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.

 

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because AHRQ identifies the paper as “Archived” and states, “It (the paper) was current when produced and now may be out of date.”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:  http://archive.ahrq.gov/clinic/tp/brfouttp.htm#Report.

Maybe out of date?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

 

Information on dosing of drugs for children with obesity not available

October 9th, 2015 No comments »

A new study has concluded that only 2 of 25 emergency care drugs for children contained dosing information on the FDA approved label for obese children and adults compared with 22 of 25 for normal weight children. Rowe and colleagues found no sufficient pharmacokinetic data in the literature for any of the emergency care drugs for children with obesity. Obesity is an important component of the appropriate dosing for drugs do to altered body composition and physiologic mechanisms. Another article by Kendrick and colleagues points out the uncertainties in prescribing information for children with obesity. Also, see this article by Oeser and colleagues on the same topic. Roux-en-Y gastric bypass surgery in adults can also affect the pharmacokinetics of drugs but the information, according to a paper by Srinivas, is mixed.

 

Swedish Children Most Mediterranean

June 20th, 2014 No comments »

You heard that right! Dr. Gianluca Tognon of the University of Gothenburg and colleagues have found that, across 8 countries, children who were highly adherent to the Mediterranean were less likely to be overweight or obese than those who were lease adherent. Data were based on surveys of parents.  Sweden and Italy ranked the highest while Cyprus was the lowest ranked country.

The irony is that the Eastern Mediterranean Region has one of the highest rates of overweight and obesity in the world, according to the World Health Organization.

 

Where is childhood obesity today?

November 8th, 2013 No comments »

To hear some folks talk these days, you would think the childhood obesity epidemic is just about over. At a conference this summer, the Robert Wood Johnson Foundation, the American Heart Association and others were celebrating Signs of Progress over childhood obesity. During the Q&A session, a family physician asked what is the broad goal of fighting childhood obesity? The panel appeared thrown by the question and finally rushed to conclude that reversing the childhood obesity epidemic was the goal. That sounds good, like Mom and apple pie. But it got me thinking what does it really mean?

This goal, expressed in similar ways by several public health authorities, is to see no further increases in the prevalence rate of childhood obesity (ages 2-12)  based on Body Mass Index (BMI). Lately, some have seen signs of success in the slowing or declines in such rates in some areas. But there are problems with this approach.

First, problems with the BMI itself are well recognized.  In particular, we should be concerned that children with high visceral adipose tissue who are very sedentary and consume a poor diet can still have a normal BMI.

Second, by looking at the average or mean BMI in a population, we run the risk of mixing two groups: those who are obesity-resistant and will never become obese and those who are obese and prone to obesity. Studies from outside the United States have shown this pattern.1 By combining the two populations, the average can appear to stabilize even though overweight/obese children continue gaining weight, and a good deal of weight at that.

Third, what does ‘reversing’ the trend mean? Are we going back to the 1995 level, 1985? 1975? 1965?  This graph shows the trend lines for US children and adolescents from 1963 to 2008. (Source: Sean Williams, Motley Fool)

The graph does not show the large differences within the age groups by gender, race, ethnicity and geography.

If we are successful at stabilizing or reducing the rates of obesity for children age 2-12 what about the rest of their lives? We know that major weight gain takes place during adolescence and early adulthood. A recent study found 98% of adolescent men and 92% of adolescent women were on upward sloping trajectories for weight gain by middle age. A lower BMI starting point may be good but it is no guarantee of maintaining a healthy weight. 2 While overweight children are more likely to become overweight/obese adults, most obese adults were not overweight as children.

