GLP-1 Drugs and Babies, Part 2

Any factor with the potential to affect a baby throughout its entire lifetime is not a thing to be taken lightly. A number of authorities have something to say about the subject of GLP-1 drugs in conjunction with pregnancy.

Many media articles mention Ozempic, a drug which, because of its early and widespread popularity, seems to stand in for and take the fall for the whole group of similar meds. But that one preparation does not represent the entire range of risk. Another brand’s packaging, for instance, warns of increased risk to the fetus, of cleft lip and cleft palate.

The Food and Drug Administration states that no one should take GLP-1 drugs if they are trying to become pregnant. For those who are planning on motherhood and are on a GLP-1, the FDA recommends stopping the medication at least two months before trying to conceive.

Jamie Winn, Pharm.D., told journalist Cathy Cassata,

While no studies have been conducted on pregnant people taking GLP-1 drugs, studies in animals such as rats, rabbits, and monkeys showed that these animals experienced high rates of miscarriages when they were given an injectable GLP-1 medication. The babies the animals gave birth to were smaller in size than usual and with more birth defects.

Just to complicate matters, pregestational diabetes has long been known to “increase the risk for potential pregnancy, including birth defects, miscarriage, fetal growth restriction, premature labor, and preeclampsia.” Some professionals believe that so far, weight-loss drugs offer no greater risk than insulin, which pregnant women with diabetes have needed to take.

Still, clinical endocrinologist Dr. Sethu Reddy has said that no GLP-1 receptor agonist is “indicated for improving fertility” and that “risk can not be ruled out.” On the other hand, GLP-1 receptor agonists seem to perform no worse than insulin, and patient acceptability and adherence are great advantages.

But this only applies to the small percentage of potential mothers who must receive extra protection because of their diabetes. Dr. Sonia Hernández-Díaz is quoted as saying,

[T]he safety of these agents in pregnancy is largely unknown, as pregnant women are typically excluded from clinical trials; hence, treatment guidelines do not recommend these agents in pregnancy.

Around the same time, a Swedish study provided reassurance about the prenatal exposure experienced by fetuses when the mothers are treated for obesity with semaglutide. Only a month later, it was announced that a study of 50,000 pregnancies in six countries, followed up for the first year after birth, provided “reassuring” answers regarding the GLP-1 drugs. Still, even though they apparently post no greater risk than insulin, one year of follow-up cannot tell the whole story.

A researcher who wants to know everything about the effects these drugs have on mothers and their babies cannot simply round up a group of suitable female subjects and keep them on the premises, while hourly monitoring every body function. Nor can they even pay women who have used or are using the substances to turn themselves and their fetuses into lab specimens.

(To be continued…)

Your responses and feedback are welcome!

Source: “Ozempic’s Effects on Pregnancy and Fertility: Experts Answer 4 Common Questions,” Healthline.com, 08/14/24
Source: “Are Weight Loss Drugs Like Ozempic Safe While Trying to Get Pregnant?,” Healthline.com, 04/25/23
Source: “Are GLP-1 receptor agonist drugs safe to use in pregnancy?,” MedicalNewsToday.com, 12/16/23
Source: “Prenatal exposure to GLP-1 receptor agonists and other second-line antidiabetics may not pose greater risk to infants than insulin,” Harvard.edu, 12/11/23
Source: “First Large Study of GLP-1 Receptor Agonists During Pregnancy,” JAMANetwork.com, 01/02/24
Image by Vladimir Pustovit/Attribution 2.0 Generic

As Obesity Booms, Doctors Seek Additional Treatment Options

A recent article on Medscape highlights the work and the opinions of Dr. Gitanjali Srivastava, a professor of medicine, pediatrics, and surgery, and the medical director of Obesity Medicine at Vanderbilt University, who had been practicing pediatric medicine for nearly a decade before completing an obesity medicine fellowship at Massachusetts General Hospital in 2013. Reflecting on that time, she recalls that there were no established guidelines or curricula for the specialty.

At that point, obesity was already a widespread issue, but there was still significant stigma both in the medical field and among the general public. After completing her fellowship, Dr. Srivastava spent months traveling and meeting with hospital executives across the country, explaining the importance and value of obesity medicine, covering details about its budget, business model, space needs, and revenue potential.

Specialized obesity treatment gains traction

Today, the field of obesity medicine is growing rapidly. More patients are seeking obesity treatment, and healthcare systems are actively recruiting specialists and building metabolic health centers. Since 2020, the number of doctors certified by the American Board of Obesity Medicine (ABOM) has nearly doubled, and fellowships have more than doubled as well. This year, over 2,100 doctors from various specialties will take the board exam, marking obesity medicine’s increasing integration with other medical fields.

