” says Litt. 

    The garden also provides a social element that’s crucial for those who want to spend time with others while they work but aren’t into Soul Cycle or Barry’s Bootcamp. 

    Doug Wooley, 42, who has spina bifida, a spinal birth defect that can cause physical impairments, has been working in the garden for the past 10 years, with many spent at the Denver Urban Gardens. 

    Wooley uses walkers and other mobility devices. As a child, he hated going to physical therapy; staring at the same four walls and medical posters week after week with little social interaction wasn’t a particularly motivational environment, he says. 

    When I go out to the garden, I’m doing essentially all the things that I was doing in physical therapy, except it’s exciting and fun,” Wooley says. 

    And on top of the benefits to his mobility, he gets the added bonuses of watching his plants grow, connecting with the food he eats, and sharing that experience with a group of people doing the same thing. 

    Litt sees a bright future for gardening as a lifestyle intervention, but she hopes that the discussion can shift away from a focus on weight and obesity. For her, going to a doctor’s office, getting on a scale, and being told that you’re overweight doesn’t address any core issues.  

    “I would love for us to focus on the building blocks to having a healthy life and active lifestyle,” says Litt. “And if you have a bigger body type, that’s OK, but let’s figure out how to eat well, have some balance, and relieve stress, and maybe these things together become the cocktail we need.” 

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  • American Society of Nephrology Statement on U.S. Preventive Services Task Force Draft Research Plan on Screening for Kidney Diseases

    American Society of Nephrology Statement on U.S. Preventive Services Task Force Draft Research Plan on Screening for Kidney Diseases

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    Newswise — Washington, DC (January 20, 2023) —The American Society of Nephrology (ASN) is encouraged by the recent U.S. Preventive Services Task Force (USPSTF) announcement to solicit comment on USPSTF’s draft research plan on screening for kidney diseases. This development follows more than a decade of advocacy in support of more kidney health screening by ASN and other stakeholders dedicated to intervening earlier to slow or stop the progression of kidney diseases.

    More than 37 million Americans suffer from kidney diseases that impact virtually every aspect of their lives as well as their families and communities. Kidney diseases are the ninth leading cause of death in the United States, yet 90% of Americans with kidney diseases are unaware that they are affected. Prevention and early detection are key to preventing kidney failure and achieving kidney health.

    People with a family history of kidney diseases and people with diabetes, obesity, or other health issues, are at a higher risk of kidney diseases. Older adults, people with lower incomes, and people who are Black/African American, Hispanic/Latinx, Native/Indigenous American, Native Alaskan, Asian, and Native Hawaiian or other Pacific Islander are also most at risk for kidney diseases and kidney failure. Dialysis, the most common therapy for those with kidney failure, has a 5-year mortality rate worse than nearly all forms of cancer and requires billions of dollars annually to manage and treat. The recent approval of numerous therapies that successfully slow or stop the progression of kidney diseases mean it is more important than ever to screen Americans who are at-risk so they can access these effective, novel drugs as soon as possible.

    “Early screening to drive faster more comprehensive intervention are critical components of a holistic prevention strategy for kidney diseases,” said ASN President Michelle A. Josephson, MD, FASN. “We fully support USPSTF and their efforts to advance the research agenda on this critical public health priority.” Dr. Josephson added, “The entire kidney community has contributed to this decades-long effort and ASN is committed to continuing our work with other advocates, including the Coalition 4 Kidney Health, and the USPSTF to prioritize screening for kidney diseases as USPSTF finalizes its draft research plan.”

    For more information, please visit https://www.asn-online.org/policy/lac.aspx?ID=36

     

    About ASN

    Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge and advocating for the highest quality care for patients. ASN has more than 20,000 members representing 132 countries. For more information, visit www.asn-online.org and follow us on Facebook, Twitter, LinkedIn, and Instagram.

     

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    American Society of Nephrology (ASN)

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  • High fat diet activates early inflammation in mouse brains, supports link to neurologic disease

    High fat diet activates early inflammation in mouse brains, supports link to neurologic disease

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    Newswise — Researchers at Michigan Medicine have discovered that a high-fat diet promotes an early inflammatory response in the brains of mice through an immune pathway linked to diabetes and neurologic diseases, suggesting a possible bridge between metabolic dysfunction and cognitive impairment. 

    For the study, published in Frontiers in Immunology, investigators analyzed activation of the cGAS/STING immune pathway in a high-fat diet mouse model of prediabetes and cognitive impairment or dementia. Though early changes in cognition were not detected, results reveal insulin resistance, as well as inflammatory activation of cGAS/STING and the microglia, the brain’s immune cells, within three days of feeding.

    “While there is evidence suggesting a role for cGAS/STING in obesity and diabetes, both of which make patients more vulnerable to cognitive impairment or dementia, its role in the brain has not been previously studied,” said Sarah Elzinga, Ph.D., first author and a postdoctoral fellow at the NeuroNetwork for Emerging Therapies at Michigan Medicine.

    “We now see that this pathway is involved in an early burst of immune response in the microglia, which plays a critical role in Alzheimer’s disease and related dementias. If microglia are activated in the hippocampus under high-fat diet conditions, that may contribute to inflammation and degeneration in the nervous system and eventual cognitive impairment or dementia.”

    Obesity and diabetes are significantly associated with the development of dementia and other neurologic diseases. Elzinga and the research team say further research is needed to examine if inhibiting the cGAS/STING pathway is a possible treatment target for reversing or preventing harmful changes in the brains of people who develop cognitive impairment or dementias.

    “Innovative ideas that can lead to novel treatment paradigms are critical in our battle against Alzheimer’s disease,” said senior author Eva Feldman, M.D., Ph.D., James W. Albers Distinguished Professor at U-M, the Russell N. DeJong Professor of Neurology and director of the NeuroNetwork for Emerging Therapies at Michigan Medicine. “This research with cGAS/STING is one such innovation and opens doors to exciting new therapeutic possibilities.”

    Additional authors include Rosemary Henn, Ph.D., Benjamin J. Murdock, Ph.D., Bhumsoo Kim, Ph.D., John M. Hayes, Ian Webber-Davis, Sam Teener, Crystal Pacut, Stephen I. Lentz, Ph.D., all of Michigan Medicine, Faye Medelson

    Funding for this study was provided in part by the NIH National Institute of Diabetes and Digestive Kidney Disease and the National Institute on Aging.

    Paper cited: “cGAS/STING and innate brain inflammation following acute high-fat feeding,” Frontiers in Immunology. DOI: 10.3389/fimmu.2022.1012594

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  • New Guidelines for Kids With Obesity: What Parents Should Know

    New Guidelines for Kids With Obesity: What Parents Should Know

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    Jan. 13, 2023 — The American Academy of Pediatrics last week issued their first new guidelines in 15 years for evaluating and treating kids and adolescents with overweight or obesity. 

    If you only saw the headlines, you might think that when a youngster is a few pounds overweight, their pediatrician will prescribe a weight loss drug or bariatric surgery. The reality is much less alarming. The guidelines take a deep dive into evidence-based treatments at various levels.

    “It’s a misunderstanding, it’s being sensationalized,” says Lori Fishman, PsyD, a child psychologist who specializes in pediatric weight management. “There’s so much more to the process. It’ll be a small percentage of kids who’ll even qualify for these treatments.” 