If indeed rates of childhood obesity are shown to be stabilizing or reducing, what is responsible? Are formal childhood obesity prevention programs effective in achieving  long-term reductions or stability in body weight?  Michelle Obama believes her “Let’s Move” Campaign is responsible for improvements. 3 Likewise, the Robert Wood Johnson Foundation is celebrating its strategies as successful.  Unfortunately, the evidence is less clear. A Cochrane Review of prevention programs found a mean difference in favor of childhood obesity programs of a BMI of only -0.15 kg/m2. The review found significant heterogeneity in studies across all age groups and only 8 of the 91 studies reported adverse events, such as unhealthy eating practices.4

A comparative effectiveness research investigation by the Agency for Healthcare Research and Quality found moderate evidence about the effectiveness of school-based interventions for childhood obesity prevention. Physical activity and diet interventions in school settings with home components were effective but few if any studies went beyond one year. 5

What then are clinicians to do? The first step may be to respect the complexity of obesity, now recognized by the American Medical Association and others as a disease. This is not just a problem of willpower. Nor can simple suggestions of “Eat less, Exercise More” be expected to overcome the influence of one’s genetic background, home environment and the role (or dysfunction) of hunger and satiety hormones. Lifestyle changes are likely to be effective in only a subset of children with obesity. 6 Close monitoring and supportive environments are more likely to keep patients motivated to keep working on their weight issues and to be cognizant of the effects of excess weight on their health than critical or stereotyping comments. Greater research, training and education are the keys to resolving the obesity problem not only during childhood but throughout one’s lifetime.

Footnotes

  1. Razak F, Corsi, DJ, Subramanian SV, Change in the body mass index distribution for women: analysis from 37 low- and middle-income countries, PLoS Med 2013;10(1):e1001367, 2013 Jan . 15.  Sperrin M, Marshall AD, Higgins V, et al, Slowing down of adult body mass index trend increases in England: a latent class analysis of cross-sectional surveys (1992-2010) Int J Obes 2013 Sep 2.  Kautiainen S, Rimpela A, Vikat A, Virtanen SM, Secular trends in overweight and obesity among Finnish adolescents in 1977-1999. Int J Obes Relat Metab Disord 2002 Apr;26(4):544-52.

  2. Malhotra R, Ostbye T, Riley CM, Finkelstein EA, Young adult weight trajectories through midlife by body mass category Obesity 2013 Sep;21(9):1923-34.

  3. http://www.downeyobesityreport.com/2013/02/mission-accomplished-michelle-obama-style/, accessed Nov. 7, 2013.

  4. Waters E, de Silva-Sanigorski A, Hall BJ, et al, Interventions for preventing obesity in children Cochrane Database Syst Rev. 2011 Dec 7;(12):CD001871.

  5. Wang Y, Wu Y, Wilson RF, et al, Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis. Comparative Effectiveness Review No. 115. http://www.effectivehealthcare.ahrq.gov/ehc/products/330/1524/obesity-child-report-130610.pdf, accessed Nov. 7, 2013

  6. Reinehr T, Lifestyle intervention in childhood obesity: changes and challenges. Nat Rev Endocrinol 2013 Oct; 9(10)607-14.

 

US probes anti-psychotics in children

August 22nd, 2013 No comments »

US Probes overprescription of anti-psychotics to children in Medicaid Program, Wall St. Journal reports. Many anti-psychotics are known to cause weight gain. A study just out in JAMA Psychiatry found a three fold increase in type 2 diabetes in children and youth prescribed anti-psychotics.

 

Snacking is Bad. Right?

June 12th, 2013 No comments »

In this uncertain world, one thing we can be sure of is that adolescent snacking is contributing to the obesity epidemic. Right? Well, er, no. Actually, young snackers (you know who you are) are likely to be less obese.

According to a literature review from 2000 to 2011 by Nicole Larson  and Mary Story at the University of Minnesota, “Although snacks can contribute to intake of key nutrients, frequent snacking has been associated with higher intake of total energy and energy from added and total sugars. Assessments in schools and retail stores have further indicated that energy-dense, nutrient-poor snacks are widely available in settings where youth spend their time. The majority of studies either found no evidence of a relationship between snacking behavior and weight status or found evidence indicating that young people who consumed more snacks were less likely to be obese; however, additional research is needed to address various methodological limitations.”

Picture: Selena Gomez snacking. Source: teennowmagazine.uk

 

More faults found in FLOTUS Victory Claims

March 2nd, 2013 2 comments »

The Weekly Standard’s Jeryl Bier is reporting more faults in First Lady’s Michelle Obama’s claims of Let’s Move role in the supposed lowering of childhood obesity rates. The analysis looks at the Robert Wood Johnson Report which indicates that the improvements preceded the formation of Let’s Move. See more.