The growing demand for obesity treatment has coincided with the U.S. Food and Drug Administration’s approval of GLP-1 injections, which have shown remarkable weight loss effects. Dr. Marcio Griebeler, head of the obesity medicine fellowship at Cleveland Clinic, explains that the recognition of obesity as a chronic disease, rather than a lifestyle issue, has been long overdue. Obesity treatment has shifted away from advice about diet and exercise to a more scientific understanding of the disease.

Dr. Kimberly Gudzune, chief medical officer for the ABOM Foundation, and others highlight that the brain functions differently in people with obesity, making it more challenging for them to lose weight through willpower alone. New treatments like GLP-1 have shown that obesity can be managed with medication, much like conditions such as high blood pressure or diabetes, but the disease often returns if treatment stops.

More obesity management and treatment training is needed

As more patients seek obesity care, doctors from various specialties are being asked about obesity treatment options, yet many feel unprepared due to a lack of education in this area. Medical training has historically neglected obesity and metabolic health, according to Dr. Nina Paddu, an obesity medicine specialist, who notes that her own training barely addressed these topics.

Dr. Srivastava explains that while the medical community has long sought to establish guidelines for obesity treatment, only recently has enough evidence emerged to create standards. Over the past five years, understanding of obesity’s underlying causes has advanced, with research highlighting the brain’s role and its connections to other diseases. This progress is transforming the way multiple specialties, including endocrinology and surgery, approach obesity.

In response to the growing need, more doctors are pursuing additional training in obesity management. The ABOM offers two certification pathways: completing 60 hours of continuing medical education (CME) credits or undertaking a 12-month fellowship. Dr. Srivastava points out that while the fellowship is more intensive, many physicians are choosing to immerse themselves in it to further their careers. Some return to their previous specialties, but many take on roles specifically focused on obesity medicine.

Despite the field’s growth, there are still not enough obesity specialists to meet the rising demand. With only a small percentage of U.S. physicians certified by the ABOM, many patients may not have access to comprehensive care. Dr. Gudzune emphasizes that while the field is expanding, it remains small relative to the number of patients in need.

Liraglutide is safe for kids as young as six, study finds

Speaking of weight loss medications, a new study shows that liraglutide, a drug already approved for treating obesity in adults and teens, is safe and effective for children as young as six when combined with diet and exercise. The results of the study were published in The New England Journal of Medicine. The drug was found to reduce body mass and slow weight gain in kids aged 6 to 11. Based on these results, the manufacturer, Novo Nordisk, has asked U.S. regulators to expand its use for this younger age group. If approved, it would be the first drug authorized for treating the most common form of obesity affecting over 20% of U.S. children in this age range.

The study involved 82 children, with those receiving liraglutide showing a 5.8% reduction in body mass index (BMI) after over a year of treatment, compared to a BMI increase of 1.6% in the placebo group. Nearly half of the children taking the drug saw significant health improvements. However, side effects, particularly gastrointestinal issues like nausea and vomiting, were common. While experts welcome the potential benefits of the drug, they urge caution in its widespread use due to the risks and lack of long-term data.

The study highlights liraglutide’s potential to treat the underlying causes of obesity in young children, potentially preventing serious health issues like diabetes and heart disease later in life. The trial will continue, with further results expected in 2027.

Your responses and feedback are welcome!

Source: “Doctors Seek Additional Obesity Training in Wake of Obesity Patient Boom,” Medscape.com, 10/1/24
Source: “Weight-loss drug Saxenda effective for kids as young as 6, study shows,” MSN.com, 9/29/24
Source: “Liraglutide for Children 6 to <12 Years of Age with Obesity — A Randomized Trial,” NEJM.org, 9/10/24
Image by Accuray on Unsplash

GLP-1 Drugs and Babies

It seems to be taking a long time for science to sort out exactly what is going on with the relationship between the GLP-1 genre of weight-loss medications and the creation of new humans. This is partly because deliberate experimentation would be unethical. Researchers can’t take a bunch of women who are pregnant or hope to be, and deliberately administer potentially harmful substances to them.

Scientists who want the knowledge are required to wait patiently for the statistics to become apparent among women who have accidentally found themselves in this situation, or who have knowingly and purposely conceived despite being cautioned against it.

