Something To Be Grateful For

November 25th, 2015 No comments »

Modern HealthCare magazine reports that Mississippi is planning to add bariatric surgery to its Medicaid program, citing research from the STOP Obesity Alliance.

Is CDC Massaging the Obesity Stats?

November 22nd, 2015 No comments »

The world was positively giddy this week following the release of a new CDC Obesity prevalence report. There was so much self-congratulation going on in the childhood obesity world I was afraid of an outbreak of carpal tunnel syndrome.

The headlines shouted that the childhood obesity numbers had stabilized and many groups claimed credit for the success. The CDC reported that, “the prevalence of obesity among U.S. youth was 17% in 2011-2014. Overall, the prevalence of obesity among preschool-aged children (2-5 years) (8.9%) was lower than among school-aged children (6-11 years) (17.5%) and adolescents (12-19) (20.5%).” The report goes on to state, “Between 2003-2004 and 2013-14, however, no change in prevalence was seen among youth.”

Hey, great news, no?  Well, the 17% figured was derived from averaging three groups: 2-5YOA, 6-11 YOA and 12-19 YOA. I question of including 2-5 year olds. The prevalence for this group is about half for the other age groups. And, frankly, they are toddlers. Their prevalence figure probably represents parental panic at the prospects of raising an overweight child. This panic may lead to restrained eating strategies which often fail as the child grows up. As soon as the child starts to exercise more control over their own feeding and behavior, the prevalence rate doubles. Doubles! Taking the 2-5 years old out of the equation, the youth prevalence rate is 19%, not 17%. , 19% is not leveling off. (Truth be told I did not attempt to re-calculate the historical figures without the 2-5 age group.) Keep in mind that CDC views obesity as a binary switch. You are either obese or not. They do not take into account the growth of body weights within the obesity category, i.e. class III or severe obesity growth.

Finally, the CDC does note, “The prevalence of obesity among U.S. adults remains higher than the Healthy People 2020 goal of 30.5%. Although the overall prevalence of childhood obesity is higher than the Healthy People 2020 goal of 14.5%, the prevalence of obesity among children aged 2-5 is below the goal of 9.4%.”

Before popping the champagne, advocates and the media should consider that we are moving further and further away from the targets of Healthy People 2020, not to mention Healthy People 2010. Therefore, it is reasonable to ask if self-congratulation based on failure is an appropriate response.

Study Affirms that Central Obesity has Higher Mortality Risk

November 21st, 2015 No comments »

A new article reaffirms earlier studies showing that in persons with a normal Body Mass Index (BMI) had the worst long-term survival compared to others with a similar BMI but no central obesity and twice the mortality risk of persons who were overweight or obese according to BMI.


Junk Food Gets Death Row Reprieve

November 6th, 2015 No comments »

A new study has given a reprieve for junk food as a cause of obesity. David Just and Brian Wansink at the Cornell University Food and Brand Laboratory found that the intake  of these foods (soda, candy, and fast food) are not related to Body Mass Index (BMI) in the average American adult.  Using NHANES data (which has its issues) they found that consumption of soda, candy and fast food is not linked to BMI for 95% of the population. The exception is for those who are underweight or who have Class III obesity (formerly morbid obesity). Dr. Just explained, “This means that diets and health campaigns aimed at reducing and preventing obesity may be off track if they hinge on demonizing specific food. If we want real change we need to look at the overall diet, and physical activity. Narrowly targeting junk foods is not just ineffective, it may be self-defeating as it distracts from the real underlying causes of obesity.

These findings are consistent with other recent studies. In a 2011 study, James Hill and colleagues found that changes in diet were consistent across normal, overweight and obesity groups. Energy intake increased in all groups. Likewise, in 2013, Yancy and colleagues found that, over 4 decades, trends in energy and macronutrients were similar across BMI classes.

A word of caution. These studies rely on BMI categories. Whether macronutrients or junk food have a greater deleterious effect on waist-hip ratio or increases in visceral adiposity remains to be determined.


Does Breastfeeding Increase Infant Weight?

October 31st, 2015 No comments »

According to a new article by Michael Goran and colleagues it depends on which components of breast milk, (sugary complex carbohydrates called human milk oligosaccharides (HMOs) are present. 25 mother-infant dyads were studied at one and six months of age. Goran is quoted in the Irish Times saying, “But typically we think of obesity risk kicking in after weaning, the timing of introduction to solid foods, early exposures to sugary beverages. Clearly there is something going on before weaning even in babies who are exclusively breast-fed.”

Two HMOs, LNFPII and DSLNT, were each associated with about an extra pound of fat mass at 6 months. Another, LNFPI,  seemed to be protective, linked to a pound less of fat at six months.


Does low improvement in life expectancy reflect obesity’s impact?

October 28th, 2015 No comments »

Do slowing improvements in life expectancy reflect the obesity epidemic? That is the question raised by a new study published in JAMA by researchers from the American Cancer Society. Analyzing mortality data from 1969 to 2013, the researchers found that the rate of decreases in the death rates for obesity-related diseases, e.g. heart disease, stroke and diabetes, may reflect the consequences of the rising rates of obesity. Alternative theories include a natural ceiling on life expectancy and medical  advances, such as statins, have taken effect on mortality rates.


CDC Spins Breastfeeding-Obesity Link

October 27th, 2015 No comments »

CDC is continuing to perpetuate the old canard that breastfeeding is protective against childhood obesity. In the recently released publication, Vital Signs: Improvements in Maternity Care Policies and Practices that Support Breastfeeding-United States, 2007-2013,  the CDC states “In addition, evidence suggests that breastfeeding is associated with a reduction in the risk for obesity and diabetes in children (3).”

The reference is a 2007 evidence report on CDC’s sister agency, the Agency for Healthcare Research and  Quality website. However, unlike several other citations, there is no link to the paper. Why? Perhaps because AHRQ identifies the paper as “Archived” and states, “It (the paper) was current when produced and now may be out of date.” Here’s the link:

Maybe out of date? No fooling! See here, here and here for updated research which CDC decided to overlook.


The Putative 104 Causes of Obesity Update

October 22nd, 2015 No comments »

What causes obesity? The question has profound implications for individuals and policy makers. So, it is natural to turn to research published in peer-reviewed journals to find the answer. So, we have updated the list of “putative” causes first published on February 28, 2013 and  updated on September 1, 2013. We have moved from 82 putative causes to 104.

The number of putative causes raises several questions. First, is there some problem with the research methodology that so many and diverse potential causes are identified? Second, are a number of named putative causes symptoms or manifestations of underlying, deeper causes? And what are those? Third, to what extent are identified putative causes reflections of local, regional, ethnic or cultural factors. Finally, many of these studies point out that the “energy-in-energy-out” formulation for the cause of obesity which most of the public and health professionals believe to be the cause.

New items on the list include too much homework, insufficient body heat, imagining the smell of food, components of dust, living with grandparents, thermogenic adipocytes, estrogens and starting college.

Here’s the most current list. If I am missing any, please let me know. (The links are not meant to be definitive or best study but merely a demonstration of the interest in the particular cause.)

1. agricultural policies

2. air conditioning,

3. air pollution,

4. antibiotic usage at early age,

5. arcea nut chewing,

6. artificial sweeteners,

7.  Asian tiger mosquitos,

8. assortative mating,

9. being a single mother,

10. birth by C-section,

11. built environment,

12. celebrity chefs,

13. chemical toxins, (endocrine disruptors)

14. child maltreatment,

15. compulsive buying,

16. competitive food sales in schools,

17. consuming skim milk in preschool children,

18. consumption of pastries and chocolate (in Burkina Faso),

19. decline in occupational physical activity,

20. delayed prenatal care,

21. delayed satiety,

22. depression

23. driving children to school

24. eating away from home

25. economic development (nutrition transition)

26. entering into a romantic relationship,

27. epigenetic factors,

28. eradication of Helicobacter pylori,

29. family conflict,

30. family divorce,

31. first-born in family,

32. food addiction,

33. food deserts,

34. food insecurity,

35. food marketing to  children,

36. food overproduction,

37. friends,

38. genetics,

39. gestational diabetes,

40. global food system,(international trade policies)

41. grilled foods,

42. gut microbioata,

43. having children, for women,

44.  heavy alcohol consumption,

45.  home labor saving devices,

46. hormones (insulin,glucagon,ghrelin),

47. hunger-response to food cues,

48. high fructose corn syrup,

49. interpersonal violence,

50. lack of family meals,

51. lack of nutritional education,

52. lack of self-control,

53. large portion sizes,

54.  living in crime-prone areas,

55. low educational levels for women,

56. low levels of physical activity,

57. low Vitamin D levels,

58.  low socioeconomic status,

59. market economy,

60. marrying in later life

61. maternal employment,

62. maternal obesity,

63. maternal over-nutrition during pregnancy,

64. maternal smoking,

65. meat consumption,

66. menopause,

67. mental disabilities,

68. no or short term breastfeeding,

69. non-parental childcare

70. outdoor advertising,

71. overeating,

72. participation in Supplemental Nutrition Assistance Program (formerly Food Stamp Program)

73. perceived weight discrimination,

74. perception of neighborhood safety,

75. physical disabilities,

76. prenatal  maternal exposure to natural disasters,

77. poor emotional coping

78. sleep deficits,

79. skipping breakfast,

80. snacking,

81. smoking cessation,

82. spanking children,

83. stair design

84. stress, artificial lighting, air conditioning,

85.  sugar-sweetened beverages,

86. taste for fat

87.  trans fats,

88. transportation by car,

89. television set in bedrooms

90. television viewing,

91. thyroid dysfunction

92. vending machines,

93. virus,

94. weight gain inducing drugs,

95. working long hours,

96. NEW too much homework,

97. NEW insufficient body heat,

98. NEW imagining the smell of food,

99. NEW dust components,

100. NEW living with grandparents in China,

101. NEW estrogens,

102. NEW thermogenic adipocytes,

103. NEW prenatal exposure to cigarette smoke,

104. NEW starting college.