Teen Surgery – the Prophylactic Argument

Fat Cynthia
Is disease prevention a sufficient justification for performing surgery? Opponents of neonatal circumcision would say no; on the other hand, women with the genetic predisposition to breast cancer want the choice of bilateral mastectomy just in case. It is a thorny problem. More specifically, is it a good idea to operate on an overweight child or teenager as a precaution?

In 2012, of all bariatric surgeries, between one and two percent were performed on patients under 21 years of age. There would be a lot more if people could afford it, but apparently insurers are reluctant to spring for it until a person is at least 18. For the New York Times, Anemona Hartocollis wrote,

The push toward surgery on the young has brought some resistance from doctors who say it is too drastic to operate on patients whose bodies might still be developing and who have not been given much time to lose pounds on their own.

Some worry that surgery, which is a pretty big deal and certainly an expensive one, would be undertaken purely for reasons of vanity. Some feel that surgery should be a last resort that would not even be suggested except in an immediately life-threatening situation.

But surgery proponents see the youth of these patients as the big selling point, because earlier intervention can prevent the obesity from spawning a host of related health problems. If someone could avoid developing high blood pressure or type 2 diabetes, that would be much preferable to treating it later. Opinion seems to be swinging from the “last resort” school to a more permissive effort to change the future by curbing the metabolic syndrome before it has a chance to take hold.

The New England Journal of Medicine published news of a study that concerned itself with 242 adolescents from 5 different American locations. Going in, the kids were between 13 and 19, and their average weight was 328 pounds. They all underwent one of two popular procedures. On three-year followup, the Roux-en-Y gastric bypass group had a mean weight loss of 28% and the sleeve gastrectomy group had declined by 26%. Not bad, but it gets better. Blood pressure had normalized in 74% of the participants, and a whopping 95% experienced remission of type 2 diabetes.

Adults with the same surgeries top out at a 60% remission rate. That is a persuasive, but not yet definitive, argument for endorsing weight-loss procedures at increasingly earlier ages. The great thing about this study is that it will also publish the follow-up results at 5, 7, and 10 years post-up.

A hard-nosed, heart-felt plea

According to a brand-new study,

Intense research efforts in humans and rodent models are underway to identify the critical mechanisms underlying the beneficial effects with a view towards non-surgical treatment options.
Although a number of changes in food choice, taste functions, hedonic evaluation, motivation and self-control have been documented in both humans and rodents after surgery, their importance and relative contribution to diminished appetite has not yet been demonstrated.
The mechanisms responsible for suppression of appetite, particularly in the face of the large weight loss, are not well understood.

In other words, a lot of observation has been going on, but no one is yet able to pull it all together in a comprehensible manner. It is apparent that surgery does promote weight loss and weight loss is followed by improvements in glycemic control, but the reason is not clear. The research emphasis tends toward pinpointing the origins of appetite and manipulating them. However,

None of the major candidate mechanisms postulated in mediating surgery-induced changes from the gut and other organs to the brain, such as gut hormones and sensory neuronal pathways, have been confirmed yet.

That was an ornate way of saying, we don’t know how to get the good stuff without taking a trip to the OR. The report also suggests that future research should concentrate on “interventional rather than descriptive approaches,” which is a politically correct way of saying “Stop telling us about the problem and tell us what to do.”

Your responses and feedback are welcome!

Source: “Young, Obese and in Surgery,” NYTimes.com, 01/07/12
Source: “Bariatric surgery in teens shows promise in study,” Triblive.com, 11/21/15
Source: “Appetite and body weight regulation after bariatric surgery,” Wiley.com, 01/22/15
Image by Eurritimia

 

 

After Teen Surgery

Gastric sleeve-themed items by Etsy craftspersons

Gastric sleeve-themed items by Etsy craftspersons

A piece in GeneralSurgeryNews.com makes an excellent point –

Although bariatric surgery is performed on unprecedented numbers of teenagers today, the number of procedures performed—and the availability of insurance coverage—barely registers compared with the size of the obese population of young Americans.

The demand far outstrips the supply. If more patients could afford it, no doubt the supply of available bariatric clinics and doctors would increase. Part of the expense is in the ongoing nature of these procedures. It’s not just a one-and-done. There are preparatory stages, the testing and history taking and counseling.

Costliness is also affected by the fact that sometimes, there is more than one surgery, either by design or because something went wrong the first time. Christina Frangou’s article was published only last month, but the latest available statistics are from 2009, when 1,600 kids under 18 had some form of digestive tract-altering surgery.