An earlier post looked at the two main situations that provided information in earlier years. In some cases, weight loss alone can facilitate conception, and that includes women being treated with Ozempic or similar drugs. But just because this effect was noticed did not imply that the combination of pregnancy and these meds could be recommended. At the same time, unintentional pregnancies were occurring because the drugs might indirectly cause a patient’s birth control pills to be diluted or expelled.

The GLP-i meds purposely delay stomach emptying, so the user does not experience hunger to the same degree as previously, or as soon. Anything consumed stays in the stomach longer than before, which is not particularly desirable for other reasons.

Additionally, the meds commonly cause vomiting, which could also lead to something quite significant, like an unplanned pregnancy because the birth control pills are vomited up too. One way or another, the absorption factor is affected.

Dr. Phillip Kadaj, for example, has said,

If the hormones in birth control pills aren’t being fully absorbed because of the delayed emptying from semaglutide, there’s a chance that the pill may not be quite as effective.

This is quite an understatement when the possible outcome might result in setting up an online “want list” for baby shower gifts and planning a gender-reveal party. It is not a decision to be lightly made. Meanwhile, animal studies have indicated the possibility of unfavorable outcomes like miscarriage and birth defects. Furthermore, the risk incurred by breastfeeding with these drugs present is still a mystery.

One or all?

Currently, it seems that only tirzepatide might, in and of itself, hinder the effectiveness of oral contraception. But all drugs of this class can potentially cause vomiting, and thus the expulsion of birth control pills. And while this type of medication could increase the potential for an unplanned pregnancy, it could also threaten that pregnancy with as-yet-unknown damage. For one thing, maternal weight loss is not usually recommended when a baby is trying to develop inside, needing resources whose availability, or lack thereof, will affect its entire subsequent life.

As is so often the case, there is not enough research yet to really nail down the answer. The sticking point is that among the hormonal and non-hormonal birth control methods, no other current method is influenced by changes in the digestive system. Some doctors don’t say enough about this whole area of risk, while others take a conservative stand and advise patients to start using condoms several weeks before starting a course of weight-loss drugs.

(To be continued…)

Your responses and feedback are welcome!

Source: “Is There a Connection Between Semaglutide (Ozempic) and Birth Control?,” Healthline.com, 09/01/23
Source: “What to Know Before Taking Obesity Drugs While on Birth Control,” Health.com, 10/24/23
Image by Alick Sung/Attribution 2.0 Generic

The Role of Digital Technology in Improving Pediatric Care

In the rapidly evolving world of healthcare, digital technology has emerged as a powerful tool, especially for pediatric populations. The September 2024 issue of Contemporary Pediatrics highlights how digital interventions are reshaping pediatric care across a range of conditions, including mental health and obesity management. With new research and technologies making it easier for both children and their families to manage health challenges, the future of pediatric care looks promising.

Enhancing Mental Health Through Digital Therapeutics

One of the standout articles in this issue presents groundbreaking research conducted by J. Khan, Ph.D., co-founder of Mightier digital therapeutics. This innovative platform uses video game interactions to help children and adolescents learn how to manage their emotions. By receiving real-time feedback during gameplay, young users are taught how to regulate their emotional responses and cope with symptoms like aggression, anxiety, and frustration.

Mightier’s effectiveness has been backed by a randomized controlled trial, which found that children who used the platform showed significant improvement in managing aggression. The potential for this technology is vast, especially for children who are waiting for mental health referrals or are already receiving care. As digital therapeutics continue to evolve, there is great hope for more personalized and accessible mental health care for young populations.

Addressing Childhood Obesity Through Digital Health Programs

Childhood obesity remains a pressing issue in pediatric healthcare, with behavioral factors playing a significant role in its development and management. Another key article in the tech issue of Contemporary Pediatrics highlights how digital tools — such as health apps, text-based interventions, and telemedicine — can support weight management in children and adolescents.

These digital programs focus on behavior change by encouraging healthier eating and physical activity, aiming to help children develop habits that support growth within the expected growth curve. The article emphasizes the need for future research to assess the effectiveness of these technologies, especially among underrepresented pediatric populations. Additionally, the development of apps targeting parental feeding habits during the first three years of life could play a crucial role in preventing childhood obesity before it starts.

The Future of Pediatric Healthcare in a Digital World

As these articles demonstrate, the integration of digital technology into pediatric healthcare offers exciting opportunities to improve outcomes for children. Whether it’s helping children manage mental health challenges, addressing obesity through behavior-focused digital tools, or supporting parents of medically complex children, technology is reshaping the future of care.