    Treating the Whole Child

    Before writing the guidelines, the AAP’s Subcommittee on Obesity spent years analyzing and synthesizing information from nearly 400 studies. 

    “We now have more information than ever that supports that obesity is a chronic, complex disease that requires a whole-child approach,” says Sarah Hampl, MD, one of two lead authors of the guidelines. “And many kids will not outgrow it, so it’s important to identify children with obesity early and offer them evidence-based treatments.”

    In the new guidelines, treatment of overweight and obesity doesn’t mean putting a kid on a diet and expecting their parents to manage it. Instead, multi-pronged approaches might include nutrition support, physical activity specialists, behavioral therapy, medications for adolescents 12 and up, and surgery for teenagers with severe obesity. 

    Before starting any of these evidence-based treatments, the guidelines remind pediatricians to consider each child’s individual circumstances — their living situation, their access to healthy food, and more.

    “As pediatricians, we ought to be especially mindful of the influences that child and family are surrounded by,” Hampl says. “We should help guide them, whether it’s to local resources for healthy food or support for a child who’s being bullied.”

    Because obesity is often stigmatized, the pediatricians’ group also included guidance for pediatricians to help them examine their own biases. It calls on them to acknowledge the myriad genetic and environmental factors that contribute to obesity and treat children and their parents with respect and sensitivity.

    The Rise of Childhood Obesity

    For kids 2-18, obesity is defined as having a BMI at or above the 95th percentile for a child’s age and sex. Rates of pediatric obesity have more than tripled since the 1960s, from 5% to nearly 20%. Just last month, the CDC released updated growth charts to take into account how many more children and adolescents now have severe obesity, well beyond the 95th percentile. By 2018, more than 4.5 million kids qualified, but the old charts didn’t go high enough.

    If these trends continue, researchers estimate that 57% of children aged 2 to 19 will have obesity by the time they hit 35. And the pandemic has only made things worse.

    “It’s about much more than what we eat and drink or how physically active we are,” Hampl says. Risk factors for obesity include genetics, socioeconomics, race and ethnicity, government policies, a child’s environment, neighborhood, and school, and even their exposure to unhealthy food marketing. Because each child is so different, these factors combine in unique ways.

    You can see an example of the variability in Jill’s family. She’s a New Jersey mom with two teenage sons. For privacy reasons, we’re using only her first name. 

    “I have two children who I raised the same way, who were offered the same foods, and yet one weighs 80 pounds more than the other,” she says. “My 16-year-old is happy to choose fruit over a cookie. He’s able to stop, to not eat another bite. The 14-year-old will eat cookies until they’re gone.”

    No More Watch and Wait

    The last set of guidelines, from 2007, called for pediatricians to monitor kids with obesity via “watchful waiting.” It would give children a chance to outgrow their excess pounds before being treated. Research conducted since then shows that’s not effective. 

    “The risk of watching and waiting, in my experience, is that a 10-pound-overweight child a year later might be 30 pounds overweight,” says Fishman. “That’s a lot harder to tackle.”

    In the new guidelines, the AAP stresses the urgency of treating children with overweight and obesity as soon as it’s diagnosed. Instead of hoping a growth spurt might take care of the problem, pediatricians should move quickly, “at the highest level of intensity appropriate for and available to the child.”

    By guiding children and their families to adopt healthier habits early, it may help to reduce some of the weight-related health issues that have also increased in the last few decades. Just within the 21st century, diabetes rates for children and teenagers have skyrocketed — between 2001 and 2017, the number of kids with type 2 went up an astonishing 95%.

    “Now we understand the consequences of untreated obesity, especially severe obesity,” says Mary Ellen Vajravelu, MD, a doctor-scientist at the Center for Pediatric Research in Obesity and Metabolism in Pittsburgh. “That includes type 2 diabetes, fatty liver disease, high blood pressure, high cholesterol. It’s important to treat obesity in childhood to avoid the complications we’re seeing in young adults.”

    Also important: Reversing the trend while a child is young can help them avoid the emotional impact of growing up with obesity. 

    “I saw the recommendations and thought, ‘How different would my life have been for the past 35 years if they had treated my obesity when I was a child?” says Heather, the mother of a 10-year-old in Florida. She’s been carrying shame and limiting herself since childhood, for instance by avoiding activities where her size might prove embarrassing. “For kids who are struggling, I think it’ll be life-changing.”

    What the Guidelines Really Say

    In a world where fat-shaming is rampant, parents often want to protect their children by encouraging them to lose weight — but parental pressure adds another layer of bad feelings. The AAP advises against putting a child on a diet or restricting their access to food without professional help. Guidelines recommend that pediatricians:

    • Treat obesity as a chronic disease. That calls for long-term care strategies and ongoing monitoring.
    • Implement a model known as the “medical home.” It takes treatment beyond the exam room to shape behavior and lifestyle changes. Pediatricians should build partnerships with families in their care and serve as a care coordinator, working with a team that may include obesity treatment specialists, dietitians, psychologists, nurses, exercise specialists, and social workers.
    • Use a patient-centered counseling style called motivational interviewing. Rather than a doctor prescribing changes for a child’s family to figure out, the process guides families to identify which behaviors to adjust based on their own priorities and goals — that might mean cutting back on sugary drinks or walking together after dinner. Research has shown it takes less than 5 hours of motivational interviewing with a pediatrician or dietitian to help bring down BMI.
    • Opt for an approach called intensive health behavior and lifestyle treatment (IHBLT) whenever feasible. As the name suggests, it’s an intense treatment that calls for at least 26 hours of face-to-face, family counseling on nutrition and exercise over a period of 3 to 12 months. More sessions produce larger reductions in BMI, with 52 hours or more over the same duration having the greatest impact. Unfortunately this treatment program isn’t available everywhere, and for many families the time and financial demands put it out of reach.
    • Offer approved weight loss drugs to adolescents 12 years and older who have obesity. Medication should always be used together with nutrition and exercise therapies.
    • Refer adolescents 13 and up with severe obesity for possible weight loss surgery. That referral should be to a surgical center with experience in working with adolescents and their families, where the teen would undergo a thorough screening process.

    Medication and Surgery

    Those last two recommendations have garnered most of the headlines, and it’s understandable. Medicating a child — or performing an operation that would permanently change their body — might seem extreme. But the research shows that for children with obesity and severe obesity, these treatments work.

    “This isn’t for a kid who’s a little overweight,” says Fishman. “It’s obesity that’s limiting this child’s ability to function. When we face something this disabling, we want to attack it from every direction we can.”

    Right now, only a handful of medications are approved to treat obesity in adolescents. Some are taken orally, while others, like the recently approved Wegovy, are injected. 

    Jill, the New Jersey mom, is using Wegovy herself. 

    “The fact that I’ve had success with it makes me more comfortable about approaching it as an option for my son,” she says. “And ultimately, it’s his choice. If he wants to see if he can just do things differently first, we’ll try that. A nutritionist’s guidance will be part of this for him regardless, so he can understand what’s involved. It’s not like he’ll get the shot and all of a sudden magic happens.”

    Losing weight with medication can help remove some of the shame that often comes with obesity. Heather, the Florida mom, is also using an injectable drug.

