Archive for November, 2014

Fat Bullying Can Kill

November 13th, 2014

Want an example? The November 13, 2014 edition of the Washington Post carries a sad story of a talented young man who put on weight, was bullied at school and turned to marijuana to ease the pain of the taunting. The marijuana use brought him into contact with violent drug dealers who are suspected in his shooting. This case will no doubt be listed as a drug-related crime and the shooter or shooters will probably be found and prosecuted. But the bullies at his school, his teachers and administrators, and his classmates who did nothing…they will not shoulder any responsibility but their guilt will be just as great.

The Memory of Starvation

November 13th, 2014

Movie buffs may remember the 1999 movie A Bridge Too Far and the book by Cornelius Ryan of the same title on which it was based. The book and movie told the tale of an Allied operation to liberate Holland and achieve a bridgehead over the Rhine and into Germany. It failed. The book and movie only dealt with the military aspects of Operation Market-Garden, as it was called. Left out was what happened afterward.

The Nazi regime was going to punish the Dutch for their support to the combined English-American invasion of Holland. So they cut off food supplies to Holland in the winter of 1944-5. Thousands starved. Subsequently, researchers found that women who were pregnant during this period had offspring who were more prone to obesity, diabetes and cardiovascular disease and who were also smaller than those who were not exposed to the “Hunger Winter.” But, they also found that the grandchildren of those women had similar health problems. This helped establish the field of epi-genetics, i.e., that there were inheritance factors other than genes which might respond to early environmental stimulus, or the lack thereof. Now, in perhaps a groundbreaking paper, Dr. Oded Rechavi and colleagues may have found the mechanism. By studying worms exposed to starvation conditions, they observed a mechanism they call, ‘small RNA inheritance’ that enables worms to pass on the memory of starvation to at least three generations, perhaps more. At the very least, the study demonstrates that we still have a lot to learn about the gene-environment interaction as it affects the development of obesity and that those who say obesity is not genetic  only show they don’t know much about genetics or obesity.

 

Problems With Defining Diabetes

November 13th, 2014

Folks familiar with obesity conversations know that the Body Mass Index (BMI) has many problems as a reliable indicator of excess adipose tissue (which is the definition of obesity). However, many may be somewhat surprised that the use of glycosylated hemoglogin (HbA1c) test with a cutoff value of >6.5% also has several problems. In a recent paper,  Juarez, Demaris, Goo et al reviewed 47 studies looking at HbA1c as a diagnostic tool. They concluded that HbA1c is useful for its convenience and effectiveness, especially in community-based and acute-care settings where tests requiring fasting are not practical. However, HbA1c may underestimate the prevalence of diabetes among whites, children, women with gestational diabetes, patients with HIV and those with pre-diabetes.  While these findings are pretty significant on their own, it is sobering to consider that the familiar Obesity-Diabetes axis or BMI- HbA1c Axis has so much, what to say, “flexibility” in interpreting results of studies, such as the Diabetes Prevention Program or Look AHEAD. As many of these studies, (consider the SCOUT trial of sibutramine, see Sept 20, 2010 statement to the FDA), draw large conclusions from relatively small differences, the “flexibility” or error-room of mistakes by relying on BMI- HbA1c has serious implications for personal and public health.

 

USPSTF Seeks Comments Due Nov. 19

November 13th, 2014

The United States Preventive Services Task Force (USPSTF) is seeking public comments on its draft research plan for Screening for Obesity and Interventions for Weight Management in Children and Adolescents. The final research plan will guide a systematic review of the evidence by researchers at an Evidence-based Practice Centerwhich will form the basis of USPSTF Recommendations on this topic. Other USPSTF recommendations, such as on intensive behavioral counseling for adults with obesity, have been included in Medicare coverage and under provisions of the Affordable Care Act.

The proposed key questions to be reviewed are:

Do screening programs for obesity in children and adolescents reduce weight or age-associated weight gain, improve health outcomes during childhood, or reduce incidence of obesity in adulthood?

Does screening for obesity in children and adolescents have adverse effects?

Do weight management interventions (defined as behavioral counseling, pharmacotherapy and health-care system level approaches) for children and adolescents that are primary care feasible or referable from primary care health outcomes during childhood or reduce the incidence of obesity in adulthood?

Do weight management interventions for children and adolescents that are primary care feasible or referable from primary care reduce weight or age-associated weight gain?

Do weight management interventions for children and adolescents have adverse effects?

The draft also proposes four contextual questions:

What is the accuracy of age and sex specific body mass index percentile in identifying children and adolescents with high body fat compared with appropriate reference standards.

What is the likelihood that childhood obesity persists into adulthood?

Are improvements in child weight outcomes associated with reduced likelihood of adult obesity, If so, how much improvement is necessary?

Is the medication bupropion being used for weight management in children or adolescents? If so, is there evidence supporting is use in children and adolescents?

The comment period is open until November 19, 2014.

 

Fast Food Giants Target Obese-Prone Children

November 13th, 2014

The Washington Post Wonkblog carries an article on research from Arizona State University’s Punam Ohri-Vachaspati which found that fast-food chains are targeting children already at high risk for obesity, including African-Americans, poor and those in rural areas.