However, as healthcare moves deeper into the digital age, the rise of artificial intelligence (AI) poses both challenges and opportunities. AI has the potential to revolutionize healthcare by offering predictive analytics, personalized treatments, and enhanced decision-making. Yet, the rapid pace of AI advancement demands thoughtful reflection on its integration into healthcare systems.

For nurse practitioners and other healthcare professionals, adapting to this technological evolution will require ongoing education and a commitment to high standards of patient care. It will be essential to develop educational programs that incorporate AI and train healthcare providers on how to use these tools effectively, while ensuring that critical thinking remains at the core of all clinical decision-making.

Preparing for the Future

The future of pediatric healthcare is undeniably intertwined with digital technology and AI. As these innovations continue to develop, healthcare professionals must stay informed, agile, and committed to the highest standards of care. By embracing these changes thoughtfully, healthcare providers can help ensure that children and their families receive the best care possible in an increasingly digital world.

Your responses and feedback are welcome!

Source: “Technology: How far we have come and how far can we go?,” Contemporary Pediatrics, 9/23/24
Source: “Digital therapeutics and what they can do for mental health,” Contemporary Pediatrics, 8/8/24
Image by Photo by National Cancer Institute on Unsplash

Awareness Month — A Few More Odds and Ends

What is the one thing more disappointing than the fact that sugar is not good for us? Learning that sugar substitutes can also be very harmful.

Childhood Obesity News has discussed neotame, as well as aspartame and other corn-based sweeteners, but let us not forget xylitol, which can be found in baked goods, candy, gum, and toothpaste. There is good evidence that xylitol causes platelets to clot and heightens the risk of arterial thrombosis, which in turn can lead to myocardial infarction (heart attack) and stroke,

And then, there is erythritol, which has 70% of sugar’s sweetness with only 6% of sugar’s calories. It comes from wheat starch or corn starch, fermented with a particular type of yeast, emerging as powdery white crystals. It enters the bloodstream, is not broken down by enzymes, and exits the body through urination. According to animal studies, it does not increase blood sugar or insulin levels:

For people who are overweight or have diabetes or other issues related to metabolic syndrome, erythritol appears to be an excellent alternative to sugar.

So, what could go wrong? After a period of optimism about the safety of this substance, it too became suspected of association with blood clots and heart attacks. Yet erythritol still seems to be regarded as the safest sugar alternative.

In the hospital

A fairly recent article about hospital care, which shows obvious concern for patient wellbeing, was written primarily for the benefit of medical professionals and institutions that wish to avoid being sued for malpractice. Consequently, it is a presumably comprehensive look at conditions that can cause unnecessary damage.

Adults with obesity are more likely to have risk factors for cardiovascular disease, prediabetes, bone and joint problems, sleep apnea, and social and psychological problems.

Obstructive sleep apnea (OSA), particularly in combination with heavy sedation and/or opioid pain medications, can cause severe postoperative respiratory depression. Before undergoing surgery, obese patients need careful evaluation, especially since OSA has typically been under-diagnosed. There is a very real danger that postoperative complications may go unrecognized, and that patients might be discharged prematurely.

Another cause for extra caution is the development of pressure ulcers (a.k.a. bedsores) due to the poor circulation of oxygen in fatty tissue. Upon admission and during the patient’s stay, hospital staff members need to carefully observe and document pressure ulcers. Frequent repositioning of the patient and a pressure-reducing mattress can go a long way toward preventing trouble of this sort.

Falling is of course a potential hazard for almost all patients, but obesity increases the possibility, so a “robust fall-prevention program,” including risk assessment and intervention planning, is strongly recommended.

Many of the special obesity-related concerns do not require extra expense, but in the areas of infrastructure and equipment, the budget may be severely strained. The needs include “oversized furniture, scales, MRI machines, OR tables, beds, wheelchairs, and gurneys.” Additionally:

Appropriately sized supplies such as blood pressure cuffs, bandages, gowns, and extra-long needles are also required. [F]loor-mounted toilets typically support much more weight than wall-mounted toilets, and doorways may be enlarged to facilitate sufficient clearance for wider wheelchairs and gurneys.
If properly sized MRI, CT, and other diagnostic equipment are not available at your facility, maintain transfer agreements with other facilities that can perform the diagnostic studies or assume care of the patients.

Of course, the article also recommends appropriate measures to make sure that hospital staff members are not injured in the care of obese patients.

Your responses and feedback are welcome!

