RESEARCH

Research

September 26th, 2009

Research is fundamental to understanding, preventing and treating obesity. And yet research reports are often not accepted by the public or policy-makers. One reason is that almost every adult is their own self-study of weight control. A study might have the most precise protocol, a powerful sample size and control for a variety of factors but if it does not comport with what “I” experience, I am not likely to believe it. But research itself in obesity is not without its difficulties. Many studies are ‘underpowered”, i.e. they have too few subjects to draw a conclusion from. That is why many preliminary studies do not pan out in larger tests. Also, in many cases, especially in drug trials, researchers try to remove “confounders” from the test subjects so they can see if there is an effect of the drug. That means that many patients who are sick, smoke, take other drugs, etc. are excluded from the trial. When the drug, for example, gets used by a more ‘real-world’ sample, the effects sometimes vanish. Studies that rely on self-reported weights or dietary recall or physical activity diaries are sometimes less reliable than studies where a more objective measurement is needed. Self-reported weight and height — Rowland 52 (6): 1125 — American Journal of Clinical Nutrition and COMPARISON OF SELF-REPORTED AND MEASURED HEIGHT AND WEIGHT — PALTA et al. 115 (2): 223 — American Journal of Epidemiology

There also may be a bias from the funding source (See Conflict of Interest in Medical Research, Education, and Practice – Institute of Medicine, Relationship between funding source and conclusion…[PLoS Med. 2007] – PubMed Result, Scope and impact of financial conflicts of interes…[JAMA. 2003 Jan 22-29] – PubMed Result) or a selection of participants which may skew the results one way or another. Currently, there is a lot of concern about ghost written scientific articles. Ghostwriting Widespread in Medical Journals, Study Says – NYTimes.com

What’s a reader to do? The first is to read skeptically. The second is to go to several different papers or research articles. If different authors appear to agree upon key points, chances are that they are on to something. Remember, extraordinary claims require extraordinary evidence. Research is a communications process among researchers and it should be thought of as a dialogue to which we can all listen.

Many readers may find useful this site, The Little Handbook of Statistical Practice. It is a handy guide to understanding some of the statistical issues involved…like association is not causation.

Research is key. If you are interested in furthering research, you should look into participating in a clinical research activity. To see what clinical trials are underway in obesity research, see www.ClinicalTrials.gov/Search of: Open Studies | “Obesity” – List Results – ClinicalTrials.gov

A major NIH initiative is support for Obesity and Nutrition Research Centers. In addition to the research they carry out, these centers are critical training facilities for new investigators exploring obesity. Most have their own websites which can provide additional, valuable information. Their sites may provide you with helpful information. Also included are their annual reports.

University of Alabama Nutrition & Obesity Research Center | Nutrition & Obesity Research Center Annual report at http://www2.niddk.nih.gov/NR/rdonlyres/E6AE7940-23AC-402E-BCAC-D4F11A9213B0/0/Alabama.pdf
University of Colorado at Denver and Health Science Center. No website. Annual report at http://www2.niddk.nih.gov/NR/rdonlyres/061BCC83-261E-4B39-95CC-226C97B03ED2/0/Colorado.pdf
Pennington Biomedical Research Center PBRC – Nutrition Obesity Research Center. Annual report at: http://www2.niddk.nih.gov/NR/rdonlyres/841B5FA5-7AC1-4DDB-AD3F-300B94468560/0/Pennington.pdf
University of Maryland, http://medschool.umaryland.edu/cnru/index.asp. Annual report at http://www2.niddk.nih.gov/NR/rdonlyres/BF6E7D31-948E-450A-AFF5-B863FF427B24/0/Maryland.pdf
Boston, MA Boston Obesity Nutrition Research Center Annual report at: http://www2.niddk.nih.gov/NR/rdonlyres/83F114DD-E707-4623-BA20-BCE02C33ADF6/0/Boston.pdf
Harvard,MA, no website. Annual report at: http://www2.niddk.nih.gov/NR/rdonlyres/9AFA2465-42C0-40CB-87DB-35813E80A978/0/Harvard.pdf
University of Minnesota. Minnesota Obesity Center | College of Food, Agricultural and Natural Resource Sciences | University of Minnesota Annual Report at http://www2.niddk.nih.gov/NR/rdonlyres/78A3842A-030C-45F7-856E-5C27BE202C15/0/Minnesota.pdf
Washington University, Missouri http://www2.niddk.nih.gov/NR/rdonlyres/BB5BBA2D-AA63-4B73-99D6-56741BB220B3/0/WashingtonUniversity.pdf
Columbia/Cornell, New York, NY http://www.nyorc.org/favicon.ico Annual Report at: http://www2.niddk.nih.gov/NR/rdonlyres/28E027FF-5212-4F15-960B-4E5C84FF952A/0/NewYork.pdf
University of North Carolina at Chapel Hill. No website. Annual report at: http://www2.niddk.nih.gov/NR/rdonlyres/8836D29C-0AF8-4C6A-914E-9D12828A1A82/0/NorthCarolina.pdf
University of Pittsburgh. No web site. Annual Report at: http://www2.niddk.nih.gov/NR/rdonlyres/C8B65B24-EE7A-495C-B441-05EAD3372283/0/Pittsburgh.pdf
University of Washington. http://depts.washington.edu/favicon.ico. Annual Report at: http://www2.niddk.nih.gov/NR/rdonlyres/739D3F88-98FE-4733-9D31-6BB81A1DA915/0/Washington.pdf

New Studies , updated October 16, 2009

Obesity driven GERD drives up health care visits Trends in Gastroesophageal Reflux Disease as Measu…[Dig Dis Sci. 2009] – PubMed Result

Psychiatrists survey on attitudes to obese patients Psychiatrists’ perceptions and practices in treati…[Acad Psychiatry. 2009 Sep-Oct] – PubMed Result