    “It’s all the morality stuff like, if you had more self-control, if you worked harder and really tried, if you just made the choice,” she says. “This pulls all the morality out of it. Obesity is a medical condition. It’s so clear. In the same way I take thyroxin because my thyroid doesn’t work well, this makes my insulin receptors work properly.”

    For kids 13 and older with severe obesity — a BMI over 35, or 120% of the 95th percentile for age and sex — metabolic or bariatric surgery may be recommended. Of course, surgery is much more invasive than medication, with a greater risk of complications. The guidelines acknowledge this and stress the need for thorough screening before proceeding.

    “The pediatrician would refer a child for evaluation. They wouldn’t say, ‘You definitely need to have surgery,’” Hampl says. “They’d say, ‘As your pediatrician, I feel that you would benefit from a comprehensive evaluation at a pediatric bariatric surgical center.’ These types of centers do a very thorough pre-op evaluation over at least 6 months, and then careful monitoring is done for years afterward.”

    Weight loss surgery for adolescents does have certain drawbacks. Any surgery has the risk of complications, and some surgical patients do gain back a significant amount of weight. Some research suggests that adolescents who have the surgery are more likely to have alcohol problems later in life.

    Even with those risks, for some teens surgery may prove life-saving.

    “We know much more about the complications of obesity in adults, we know those are devastating,” says Hampl. “If we can prevent heart attacks, stroke, sleep apnea, diabetes, and other really serious medical complications, that in itself is a huge benefit to the person’s health.”

    The Question of Equity

    The guidelines point out that obesity has inequities baked into the condition. Risk factors increase depending on your economic status and your race. Access to treatment is lopsided. Some of the most effective treatments, like intensive health behavior and lifestyle treatment, aren’t available everywhere. Providers may not be in-network or even accept insurance. 

    If the family of a child with overweight can’t access effective programs to help them build healthy habits, the child’s odds for developing obesity grow. As they get older and their BMI reaches the level of obesity or severe obesity, treatments like medication and surgery become an option. But they’re even more costly, which leaves many families with no help at all.

    That’s why the guidelines also include policy recommendations aimed at covering comprehensive obesity prevention, evaluation, and treatment. They call attention to the ways unhealthy food is marketed, the effects of limited resources on a community, how socioeconomic and immigration status factor in, and the challenges posed by food insecurity.

    “We hope the guidelines will serve as impetus to help improve access to care for all children with obesity,” Hampl says. “That includes everything from infrastructure and policy to systems change as well.”

    For parents who struggle to help their children with overweight and obesity, having such an authoritative resource can pave the way to getting real help.

    “It’s good that they issued these guidelines. I’m hoping, for my son and all the kids out there who are struggling, that it will help to have it recognized as something worthy of clinical, medical management,” Jill says. “It’s validating.” 

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  • Consumption of fast food linked to liver disease

    Consumption of fast food linked to liver disease

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    Newswise — LOS ANGELES — The new year has begun, and with it, resolutions for change.

    A study from Keck Medicine of USC published today in Clinical Gastroenterology and Hepatology gives people extra motivation to reduce fast-food consumption.

    The study found that eating fast food is associated with nonalcoholic fatty liver disease, a potentially life-threatening condition in which fat builds up in the liver.

    Researchers discovered that people with obesity or diabetes who consume 20% or more of their daily calories from fast food have severely elevated levels of fat in their liver compared to those who consume less or no fast food. And the general population has moderate increases of liver fat when one-fifth or more of their diet is fast food.

    “Healthy livers contain a small amount of fat, usually less than 5%, and even a moderate increase in fat can lead to nonalcoholic fatty liver disease,” said Ani Kardashian, MD, a hepatologist with Keck Medicine and lead author of the study. “The severe rise in liver fat in those with obesity or diabetes is especially striking, and probably due to the fact that these conditions cause a greater susceptibility for fat to build up in the liver.”

    While previous research has shown a link between fast food and obesity and diabetes, this is one of the first studies to demonstrate the negative impact of fast food on liver health, according to Kardashian.

    The findings also reveal that a relatively modest amount of fast food, which is high in carbohydrates and fat, can hurt the liver. “If people eat one meal a day at a fast-food restaurant, they may think they aren’t doing harm,” said Kardashian. “However, if that one meal equals at least one-fifth of their daily calories, they are putting their livers at risk.”

    Nonalcoholic fatty liver disease, also known as liver steatosis, can lead to cirrhosis, or scarring of the liver, which can cause liver cancer or failure. Liver steatosis affects over 30% of the U.S. population.

    Kardashian and colleagues analyzed the most recent data from the nation’s largest annual nutritional survey, the 2017-2018 National Health and Nutrition Examination Survey, to determine the impact of fast-food consumption on liver steatosis.

    The study characterized fast food as meals, including pizza, from either a drive-through restaurant or one without wait staff.

    The researchers evaluated the fatty liver measurement of approximately 4,000 adults whose fatty liver measurements were included in the survey and compared these measurements to their fast-food consumption.

    Of those surveyed, 52% consumed some fast food. Of these, 29% consumed one-fifth or more daily calories from fast food. Only this 29% of survey subjects experienced a rise in liver fat levels.

    The association between liver steatosis and a 20% diet of fast food held steady for both the general population and those with obesity or diabetes even after data was adjusted for multiple other factors such as age, sex, race, ethnicity, alcohol use and physical activity.

    “Our findings are particularly alarming as fast-food consumption has gone up in the last 50 years, regardless of socioeconomic status,” said Kardashian. “We’ve also seen a substantial surge in fast-food dining during the COVID-19 pandemic, which is probably related to the decline in full-service restaurant dining and rising rates of food insecurity. We worry that the number of those with fatty livers has gone up even more since the time of the survey.”

    She hopes the study will encourage health care providers to offer patients more nutrition education, especially to those with obesity or diabetes who are at higher risk of developing a fatty liver from fast food. Currently, the only way to treat liver steatosis is through an improved diet.

    Jennifer Dodge, MPH, assistant professor of research medicine and population and public health sciences at the Keck School of Medicine of USC and Norah Terrault, MD, MPH, a Keck Medicine gastroenterologist and division chief of gastroenterology and liver diseases at the Keck School, were also authors on the study.

     

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    For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

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  • New guidance: Treat childhood obesity aggressively

    New guidance: Treat childhood obesity aggressively

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    New guidance: Treat childhood obesity aggressively – CBS News


    Watch CBS News



    Children struggling with obesity should be evaluated and treated early and aggressively, according to new guidelines from the American Academy of Pediatrics. CBS News chief medical correspondent Dr. Jon LaPook shares more.

    Be the first to know

    Get browser notifications for breaking news, live events, and exclusive reporting.


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  • Best Diets in 2023: Mediterranean Diet Wins Again

    Best Diets in 2023: Mediterranean Diet Wins Again

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    Jan. 3, 2022 – It’s officially 2023, and if history repeats, millions of Americans are likely vowing that this year will be one when they drop those unwanted pounds for good. After all, weight loss usually lands one of the top spots on New Year’s resolution surveys. 

    And just in time, there’s guidance to pick the best plan. Released today are U.S. News & World Report’s annual rankings of the best diet plans.

    Once again, the Mediterranean diet, which emphasizes fruits, vegetables, olive oil, and fish, got the top spot, as best diet overall. It’s the sixth consecutive year for that win. But many other diets got top marks as well.

    This year, U.S. News, with the help of more than 30 nutritionists, doctors, and epidemiologists, ranked 24 diets in several categories to help people find a plan that meets their goals, whether it’s finding the best weight loss diet, easiest one to follow, or plans for other goals, such as managing diabetes or heart disease. Two new categories were added: Best Diets for Bone & Joint Health and Best Family-Friendly Diets. 

    In previous years, the publication ranked 40 diets. Even if a diet is no longer ranked, its profile with detailed information remains on the site. 

    “Each year we ask ourselves what we can do better or differently next time,” says Gretel Schueller, managing editor of health for U.S. News. When the publication got feedback from their experts this year, they had requests to consider sustainability of diets and whether they meet a busy family’s needs, in addition to considering many other factors. 

    This year’s report ranks plans in 11 categories.

    The winners and the categories:

    Best Diets Overall

    After the Mediterranean diet, two others tied for second place:

    • DASH (Dietary Approaches to Stop Hypertension) diet, which fights high blood pressure and emphasizes fruits, vegetables, whole grains, lean protein, and low-fat dairy.
    • Flexitarian diet, which focuses on fruits, vegetables, and other healthy foods but also allows occasional meat.

    Best Weight Loss Diets

    WW, formerly known as Weight Watchers, got first place. The plan emphasizes not only weight loss but healthier eating and regular activity. The Points program, which assigns specific points to foods, with a daily Points budget, is more personalized than in the past.

    • DASH got second place.
    • Mayo Clinic Diet and TLC diet tied for third place. The Mayo Clinic Diet focuses on fruits, vegetables, and whole grains. It helps people improve their eating habits. The TLC diet (Therapeutic Lifestyle Changes) focuses on vegetables, fruit, lean protein, and reducing cholesterol levels. 

    Best Fast Weight Loss Diets

    The keto diet got first place. It’s a high-fat, low-carb diet that aims to achieve weight loss through fat burning. Four others tied for second place:

    • Atkins, a diet created by the cardiologist Robert Atkins, which begins with very few carbs and then recommends progressively eating more until the weight loss goal is achieved 
    • Nutrisystem, a commercial program that includes prepackaged meals and focuses on high-protein, lower-glycemic foods to stabilize blood sugar levels
    • Optavia, a plan focused on low-carb, low-calorie foods and including fortified meal replacements 
    • SlimFast Diet, a plan of shakes, smoothies, and meal bars to replace two of three meals a day

    Best Diets for Healthy Eating

    • Mediterranean
    • DASH
    • Flexitarian

    Best Heart-Healthy Diets

    • DASH
    • Mediterranean
    • Flexitarian and Ornish tied for third. The Ornish Diet focuses on plant-based and whole foods and limiting animal products. It recommends daily exercise and stress reduction.

    Best Diets for Diabetes

    • DASH
    • Mediterranean
    • Flexitarian

    Best Diets for Bone and Joint Health

    DASH and Mediterranean are in a first-place tie, followed by the flexitarian diet.

    Best Family-Friendly Diets

    This category has a three-way tie: the flexitarian, Mediterranean, and TLC diets. 

    Best Plant-Based Diets

    Mediterranean was first, then flexitarian and the MIND diet. The MIND diet combines the DASH and Mediterranean diets and focuses on “brain-healthy” foods.

    Easiest Diets to Follow

    Flexitarian and TLC tied for first, followed by a tie between DASH and Mediterranean.

    Best Diet Programs (formerly called commercial plans)

    • WW
    • There was a tie for second place between Jenny Craig and Noom, the latter of which focuses on low-calorie foods, with personalized calorie ranges and coaching to help meet goals.

    Methodology

    A variety of factors were considered, such as whether a diet includes all food groups, how easy it is to follow, whether it can be customized to meet cultural and personal preferences, and if it has a realistic timeline for weight loss. 

    Response from Diet Plans

    Representatives from two plans that received mixed reviews in the rankings responded.

    Jenny Craig was ranked second for best diet program but much lower for family-friendly, landing at 22nd place of 24. 

    “Our program is designed to address the needs of the individual through personalized experiences,” Jenny Craig CEO Mandy Dowson says. “We have many families that participate in our program together but are still evaluated separately to determine appropriate individual goals.”

    Its high ranking for best diet program reflects feedback from satisfied members, she says. Among advances will be the new Jenny Fresh program, a line of entrées prepared fresh and delivered to customers’ doors.

    Atkins got second place for best fast weight loss but ranked near the bottom for best overall, best weight loss, diabetes, healthy eating, and heart health. In response, Colette Heimowitz, vice president of nutrition and education for Simply Good Foods, which makes Atkins’s food products, says that low-carb eating approaches are a viable option for anyone today.

    “There are more than 130 independent, peer-reviewed published studies that show the efficacy and safety of low-carb eating,” she says. “The studies have been conducted for several decades and counting.” 

    Expert Perspective

    Samantha Cassetty, a registered dietitian, nutritionist, and wellness expert in New York City and author of Sugar Shock, reviewed the report for WebMD. She was not involved in the rankings.

    “I think what this shows you is, the best diet overall is also the best for various conditions,” she says. For instance, the Mediterranean, the number one overall, also got high ranking for diabetes, heart health, and bone and joint health, she points out.

    For consumers trying to lose weight: “If you see fast weight loss, that should be a red flag. A healthy diet for weight loss is one you can sustain,” she says. 

    She’s not a fan of the programs with prepackaged foods. “It takes the guesswork out, but the portion sizes tend to be unsatisfying. They don’t teach you how to deal with some of the challenges [such as realizing an ‘ideal’ portion size].”

    How to Use the Report

    Schueller’s advice: “Recognize that no diet fits everyone.” When considering which plan to choose, she suggests thinking long-term. 

    “Whatever we choose has to work in the long run,” she says.

    Consumers should consider expenses, meal prep time, and whether the diet fits their lifestyle.

    Ideally, she says, the best diet “teaches you smart food preparation and how to make healthy choices, allows the flexibility to be social and eat with groups, whether family or friends.”

    Before choosing a diet to follow, consult a medical professional for input on the decision, U.S. News cautions.

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  • Obesity Might Lower Milk Production in Breastfeeding Moms

    Obesity Might Lower Milk Production in Breastfeeding Moms

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    By Cara Murez 

    HealthDay Reporter

    THURSDAY, Dec. 29, 2022 (HealthDay News) — While 8 of 10 mothers breastfeed their newborns for a short time, the number plummets despite recommendations from experts, in part because milk production falls off.

    Researchers investigating why that happens found that in women who are obese, inflammation may be the culprit.

    Prior research has shown that when a person is obese, chronic inflammation starts in the fat and spreads to organs and systems throughout the body. And that inflammation may disrupt absorption of fatty acids from the blood into body tissues.

    These fatty acids are the building blocks for the fats needed to feed a growing infant.

    “Science has shown repeatedly that there is a strong connection between the fatty acids that you eat and the fatty acids in your blood,” said lead author Rachel Walker, postdoctoral fellow in nutritional sciences at Penn State University. “If someone eats a lot of salmon, you will find more omega-3s in their blood. If someone else eats a lot of hamburgers, you will find more saturated fats in their blood.”