Source: “Cleveland Clinic-Led Study Links Sugar Substitute to Increased Risk of Heart Attack and Stroke,” ClevelandClinic.org, 06/06/24
Source: “Erythritol — Like Sugar Without the Calories?,” Healthline.com, 09/14/23
Source: “Safely Caring for the Hospitalized Patient with Obesity,” TheDoctors.com, 06/15/2020
Image by Quinn Dombrowski/Attribution-ShareAlike 2.0 Generic

Childhood Obesity Awareness Month — Odds and Ends

Dengue fever is one of the reasons to avoid mosquitoes if at all possible. Millions of people catch it every year, and while four out of five don’t even show symptoms, others get it really bad — as in, total body pain, and bleeding from places that do not normally bleed. While many cases may be almost negligible, the disease can also usher in a miserable death. The same person might have a barely noticeable case one time, and the next time a fatal one.

To make matters worse, dengue has traveled to geographical areas where it did not use to exist, like the southern United States. And according to other recent news, both obesity and diabetes are risk factors that increase the likelihood of a person’s case of dengue being severe.

Researchers in Sri Lanka looked at 4,782 cases among young people aged 10 to 18. The Conclusions follow:

Obesity appears to be associated with an increased risk of hospitalization in dengue, which should be further investigated in longitudinal prospective studies. With the increase in obesity in many countries, it would be important to create awareness regarding obesity and risk of severe disease and hospitalization in dengue.

Another source pins down the hospitalization risk for obese children as being twice as high as for the others. The same report notes that “there has been limited focus on the impact of obesity on many infectious diseases.” Furthermore, the odds are worse for girls than for boys. (This caveat also applies to influenza, COVID-19, and “many other infections.”) Dengue has been identified as a Neglected Tropical Disease, so maybe having this connection pointed out will lead to more strenuous efforts toward prevention.

They just can’t seem to get it right

A study published in Nutrients reveals that “60% of all baby foods don’t meet standards established by the World Health Organization.” The research team tested 651 products sold by 10 different major retail chains and found that infant and toddler foods on supermarket shelves contain too much bad stuff and not enough good stuff:

In fact, researchers discovered that only about 30% of these products complied with the WHO’s protein recommendations and only 56% complied with sugar guidelines.

During the first year, a child does just fine with breast milk or iron-fortified formula. In the words of neonatal dietician Chelsea Britton, “Food before one is just for fun,” which is an excellent reason to ignore the commercial offerings and start acclimating a child to real food.

Recommended are “natural purees like yogurt, hummus, smashed beans, and smashed avocado.” Aim for protein, iron and calcium, and don’t add any salt or sugar. Let a child become accustomed to what real, genuine food is supposed to taste like, and don’t assume that your own jaded palate and overworked taste buds can be the judge of that.

In a separate but equally appalling offense, no brands meet the promotional standards set by the WHO, meaning that their advertising is misleading and the information they provide for the buyer is incorrect. It is forbidden to advertise a product as organic, non-GMO, BPA-free, or without artificial flavors or colors, if this claim is not factually true.

Forbidden, but apparently not enforceable. Another example would be calling something a fruit snack, whose main ingredient is flour. Lead researcher Daisy Coyle found that the average infant/toddler food label includes several prohibited claims. Only four products were found whose packaging featured no prohibited claims.

And don’t even look at the front label. Turn the jar around, take out your magnifier, and check the ingredients list and nutrition label, for the real story. Baby food from a grocery shelf should have a very short list of ingredients — the main vegetable, fruit or meat, and enough water to make it spoonable. The cereals, like oatmeal and rice, ought to contain added minerals and vitamins.

Your responses and feedback are welcome!

Source: “Dengue fever,” MayoClinic.org, undated
Source: “Is the rise in childhood obesity rates leading to an increase in hospitalizations due to dengue?,” AC.uk, 2024
Source: “Childhood obesity tied to double the risk of dengue hospitalization,” UMN.edu, 06/28/24
Source: “Most Baby & Toddler Foods Don’t Meet Nutrition Standards, Study Finds,” Parents.com, 08/28/24
Image by markus119/Attribution 2.0 Generic

Exactly How Multifactorial Is Childhood Obesity?

The full title of this study is “Unraveling Childhood Obesity: A Grounded Theory Approach” to Psychological, Social, Parental, and Biological Factors.” Its four authors are from three different universities and they look at seven major categories of interest: social factors; biological and genetic factors; psychological factors; family condition-related factors; feeding and health-related practices; parenting style factors; and consequences of obesity.

These are further broken down into a couple of dozen subcategories. In other words, there is very thorough coverage of everything that is known, or suspected, to affect the bodies of young humans. Why? Because…

Despite the extensive studies that have been conducted to explore the specific issue, the impact of several factors that influence, generate, worsen, and make chronic the phenomenon needs further exploration.