More evidence for role of FTO gene in obesity via loss of control and selecting diet high in fat The FTO gene rs9939609 obesity-risk allele and los…[Am J Clin Nutr. 2009] – PubMed Result

AHRQ summarizes evidence on breast-feeding, finds reduced risk of obesity, type 2 diabetes A Summary of the Agency for Healthcare Research an…[Breastfeed Med. 2009] – PubMed Result

Weight loss after bariatric surgery may be explained by changes in gut hormones controlling appetite. The Gut Hormone Response Following Roux-en-Y Gastr…[Obes Surg. 2009] – PubMed Result

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Posted in RESEARCH

Tags: AHRQ appetite Bariatric Surgery clinical trials Columbia University confounders drugs funding funding sources gut hormones Harvard University NIH Obesity Research RESEARCH smoking statistics statistics on obesity Type 2 diabetes University of Alabama University of Colorado University of Minnesota University of North Carolina Chapel Hill University of Pittsburch University of Washington Washington Univesity

Genetic Basis of Obesity

September 26th, 2009

Often one hears it stated that obesity is not a genetic disease. If by that the speaker is saying that obesity is probably not due to a single genetic change they are not quite right. There are some rare forms of obesity which are due to a single gene change. Genetic obesity syndromes. [Front Horm Res. 2008] – PubMed Result; Genetic and hereditary aspects of childhood obesit…[Best Pract Res Clin Endocrinol Metab. 2005] – PubMed Result But if they mean a single genetic change cannot account for a worldwide epidemic of obesity occurring over the last 30 years they are probably right. If the speaker means it is unlikely that there will be a treatment for obesity based on gene therapy, they are probably correct. (Although who can predict the future?) However, they miss the point if they do not understand that for millions of years of evolution, the species we call humans have favored genes which maximize its chances for survival and reproduction. So our taste preferences, our physical activity preferences and the like are passed on in the genome and our part of our inheritance. The problem is that for centuries we humans lived in an environment which was totally different than the one we live in now. The disconnect is that our bodies have not yet adapted to this new world where tasty, nutritious food is readily available and where most of us do not have to expend anything other than a minimal effort to obtain it, survive and flourish. Anything policy-makers or parents want to do about obesity must be understood in the context of the powerful force evolution has been in designing how humans acquire, store and use energy from food.

According the CDC:

Biological relatives tend to resemble each other in many ways, including body weight. Individuals with a family history of obesity may be predisposed to gain weight.
Different responses to the food environment are largely due to genetic variation between individuals.
Fat stores are regulated over long periods of time by complex systems that involve input and feedback from fat tissue, the brain and endocrine glands like the pancreas and the thyroid. http://www.cdc.gov/genomics/training/perspectives/files/obesknow.htm,
The tendencies to overeat and be sedentary, the diminished ability to use dietary fat as fuel and enlarged, easily stimulated capacity to store body fat are all genetically influenced. The variation in how individuals respond to the food rich environment and the differences in acquiring obesity related comorbid conditions are also genetically determined. http://www.cdc.gov/Features/Obesity/

Since 1997, published studies have found that variation in BMI is largely due to heritable genetic differences, with estimates ranging from 55% to 85%. A 2008 study found that 77% of the adiposity in preadolescent children born since the start of the obesity epidemic was due to genetic inheritance compared to 10% for the environment. Evidence for a strong genetic influence on childho…[Am J Clin Nutr. 2008] – PubMed Result

A fast rate of eating appears to be heritable. Eating rate is a heritable phenotype related to we…[Am J Clin Nutr. 2008] – PubMed Result Differences in responding to the obesogenic environment may also be heritable Genetic influence on appetite in children. [Int J Obes (Lond). 2008] – PubMed Result and Appetite is a Heritable Phenotype Associated with …[Ann Behav Med. 2009] – PubMed Result. The FTO gene may be involved. The FTO gene and measured food intake in children. [Int J Obes (Lond). 2009] – PubMed Result and Increasing heritability of BMI and stronger associ…[Obesity (Silver Spring). 2008] – PubMed Result Parental leanness appears to provide strong protection against the development of obesity in children. Development of overweight in children in relation …[Obesity (Silver Spring). 2009] – PubMed Result

There is an interesting scientific debate about what is called the “thrifty gene” hypothesis about how a genetic preference for storing extra energy on our bodies might have developed. Thrifty genes for obesity, an attractive but flawe…[Int J Obes (Lond). 2008] – PubMed Result and The clinical biochemistry of obesity. [Clin Biochem Rev. 2004] – PubMed Result. Some think that childhood obesity is increasing due to ‘associative mating’ by overweight parents who pass on their genetic disposition to obesity to their children. Childhood obesity: are genetic differences involve…[Am J Clin Nutr. 2009] – PubMed Result

The evidence for the genetic basis of obesity, in addition to environmental changes is quite strong. See Implications of gene-behavior interactions: preven…[Obesity (Silver Spring). 2008] – PubMed Result; Genome-wide association scan shows genetic variant…[PLoS Genet. 2007] – PubMed Result and The genetics of obesity. [Metabolism. 1995] – PubMed Result

The environment is thought to be responsible for variations between populations but genetics is responsible for the variations within a given population. Obesity – Missing Heritability and GWAS Utility and Genetic and environmental factors in relative body…[Behav Genet. 1997] – PubMed Result. Genetics may account for many cases of morbid obesityFamilial aggregation of morbid obesity. [Obes Res. 1993] – PubMed Result.

Genetics may play an important role in determining who can benefit from different types of intervention. Implications of gene-behavior interactions: preven…[Obesity (Silver Spring). 2008] – PubMed Result or who is more likely to be affected by obesity Ethnic variability in adiposity and cardiovascular…[Int J Epidemiol. 2009] – PubMed Result. Or experience a comorbid condition like Type 2 diabetes Mechanisms of disease: genetic insights into the e…[Nat Clin Pract Endocrinol Metab. 2008] – PubMed Result

The FTO gene is currently under active research interest for providing a link to how obesity related conditions might arise and how patients can benefit from this knowledge. FTO: the first gene contributing to common forms o…[Obes Rev. 2008] – PubMed Result Genome-wide association scan shows genetic variant…[PLoS Genet. 2007] – PubMed Result

The FTO gene may explain different responses to exercise. FTO Genotype Is Associated With Exercise Training-…[Obesity (Silver Spring). 2009] – PubMed Result .Physical activity and the association of common FT…[Arch Intern Med. 2008] – PubMed Result

A factor in the resistance to describe obesity as a genetic disease may be in the assumption that the human genome does not change rapidly whereas the increase globally in the rates of obesity have occurred in the last 40-50 years. However, evolutionary biologists are debating the speed of genetic change. In “Catching Fire, How Cooking Made us Human” (Basic Books, New York, 2009) Richard Wrangham, the Ruth Moore Professor of Biological Anthropology at Harvard University writes,

A long delay between the adoption of a major new diet and resulting changes in anatomy is also unlikely. Studies of Galapagos finches by Peter and Rosemary Grant showed that during a year when finches experiences an intense food shortage caused by an extended drought, the birds that were best able to eat large and hard seeds – those birds with the largest beaks- survived best. The selection pressure against small-beaked birds was so intense that only 15 percent of birds survived and the species as a whole developed measurably larger beaks within a year. Correlations in beak size between parents and offspring showed that the changes were inherited. Beak size fell again after the food supply returned to normal, but it took about fifteen years for the genetic changes the drought had imposed to reverse. The Grants’ finches show that anatomy can evolve very quickly in response to dietary changes…Other data show that if an ecological change is permanent, the species also changes permanently, and again the transition is fast…The adaptive changes brought on by the adoption of cooking would surely have been rapid. (p. 93-94, emphasis added.) (See Book Reviews)

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Posted in Genetic Basis of Obesity, RESEARCH

Tags: appetite Behavior BMI brain cooking eating rate endocrine organs Environment evolution fat tissue food environment FTO gene gene therapy and obesity genetics genome Obesity Research phenotype Physical Activity taste tendency to overeat thrifty gene

Inheritance Factors

September 26th, 2009

Genes are not the only way characteristics may be passed from generation to generation. Researchers are actively pursuing what is called epigenetics. Epigenetics refers to changes in appearance, or phenotype, which is not due to changes in the DNA, which regulates genes and their expression.

Intrauterine Environment

The intrauterine environment (the womb) has been shown to affect the child’s disposition to obesity. Fetal origins of obesity. [Obes Res. 2003] – PubMed Result and Programming of body composition by early growth an…[Proc Nutr Soc. 2007] – PubMed Result Maternal and child obesity: the causal link. [Obstet Gynecol Clin North Am. 2009] – PubMed Result Gestational weight gain may predispose offspring to obesity and high blood pressure Associations of gestational weight gain with offsp…[Circulation. 2009] – PubMed Result and Gestational weight gain and risk of overweight in …[Am J Clin Nutr. 2008] – PubMed Result

Multiple factors are probably at work leading to an increased risk of developing obesity. Developmental origins of childhood overweight: pot…[Obesity (Silver Spring). 2008] – PubMed Result and Early determinants of overweight at 4.5 years in a…[Int J Obes (Lond). 2006] – PubMed Result

The question is to what extent the genes or the intrauterine environment influence the progression to adult obesity. The influence of birthweight and intrauterine envi…[Int J Obes Relat Metab Disord. 2003] – PubMed Result

One way in which the fetus might be affected in his or her development is by enhanced nutrition in the womb

Intrauterine changes are thought by some to contribute to the increase in obesity in India. Obesity epidemic in India: intrauterine origins? [Proc Nutr Soc. 2004] – PubMed Result

Maternal weight gain during pregnancy may affect the baby’s birth weight and long term risks Gestational weight gain and child adiposity at age…[Am J Obstet Gynecol. 2007] – PubMed Result

Detrimental influences in the womb, such as smoking Maternal smoking during pregnancy and child overwe…[Int J Obes (Lond). 2008] – PubMed Result, Association of maternal lifestyles including smoki…[Obesity (Silver Spring). 2007] – PubMed Result, Associations of maternal prenatal smoking with chi…[Obes Res. 2005] – PubMed Result, and famine The Dutch Famine of 1944-1945: a pathophysiologica…[Curr Opin Clin Nutr Metab Care. 2006] – PubMed Result or harmful chemicals Developmental exposure to endocrine disruptors and…[Reprod Toxicol. 2007 Apr-May] – PubMed Result and Role of nutrition and environmental endocrine disr…[Mol Cell Endocrinol. 2009] – PubMed Result

An unique, new study found that maternal weight loss from bariatric surgery may improve cardiometabolic risks in infants which is sustained into adulthood.Effects of Maternal Surgical Weight Loss in Mother…[J Clin Endocrinol Metab. 2009] – PubMed Result

Early infancy

Weight status in the first 6 months of life and ob…[Pediatrics. 2009] – PubMed Result

Predictors of body size in infancy Predictors of body size in the first 2 y of life: …[Int J Obes Relat Metab Disord. 2004] – PubMed Result

Parental feeding styles

Children from obese parents were more likely to have a preference for fatty foods, lower liking for vegetables and a more overeating type eating style than children with lean parents as well as a greater preference for sedentary activities. Food and activity preferences in children of lean …[Int J Obes Relat Metab Disord. 2001] – PubMed Result The picture of the obese mother using food for non-nutritive purposes may be a myth but there obese mothers may exercise less control. Parental feeding style and the inter-generational …[Obes Res. 2002] – PubMed Result Infants of overweight/obese mothers have higher energy intake Relationship between maternal obesity and infant f…[Nutr J. 2005] – PubMed Result Infants born to overweight/obese mothers have lower resting metabolic rate, higher BMI Lower energy expenditures in infants from obese bi…[Nutr J. 2008] – PubMed Result

Breastfeeding

Breastfeeding has long been considered protective against the development of obesity Association between infant breastfeeding and overw…[JAMA. 2001] – PubMed Result

But not everyone is convinced.Critical review of the World Health Organization’s…[Obes Rev. 2008] – PubMed Result and Breastfeeding and the risk of childhood obesity. [Coll Antropol. 2007] – PubMed Result

How breastfeeding might be protective has not yet been determined. Mechanisms underlying the association between brea…[Int J Pediatr Obes. 2009] – PubMed Result

Overweight/obese mothers may be less likely to breastfeed their children than normal weight mothers. A systematic review of maternal obesity and breast…[BMC Pregnancy Childbirth. 2007] – PubMed Result

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Posted in Inheritance Factors, RESEARCH

Tags: breastfeeding chemicals Childhood Obesity DNA Dutch famine endocrine disruptors epigenetics feeding styles fetal origins of obesity fetus gestational weight gain India infancy feeding inheritance and obesity intrauterine environment maternal weight gain nutrition nutrition in the womb phenotype Prevention smoking

Brain and Gut

September 26th, 2009

Frequently, when persons with obesity are depicted in the media, they are headless forms (butts and guts I call the pictures) for we think of obesity in terms of body fat accumulation. But obesity really starts in the brain with multiple signals coming from the gut. Adipose tissue itself generates hormones such as leptin and adiponectin; the GI tract generates ghrelin which signals the brain to initiate feeding . Other products which may stimulate feeding or signal time to stop feeding include leptin, insulin neuropeptide Y among others. Parts of the brain involved are the hypothalamus, the dorsal vagal complex and the reward system.

Researchers now appreciate that food acquisition, preparation, and intake are the result of a several physical signals by which the body communicates to the brain that it is hungry and needs to start feeding or full and needs to stop. MD

Brain

So, just how does the body regulate its weight? The body needs to get its weight just right. Too little nourishment and the body becomes ill and cannot reproduce. Too much also a problem. Look at the precision needed. If one ate the recommended 2,200 calories per day (and a lot eat a lot more) they would consumer 792,000 calories in a year. If they are just 1% more calories, they would add 2 pounds per year or 20 pounds over a decade of life. That’s just an extra 22 calories a day – about half a lower fat Oreo cookie. 100 extra calories a day – about 2/3 of 1 ounce of potato chips – can result in a 5-pound weight gain a year. To keep within these narrow boundaries of health body weight, our bodies have evolved a sophisticated, redundant system to gauge its body weight and when to feed and when to stop feeding.

The four parts of this system are (1) the nervous system which connects the brain, gut and adipose tissue, (2) hormones, including those made by fat cells, (3) neuropeptides which act as messengers and (4) messenger molecules in the immune system called cytokines. These molecules control body weight. The pancreas and adipose tissue make leptin, insulin, adiponectin, visfatin and resistin. The brain makes NPY, melanocortin and cocaine and amphetamine regulated transcript called CART. The stomach makes ghrelin, PYY and CCK.

The process can begin before you eat. Even the sight, smell or thought of food can trigger the “cephalic response.” This can start the production of insulin. Ghrelin increases the desire to eat. PYY can signal an end to feeding. Under stress, the sympathetic nervous system is activiated. This promotes storage of fat, decreases metabolism and promotes insulin resistance. Weight increases and metabolism slows down when this system is activated. The key hormone is insulin which is produced in the pancreas. It is designed to use carbohydrates or store them for later use.

The signals to the brain come from both the central nervous system and the peripheral nervous system Central and peripheral regulation of food intake a…[Obesity (Silver Spring). 2008] – PubMed Result

They appear to converge in the hypothalamus region of the brain.Hypothalamic control of energy balance. [Curr Drug Targets. 2004] – PubMed Result

No fewer than ten possible automatic and largely uncontrollable responses to the modern food environment have been proposed to understand why people can consume more calories than they need without their full awareness or control over their behavior Neurophysiological pathways to obesity: below awar…[Diabetes. 2008] – PubMed Result

Obese individuals appear to respond differently to food visual cues Obese adults have visual attention bias for food c…[Int J Obes (Lond). 2009] – PubMed Result

Obese and overweight persons appear to have lower brain volume Brain structure and obesity. [Hum Brain Mapp. 2009] – PubMed Result

Gut Hormones

Leptin has been identified as one of the most powerful hormones involved in appetite regulation. Appetite control and energy balance regulation in …[Int J Obes (Lond). 2009] – PubMed Result Now, newer techniques like brain imaging can be used to understand the role the brain and central nervous system play in eating behaviours.Leptin regulates striatal regions and human eating…[Science. 2007] – PubMed Result and Neuroimaging and obesity: mapping the brain respon…[Ann N Y Acad Sci. 2002] – PubMed Result

Another class of signaling substances are neuropeptides. Orexin is one of several currently of interest to scientists. Orexin/Hypocretin: a neuropeptide at the interface…[Pharmacol Rev. 2009] – PubMed Result and Orexin neuronal circuitry: role in the regulation …[Front Neuroendocrinol. 2008] – PubMed Result

Chronic stress and obesity: a new view of “comfort…[Proc Natl Acad Sci U S A. 2003] – PubMed Result

Maternal corticotropin-releasing hormone levels du…[Obesity (Silver Spring). 2006] – PubMed Result

The role of gut hormones in the regulation of body…[Mol Cell Endocrinol. 2009] – PubMed Result

Gut hormones: a weight off your mind. [J Neuroendocrinol. 2008] – PubMed Result

Gut hormones and appetite control. [Gastroenterology. 2007] – PubMed Result

Cord blood leptin and adiponectin as predictors of…[Pediatrics. 2009] – PubMed Result

The leptin/adiponectin ratio in mid-infancy correl…[J Pediatr Endocrinol Metab. 2008] – PubMed Result

As research progresses, new theories of evolutionary development are looking at Build-ups in the supply chain of the brain: on the…[Front Neuroenergetics. 2009] – PubMed Result

Ghrelin is a gut hormone which appears to be very significant and is the subject of much research.Lean Mean Fat Reducing “Ghrelin” Machine: Hypothal…[Neuropharmacology. 2009] – PubMed Result

Appetite

Viewing photographs of fattening foods, compared to non-food objects can result in greater activiation in parts of the brain. Activation in brain energy regulation and reward c…[Int J Obes (Lond). 2009] – PubMed Result In one study, obese women had greater brain activity in response to pictures of high fat foods than did non-obese women. Widespread reward-system activation in obese women…[Neuroimage. 2008] – PubMed Result and Effective connectivity of a reward network in obes…[Brain Res Bull. 2009] – PubMed Result

Gut peptides and the regulation of appetite. [Obes Rev. 2006] – PubMed Result

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Posted in Behavior, Brain and Gut, Is Obesity A Disease?, MANAGING OBESITY, RESEARCH

Tags: adiponection CI tract adipose tissue appetite brain brain structure calories cephalic response food environment food visual cues ghrelin gut gut hormones healthy body weight hungry hypothalmus insulin leptin nervous system neurogenetics Neuropeptiedes orexin reward stress visual cues and food

Behavior

September 26th, 2009

Understanding the gene-environment-behavior connections Implications of gene-behavior interactions: preven…[Obesity (Silver Spring). 2008] – PubMed Result

Some see eating as an automatic behavior over which individuals have less control than they think Eating as an automatic behavior. [Prev Chronic Dis. 2008] – PubMed Result

While controversial, the view of eating or hunger as an addiction has many interesting parallels with studies of addictive behavior The neurobiology of appetite: hunger as addiction. [Int J Obes (Lond). 2009] – PubMed Result

It is generally accepted that humans have a genetic predisposition to obesity which is fueled by our modern environments. However, not everyone is becoming obese. Why? Individual differences in the neurophysiology of r…[Int J Obes (Lond). 2009] – PubMed Result Obese-resistant individuals may sense changes in their energy intake more quickly than persons who are obese. The effects of overfeeding and propensity to weigh…[Physiol Behav. 2009] – PubMed Result

Obese individuals may have evolved weak mechanism which favor overeating. Control of food intake in the obese. [Obes Res. 2001] – PubMed Result High concern over food intake may, paradoxically, lead to higher intake Determinants of food choice: relationships with ob…[Obes Res. 2001] – PubMed Result

Stringent parental controls may also disrupt a child’s development of internal cues for controlling eating. Development of eating behaviors among children and…[Pediatrics. 1998] – PubMed Result

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Posted in Behavior, RESEARCH

Tags: addiction Behavior control Environment food choice gene-behavior connection genes hunger as addiction overeating parental control

Environment

September 26th, 2009

The modern built environment may send cues to individuals for eating. Obesity and the built environment: changes in envi…[Int J Obes (Lond). 2008] – PubMed Result

The local number of fast food outlets is associated with higher BMI, as is car ownership. Body mass index, neighborhood fast food and restau…[J Urban Health. 2009] – PubMed Result

Better access to supermarkets and less access to convenience stores are associated with higher BMI levels. Neighborhood environments: disparities in access t…[Am J Prev Med. 2009] – PubMed Result

Research Activities, April 2009: Child/Adolescent Health: Boosting and preserving green spaces in urban neighborhoods may help reduce childhood obesity

Local food environments, obesity and diabetes: http://www.healthpolicy.ucla.edu/pubs/files/Designed_for_Disease_050108.pdf

Journal of Public Health Policy – New Recreational Facilities for the Young and the Old in Los Angeles: Policy and Programming Implications

Journal of Public Health Policy – Disparities in Urban Neighborhood Conditions: Evidence from GIS Measures and Field Observation in New York City

Journal of Public Health Policy – The Relation of the Perceived Environment to Fear, Physical Activity, and Health in Public Housing Developments: Evidence from Chicago

Free full articles on the built environment: Journal of Health Politics, Policy and Law — Table of Contents (June 2008, 33 [3])

Neighborhood safety, collective efficacy, and obes…[Obesity (Silver Spring). 2006] – PubMed Result

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Posted in Environment, RESEARCH

Tags: access to supermarkets adolescents built environment convenience foods fast food fast-food outlets food environments green spaces Los Angeles CA neighborhood safety neighborhoods Physical Activity

Is Obesity a Disease?

September 26th, 2009

It is a sign of our confusion about obesity that the issue of whether obesity is a disease or not is hotly debated. I have written extensively that it is a disease and helped persuade some federal agencies that it should be described as a disease. I think the reason to consider obesity is a disease is straightforward – take any definition of ‘disease’ and see if it fits. Usually, three things are necessary – an interruption, cessation or alteration in the body having characteristic signs or symptoms resulting from known or unknown causes resulting in a deviation from normal structure or function. Resistance to talking about obesity as a disease seems to rely on an assumption that excess weight is a matter of choice and easily resolved. Therefore, if it is something under a person’s control, it cannot be a disease. When asked whether this means that skin cancer, which is preventable by taking protective measures should not be considered a disease or whether HIV/AIDs which is also highly preventable should not be considered a disease, the response is usually some mumbling response, “Well, that’s different.” Fortunately, it appears that many people in society are coming to regard obesity as a disease which hopefully means a better approach to both the health effects and stigmatization. MD

Results of Expert Meetings: Obesity and Cardiovasc…[Am Heart J. 2001] – PubMed Result

Medicare Changes Policy on Obesity (washingtonpost.com)

The Campaign To Make Obesity A ‘Disease’

Asking if Obesity Is a Disease or Just a Symptom – New York Times

USATODAY.com – Designate obesity as disease

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Posted in Is Obesity A Disease?, RESEARCH

Tags: disease disease deminiton federal agencies HIV/Aids

Obesity A-Z

September 26th, 2009

There are numerous issues involved in understanding, preventing and treating obesity. Specific diseases are treated in the Health Effects section. Below are a number of other issues. The citations are not meant to be exhaustive but merely to help the reader begin the search for various sources of information. MD

Adherence

Adherence can also be called willpower or compliance. It refers to individual behavior continuing a program of recommended advice, from following a diet to taking medications. Adherence or compliance is a major issue in health care.

http://obssr.od.nih.gov/pdf/Workshop_final_report.pdf

In spite of many efforts to improve Americans life style, the percentage of Americans following all five recommendations has dropped to an all time low – just 8% Adherence to healthy lifestyle habits in US adults…[Am J Med. 2009] – PubMed Result

For more information, see NIH Office of Behavioral and Social Sciences Research (OBSSR) – Adherence

Adiponectin

Higher adiponectin levels associated with lower risk of type 2 diabetes Adiponectin levels and risk of type 2 diabetes: a …[JAMA. 2009] – PubMed Result

Adipose Tissue

Obesity is about excess adipose tissue. However, adipose tissue is essential for survival and reproduction of the species. In excess amounts, it can, of course cause poor health and early mortality. Researchers have made great strides in understanding this tissue.

The perfect storm: obesity, adipocyte dysfunction,…[Clin Chem. 2008] – PubMed Result

Impact of increased adipose tissue mass on inflamm…[Curr Diab Rep. 2009] – PubMed Result

The role of adipose tissue dysfunction in the path…[Physiol Behav. 2008] – PubMed Result

Fat storage and the biology of energy expenditure. [Transl Res. 2009] – PubMed Result

Adiposity Rebound

Adiposity or fatness increases in the first of year of life and then decreases. About age 6, fatness increases again. This is called adiposity rebound and it is considered to be a critical time when the conditions for adult obesity can become established.

Early adiposity rebound: review of papers linking …[Curr Opin Clin Nutr Metab Care. 2005] – PubMed Result

Adolescence

Food companies targeting adolescence in the digital age Interactive food and beverage marketing: targeting…[J Adolesc Health. 2009] – PubMed Result

Maternal gestational weight gain and offspring wei…[Obstet Gynecol. 2008] – PubMed Result

Adolescent pregnancy and subsequent obesity in Afr…[J Adolesc Health. 1994] – PubMed Result

Changes in physiology with increasing fat mass. [Semin Pediatr Surg. 2009] – PubMed Result

Drugs shown to have efficacy, safety for adolescents Efficacy of weight loss drugs on obesity and cardi…[Obes Rev. 2009] – PubMed Result

No difference between obese and non-obese adolescent food consumption Comparison of high-calorie, low-nutrient-dense foo…[Obes Res. 1999] – PubMed Result

Problem eating behaviors Problem eating behaviors related to social factors…[Int J Behav Nutr Phys Act. 2007] – PubMed Result

Changes in adolescent beverage consumption Five-year longitudinal and secular shifts in adole…[J Am Diet Assoc. 2009] – PubMed Result

And in physical activity Longitudinal and secular trends in physical activi…[Pediatrics. 2006] – PubMed Result

International Journal of Obesity – Clinical research in adolescents: challenges and opportunities using obesity as a model

Comorbidities of overweight/obesity experienced in…[Arch Dis Child. 2009] – PubMed Result

Longitudinal and secular trends in weight-related …[Obesity (Silver Spring). 2008] – PubMed Result

Overweight, obesity, and health-related quality of…[Pediatrics. 2005] – PubMed Result

Depression in adolescents A prospective study of the role of depression in t…[Pediatrics. 2002] – PubMed Result

Agricultural subsidies

No effect on obesity, from USDA http://www.agecon.ucdavis.edu/extension/update/articles/v11n2_1.pdf

EconPapers: Farm subsidies and obesity in the United States: National evidence and international comparisons

Are rising obesity rates linked to U.S. farm aid? | McClatchy

Farm Subsidies Over Time

ScienceDirect – Food Policy : Farm subsidies and obesity in the United States: National evidence and international comparisons

Alcohol Calorie Calculator

http://www.collegedrinkingprevention.gov/CollegeStudents/calculator/alcoholcalc.aspx

Basal Metabolic Rate

The basal metabolic rate (closely related to the resting metabolic rate) is the amount of calories our bodies need to just maintain their normal functions, like metabolism, breathing, blood flow, etc. It is the baseline for determining one’s caloric input.

Basal Metabolism Rate Calculator (note: BMR calculators can have a high degree of variation : BMR Calculator

Breakfast

Is consumption of breakfast associated with body m…[J Am Diet Assoc. 2005] – PubMed Result

Breast-feeding

Mothers more likely to cease breastfeeding The association of maternal overweight and obesity…[J Pediatr. 2006] – PubMed Result

Overweight obese mothers less likely to breastfeed. A systematic review of maternal obesity and breast…[BMC Pregnancy Childbirth. 2007] – PubMed Result

Breastfeeding in infancy and adult cardiovascular …[Am J Med. 2009] – PubMed Result

Australian study shows mothers with obesity more likely to cease breastfeeding Maternal obesity and initiation and duration of br…[Matern Child Nutr. 2008] – PubMed Result

Exclusive breastfeeding of Swedish children and it…[BMC Pediatr. 2008] – PubMed Result

Calculators

Calories Burned UMMS: Calories Burned Calculator

Canada

See Canadian Obesity Network – Obesity Canada

Quality of life of patients with obesity The health status of obese individuals in Canada. [Int J Obes Relat Metab Disord. 2001] – PubMed Result

Prevalence of obesity in Canada. [Obes Rev. 2005] – PubMed Result

BMI and Mortality: Results From a National Longitu…[Obesity (Silver Spring). 2009] – PubMed Result

Child Abuse

Childhood maltreatment in extremely obese male and…[Obes Res. 2005] – PubMed Result

Relation of childhood sexual abuse and other forms…[Obes Surg. 2006] – PubMed Result

Childhood sexual abuse and obesity. [Obes Rev. 2004] – PubMed Result

Child abuse is associated with both obesity and depression in middle age women

Associations of child sexual and physical abuse wi…[Child Abuse Negl. 2008] – PubMed Result

Obesity risk for female victims of childhood sexua…[Pediatrics. 2007] – PubMed Result

Obesity and type 2 diabetes risk in midadult life:…[Pediatrics. 2008] – PubMed Result

Common Sense

‘Common sense’ when used to describe some obesity intervention usually is short for “there’s no data to support this.” Usually within 18 to 24 months there is study showing the ‘common sense’ recommendation didn’t work.

Cuba

Cuba presents an interesting case study. With the fall of the Soviet Union, Cuba, faced with reduction of subsidies from their former patron, went into an economic crisis, known as the “Special Period.” As a result, calories consumed per day dropped, physical activity increased and there was a modest 1.5 unit shift in BMI with reductions in obesity prevalence and increases in overweight and normal weight. Deaths attributed to diabetes, coronary heart disease, stroke and all causes declined as well, suggesting population wide measures might reduce disease and increase mortality. Obesity reduction and its possible consequences: w…[CMAJ. 2008] – PubMed Result and Impact of energy intake, physical activity, and po…[Am J Epidemiol. 2007] – PubMed Result (While the Cuban experience is an extremely interesting situation, the question must be asked whether a democratic government not in extreme economic peril could impose such a draconian situation on its people. MD)

Disparities

While rates of obesity are increasing in all demographic categories, large difference between groups are very evident, leading researchers to ask why different groups in the same environment should have such divergent outcomes.

Obesity, Gynecological Factors, and Abnormal Mammo…[J Womens Health (Larchmt). 2009] – PubMed Result

State of disparities in cardiovascular health in t…[Circulation. 2005] – PubMed Result

Disparities in preventive care by body mass index …[Women Health. 2008] – PubMed Result

The obesity epidemic in the United States–gender,…[Epidemiol Rev. 2007] – PubMed Result

Racial divergence in adiposity during adolescence:…[Pediatrics. 2001] – PubMed Result

Gender-ethnic disparity in BMI and waist circumfer…[Obesity (Silver Spring). 2009] – PubMed Result

Women Obesity in black women. [Epidemiol Rev. 1987] – PubMed Result

Eating Behavior

The psychology of food craving. [Proc Nutr Soc. 2007] – PubMed Result

RAND | RAND Health | Eating as an Automatic Behavior

Food cravings and energy regulation: the character…[Int J Obes (Lond). 2007] – PubMed Result

Eating Disorders

[Night eating syndrome and nocturnal eating--what ...[Psychother Psychosom Med Psychol. 2009] – PubMed Result

Teasing history, onset of obesity, current eating …[Obes Res. 2000] – PubMed Result

Childhood psychological, physical, and sexual malt…[Obes Res. 2001] – PubMed Result

Eating disorders and obesity: two sides of the sam…[Epidemiol Psichiatr Soc. 2009 Apr-Jun] – PubMed Result

http://www.womenshealth.gov/BodyImage/bodyworks/CompanionPiece.pdf

Does talking about weight lead to eating disorders? A Parent’s Innocent Word Can Trigger a Dangerous Eating Disorder – washingtonpost.com

Role of parents: Risk Factors for Full- and Partial-Syndrome Early …[J Am Acad Child Adolesc Psychiatry. 2009] – PubMed Result

Elderly

Obesity: What is an elderly population growing int…[Maturitas. 2009] – PubMed Result

Elderly risk for obese men Overweight and obesity and the burden of disease a…[Int J Obes Relat Metab Disord. 2004] – PubMed Result

Applicability of Federal Guidelines An evidence-based assessment of federal guidelines…[Arch Intern Med. 2001] – PubMed Result

Fat or Fit Debate

Relationship between low cardiorespiratory fitness…[JAMA. 1999] – PubMed Result

Fitness and abdominal obesity are independently as…[J Intern Med. 2009] – PubMed Result

Food

The obesity-by-choice debate. Effect of nutrient composition Obesity by choice revisited: effects of food avail…[Physiol Behav. 2007] – PubMed Result

Biology trumps knowledge in model of food choices Is Dietary Knowledge Enough? Hunger, Stress, and Other Roadblocks to Healthy Eating

USDA Food Plans: Cost of Food Cost of Food at Home

Eating and Health Module (ATUS)

Food and Beverage Marketing

See Institute of Medicine Report, Food Marketing and the Diets of Children and Youth – Institute of Medicine

CDC Congressional Testimony CDC Washington Testimony September 23, 2008

Use of branded web sites Food and beverage brands that market to children a…[J Nutr Educ Behav. 2009 Sep-Oct] – PubMed Result

Use of cartoon and other characters Marketing foods to children and adolescents: licen…[Public Health Nutr. 2009] – PubMed Result

The ‘Sydney Principles’ for reducing the commercia…[Public Health Nutr. 2008] – PubMed Result

Glycemic Index

Low glycaemic index or low glycaemic load diets fo…[Cochrane Database Syst Rev. 2007] – PubMed Result

Hunger

Hunger as powerful, primordial emotion The role of primordial emotions in the evolutionar…[Conscious Cogn. 2009] – PubMed Result

Ireland

Prevalence of overweight and obesity on the island…[BMC Public Health. 2007] – PubMed Result

Intensive Care

Effect of obesity on intensive care morbidity and …[Crit Care Med. 2008] – PubMed Result

Menu Labeling

Menu Labeling in Food Chains http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf

Microorganisms

Fat Factors – New York Times

Obesity – Extending the Hygiene Hypothesis. [Nestle Nutr Workshop Ser Pediatr Program. 2009] – PubMed Result

Interplay between obesity and associated metabolic…[Curr Opin Pharmacol. 2009] – PubMed Result

Gut microbiota and its possible relationship with …[Mayo Clin Proc. 2008] – PubMed Result

Military

Military family physician attitudes toward treatin…[Mil Med. 2008] – PubMed Result

Attitudes and practices of military family physici…[Mil Med. 2001] – PubMed Result

Mortality

For many years, the issue of whether obesity causes an increase in premature deaths has been hotly debated. The public frequently receives conflicting information on the topic. Is it ok to be overweight? Are only persons with severe obesity at risk? In the final analysis, I think the American Heart Association’s Scientific Consensus gets it right…at some point (the curve of body weight) the heavier have higher rates of premature deaths. At what exact point on the BMI scale that takes place is open to discussion, but the curve always goes up. MD)

See Mortality, health outcomes, and body mass index in…[Circulation. 2009] – PubMed Result

An August 2009 study shows obesity is responsible for about 95 million Years-of-Life-Lost. White femals account for more than 2/3 of that amount. Without changes in the obesity prevalence, the life expectancy of US adults may decrease. Individual and Aggregate Years-of-life-lost Associ…[Obesity (Silver Spring). 2009] – PubMed Result

New: Study estimates overweight/obesity and physical inactivity each responsible for 1 in 10 deaths in the US.The preventable causes of death in the United Stat…[PLoS Med. 2009] – PubMed Result

Will the rise in obesity affect future mortality rates? Trends in Health Behaviors and Health Outcomes

The preventable causes of death in the United Stat…[PLoS Med. 2009] – PubMed Result

Optimal Body Weight for the Prevention of Coronary…[Obesity (Silver Spring). 2009] – PubMed Result

Will the rise in obesity affect future mortality rates? Trends in Health Behaviors and Health Outcomes

Does intentional weight loss increase longevity? Long-term weight loss effects on all cause mortali…[Obes Rev. 2007] – PubMed Result

Obesity and Mortality after Stroke The Impact of Body Mass Index on Mortality After S…[Stroke. 2009] – PubMed Result

Preventable causes of death The preventable causes of death in the United Stat…[PLoS Med. 2009] – PubMed Result

Effect of physical inactivity Effects of physical inactivity and obesity on morb…[Med Sci Sports Exerc. 1999] – PubMed Result

Obesity, Mortality and Nursing Home Residents Obesity and mortality in elderly nursing home resi…[J Gerontol A Biol Sci Med Sci. 2005] – PubMed Result

Morbid obesity is an independent determinant of de…[Crit Care Med. 2006] – PubMed Result

The body mass index paradox and an obesity, inflam…[Semin Dial. 2004 May-Jun] – PubMed Result

Overweight, obesity, and mortality from cancer in …[N Engl J Med. 2003] – PubMed Result

Nursing Homes

Elderly in nursing homes Obesity in nursing homes: an escalating problem. [J Am Geriatr Soc. 2005] – PubMed Result

Oral Bacteria

Is obesity caused by an oral bacteria? Is obesity an oral bacterial disease? [J Dent Res. 2009] – PubMed Result

Pets

The young and old, rich and poor, black and white are becoming more obese. Is it any wonder that our pets would also see increases in their weight? As a matter of fact, veterinarians are very concerned about obesity in pets and have even formed a society to address the problem. See Pet Obesity Facts and Risks

Overweight in dogs, but not in cats, is related to…[Public Health Nutr. 2009] – PubMed Result

Portion Size/Control

The contribution of expanding portion sizes to the…[Am J Public Health. 2002] – PubMed Result

The influence of food portion size and energy dens…[Am J Clin Nutr. 2005] – PubMed Result

Energy density and portion size: their independent…[Physiol Behav. 2004] – PubMed Result

Public Health

Prevalence of selected risk behaviors and chronic …[MMWR Surveill Summ. 2008] – PubMed Result

Reimbursement

Should medicare reimburse providers for weight los…[Am Psychol. 2007] – PubMed Result

http://www.obesityaction.org/advocacytools/insurance/OAC%20Insurance%20Piece.pdf

Social Networks

In the past couple of years, researchers have been exploring new theories for the rapid spread of obesity. One of these areas is social networks of individuals, i.e. their close friends and relatives.

One of the earlier studies can be found here The spread of obesity in a large social network ov…[N Engl J Med. 2007] – PubMed Result but also see Adolescent obesity and social networks. [Prev Chronic Dis. 2009] – PubMed Result

Weight loss may positively impact spouses Weight loss treatment influences untreated spouses…[Int J Obes (Lond). 2008] – PubMed Result

Stress

Shaping the stress response: interplay of palatabl…[Mol Cell Endocrinol. 2009] – PubMed Result

Chronic stress and comfort foods: self-medication …[Brain Behav Immun. 2005] – PubMed Result

Role of stress and weight gain Stress and obesity: the role of the hypothalamic-p…[Curr Opin Endocrinol Diabetes Obes. 2009] – PubMed Result

Sugar sweetened Beverages

Sugar-sweetened soft drinks and obesity: a systema…[Nutr Res Rev. 2008] – PubMed Result

Soft drinks and weight gain: how strong is the lin…[Medscape J Med. 2008] – PubMed Result

Intake of sugar-sweetened beverages and weight gai…[Am J Clin Nutr. 2006] – PubMed Result

Soft drinks and weight gain: how strong is the lin…[Medscape J Med. 2008] – PubMed Result

Sugary soda consumption and albuminuria: results f…[PLoS One. 2008] – PubMed Result