    The study is among the first to examine whether fatty acids in blood are also found in breast milk, Walker said.

    “For women who are exclusively breastfeeding, the correlation was very high; most of the fatty acids that appeared in blood were also present in the breast milk,” she said in a university news release.

    But for women with chronic inflammation who were struggling to make enough milk, that link was almost gone, Walker said.

    “This is strong evidence that fatty acids are not able to enter the mammary gland for women with chronic inflammation,” she added.

    For this study, researchers analyzed blood and milk from a study conducted at Cincinnati Children’s Hospital and the University of Cincinnati.

    In the original study, researchers recruited 23 mothers who had very little milk despite efforts to stimulate production through frequent breast emptying; 20 mothers with moderate milk production; and a control group of 18 who breastfed exclusively.

    Compared to the other mothers, those with very little milk had significantly higher rates of obesity and biological markers of systemic inflammation.

    While milk and blood fatty acids were strongly linked in the control group, that was not true in the groups with moderate or very low milk production.

    “Breastfeeding has innumerable benefits for both the mother and child, including lower risk of chronic disease for mom and lower risk of infections for baby,” said study co-author Alison Gernand, associate professor of nutritional sciences at Penn State.

    “This research helps us understand what might be happening in mothers with high weight status and inflammation, which down the road could lead to interventions or treatments that allow more moms that want to breastfeed to do so,” Gernand said in the release.

    The U.S. Centers for Disease Control and Prevention recommends breastfeeding exclusively for a baby’s first six months. Just 25% of mothers do so, citing job pressures and a lack of social support as obstacles.
     

    The findings were recently published in the Journal of Nutrition.

    More information

    The U.S. Centers for Disease Control and Prevention has more on the importance of breastfeeding.

     

    SOURCE: Penn State University, news release, Dec. 21, 2022

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  • Understanding the “eating just one potato chip is impossible” gene

    Understanding the “eating just one potato chip is impossible” gene

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    Newswise — High-calorie foods—high in fat, oil, and sugar—can taste good but often cause overeating, leading to obesity and major health problems. But what stimulates the brain to cause overeating?

    Recently, it has become clear that a gene called CREB-Regulated Transcription Coactivator 1 (CRTC1) is associated with obesity in humans. When CRTC1 is deleted in mice, they become obese, indicating that functioning CRTC1 suppresses obesity. However, since CRTC1 is expressed in all neurons in the brain, the specific neurons responsible for suppressing obesity and the mechanism present in those neurons remained unknown.

    To elucidate the mechanism by which CRTC1 suppresses obesity, a research group led by Associate Professor Shigenobu Matsumura from the Graduate School of Human Life and Ecology at Osaka Metropolitan University focused on neurons expressing the melanocortin-4 receptor (MC4R). They hypothesized that CRTC1 expression in MC4R-expressing neurons suppressed obesity because mutations in the MC4R gene are known to cause obesity. Consequently, they created a strain of mice that expresses CRTC1 normally except in MC4R-expressing neurons where it is blocked to examine the effect that losing CRTC1 in those neurons had on obesity and diabetes.

    When fed a standard diet, the mice without CRTC1 in MC4R-expressing neurons showed no changes in body weight compared to control mice. However, when the CRTC1-deficient mice were raised on a high-fat diet, they overate, then became significantly more obese than the control mice and developed diabetes.

    “This study has revealed the role that the CRTC1 gene plays in the brain, and part of the mechanism that stops us from overeating high-calorie, fatty, and sugary foods,” said Professor Matsumura. “We hope this will lead to a better understanding of what causes people to overeat.”

    The research results were published in the FASEB Journal on November 9, 2022.

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    Osaka Metropolitan University is a new public university established by a merger between Osaka City University and Osaka Prefecture University in April 2022. For more science news, see https://www.omu.ac.jp/en/info/research-news/, and follow @OsakaMetUniv_en, or search #OMUScience. 

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  • Research shows fatty liver disease endangers brain health

    Research shows fatty liver disease endangers brain health

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    Newswise — In a study examining the link between non-alcoholic fatty liver disease (NAFLD) and brain dysfunction, scientists at the Roger Williams Institute of Hepatology, affiliated to King’s College London and the University of Lausanne, found an accumulation of fat in the liver causes a decrease in oxygen to the brain and inflammation to brain tissue – both of which have been proven to lead to the onset of severe brain diseases. 

    NAFLD affects approximately 25% of the population and more than 80% of morbidly obese people. Several studies have reported the negative effects of an unhealthy diet and obesity can have on brain function however this is believed to be the first study that clearly links NAFLD with brain deterioration and identifies a potential therapeutic target. 

    The research, conducted in collaboration with Inserm (the French National Institute of Health and Medical Research) and the University of Poitiers in France, involved feeding two different diets to mice. Half of the mice consumed a diet with no more than 10% fat in their calorie intake, while the other half’s calorie intake contained 55% fat; intended to resemble a diet of processed foods and sugary drinks. 

    After 16 weeks researchers conducted a series of tests to compare the effects of these diets on the body and more specifically, on the liver and the brain. They found that all mice consuming the higher levels of fat were considered obese, and developed NAFLD, insulin resistance and brain dysfunction.  

    The study which was funded by the University of Lausanne and Foundation for Liver Research also showed that the brain of mice with NAFLD suffered from lower oxygen levels. This is because the disease affects the number and thickness of the brain blood vessels, which deliver less oxygen to the tissue, but also due to specific cells consuming more oxygen while the brain is becoming inflamed. These mice were also more anxious and showed signs of depression. 

    By comparison, the mice consuming the healthy diet did not develop NAFLD or insulin resistance, they behaved normally, and their brain was completely healthy.  

    “It is very concerning to see the effect that fat accumulation in the liver can have on the brain, especially because it often starts off mild and can exist silently for many years without people knowing they have it,” said lead author Dr Anna Hadjihambi, sub-team lead in the Liver-Brain Axis group at the Roger Williams Institute of Hepatology and honorary lecturer at King’s College London.  

    To try and combat the dangerous effect that NAFLD has on the brain, the scientists bred mice with lower levels of a whole-body protein known as Monocarboxylate Transporter 1 (MCT1) – a protein specialised in the transport of energy substrates used by various cells for their normal function. 

    When these mice were fed the same unhealthy fat- and sugar-rich diet as those in the initial experiment, they had no fat accumulation in the liver and exhibited no sign of brain dysfunction – they were protected from both ailments. 

    “Identifying MCT1 as a key element in the development of both NAFLD and its associated brain dysfunction opens interesting perspectives,” said Professor Luc Pellerin, director of the Inserm U1313 research unit at the University of Poitiers in France and senior researcher in the study. “It highlights potential mechanisms at play within the liver-brain axis and points to a possible therapeutic target.” 

    Dr Hadjihambi added: “This research emphasises that cutting down the amount of sugar and fat in our diets is not only important for tackling obesity, but also for protecting the liver to maintain brain health and minimise the risk of developing conditions like depression and dementia during ageing, when our brain becomes even more fragile. 

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  • Why Are Black Mothers at Higher Risk for Miscarriage?

    Why Are Black Mothers at Higher Risk for Miscarriage?

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    NeCara McClendon was 19 weeks pregnant and home on a Tuesday evening after work in August of 2022 when she started to bleed – heavily. 

    At the nearest ER in Fredericksburg, VA, where she lives, medical personnel told her that her cervix was opening. Her baby and the amniotic sac were moving into the birthing canal too early. 

    One doctor told her there was no hope, a second doctor said she needed an expert consult, and a third doctor via telehealth recommended a transfer and a technique in which the mother is tilted head down in a hospital bed to try and avoid miscarriage. 

    The mixed messages were disheartening, Mclendon said. “It felt like they kept giving me a little hope and then taking it away.”

    After the transfer, McClendon found out that the new hospital didn’t offer the tilt treatment. Instead, they gave her medicine and told her to wait. And she did – for 3 days – before an ultrasound showed her son’s legs in the birth canal. 

    The doctor said there was nothing that could be done. McClendon delivered her son the next morning at 19 weeks and 5 days, too young to survive outside her womb. 

    “The days afterward were nonstop crying – asking [myself] why did this happen to me. I started to feel like a failure.”

    Why It Happens

    Miscarriage is more common than many people think. It happens in about 1 in 4 pregnancies, usually in the first trimester. It’s often not clear why it happens. 

    Still, some things raise the risk of miscarriage. Weight is one of them and McClendon is slightly overweight. She also has polycystic ovarian syndrome (PCOS), which means her ovaries produce too many male sex hormones called androgens. PCOS can raise the risk of an early miscarriage in the first 3 months of pregnancy. (McClendon didn’t lose her son until almost the fifth month.)

    But there is another factor: McClendon is Black. 

    In the United States, Black women are  43% more likely than white women to have a miscarriage, according to a 2021 study that looked at more than half a million U.S. women. (A Black mother is also more likely than a white mother to lose her baby after 20 weeks or in delivery (stillbirth), or to lose her life, according to the CDC.)

    “The scandal is we really don’t know [why],” said the study’s lead author, Siobhan Quenby, MD.  “We desperately need more research. It’s not acceptable in 2022 not to know.” 

    Doctors do know that health risk factors for miscarriage like diabetes, obesity, and high blood pressure are more common in Black women than white women. 

    But again, the question is why? Factors include differences in biology, society, culture, lifestyle, and medical care, among others. And these can be quite hard to separate out, according to experts. 

    Other lesser-studied biological factors may also play a part. For example, fibroids – muscular tumors that grow on the wall of the uterus — can sometimes cause miscarriage. Almost 25% of Black women aged 18 to 30 have them, compared to 6% of white women. Black women are also two to three times more likely to have recurring fibroids or complications, which could add to the problem. 

    The difference in vaginal microbiota between Black and white women may be involved since the vaginal microbiome has been linked to recurrent miscarriage. 

    But it’s discrepancies in access and use of medical care that could make the biggest difference, said Ana Langer, MD, director of the Women’s Health Initiative at Harvard’s T.H. Chan School of Public Health. 

    Black women are less likely to seek adequate prenatal care for any number of reasons, Langer said. These may include lack of insurance, lack of financial and educational resources, lack of nearby health facilities, fear of mistreatment, and more. Even the perception of racial discrimination in society at large can delay prenatal care, according to some research. 

    The effect of race in medical settings can be hard to unpack. In one striking study, the death rate of Black newborns, which is three times higher than white newborns in the U.S., was cut in half when they were cared for by a Black doctor. But oddly, physician race did not affect the mother’s outcomes, the study found. Researchers continue to study these issues.

    After the Miscarriage

    Since August, McClendon and her partner have been trying to find an in-person grief counselor they could see as a couple. But so far, they’ve had no luck. So they’ve been making their way on their own – with some success. “I won’t say it gets better, but you handle it better,” she said. 

    The grief comes in waves, she says. Some days they’re OK and other days the pain unexpectedly resurges. The approach of the baby’s due date has been particularly hard. 

    “This past Saturday was supposed to be the date of my baby shower,” McClendon said. A day intended to celebrate McClendon and her future son turned into a day to remember what she had lost. It was a tough day. But she made it through. “It started off sad, but it eventually turned OK,” she said.

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  • The TikTok Trend That Triggered a Diabetes Drug Shortage

    The TikTok Trend That Triggered a Diabetes Drug Shortage

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    Nov. 29, 2022 – Weight loss advice is everywhere you look on social media, but one trend sweeping TikTok has led to shortages of an important diabetes drug. 

    Ozempic, a weekly injection that helps boost insulin sensitivity in people with type 2 diabetes, also suppresses appetite, which leads to weight loss. Stories of celebrities using the drug off-label to lose a few pounds have led to an explosion of interest. And now people with diabetes – people whose lives could be saved by the drug – are having trouble finding it.

    Kim Kardashian and Elon Musk

    In the spring, Kim Kardashian pulled off a dramatic weight loss to fit into Marilyn Monroe’s dress for the Met Gala. Soon rumors began to circulate that she’d used Ozempic to do it. Just this week, new Twitter owner Elon Musk tweeted about his own use of Ozempic and its sibling drug, Wegovy.

    Variety dubbed Ozempic “the worst kept secret in Hollywood – especially given that its most enthusiastic users are not pre-diabetic and do not require the drug.” The rich and famous are spending $1,200 to $1,500 a month to get access. 

    As so often happens, high-profile use sparked a trend. Videos on TikTok hashtagged #ozempic have amassed more than 275 million views, and #ozempicweightloss has more than 110 million.

    This raises concerns about who, exactly, is watching these videos, and what message they’re receiving.

    “Forty-two percent of Americans have obesity, and even more have overweight. That’s affecting our younger people and our adolescents,” says Caroline Apovian, MD, co-director of the Center for Weight Management and Wellness at the Brigham and Women’s Hospital in Boston. “They’re looking at TikTok and other social media outlets for help.”

    A new study shows how damaging this can be: Researchers analyzed 1,000 videos with nutrition, food, and weight-related hashtags, with over 1 billion views combined. They found that nearly all included messages glorifying weight loss and thinness.

    At Last, an Effective Weight Loss Drug

    Ozempic is Danish drug company Novo Nordisk’s brand name for semaglutide, which works by mimicking a naturally occurring hormone known as GLP-1. It travels to your brain and helps you feel full on less food. That leads to weight loss. In one 68-week study, semaglutide helped people lose an average of 15% of their body weight. But it’s not a miracle drug: You still have to change your eating habits and stay physically active.

    The FDA approved Ozempic to treat people with type 2 diabetes in 2017. Four years later, Novo Nordisk received the green light for a higher-dose version meant specifically for people with obesity. Wegovy is approved for use only if you have a BMI of at least 27 with one or more weight-related ailments, or a BMI of 30 or more with none.

    “These drugs are dominating my practice, because they’re so effective,” says Amanda Velazquez, MD, director of obesity medicine at Cedars-Sinai Medical Center in Los Angeles. The drug is considered safe, “so the majority of patients are good candidates.”

    More Demand Than Supply

    As word spread about how well Ozempic and Wegovy worked, social media posts helped drive even more people to seek out the drugs. Now demand is outpacing the supply – according to the FDA, starter doses of Ozempic will have limited availability through January. 

    “In Hollywood, people are losing 10 pounds, getting it for $1,500 a month, and depleting stores for people who have such severe obesity that they have congestive heart failure and diabetes,” Apovian says. “These are people who are going to die, and you’re taking it away just for cosmetic weight loss. That is deplorable.”

    In addition to huge demand, Wegovy also had a disruption in its supply chain. Right now, it isn’t available at all in lower doses, which is helping to spike off-label demand for Ozempic. Novo Nordisk expects to have these problems sorted out by the end of the year, with distribution following soon after.

    The Price of Access

    With a list price of $1,350 a month, Wegovy costs as much as many mortgages. And Medicaid, Medicare, and many insurance companies don’t cover it. Although obesity is a disease, the insurance industry treats weight loss as more of a vanity issue – so even if you could find the drug, you might not be able to afford it. 

    “We’re seeing that roughly half the prescriptions we write aren’t being covered,” Apovian says. “And for the half that are covered, we have to do prior authorization, which takes days, and it’s laborious.” In some instances, she says, insurance companies withdraw authorization after 3 months if they don’t see enough weight coming off.

    It’s not like you can take Wegovy for 3 months, lose some weight, and expect it to stay off, either. The medication requires a real commitment, potentially for life. That’s because once the semaglutide leaves your system, your appetite returns. In one study, people regained two-thirds of the weight they’d lost within a year of stopping.

    Many see a double standard in the insurance companies’ refusal to cover a drug that could prevent serious illness or death. 

    “They’re saying it’s not cost-effective to give the 42% of Americans who have a BMI over 30 Wegovy. Did they say this when statins came out?” Apovian says. “Why are they doing this with antiobesity agents? It’s the culture. The culture isn’t ready to adopt obesity as the disease that it is.”

    Unpleasant Side Effects

    Let’s assume you’re one of the lucky ones – your insurance covers Wegovy, and you can actually find some. You might discover that using it is no walk in the park. Common side effects include gastrointestinal issues like nausea, vomiting, and diarrhea. 

    “The way we counteract that is to start very slowly at a low dose of these medications,” Apovian says. “We only go up when the patient doesn’t have nausea or it gets better.”

     

    Elise Davenport was excited to try Wegovy. “I did my online research. I’m the type who’s interested in early adoption, tech gadgets and stuff,” says the 40-year-old technical writer. “I wanted to try it because I’d tried so many other things that failed, or hadn’t worked long-term.”

    With a BMI over 30, Davenport qualified for the drug. She signed up for an online program that guaranteed insurance coverage and started taking it in October 2021. At first, the side effects were mild, just a touch of nausea and diarrhea. And the results were impressive. She found it easy to feel satisfied with smaller portions and lost her cravings for sugar and highly processed foods. The weight fell off, roughly 5 pounds a week. 

    It turns out, that’s too much, too fast. Apovian and Velazquez say their patients lose more like 2 pounds each week, with careful monitoring. 

    By early December, Davenport’s side effects were ramping up. Because of shortages in lower dosages, the online program wasn’t able to adjust hers right away. She felt nauseated all the time, bad enough that brushing her teeth made her vomit and she had to force herself to eat. Some weeks, she managed less than 500 calories a day. Her sleep patterns became erratic. And then her depression, which medication had kept under control for years, spiraled.

    “I remember sitting on the floor of my bathroom crying, thinking I’d rather carry the extra weight,” she says. “I used to take a lot of enjoyment from food, and I had none of that anymore. It was such a joyless experience at that point.” 

    Eventually, her dosage was reduced and the symptoms let up, but her primary care doctor encouraged her to stop. By the time she did, in March, she’d lost 55 pounds. So far, she’s gained back about 10.

    More Than Just Weight Loss

    Even though Davenport’s experience wasn’t a good one, with better monitoring, she’d be willing to try again. For one thing, seeing how easy it was to eat less with medical help helped to undo years of shame.

    “Our culture treats obesity like a moral failing. I realized I’d been made to feel that way by doctors and programs – that I wasn’t doing enough,” she says. “This drug made me realize there are legit physiological things going on in my body, things that are often excluded from the conversation.”

    Apovian and Velazquez say their patients regularly discover similar things.

    “Obesity is not a disease of willpower. Medications are not the easy way out,” Velazquez says. “This is a chronic, relapsing medical condition, and because of that, we should treat it how we treat diabetes, high blood pressure, all these other conditions. We’d never hold back medication for individuals coming in with high blood pressure, tell them to work on willpower and withhold drugs they’d qualify for.”

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  • Weight-Loss Surgery Slashes Odds for Heart Attack in Very Obese People

    Weight-Loss Surgery Slashes Odds for Heart Attack in Very Obese People

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    By Cara Murez 

    HealthDay Reporter


    WEDNESDAY, Nov. 16, 2022 (HealthDay News) — Getting bariatric surgery may significantly help prevent heart attacks, strokes and angina in very obese people, a new study finds. The study participants were also affected by what’s known as nonalcoholic fatty liver disease (NAFLD), which is often linked with obesity.
     

    While studying patients who had a body mass index (BMI) higher than 40 and NAFLD, researchers from Rutgers University-New Brunswick and Ohio State University found these patients were 50% more likely to suffer heart attacks, strokes and angina.

    But the new findings “provide evidence in support of bariatric surgery as an effective therapeutic tool to lower elevated risk of cardiovascular disease for select individuals with obesity and NAFLD,” said study author Dr. Vinod Rustgi, director of the Center for Liver Diseases and Liver Masses at Rutgers Robert Wood Johnson Medical School in New Jersey. “These finding are tremendously impactful for many reasons.”

    Rustgi and his colleagues used a medical insurance database for the years 2007 to 2017.

    They found nearly 87,000 adults ages 18 to 64 who had obesity and NAFLD, about 64% of whom were women. About 35% of these patients had bariatric surgery, while 65% received nonsurgical care.

    The patients who had bariatric surgery had a 49% decrease in the risk of developing heart attacks, heart failure or ischemic strokes (those caused by a blockage). They were also far less likely to experience angina, plaque buildup in the arteries or arterial blood clots, researchers found.

    About 697,000 people died of heart disease in 2020 in the United States, according to the U.S. Centers for Disease Control and Prevention. Heart disease is the leading cause of death for both men and women.

    NAFLD, along with a more advanced form of liver disease known as NASH, is a rapidly increasing cause of liver disease, according to the study. This happens when too much fat is stored in liver cells, triggering an inflammatory state. NAFLD is more common in people with obesity and type 2 diabetes.

    Bariatric surgery can offer heart health benefits because of the positives that happen with weight reduction, according to the researchers.


    Continued

    An earlier study by Rustgi and colleagues found that bariatric surgery could also significantly reduce the risk of cancer — especially obesity-related cancers — in obese individuals with NAFLD.

    “Although bariatric surgery is a more aggressive approach than lifestyle modifications, it may be associated with other benefits, such as improved quality of life and decreased long-term health care burden,” Rustgi said in a Rutgers news release.
     

    The findings were published recently in the journal JAMA Network Open.


    More information

    The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on weight-loss surgery.

     

    SOURCE: Rutgers University-New Brunswick, news release, Nov. 14, 2022



    WebMD News from HealthDay



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  • Weight-Loss Drug, Approved for Adults, Shows Promise in Kids

    Weight-Loss Drug, Approved for Adults, Shows Promise in Kids

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    Nov. 10, 2022 — The prospect of being involved in a research program that might help her lose weight intrigued Emmalea Zummo. At 15, the self-assured, energetic teenager from Jeanette, PA, weighed 250 pounds – enough to be considered obese. The trial she learned about through her endocrinologist was for a drug called semaglutide. 

    Before joining the study, Emmalea had exhausted a reservoir of strategies. 

    “She had been doing a variety of exercise programs, was involved in countless sports and activities to stay active, as some of her early doctors said that would work,” Davina Zummo, Emmalea’s mother, says. “She counted calories, did a gluten-free diet, limited what she ate, when she ate, and how much.” 

    Emmalea cut out all snacks, junk food, and sweets, but nothing made a difference, Zummo says: “She felt defeated.”

    The FDA last year approved semaglutide, which was developed initially as a treatment for type 2 diabetes, for weight loss in adults. But researchers wanted to know if the drug, which targets areas of the brain that regulate appetite, also could help adolescents lose weight. Emmalea was curious, too. 

    Although often teenagers can be judgmental of each other, Emmalea’s friends “were happy for me, constantly motivating and supportive,” she says.

    Today, Emmalea, now nearly 18, says the medication helped her lose 75 pounds, giving a boost to the lifestyle and diet coaching she received throughout the 68-week study. 

    Parents of teens like Emmalea who struggle with obesity hear the same refrain: If their kids slash the sugar, eat healthy snacks instead of junk foods, and exercise regularly, the results will follow. 

    But for many overweight youths — as with adults — shedding pounds often proves frustrating. Gains come and go, despite good intentions. 

    Could medication help? 

    A new study in the New England Journal of Medicine shows that semaglutide can indeed lead to small but meaningful losses of excess bodyweight. Whether that’s enough to tip the scales, as it were, toward overall better health is unclear, but the findings have specialists in child health optimistic. 

    “There is a real need for safe and effective medications to treat obesity,” says Silva Arslanian, MD, a pediatric endocrinologist at the University of Pittsburgh School of Medicine and a co-author of the new study. 

    “Typically, we make lifestyle recommendations: Eat more vegetables; don’t eat fried food; don’t drink soda,” Arslanian says. Unfortunately, she says, we live in a world where “it can be very hard to make those changes.”

    Many experts agree that medication should be part of the conversation.

    “It’s exciting to see this treatment becoming available. And the study results suggest few side effects, so the drug was safe and tolerable,” says Amanda Staiano, PhD, a researcher at the Pennington Biomedical Research Center at Louisiana State University in Baton Rouge. “Although not approved yet by the FDA, semaglitude and other new medications are transforming obesity treatment for adolescents. It’s going to be an exciting time for treating obesity.”

    Staiano stresses, however, that lifestyle and behavioral counseling are key for the success of any obesity treatment, including drugs like semaglutide. 

    Daniel Weghuber, MD, a pediatrician at Paracelsus Medical University in Salzburg, Austria, says that although obesity is “not an issue of lack of willpower, this drug seems to enable people who are living with obesity to adhere to the recommendations that they have been following for years and years but were not able to achieve the goal. I think that this is important. It enables people to achieve their goals.”

    In the new study, 201 obese or overweight boys and girls between the ages of 12 and 18 received either once-weekly injections of semaglutide or sham shots. They also all received lifestyle interventions — counseling on healthy nutrition and physical activity — throughout the nearly 16-month study.   

    By the end of the study, 75% of the adolescents who received semaglutide had lost and kept off at least 5% of their excess body weight, compared to 17% of those who got the sham injections. On average, those treated with the drug lost 33.7 pounds, compared to an average of just 5.3 pounds in the other group.

    Weghuber said the research suggests the combination of lifestyle changes and obesity medications “will open up a new chapter” for treating adolescents with obesity. 

    More than 340 million children and adolescents worldwide aged 5-19 were overweight or obese in 2016. In the United States, obesity affected 22.2% of 12- to 19-year-olds from 2017 to 2020, according to the CDC.   

    Obesity is linked with decreased life expectancy and higher risk of developing serious health problems such as type 2 diabetes, heart disease, nonalcoholic fatty liver disease, sleep apnea, and certain cancers. Teenagers with obesity are also more likely to have depression, anxiety, poor self-esteem, and other psychological issues.

    While obesity in children has long been a public health concern, the problem has worsened during the COVID-19 pandemic, Melissa Ruiz, MD, with the Pediatric Diagnostic Center in Ventura, CA, says. Some of her patients who had been “chubby” pre-pandemic had weight gains of 20-30 pounds at post-pandemic clinic visits, she estimates.

    Ruiz and other experts say parents should discard the notion that obesity is something children – or adults — are doing to themselves, or that they are failing their children by not keeping their weight in check. 

    “There are genetic components that figure into obesity, and we have to acknowledge that,” Ruiz says.  

    Parents should seek help from their child’s pediatrician. “If the pediatrician cannot help you, ask, ‘Where can I go?’ Say, ‘I understand that you might not be trained in this yet’ and ask for a reference for someone who can help,” Ruiz says. 

    But medication should not be considered an all-in remedy, according to one expert. 

    “Medication is a last resort, only after behavioral interventions fail and after exploring the range of behavioral strategies to weight loss, including changing dietary patterns such as timing and meal plan,” says Lydia Bazzano, MD, PhD, a nutrition researcher at the Tulane University School of Public Health and Tropical Medicine in New Orleans.

    Medication and even surgery have a place, but only if patients have exhausted all the dietary and lifestyle options, Bazzano says. “You don’t want the adolescent to have a lifetime of medication. Medication should only be used to kickstart the child to the point he should be — and then maintain that weight,” she says.

    Adolescent obesity is a very difficult subject to navigate, Bazzano adds. “You have to engage the entire family, and not just the child. It has to be at the level of the whole family, and that can be very challenging. If the entire family engages together, there can be a modest weight loss.”

    And Bazzano says she’s not impressed with the weight loss seen in the latest study. A 5% drop in body weight is helpful, she says, but “that’s not enough of a decrease to say the child is out of the risky range.”

    Staiano thinks experts need more information about semaglutide before they should start prescribing it to kids. 

    “We need to see long-term outcomes from chronic medication use and whether weight rebounds when adolescents stop using the medication,” she says. 

    “How long should the medication be prescribed? For the rest of their lives? How do we support patients who are able to lose such a significant amount of weight? How do we ensure these treatments — behavioral counseling, medications, and weight loss surgery — are accessible and financially within reach of families?”

    Emmalea, who stopped taking semaglutide about a year ago, has maintained her weight thanks to concentrating on a well-balanced diet and exercise. While she says she’s pleased with her progress and “feels comfortable in my own skin,” she doesn’t consider her current weight of 171 pounds to be the end zone. “I’d like to be somewhere between 145-150,” says the 5’4” high school senior.

    Still, she says, “I don’t strictly monitor myself because thinking of food in a negative way is not healthy and can actually lead to worsening a food disorder.”

    When she embarked on the study, she wasn’t sure it would be effective for her. But because of her interest in medicine and research, she says, she wanted to be involved: “I thought that if it didn’t help me, at least it might others.” 

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