This work was done in order to come up with a “grounded theory” that includes them all. According to the study authors,

Grounded theory, as a qualitative research methodology, shows great potential for solving the complexities inherent in multifactorial issues. The aim […] is to construct a theoretical framework or a cohesive explanatory mechanism that explains the phenomena being studied. The application of grounded theory methodology includes analyzing and interpreting data that are mostly qualitative like observations, interviews, texts, and documents.

Needless to say, the numerous factors “interact in complex ways, highlighting the multifactorial nature of childhood obesity.” The authors begin by discussing BMI (body mass index) and other measurement tools, and note that “the absence of a universally agreed-upon definition” of childhood obesity makes every aspect of the search for knowledge more challenging. But it is more necessary than ever, because…

[…] obesity represents a significant component of the worldwide challenge of chronic illness and disability, carrying substantial social and psychological consequences that impact individuals of all ages and socioeconomic backgrounds.

In the realm of causation classification, which area holds the most sub-categories? Perhaps surprisingly to some interested parties, “social factors” includes an abundance of categories, five to be exact. One of them has to do with specific time periods, which in turn will surely be divided into even more sub-categories.

Three possibilities spring to mind. First, there is the historical era. When Americans plodded westward with covered wagons pulled by horses, very few cases of childhood obesity existed. Another place where time makes a difference is in the child’s lifespan. As one example, there appears to be a stage of infancy when trying to shovel solid food into a baby can cause lifelong damage to the digestive system.

Likewise, there is a specific time period during which a problem can be solved. Younger people are more likely to be able to lose weight through one means or another, while adults are more likely to stay fat. That is simply how things are and, as always, further research is needed on every front.

The “biological and genetic factors” category has four sub-categories, and so does “family condition-related factors.” Perhaps it is unfair, that what parents say, do, practice, preach, model, ignore, punish, reward, discuss, clam up about, encourage, discourage, and pay for (or don’t), makes so much difference. Family influence (and lack of it) is responsible for an awful lot, and there is no point in pretending.

One way or another, childhood obesity ends up being everybody’s problem. On the importance of starting early, agreement is universal. The need is felt to construct a theoretical framework that includes all the recognized factors and all the connections between them.

Your responses and feedback are welcome!

Source: “Unraveling Childhood Obesity: A Grounded Theory Approach,” ResearchGate.net, August 2024
Image by Roy Patrick Tan/Attribution-ShareAlike 2.0 Generic

New Findings on Liraglutide for Younger Children

September is National Childhood Obesity Month, and we don’t need to tell you that obesity is a growing health crisis in the United States, affecting people of all ages. For children, the situation is particularly alarming: nearly 20% of all children in the U.S. have obesity, a number that has tripled since the 1970s.

This troubling rise has serious implications, not only for their immediate health but also for their future well-being. Children with obesity often become adults with obesity, facing a higher risk of developing long-term health problems like diabetes, heart disease, and even cancer. Despite these risks, weight loss for children — especially younger ones — has proven to be a significant challenge.

Doctors have long recognized how difficult it is for individuals with obesity to lose weight, regardless of age. While medications like GLP-1 receptor agonists, including the well-known drug liraglutide, offer promising results for adults and teens, younger children have been left with fewer options.

Until recently, children under the age of 12 could only rely on lifestyle changes like diet, exercise, and counseling to manage their weight. However, groundbreaking research on liraglutide is showing that this may be about to change.

Study details

A new study published in the New England Journal of Medicine explains how GLP-1 drugs could play a critical role in treating obesity in younger children. Dr. Claudia Fox, a pediatrician from the University of Minnesota, presented the findings at the European Association for the Study of Diabetes conference. The study focused on children between the ages of 6 and 12 who had high BMIs. Over the course of a year, 82 children participated, with 56 receiving daily injections of liraglutide while the rest received a placebo. Both groups were also provided with counseling to promote healthy diet and exercise habits.

Study findings

The results were impressive. Children who received liraglutide saw their BMI drop by 5.8%, compared to a 1.6% increase in the placebo group. This difference — 7.4 percentage points — was even more significant than the results seen in studies with teenagers. According to Dr. Fox, these outcomes suggest that early intervention with medications like liraglutide may yield better results, possibly even preventing the progression of obesity as children grow older.

Safety and Side Effects

One of the key concerns about using weight-loss medications in younger children is safety. Fortunately, liraglutide proved to be safe for the participants in the study. While some children experienced side effects like nausea, diarrhea, and vomiting, these issues were generally mild and tended to subside as the trial progressed. Very few participants dropped out due to adverse reactions.