Of the study participants, 13% required at least one additional abdominal procedure during the three-year period, most commonly gallbladder removal. In all, 30 patients required a total of 47 additional procedures.

She notes that before surgery, only 5% of the subjects were iron-deficient, a number that rose to more than half, after surgery. Their ability to squeeze the goodness out of other nutrients is also affected. Lab work is needed to stabilize the levels of everything. For these and other reasons, bariatric surgery is a long-term commitment that includes continuing interface with the medical profession, and it’s not the kind of commitment just anyone can make.

The usual post-op course (after for instance an appendectomy or a knee replacement) is for a wound to close, infection to be avoided, and all the customary care to be taken so the patient will emerge in a better state than she or he previously endured. After a certain point, it’s over, and the patient many not see a doctor about that body part for years, or ever.

After bariatric surgery, however, follow-up is vital and and perpetual. There is no return to normalcy. Life is not like it was before, and not like most other people’s lives. It requires deliberate maintenance under a stringent set of rules, and who wants that? Young people, especially, find it difficult to adhere to such discipline.

Basic principles

An underlying assumption is that bariatric surgery on the young should only be undertaken when other methods have failed. The paradox is, sometimes the patient has to lose weight first, or else the operation will be unacceptably dangerous. But if they can do that, doesn’t it indicate that other methods actually do work? A question naturally comes to mind: why then resort to surgery at all? Why not continue with traditional methods like, for instance, eating less and exercising more?

Overeating and slothfulness are not the only causes of childhood obesity. Ideally, children and teens who contemplate surgery would sign up with W8Loss2Go, and put the big decision on hold for a while. The long-range outcome for bariatric surgery is not overwhelmingly impressive. Sure, a lot of patients get better for a year or even a few years. Also, a lot of patients eventually return to their former sizes. W8Loss2Go, on the other hand, advocates and teaches a relearning that lasts a lifetime.

Your responses and feedback are welcome!

Source: “Teens Gain Big Benefits From Bariatric Surgery,” GeneralSurgeryNews.com, 12/07/15
Image by Etsy craftspersons

Bariatric Surgery for Teens – Risks and Complications

Fat Anna Grace Pink Hair

Weight loss saves lives and reduces the likelihood of numerous co-morbidities. Alas, the effects rarely last. Without surgical intervention, it is said that “only 2% of severely obese teenagers can lose weight and keep it off.” So a case can be made that for many morbidly obese young people, bariatric surgery is their only hope. The New England Journal of Medicine published an editorial by Elias S. Siraj, M.D., and Kevin Jon Williams, M.D. that recognized these unfortunate facts and added:

Bariatric surgery results in the most weight loss and the highest rates of remission of type 2 diabetes, but the potential side effects are of concern. Furthermore, performing bariatric surgery in approximately 400 million obese persons worldwide is not feasible.

Absolutely correct. 400 million people are not about to hop onto operating tables any time soon. But how does it work out for the very small fraction who can afford it, and who are near an appropriate medical facility, and are physically and psychologically qualified? The National Institutes of Health set the recommended criterion for surgical intervention as a BMI of at least 40, or at least 35 if there are significant comorbidities present that are related to the obesity. In 2006, there were complications in 7.6% of cases. As recently as 2012, the New York Times said that studies had placed the death rate for open (not laparoscopic) surgeries, as high as 2% within 30 days. A more recent source says,

Along with the increased volume of surgical procedures, a dramatic decrease in mortality and complications related to surgical intervention has been achieved, as demonstrated in a recent meta-analysis showing a mortality rate of 0.08% within 30 days and 0.31% after 30 days.

As surgeons gained experience and the proportion of laparoscopic surgeries increased, risk declined across the board, and the number of complications decreased. But the Times suggested it was also because bariatric surgery became less of a last-resort rescue mission, and more of an elective option for patients who were thinner and healthier to begin with.

The varieties

The type of surgery makes a difference. Laparoscopic adjustable gastric banding (LAGB) and vertical sleeve gastrectomy are both restrictive procedures in that they leave less available stomach, in the first instance by blocking part of it off, and in the other, by removing part of it. Biliopancreatic diversion is a malabsorptive procedure that skips much of the small intestine, and the Roux-en-Y gastric bypass (abbreviated as RNYGBP) is a combination of both restrictive and malabsorptive types.

As in many areas of life, sometimes a do-over is necessary. The conditions that might indicate the need for a revisional procedure include the inability to tolerate solid food; nausea and vomiting,; strictures; nonhealing ulcers; and severe dumping syndrome. The revisional procedures come under the headings of conversion, correction, or reversal. With them, the mortality goes up to 1.65%. The need for a reversal is counted as a treatment failure. In addition, some of these surgical interventions are designed from the start to occur in stages, which guarantees the need for additional surgery.

Also deemed a treatment failure is a 6-year post-op patient’s BMI of 35 or higher. Sadly, in an increasing number of cases, inadequate weight loss is deemed to be sufficient reason for revisional surgery. How is it that lifestyle changes can’t pick up the slack? Could primary procedures be successful more often if the patients adopted the W8Loss2Go program? With that kind of help, could some patients be spared the need for revisional procedures?

Your responses and feedback are welcome!

Source: “Adolescent Bariatric Surgery Reverses Type 2 Diabetes in 95 Percent of Teens, Achieves Major Weight Loss and Improves Quality of Life,” PRNewswire.com, 11/06/15
Source: “Another Agent for Obesity — Will This Time Be Different?,” NEJM.org, 07/02/15
Source: “Young, Obese and in Surgery,” NYTimes.com, 01/07/12
Source: “Gastrointestinal Complications After Bariatric Surgery,” gastroenterologyandhepatology.net, August 2015
Source: “Bypass Beats Band for Weight Loss,” WSJ.com, 01/17/12

Image by ppfaceannagrace

Two Very Obese Little Boys

Fatboy neon

 

For a time, a Chinese youngster named Lu Hao was one of the most photographed children in the world, because he was billed as the fattest boy in the world. In March of 2011, he was 3 years old and weighed 132 pounds, the equivalent of 5 normal-weight children his age. Because of the danger he might pose to the others, Lu Hao couldn’t be enrolled in nursery school, so his parents were stuck with him full-time. Weirdly, his birth weight was skimpy – a mere 5.7 pounds. At around three months, he inexplicably began to expand, and nobody knew why. Isabel Jensen reported,

He is getting so big his family are frightened of him — and have given up trying to stop the youngster from gorging on huge plates of ribs and rice. His parents claim he throws vicious tantrums if he doesn’t get third or fourth helpings of dinner.

Another news piece, also published in March of 2011, said Lu Hao was four, and had started kindergarten. Chris Parsons wrote that Lu Hao hated walking to school, and was often given a ride on his mother’s motorbike. He still cried if not given all the food he wanted. His parents made a heartfelt effort to get him swimming, playing basketball and so on – but the exercise made him hungry and he demanded more food than ever. They took him to three different hospitals.

Experts examined Lu Hao, but his hormones tested out as normal. One institution suspected a brain tumor, but the other two ruled it out. Guangdong Children’s Hospital suggested that hormone treatment might be an option, but there is no mention of anyone thinking bariatric surgery, and for good reason. The risks would be horrific.

The real mystery is how the child managed to see at all. In every photo, his eyes are squeezed tightly closed by the fat of his cheeks and eyelids. Sadly, Lu Hao does not seem to have appeared in the news during the subsequent five years.

A first

News of it apparently didn’t come out for quite some time, but in 2010 irreversible bariatric surgery was performed in Riyadh, Saudi Arabia, on a two-year-old boy, who at the time was the youngest person ever to undergo a laparoscopic sleeve gastrectomy (LSG). The child weighed 73 pounds, and traditional weight-loss methods had been tried to no avail. He suffered from sleep apnea, and his legs were noticeably bowed.

The case attracted unfavorable attention from obesity experts, one of whom described the surgical decision as shocking, and who raised concerns about future vitamin deficiencies that could arise from only having a tiny bit of stomach. Another confirmed that LSG should be considered only as a last resort. Of course it also gave the “Fat Can be Fit” people a chance to weigh in and express disapproval.

At any rate, two years after his surgery, the Saudi boy was reported to weigh around 50 pounds.

Your responses and feedback are welcome!

Source: “Tragic toddler weight nine stone,” thesun.co.uk, 03/23/11
Source: “’We just don’t know why our son is so big’:,” DailyMail.co.uk, 03/31/11
Source: “Saudi Boy Is Youngest Patient To Ever Undergo Weight Loss Surgery Procedure,” huffingtonpost.com, 09/20/13
Source: “Two-year-old becomes youngest person ever to have weight loss surgery,” Examiner.com, 09/22/13
Image by wsilver

 

Fat and Famous Folks

Stand up for something

St. Thomas Aquinas (1225-1274) started out as a big, hefty young boy  who only grew bigger, as his biographer G.K. Chesterton wrote:

St. Thomas was a huge heavy bull of a man, fat and slow and quiet…
His bulk made it easy to regard him humorously as the sort of walking wine-barrel, common in the comedies of many nations: he joked about it himself.

It was rumored that a crescent shape had to be removed from his dinner table and/or desk to even allow him to be seated, but Chesterton suggests this story may have originated with a joke that the self-deprecating saint made about himself. Coincidentally, the biographer was no sylph, either.

British author G. K. Chesterton, who wrote a vast amount of fiction, nonfiction, stage plays, biographies, essays and poetry, was himself rather vast. He was known as one of the “secular saints” of Catholicism, and at one point there was talk of canonizing him into an actual saint. But opponents reminded everyone that Chesterton had been fat, and obesity implies gluttony, and gluttony is one of the seven deadly sins. (He also drank a lot of alcohol.) For a religious website, Jennifer Pierce wrote in his defense:

I can imagine a rail-like wraith of a man, with similar propensities toward drink and food, who does not suffer from a hormonal imbalance driving his appetites; his drive is solely a gluttonous one. So while he may, in fact, even eat a smaller amount than his more fleshed-out brethren, his drive toward food and drink could be pure gluttony; whereas for the latter, the drive toward food and drink is magnified by an increasing and imbalanced hormonal cycle that seems to have at least some genetic components to it.

History has been replete with overweight rulers, like Mieszko II the Fat who was a duke, back in the 13th Century, in a territory that later became part of Poland. He seems to have been a pretty good guy, but had health problems (presumably associated with his size) and died at the very young age of 26. Childhood Obesity News has discussed obese U.S. presidents and, in particular, the chances of New Jersey governor Chris Christie, who hoped to become a candidate, but who seems to have disappeared from the list.

Sir Winston Churchill was Prime Minister of the United Kingdom during World War II and again in the 1950s. One of the most powerful and quoted political leaders in history, he stood about 5’8” or 5’9” and is said to have weighed over 300 pounds.

According to one source, he received corporal punishment at school after stealing sugar from the kitchen storeroom. Historyextra.com also reports that only a year before his death, his wife insisted that he go on a diet, so he bought a trick scale that would make him appear to weigh less.

Winston Churchill died in 1965, and was the last commoner to be given a State Funeral, an honor usually reserved for monarchs. Only a year ago, on the 50th anniversary of his death, a secret was revealed when the BBC’s Lucy Wallis interviewed Lincoln Perkins, one of the 8 pallbearers. They had to climb the steps of St. Paul’s Cathedral, and their momentum was interrupted when another former Prime Minister, who was walking before them in the procession, stumbled and paused. Perkins told the reporter,

We had to come to a stop and [the coffin] did actually slide off the two front shoulders of the two bearers. It was very lucky that we [had] the two gentlemen at the back who were what we called ‘pushers,’ who pushed us up.

More factors were in play than Churchill’s own weight. The coffin was lined with lead, and the pallbearers had not had the opportunity to practice with an object approximating the actual weight. Still, if they had dropped the great leader’s coffin, the disgrace would have been ineradicable.

Your responses and feedback are welcome!

Source: “St. Thomas Aquinas,” Gutenberg.net, March 2006
Source: “Chesterton Was Fat,” crisismagazine.com, 02/05/10
Source: “9 things you (probably) didn’t know about Winston Churchill,” Historyextra.com, 01/13/15
Source: “‘We nearly dropped Churchill’s coffin’,” BBC.com, 01/28/15
Image by Celestine Chua

 

 

Obesity Villains – Insufficient Hormone; Excessive Faith

Unicorn Cake of Awesomeness

Here is the gist of interesting research from Rutgers University, as reported by Robert Gebelhoff:

A new study published this week in the journal Cell Reports suggests that overeating happens when people don’t have enough of a hormone called glucagon-like peptide-1, or GLP-1. The chemical is secreted from cells in both the small intestine and the brain to let our brain know when we’ve had enough to eat… When GLP-1 was reduced in the mice, they over-ate and consumed more high-fat food.

Gebelhoff mentions up front a detail that many journalists forget or omit, namely that “it still needs to be established that the same effect happens in humans.” Meanwhile, word comes from the University of Copenhagen of a small study of just 37 subjects, yet they were human women and not mice, and the authors suggest that an answer to a troublesome aspect of obesity therapy might be found here. Extreme weight loss, especially if it is rapid, can cause the bones to lose mass and break more easily, and apparently this happens “frequently.”

The good news is that GLP-1 might be capable of aiding weight loss without increasing the risk of brittle bones. It might even of help to build new bone. Not actual GLP-1, but its analogue or mimetic, a pharmaceutical product that is also a GLP-1 receptor agonist capable of fooling the body into thinking it is the real thing. Its generic name is liraglutide, marketed as Saxenda. It also helps to keep blood sugar levels as close to optimal as possible, and is even credited with benefiting the sugar metabolism in ways that outperform diet-induced weight loss. This is the assertion of the University of Copenhagen Associate Professor Signe Soerensen Torekov, the study’s lead author, who said

It appears that treatment with liraglutide makes it possible to lose weight and maintain the beneficial effect on the bones, while at the same time reducing the risk of cardiovascular disease and type 2 diabetes.

A functional weight-loss drug is the unicorn everyone has been chasing. What could go wrong? Sadly, it turns out that liragludite can adversely affect the patient’s gallbladder, pancreas, or kidneys – parts that it’s really not advisable to mess with. That is only the beginning. Drugs.com lists an astonishing array of debilitating side effects.

Also, the patient has to deal with a needle every day forever, which is a major drawback in the quality-of-life sweepstakes, and comes at a “nontrivial cost,” according to other authorities. Drs. Elias S. Siraj and Kevin Jon Williams wrote in the New England Journal of Medicine that liraglutide is not a cure, because “Most obese participants stayed obese, reversal of the metabolic syndrome was not quantified, and liraglutide may be required indefinitely.” Then there’s the little matter of breast cancer, which may not be a factor but definitely needs to be monitored.

Adjunct, not replacement

Liraglutide is permitted to be sold as an adjunct to calorie reduction and increased exercise, not as a replacement for them, and the same goes for any pharmaceutical that makes weight-loss claims, whether injectable, orally administered, or otherwise. Not long ago, the American Marketing Association (AMA) commented on a study that appeared in the Journal of Public Policy & Marketing and named yet another obesity villain – the public’s false beliefs about the efficacy of pharmaceuticals. It concluded that,

Weight management remedies that promise to reduce the risks of being overweight may undermine consumer motivation to engage in health-supportive behaviors.

In other words, knowing that a weight-loss drug is available encourages overweight people to eat even more. Rather than welcoming a temporary boost that will kick-start their weight loss efforts, many apparently interpret the existence of such a medication as permission to abandon all restraint. In fact, the study authors warned, “the more fattening the cookie, the more the participants would overeat, as long as they expected to be able to take the weight loss pill.”

One might think the AMA would wish to sweep such a study under the rug. After all, the interests of the marketers are aligned with those of the pharmaceutical corporations. It seems like the last thing they would want to do is publicize a study that says people are foolish to put faith in weight-loss drugs. Then again, consider the old Hollywood saying– there is no such thing as bad publicity.

For the pill mills, this is a wonderful piece of propaganda – a gift to them, really. They have been handed a universal disclaimer. If patients don’t lose weight, it is not because the products don’t work, good heavens, no. It’s because the customer’s expectations were unrealistically high!

Your responses and feedback are welcome!

Source: “Overeating may be caused by a hormone deficiency, scientists say,” WashingtonPost.com, 07/24/15
Source: “Treating obesity with GLP-1 hormone helps prevent loss of bone mass associated with weight loss,” News-medical.net, 06,11/15
Source: “Saxenda Side Effects,” Drugs.com, undated
Source: “Another Agent for Obesity — Will This Time Be Different?,” NEJM.org, 07/02/15
Source: “There’s a pill for that: How are weight loss drugs fueling the obesity epidemic?,” ScienceDaily.com, 11/11/14
Image by randy stewart

Visual Obesity Villains: Light and Heaviness

El camarero

In regard to the worldwide obesity epidemic, Dr. Pretlow has referred to the concatenation of events and influences as the “perfect storm,” a term borrowed from meteorology that refers to large-scale synergy. It is what happens when a number of elements come together that, separately, might have been merely bad but not catastrophic. In combination, however, the various influences combine their forces to wreak havoc. Childhood Obesity News published an overview of many of these larger forces in an 8-part series. Some, like the widespread presence of high fructose corn syrup in processed foods and sweet drinks, seem obvious.

Another large and obvious problem is the increasingly sedentary lifestyle practiced by almost everyone on earth. Physical exertion burns calories of course, but as Dr. Colin Higgs noted, along with maintaining a healthy weight there are 14 other benefits to be obtained from exercise – all of which can contribute indirectly to that healthy weight goal.

Those are only two of several mega-causes, and there are also random less extensive ones. Over the past couple of weeks we have looked at a large number of factors claimed by someone, somewhere, to contribute to the epidemic. These items are presented as information, and are not necessarily endorsed. Some seem far-fetched, even silly. Other detrimental factors affect only a small segment of the population. Astonishingly, our survey of possible obesity villains is not yet complete.

Artificial light

Artificial light includes everything that isn’t the sun: interior and exterior electric lighting, tablets and other computer monitors, mobile phones, and television screens. Such light has biological effects described as “acute.” The intensity and duration of the light, and the time of day at which it is experienced, all are significant. Animal experiments had already shown that metabolic function and body weight are influenced by artificial light.

The world total of obese children is said to now be 42 million, a mind-boggling number that translates into a mountain of financial expense and an unimaginable amount of human misery. In Australia, the Queensland University of Technology did some research on the link between artificial light and body weight. The results were published by the journal PLOS ONE. PhD candidate Cassandra Pattinson and colleagues obtained information about children ages 3 to 5 from several preschool childcare centers in Brisbane. They started (Time 1) by measuring each child’s height and weight, then observed their sleep patterns, activity levels, and light exposure for two weeks. Pattinson is quoted as saying,

The circadian clock – also known as the internal body clock – is largely driven by our exposure to light and the timing of when that happens. It impacts on sleep patterns, weight gain or loss, hormonal changes and our mood… At time 1, we found moderate intensity light exposure earlier in the day was associated with increased body mass index (BMI) while children who received their biggest dose of light – outdoors and indoors – in the afternoon were slimmer.

Returning a year later, they re-measured everything and arrived at their conclusions. The kids whose total light exposure at Time 1 had been greater had higher BMI scores. A parenting “best practice” is to provide a bedroom with no television, computer, or smartphone in it. The consensus is that children need to go to sleep earlier, sleep later, and in general reduce their time spent with electronic screens.

Heavy servers

As if ill-timed exposure to light were not bad enough, it is also suggested that damage can be caused by the sight of overweight waiters and waitresses. It sounds like the basis for a comedy sketch, but the results of a study performed by Cornell University’s Food and Brand Lab were published in the professional journal Environment and Behavior.

Researchers looked at 497 diners in 60 casual restaurants. They found that those served by heavier waiters or waitresses were four times more likely to have dessert and to consume 17 percent more alcohol… The researchers also found that the apparent effect heavy servers had on customers’ ordering was strongest on the skinniest diners.

A mitigating tip offered by the study authors is to make the decision ahead of time to either order an appetizer or dessert, but never both.

Your responses and feedback are welcome!

Source: “Global research hub publishes QUT study on light exposure and kids’ weight,” qut.edu.au, 10/07/16
Source: “Heavy waiters, waitresses may prompt bigger orders,” WMBFnews.com, 01/12/16
Image by Marta Diarra

 

What, More Obesity Villains? Yes, Salt and Protein

Spijkenisse - New-Born Calf

Humans live on one-quarter of what they eat; on the other three-quarters lives their doctor.

This pithy observation is said to have been carved on an Egyptian pyramid nearly 6,000 years ago and is unmistakable proof that knowledge is not enough to save us. If humankind has known such a simple truth for all these millennia, why is the world now experiencing an unprecedented obesity epidemic?

Salt is one of the many problematic chemicals that humans can mess themselves up with. Investigating the connection between salt and obesity, journalist Judy Rupp even called it a big villain, using that exact word and providing circumstantial evidence:

According to sales figures of the American Salt Institute, salt consumption by Americans increased more than 50 percent from the mid-1980s to the late-1990s—a period when the prevalence of obesity was increasing rapidly. During that same period, intake of sugar-sweetened beverages increased by 135 percent, raising average daily calorie intake by 278 calories per person.

Astonishingly, salt manages to accomplish this villainy despite being completely devoid of calories. It inspires the desire for another no-calorie substance, water, which in many times and places throughout history was the only potable liquid available. Even today, a sensible person will prefer water, especially if weight management is an issue. But a thirsty child, given the opportunity, will choose a sugar-sweetened beverage (SSB). There is a suggestion that sodium and sugar are “part of a package,” and seem to work together with ill intent—another example of negative synergy.

In a 2012 study that concerned 4,283 kids, the ones who drank more than one SSB per day were 26% more likely to measure up as overweight or obese. A 2014 study of adolescents determined that they ate as much salt as their parents, and get this:

Those with a high sodium intake tended to be heavier and had more body fat than those who ate less salt, regardless of how much food they ate and how many sugary beverages they consumed.

Say that again? Salt junkies are heavier regardless of food and SSB intake? Indeed, and hypertension is almost guaranteed. Compared to low-level consumers, the salt fiends also showed more signs of systemic inflammation, considered to be the forerunner of diabetes, cancer, and cardiovascular disease. Here is an interesting clump of information:

One study found that 43 percent of sodium in a child’s diet came from the following categories: pizza; yeast bread and rolls, including doughnuts; cold cuts and cured meats; salty snacks such as chips and pretzels; sandwiches such as cheeseburgers; cheese; chicken patties, nuggets and tenders; pasta dishes; Mexican dishes such as burritos and tacos; and canned soups.

The ingestion of nourishing substances begins early, and plenty of research has shown that breast-fed babies fare better. The Child Nutrition Research Centre attached to the University of Queensland wanted to know more about the reason. In explaining it for the American Journal of Clinical Nutrition, Dr. Rebecca Hill began, as so many experts do, by noting that obesity is multi-factorial. But exactly why do breast-fed babies develop less obesity later?

It might be all about the protein. When a newborn begins nursing, the mother’s milk contains a goodly amount of protein. According to nature’s design, the level starts to fall, and by the time the baby is three months old, the mother’s milk contains only half as much protein as at the beginning.

Many brands of baby formula, however, boast a higher protein content than breast milk. This Australian study of 1,500 babies points a finger at “excessive protein intake in the first two years of an infant’s life” for apparently leading to future overweight and obesity.

Speaking of which, Matthew Kirby wrote a piece titled “Cow’s Milk is the Reason You’re Fat and Hate Your Parents, Study Finds.” This was based on data gleaned from 1,112 infant subjects in the Avon Longitudinal Study of Parents and Children. Kirby says:

According to a paper published in the American Journal Of Clinical Nutrition, children who drank just over a pint of [cow] milk each day at eight months gained weight faster and continued to become heavier than their breast-fed counterparts.

Apparently, cow milk is an even bigger obesity villain than formula. Mother’s milk is still the best of all.

Your responses and feedback are welcome!

Source: “Salt: Making kids fatter? ,” EnidNews.com, 06/17/15
Source: “Childhood obesity: Higher protein intake in infancy, possibly through formula, seen as factor,” ABC.net.au, 04/16/15
Source: “Cow’s Milk is the Reason You’re Fat and Hate Your Parents, Study Finds,” konbini.com, November 2015
Image by Roger W

 

Infamous Obesity Villains – Marriage and Divorce

divorce

A very prevalent and active obesity villain is interpersonal stress, particularly the kind that originates with familial discord. Childhood Obesity News has discussed parent-child relationships extensively, but by no means definitively. In this area of life, unfortunately, there is always more to say, because of the seemingly infinite number of ways in which people sabotage even their nearest and dearest.

Synergy happens when the whole is greater than the sum of its parts. Two or more conditions or forces are at work, and their combined efforts add up to more than they logically should. Sometimes synergy accomplishes an unexpectedly good result, but often it goes the other way. A study from Ohio State University’s Institute for Behavioral Medicine Research found that when a history of depression is mixed with a hostile marital relationship, the total effect can be very harmful.

When these factors combine, they can increase an adult’s obesity risk by altering how the body processes foods high in fat, increasing the likelihood of metabolic syndrome, and thus the likelihood of the person developing heart disease and diabetes. Fewer calories are burned. More insulin is produced, which contributes to fat storage. Triglyceride levels rise, and that particular marker is considered a risk factor for cardiovascular disease. That is what appears to be happening with spouses who suffer from depression and who customarily get into heated arguments. The study’s lead author, Dr. Jan Kiecolt-Glaser, says:

Most people eat every four to five hours, and often dine with their spouses. Meals provide prime opportunities for ongoing disagreements in a troubled marriage, so there could be a longstanding pattern of metabolic damage stemming from hostility and depression.

The research team reckoned that such negative synergy could translate into as much as 12 extra pounds per year. A report by Emily Caldwell goes into great detail about how the research on 43 couples was conducted, with extensive measurements and blood testing and the consumption of high-calorie, fat-intensive meals such as might be found at a fast-food franchise. The husbands and wives were given opportunities to discuss hot topics like in-laws, money, and communication or the lack thereof. Caldwell writes:

Researchers left the room during these videotaped discussions, and later categorized the interactions as psychological abuse, distress-maintaining conversations, hostility or withdrawal. After the meals, participants’ energy expenditure—or calories burned by converting food to energy—was tested for 20 minutes of every hour for the next seven hours.

The takeaway is the importance of treating mental and emotional disorders, because they so often lead to physical problems.

Obesity Triggers Vary by Gender

A University of Houston study looked at the types of family stress that are most likely to result in obese adolescents. The data came from 4,700 young people of both sexes, and showed that male and female teens react differently to family-generated emotional stress. The three distinct stressors they looked at were family disruption, financial stress, and maternal poor health. It appears that girls respond badly to poverty and “broken family” situations, and react by becoming overweight or obese. The same outcome in boys is much more frequently caused by a mother’s chronic illness or other health deficit.

Since school-based anti-obesity programs that concentrate on diet and exercise result in only short-term benefits, recognition of these gender differences could help to design better programs. Of course, there is never enough help to go around, but ideally a lot of good could be done by aiding families who need financial assistance, better individual mental health, and family counseling.

The Big D: Divorce and Obesity

If family counseling fails and divorce looms on the horizon, keep an eye on the kids, because chances are they will turn for consolation to sugar-sweetened beverages. In the pleasure sweepstakes, a cold fizzy sweet drink delivers a lot of bang for the buck. This disturbing news comes from San Francisco State University. With care, this dangerous proclivity can be avoided.

Researchers were surprised to find that the more a divorced family maintained routines such as eating a regular dinner together or making time for family activities, the less likely children were to drink sugary beverages.

Your responses and feedback are welcome!

Source: “Study Shows How Troubled Marriage, Depression History Promote Obesity,” OSU.edu, 10/20/14
Source: “Stress and obesity: Your family can make you fat,” eurekalert.org, 04/06/15
Source: “Divorce implicated in sugary beverage consumption,” Science Codex.com, 03/03/15
Image by Tony Guyton

Incomparable Obesity Villains – Soda Pop, Pizza and Potato Snacks

A Chip Butty

Analysis of data provided to the National Health and Nutrition Examination Survey (NHANES) by thousands of American children and teenagers revealed that on any given day, 22% of them eat pizza. Difficult as it may be to believe, this is actually an improvement over earlier reports, according to Lisa M. Powell, a health policy researcher from the University of Illinois, and her colleagues.

Kids from middle-income and high-income families have slacked off a bit on the pizza consumption. Also, the young are eating less pizza for dinner, although the breakfast, lunch, and snack amounts have apparently not diminished by much. This particular research team accused pizza of being an obesity villain equal to sugary drinks, which makes pizza a very sizable villain. The report says:

On days when children eat pizza, they consume an average of 408 additional calories, three additional grams of fat and 134 additional milligrams of salt compared with their regular diet. For teens, putting pizza on the day’s menu adds 624 calories, five grams of fat and 484 milligrams of salt.

Chips, Crisps, and Fries

Evidence against fried snacks continues to pile up—as if there were ever any doubt. Young people who responded to a poll at Dr. Pretlow’s Weigh2Rock website voted for potato chips as the worst, most seductive and addictive problem food. Like their softer cousins the French fries, chips (“crisps” in the United Kingdom) turn bland potatoes into delicious grease delivery systems.

Crisps are one reason why, as Lizzie Parry phrased it for The Daily Mail, “British girls under 20 are the fattest in Europe.” She told the story of Brooke Clarke, who at age 10 was so big she was forced to wear her mother’s size 14 clothing. Apparently, the 5’1” Brooke was overweight by two stone, or 28 pounds. Granted, that is nowhere close to the ideal for a 10-year-old, but in the world sweepstakes of massively obese children, 28 extra pounds are far from impressive.

As so often happens, there was a complication—asthma, which left Brooke dependent on her inhaler. The short walk to school left her out of breath. The reason this even became a story is that the young girl eventually lost the extra weight. Parry describes her former condition:

At her peak, Brooke ate three to four packets of crisps a day, washed down with two liters of Coke…At her heaviest, Brooke was consuming almost double her daily recommended amount of calories and three times the amount of sugar…

Two liters is an awful lot of sugar-sweetened beverage to be consuming in one day, especially for someone who mainly sits around watching TV. Nowadays, there is more physical activity by Brooke, with her little brother and her mum, in the form of bike rides or swimming. The interesting part is, by cutting out the fried snacks and the fizzy drinks, Brooke dropped the extra weight in just three months.

Brooke’s mother told the press that losing the weight saved her daughter’s life. That is wonderful, but why did it take so long? Had she really never heard before that being overweight is not healthful, or that fizzy drinks cause obesity? Was this really momentous news? Probably not. The turning point here was a warning from the school nurse that Brooke was “very overweight.” Which at least goes to show that parents are not universally resentful of this intervention.

Your responses and feedback are welcome!

Source: “Experts zero in on pizza as prime target in war on childhood obesity
LATimes.com, 01/19/15
Source: “10 stone at 10 years old
DailyMail.co.uk, 07/27/15
Image by Smabs Sputzer

 

Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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