However, one major question remains unanswered: How long would children need to stay on these medications to maintain the benefits? Once the trial ended and children stopped taking liraglutide, their BMI started to increase again, though not as sharply as seen in older children. This suggests that while the drug may be effective, it might require ongoing use to sustain weight loss, similar to how other chronic conditions like diabetes or hypertension require long-term management.

Dr. Sarah Armstrong, a professor of pediatrics at Duke University and a co-author of the American Academy of Pediatrics guidelines, said that medication will probably be necessary for children with severe obesity; that is, a BMI of at least 35. She said:

It is pretty clear that without effective treatment, this does tend to get worse, not better, over time… If a child has severe obesity and maybe has developed some early life comorbidities, it’s probably the right thing to do.

Dr. Armstrong does have some concerns about the use of medications in young kids because of the long-term nature of treatment:

What happens to kids if you put them on medication that makes them less hungry while they’re still growing? Are they going to have delayed puberty? Are they going to have delayed growth? Will it somehow affect their bone density? Will it create disordered eating patterns that are going to cause other problems later in life?

A New Era of Treatment for Childhood Obesity?

The potential for GLP-1 drugs like liraglutide to revolutionize treatment for childhood obesity cannot be overstated. While lifestyle changes are crucial, they often aren’t enough on their own. Dr. Fox and other experts emphasize that obesity is a biological disease, not simply a matter of poor lifestyle choices. As such, more aggressive interventions — including medications and, in some cases, surgical procedures — may be necessary to provide meaningful results.

The implications of these findings could be enormous. Children with obesity face not only physical health challenges but also significant social stigma and emotional stress. Successfully treating obesity in childhood could lead to long-lasting health benefits, reducing the risk of complications like type 2 diabetes, heart disease, and even early puberty. This could also help ease the burden on healthcare systems in the long term.

However, more research is needed, and questions about long-term use, the cost, insurance coverage, potential effects on growth and puberty, and the best time to start treatment are still open.

Your responses and feedback are welcome!

Source: “Weight loss drug liraglutide shows promise for younger children with obesity, study finds,” CNN.com, 9/10/24
Source: “A Novo Nordisk weight loss drug lowers BMI in kids as young as 6,” NBC News, 9/10/24
Image by Lidya Nada on Unsplash

And How Is Japan These Days?

China is huge, covering a large percentage of the continent. Japan is a relatively tiny island. Both are in the world’s top four economies. China’s population is much larger than Japan’s, and so is its military budget. China is straight-up Communist; Japan is not.

China was the major influence on Japan until world events changed the configuration and the United States became a more powerful influence. Political issues between China and Japan are numerous and complicated, and apparently, they view each other with more animosity than any other countries regard either of them.

In 2018, Dr. Shuhua Xu wrote of how the Japanese, Korean, and Han Chinese ethnic groups share many traits of appearance, culture, and language, and noted that…

It is usually difficult to tell which of the three East Asian groups a person comes from just by looking at their appearance… Such similarities are also reflected in our genetic data. The genetic difference between any of the three groups is less than 1% of their total genetic diversity, which is much smaller than that between any of the groups and a European population (~10%).

It appears that the three groups diverged from their common ancestry between 3,000 and 4,000 years ago, during the Chinese Shang dynasty. Some differences in northeastern Japan have recently puzzled researchers, but still everyone in what used to be called the Orient shares more heritage with each other than with Europeans or any other group. This is why it is strange that, as Childhood Obesity News recently observed, China’s obesity rate has enlarged rapidly.

According to WHO’s Global Health Observatory, on the obesity scale, Japan ranks at #183 in the world, with only 4.94% of its adults obese. South Korea is #174, with 6.74% of adults obese. China is unhappily the 166th most obese country, with 8.21% of adults obese. None of these even comes close to the current stats of the United States — the 13th fattest, with 42.87% of our adults obese.

Nevertheless, China seems not to understand why its adult population is fatter than those of the two countries with which it shares such close genetic links — or why its children show every sign of ballooning into even more unacceptable proportions.

A very recent news report is titled, “Avoiding Obesity: What the World Can Learn From Japan.” As it turns out, Japan’s slim profile is attributable to the same old familiar wisdom that we have all heard, and that so many of us have chosen to ignore. Try not to be too surprised — the Number One secret is healthy eating. That translates into simplicity, even minimalism. The point is to get hold of a small amount of fresh, basic food and then interfere with it as little as possible. The plate heaped with a hearty mountain of food is shunned. Quality and variety are definitely preferred over quantity.

Namiko Chen writes,

Diners in Japan might enjoy three or four more small courses, like the ever-popular protein-packed edamame. Eating smaller portions over several courses lets your stomach tell your brain when satisfied, lessening the risk of overeating. Light and nutritious broth soups like traditional miso soup often accompany Japanese dinners and make great stomach fillers between courses.

The people live longer, and without so much medicine, because there is less heart disease and diabetes. The journalist says, “Japan still strolls along its path to wellness relatively pharmaceutical-free.” This is particularly true in the area of weight control. The demand for weight-loss drugs is tiny.

Exercise is regarded not just as a beneficial option, but as an essential condition of life. The country’s built environment is purposely more geared toward walking, and the average Japanese averages 7,000 steps per day as compared to an American’s 5,000. Mainly,

Japanese Zen culture encourages self-care and healthy living from an early age.

Your responses and feedback are welcome!

Source: “Common ancestor of Han Chinese, Japanese and Koreans dated to 3000-3600 years ago,” BiomedCentral.com, 04/10/18
Source: “The Global Health Observatory,” WHO.int, undated
Source: “Avoiding Obesity: What the World Can Learn From Japan,” TallasseeTribune.com, 09/10/24
Image by electricnude/Attribution-ShareAlike 2.0 Generic

Mukbang: A Regrettable Trend Revisited

For a review course on the revolting cultural phenomenon of eating as much as possible for no good reason, we suggest one or more of a number of previous Childhood Obesity News posts about mukbang. Why? Because there are two newsworthy updates, and anyone who has managed to escape the knowledge of the mukbang fad up to this point will require orientation.

Okay, ready? So, a young fella who calls himself Nikocado Avocado has become famous in the mukbang sector of YouTube for — what else? Eating enormous amounts of food and weighing a ton. Just a few days ago, Nicholas Perry astonished his world by revealing that he secretly lost 250 pounds while fooling everybody into thinking he was still mukbanging away.

The pertinent video garnered 26 million views over one weekend, with Avocado/Perry saying, among other things:

And just yesterday, people were calling me fat and sick and boring and irrelevant. People are the most messed-up creatures on the entire planet, and yet I’ve still managed to stay two steps ahead of everyone. The joke’s on you.

Having attained the weight of 411 pounds a couple of years ago, Perry stealthily got down to 158, all the while publishing pre-made videos of his customary mukbang sessions, cleverly staged to avoid looking dated. It was a carefully plotted long con that only a few fellow content creators knew about, and they all kept the secret.

The first step in the performer’s deception was to make what must have been the painful sacrifice of shaving his head to avoid public recognition as his pounds disappeared. In the revelatory speech, Perry compared the viewers who care about his long-term prank to “ants on an ant farm,” as they unwittingly participated in “the greatest social experiment of my entire life.”

One of his philosophical aims is to point out how people tend to see things in black-and-white terms, while another is to remind us all “not to take the internet so seriously.” Angela Yang’s reportage for NBCNews.com contains many more fascinating details of this sociological/psychological saga, including Perry’s statement:

That is where a deeper level of over-consumption lies — and it’s the parallel I wanted to make.

Meanwhile, a more melancholy headline summarizes its own whole story:

Horror as extreme eater, 24, dies during livestream after 10-hour food binge.

The self-created victim was Pan Xiaoting of China, a country very unhappy with its increasingly overweight image. Having progressed from the dull field of food service to the rarefied atmosphere populated by social media “influencers,” the carefully made-up young woman would chat with fans and stare seductively into the camera lens while shoveling in mouthfuls of food.

Neither the threat of fines levied by the government, nor public disapproval, nor medical crises could impel her to stop.

Reporter Kelly Williams quoted critics who said,

I’ll never understand why anyone would want to watch someone eat.

That’s terrible. Why do people try and glorify obesity these days?

When you think that there are people dying of hunger… it’s maddening.

Pan Xiaoting customarily entertained her public with eating sessions that would last as long as 10 hours and encompass more than 20 pounds of groceries. It is not clear why an autopsy was even performed, but the procedure revealed a grotesquely deformed stomach full of undigested food.

Your responses and feedback are welcome!

Source: “YouTuber Nikocado Avocado bamboozles viewers with secret weight loss transformation,” NBCNews, 09/08/24
Source: “Horror as extreme eater, 24, dies during livestream after 10-hour food binge,” DailyStar.co.uk, 07/22/24
Image by Republic of Korea/Attribution-ShareAlike 2.0 Generic

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources