Complexity Of Obesity Research Articles

Development of the International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) Grade-Based Guidelines on the Surgical Treatment of Obesity Using Multimodal Strategies: Design and Methodological Aspects.

Background: The prevalence of obesity is already a worldwide health concern. The development of straightforward guidelines regarding the whole available armamentarium (i.e., medical, endoscopic, and surgical interventions in conjunction with a guidance program) is paramount to offering the best multimodal approach to patients with obesity. Methods: The International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) identified a panel of experts to develop the present guidelines. The panel formulated a series of clinical questions (based on the patient, intervention, comparison, and outcome conceptual framework), which have been voted on and approved. A GRADE methodology will be applied to assess the quality of evidence and formulate recommendations employed to minimize selection and information biases. This approach aims to enhance the reliability and validity of recommendations, promoting greater adherence to the best available evidence. Results: These guidelines are intended for adult patients with a body mass index (BMI) ≥ 30 kg/m2 who are candidates for metabolic bariatric surgery (MBS). The expert panel responsible for developing these guidelines comprised 25 panelists (92% were bariatric surgeons) and 3 evidence reviewers, with an average age of 50.1 ± 10.2 years. The panel focused on 3 key questions regarding the combined use of structured lifestyle interventions, approved obesity management medications, and endoscopic weight loss procedures with MBS. Conclusions: The complexity of obesity as a chronic disease requires a comprehensive knowledge of all the available and feasible therapeutic options. The IFSO-EC society felt the urgent need to develop methodologically valid guidelines to give a full picture and awareness of the possible surgical and non-surgical therapeutic strategies employed with a multimodal approach.

Comprehensive care for childhood obesity in Brazilian municipalities.

To understand the potential and limits of care for childhood obesity from the perspective of comprehensiveness, in the context of Primary Health Care, in Brazilian municipalities. A qualitative approach was adopted, with an electronic form of a dissertative nature being applied in 11 municipalities in the five Brazilian regions, derived from the four axes of comprehensiveness defined by Ayres (needs, purposes, articulations, and interactions). Among the strengths for comprehensive care, the following were observed: the provision of services at different levels of care; the relevance of intersectoral programs in the development of actions aimed at the multidimensionality of childhood obesity; the implementation of strategies for systematizing care and tools that encourage the expansion of dialogue and humanization; and intersectoral coordination to create appropriate responses to the expanded needs of children and their families. Limitations include: the centralization of actions in nutrition professionals and in the care sphere; the failure to prioritize childhood obesity in health agendas; and the lack of trained professionals to deal with the complexity of obesity. The findings suggest that child obesity care practices, in order to be transformative, need to be understood in the context of comprehensiveness. And this includes (re)thinking public policies, professional practices, and the organization of work processes so that they are, in fact, more inclusive, participatory, dialogical, humanized, supportive, fair, and, therefore, effective.

Contrasting obesity: is something missing here?

The fight against obesity is largely based on recommendations about lifestyle and therapies to initiate weight loss and, hopefully, to achieve and maintain an ideal weight. The failure of this approach is witnessed by the steady increasing rates of obesity worldwide. Lifestyle modifications yield mild weight loss with poor results in the long-term. The pharmaceutical industry is engaged to produce the best anti-obesity drugs, and this market is projected to grow massively. Guidelines on pharmacological and surgical approach to obesity are continuously developed, taking into account that benefits are counterbalanced by high costs, are limited to the period of drug intake, and potential adverse effects are possible, such as pancreatitis, gastroparesis, and bowel obstruction. Meantime, people living with obesity might simply think that taking the "magic pill" or undergoing bariatric surgery can change their life. In the long term, this tendency might lead to scarce cost-effectiveness, increasing adverse effects and inequities in the most vulnerable age classes. Furthermore, the main actors responsible for generating an obesogenic world will continue undisturbed to produce negative effects. Obesity is not only generated from voluntary individual behaviors, and no guideline can truly counteract the detrimental effects of environmental factors driving the progressive rise of obesity globally. Unsustainable food production, packaging and marketing, environmental pollution, widely diffused endocrine disrupting chemicals, and climate change are largely neglected by health professionals and generate food insecurity and malnutrition. The complexity of obesity cannot be managed only pointing to individual responsibilities of people living with obesity. There is a missing link here, and this war cannot be won in the absence of effective primary prevention measures involving changes in food production and marketing, and decreased release of toxic chemicals into the environment.

Obesity

Obesity is a complex medical condition characterized by an excessive accumulation of body fat, leading to adverse health outcomes. Influenced by genetic, environmental, and lifestyle factors, obesity has become a global epidemic with significant implications for physical and mental well-being. This abstract provides a brief overview of the causes, consequences, and public health challenges associated with obesity, emphasizing the importance of multifaceted interventions to address this pervasive health issue. Introduction: In a world where sedentary lifestyles and unhealthy dietary habits have become the norm, obesity has emerged as a pressing global health concern. This article delves into the multifaceted issue of obesity, exploring its roots in genetics, environmental influences, and lifestyle choices. Beyond its impact on physical health, we unravel the intricate web of consequences, from increased risk of chronic diseases to the profound effects on mental well-being. As we navigate through the complexities of obesity, we seek to shed light on effective strategies for prevention and intervention, fostering a broader understanding of this weighty challenge that affects millions worldwide.

Patients’ experience of accessing healthcare for obesity in Peninsular Malaysia: a qualitative descriptive study

ObjectiveTo explore patients’ experiences accessing healthcare for obesity and their perceived behaviour changes following the care.DesignUsing a descriptive qualitative research approach informed by Levesque’s framework of access to healthcare, we...

Weight bias internalization and beliefs about the causes of obesity among the Canadian public

BackgroundExplicit weight bias is known as negative attitudes and beliefs toward individuals due to their weight status and can be perpetuated through misconceptions about the causes of obesity. Individuals may also experience weight bias internalization (WBI) when they internalize negative weight-related attitudes and self-stigmatize. There is a paucity of research on the beliefs about the causes of obesity and the prevalence of WBI among public Canadian samples. The aim of this study was to describe these attitudes and beliefs about obesity among a large Canadian sample across the weight spectrum.MethodsA Canadian sample of adults (N = 942; 51% Women; mean age group = 45–54 years; mean body mass index [BMI] = 27.3 ± 6.7 kg/m2) completed an online questionnaire. Participants completed the Modified Weight Bias Internalization Scale, the Anti-Fat Attitudes Questionnaire, and the Causes of Obesity Questionnaire.ResultsMean WBI score within the entire sample was 3.38 ​​ ± 1.58, and females had higher mean scores as compared to males (p < 0.001). Mean scores were also higher among individuals with a BMI of > 30 kg/m2 (4.16 ± 1.52), as compared to individuals with a BMI of 25–30 kg/m2 (3.40 ± 1.50), and those with a BMI of 20–25 kg/m2 or below 18.5 kg/m2 (2.81 ± 1.44) (p < 0.001 for all). Forty four percent of Canadians believed behavioural causes are very or extremely important in causing obesity, 38% for environmental causes, 28% for physiological and 27% for psychosocial causes. Stronger beliefs in behavioural causes were associated with higher levels of explicit weight bias. No BMI differences were reported on the four different subscales of the Causes of Obesity Questionnaire.ConclusionsWeight bias internalization is prevalent among Canadians across all body weight statuses, and the public endorses behavioural causes of obesity, namely physical inactivity and overeating, more than its other causes. Findings warrant the reinforcement of efforts aimed at mitigating weight bias by educating the public about the complexity of obesity and by highlighting weight bias as a systemic issue that affects all Canadians living in diverse body weight statuses.

Leverage point themes within Dutch municipalities' healthy weight approaches: A qualitative study from a systems perspective.

Despite all efforts of national and local approaches, obesity rates continue to rise worldwide. It is increasingly recognized that the complexity of obesity should be further addressed by incorporating a systems perspective when implementing approaches. Such an approach has four interconnected system levels: events, structures, goals, and beliefs, in which small changes ('leverage points') can lead to substantial changes in the functioning of the entire system. The current research examined the functioning of five Dutch municipalities' healthy weight approaches (HWAs) and the leverage point themes that can be identified in their system. Thirty-four semi-structured interviews were conducted with various stakeholders about the HWA, including policy advisors, care professionals, practice professionals, and citizens. An inductive thematic analysis was performed. Three main themes were identified: 1) HWA organization structure, 2) collaboration between professionals, and 3) citizen participation. Across all system levels, we identified leverage point themes. The upper-levels events and structures occurred the most and were explained by underlying goals and beliefs. Leverage point themes regarding "HWA organization structure" were municipal processes, such as perceived impact; diversity of themes, activities, and tasks; network; and communication strategies, such as messages about the HWA. Leverage point themes regarding "collaboration between professionals" were linking pins, indicating central players within the network; motivation and commitment including support base; and stimulating one another to work on the HWA by spurring other professionals into action. Lastly, leverage point themes under "citizen participation" included reaching the target group, e.g., look for entry points; and citizens' motivation, including customization. This paper provides unique insights into HWAs' leverage point themes that can lead to substantial changes in how the entire system functions and makes suggestions about underlying leverage points to help stakeholders improve their HWA. Future research could focus on studying leverage points within leverage point themes.

Differential alternative polyadenylation response to high-fat diet between polygenic obese and healthy lean mice

Obesity's complex etiology due to the interplay of environment and genetics makes it a more challenging research and health problem. Some of the contributing genetic factors that have not yet been examined in detail entail mRNA polyadenylation (PA). Genes with multiple PA sites express mRNA isoforms differing in coding sequence or 3′UTR through alternative polyadenylation (APA). Alterations in PA have been associated with various diseases; however, its contribution to obesity is not well-researched. Following an 11-week high-fat diet, the APA sites in the hypothalamus of two unique mouse models for polygenic obesity (Fat line) and healthy leanness (Lean line) were determined using whole transcriptome termini site sequencing (WTTS-seq). We found 17 genes of interest with differentially expressed APA (DE-APA) isoforms, among which seven were previously associated with obesity or obesity-related traits (Pdxdc1, Smyd3, Rpl14, Copg1, Pcna, Ric3, Stx3) but have not yet been studied in the context of APA. The remaining ten genes (Ccdc25, Dtd2, Gm14403, Hlf, Lyrm7, Mrpl3, Pisd-ps3, Sbsn, Slx1b, Spon1) represent novel candidates associated with obesity/adiposity due to variability brought about by differential usage of APA sites. Our results provide insights into the relationship between PA and the hypothalamus in the context of obesity, by being the first study of DE-APA sites and DE-APA isoforms in these mouse models. Future studies are needed further to explore the role of APA isoforms in polygenic obesity by expanding the scope of research to other metabolically important tissues (such as liver and adipose tissues) and investigating the potential for targeting PA as a therapeutic strategy for obesity management.

Conducting a psychosocial and lifestyle assessment as part of an integrated care approach for childhood obesity: experiences, needs and wishes of Dutch healthcare professionals

BackgroundThe causes and consequences of childhood obesity are complex and multifaceted. Therefore, an integrated care approach is required to address weight-related issues and improve children’s health, societal participation and quality of life. Conducting a psychosocial and lifestyle assessment is an essential part of an integrated care approach. The aim of this study was to explore the experiences, needs and wishes of healthcare professionals with respect to carrying out a psychosocial and lifestyle assessment of childhood obesity.MethodsFourteen semi-structured interviews were conducted with Dutch healthcare professionals, who are responsible for coordinating the support and care for children with obesity (coordinating professionals, ‘CPs’). The following topics were addressed in our interviews with these professionals: CPs’ experiences of both using childhood obesity assessment tools and their content, and CPs’ needs and wishes related to content, circumstances and required competences. The interviews comprised open-ended questions and were recorded and transcribed verbatim. The data was analysed using template analyses and complemented with open coding in MAXQDA.ResultsMost CPs experienced both developing a trusting relationship with the children and their parents, as well as establishing the right tone when engaging in weight-related conversations as important. CPs indicated that visual materials were helpful in such conversations. All CPs used a supporting assessment tool to conduct the psychosocial and lifestyle assessment but they also indicated that a more optimal tool was desirable. They recognized the need for specific attributes that helped them to carry out these assessments, namely: sufficient knowledge about the complexity of obesity; having an affinity with obesity-related issues; their experience as a CP; using conversational techniques, such as solution-focused counselling and motivational interviewing; peer-to-peer coaching; and finally, maintaining an open-minded, non-stigmatizing stance and harmonizing their attitude with that of the child and their parents.ConclusionsAlongside the need for a suitable tool for conducting a psychosocial and lifestyle assessment, CPs expressed the need for requisite knowledge, skills and attitudes. Further developing a supporting assessment tool is necessary in order to facilitate CPs and thereby improve the support and care for children with obesity and their families.

Time to end weight stigma in healthcare.

Weight stigma and discrimination is experienced by people living with obesity (PLWO) on almost a daily basis, across many settings. Counterintuitively, given that healthcare settings should be a safe space that is free of judgement, empirical evidence has demonstrated that weight stigma in healthcare settings is pervasive, where PLWO are stigmatised, disrespected, and in some instances discriminated against through lack of equitable access to care [1]. The conscious and unconscious stigmatising attitudes held by healthcare professionals is a reflection of (1) exposure to consistent and widespread weight stigma, and (2) the lack of training and education for healthcare professionals about the complexity of obesity as well as how to avoid bias and stigmatising attitudes that may impact care for PLWO.

Acyl-CoA Synthetase Long Chain Family Inhibition with Triacsin C Inhibits Multiple Myeloma Cell Proliferation and Survival

Multiple myeloma (MM) is defined by the clonal expansion of malignant plasma cells in the bone marrow (BM) and has a 5-year survival rate of 50% (Siegel el al. 2018, Cancer J. Clin.). MM remains incurable due to the development of resistance to current chemotherapies; therefore, it is paramount to investigate novel treatments and the mechanisms of drug resistance in MM cells. Interestingly, obesity correlates with increased incidence of MM and high body mass index correlates with a poor treatment response (Marinac et al. 2019, JNCI Cancer Spectr, Groß et al. 2017, Oncotarget). Obesity is a major risk factor for many cancers, however, given the complexity of obesity, there are an array of mechanisms by which obesity may support tumor cells. Studies of obesity and MM are mainly at the epidemiological level and have not extensively explored the mechanism of this relationship. Therefore, there is a critical need to understand how obesity contributes to support cancers such as MM. Possible mechanisms may be through the increased availability of free fatty acids or through other factors that are found in obese patients. We hypothesize that lipid metabolism contributes to obesity-linked cancers such as MM. Recently, changes in lipid metabolism have been shown to support the proliferation, migration and the development of drug resistance in other blood cancers such as acute myeloid leukemia (Tabe et al. 2017, Cancer Res, Tabe et al. 2018, Sci. Reports) and solid tumors such as breast (Wang et al. 2017, JCI Insights) and prostate (Mitra et al. 2017, BMC Cancer) cancer. However, the role of lipid metabolism in MM cells has been understudied. Therefore, we hypothesized that genes within the Hallmark Fatty Acid Metabolism gene set (https://www.gsea-msigdb.org) would be differentially expressed between healthy patients and those with MM. We mined the clinical data (GSE6477, Chng et al. 2007, Cancer Res.) and found that transcripts of an enzyme critical for lipid metabolism, acyl-CoA synthetase long chain member 1 (ACSL1), was significantly downregulated (Figure 1A, Log2(Fold Change)=-2.33, adjusted p value=1.64*10-5, false discovery rate) in patients with newly diagnosed MM relative to normal plasma cells. Therefore, we hypothesized that ACSL1 may act as a tumor suppressor in MM. In order to test the role of the ACSL family as tumor suppressors, we treated human (MM1.S, OPM2 and RPMI-8226) and mouse myeloma (5TGM1) cell lines with an inhibitor (Triacsin C, TriC) of four of the five human acyl-CoA synthetase long chain family members (ACSL1,3,4 and 5). Contrary to our hypothesis, TriC treatment significantly decreased MM cell proliferation (Figure 1B, p&amp;lt;0.0001, One-way ANOVA Tukey's multiple comparisons test is used throughout unless otherwise noted), increased apoptosis (Figure 1C, p&amp;lt;0.001) and caused G0 arrest (Figure1D, p&amp;lt;0.0001) in a dose-dependent manner. Motivated to understand if TriC's toxicity was due to changes in metabolic dynamics, MM1.S cells were treated with 1 μM TriC for 30 minutes and subjected to a metabolic flux assay (Seahorse XF, Agilent). TriC treatment significantly reduced ATP-dependent respiration from fatty acid oxidation (FAO) (Figure 1F, p&amp;lt;0.0001 Student's t-test) and increased proton leak (p&amp;lt;0.0001). Taken together, our data demonstrate that TriC-mediated ACSL inhibition in MM cells decreases proliferation, induces G0 arrest, apoptosis and decreases FAO-dependent respiration and mitochondrial function. It is unclear what ACSL family member is responsible for the phenotype we report here. To address these questions, future studies will focus on genetically targeting individual ACSL family members and characterizing the lipidomic profile of MM ACSL mutants. Our data also suggests that fatty acids are used as an energy source, therefore we will explore how FAO contributes to MM cell proliferation and survival. Disclosures No relevant conflicts of interest to declare.

Campbelltown \u2013 Changing our Future: study protocol for a whole of system approach to childhood obesity in South Western Sydney

BackgroundIn Australia, around 67% of adults and 25% of children (5–17 years) are currently overweight or obese (Australian Bureau of Statistics, 4364.0.55.001 - National Health Survey: First Results, 2017–18, 2018). The Campbelltown – Changing our Future study will translate ‘a whole of system’ approach, previously trialed in rural communities in Victoria and the Australian Capital Territoty, to Campbelltown Local Government Area (LGA), a socioeconomically and ethnically diverse urban community in south western Sydney, NSW.MethodsThe study intervention will use a five-step approach; 1 – set up a childhood obesity monitoring system by collecting baseline data from children in primary schools across Campbelltown LGA to give a local context to the community when developing the systems map; 2 - key stakeholders develop systems maps which inform the development of the interventions; 3 - key stakeholders and community groups identify priority areas for action and form working groups; 4 - implementation of the interventions; 5 - evaluation of the interventions. The study will adopt a longitudinal pre/post design with repeated measures at baseline, 2 years and 4 years. Both qualitative and quantitative methods will be used to collect and analyse the data.DiscussionAddressing childhood overweight and obesity is complex and requires a multifaceted intervention. This approach has the capacity to impact a range of factors that influence childhood overweight and obesity utilising existing capacity of multiple partners with broad community reach. Findings will develop local responses which capture the complexity of obesity at a community level and further our understanding of the interrelationships and relative importance of local factors impacting childhood overweight and obesity. This study aims to provide evidence for systems methods and approaches suitable for adaption and scaling and may provide evidence of successful community intervention elements.

The complexity of obesity

The complexity of obesity

Pharmacological management of obesity.

Current management of obesity includes three main arms: behavioral modification, pharmacologic therapy, and bariatric surgery. Decades prior, the only pharmacological agents available to treat obesity were approved only for short-term use (≤12 weeks) by the Food and Drug Administration (FDA). However, in the last several years, the FDA has approved several medications for longer term treatment of obesity. This highlights the important progression that we, as a society, better appreciate now the chronicity and complexity of obesity as a disease. Also, availability of more medication options gives healthcare providers more possibilities to consider in the management of obesity. Medications for obesity can be simply categorized as FDA approved short-term use (diethylproprion, phendimetrazine, benzphetamine, and phentermine) and long-term use (orlistat, phentermine/topiramate ER, lorcaserin, naltrexone/bupropion ER and liraglutide). Additionally, type 2 diabetes (T2DM) is commonly seen in patients with obesity and necessitates consideration of pharmacological options that do not hinder patients' weight loss. Finally, weight-centric prescribing is also an important component to pharmacological management of obesity. It warrants that healthcare providers thoroughly review their patients' medication lists to determine if any of these agents could be contributing to weight gain.

Precision Bariatrics: Toward a New Paradigm of Personalized Devices in Obesity Therapeutics.

The prevalence and complexity of obesity and its associated metabolic complications highlight the importance of building a rigorous investigative framework for the development of novel weight loss therapies. Device-based interventions in particular constitute a market poised for rapid expansion in the coming years. Optimizing outcomes for this new class of therapies requires attention to an evolving taxonomy of subdivisions within the broader obesity phenotype and a means for stratifying patients toward maximally effective interventions. Extant bariatric devices implicitly prioritize anatomic variables as surrogates for physiology, a somewhat arbitrary assumption that merits empiric validation. Utilizing the governing principles of systems biology and recent innovations in clinical trial design, a robust and precise research infrastructure can and should be developed to more effectively mitigate this contemporary epidemic.

How Can I Prepare My Patient for Bariatric Surgery? Practical Tips from Orientation to Operating Room

s / Can J Diabetes 39 (2015) S10eS16 S13 interactions. It suggested that shifting fromweight-focused towellbeing-focused approaches has potential to improve population health and address the problems associated with obesity in ways that protect and promote mental well-being. Our latest project supplements the paper by considering the evidence of biological and physical factors in the context of a well-being model and complexity. Experts were interviewed for the latest evidence on how the numerous factors contributing to and resulting from obesity andwell-being are related to each other. This workshopwill present the result as a conceptual map and provide opportunity for participants to navigate the complexity of obesity andwell-being to better understand the relationships and levers for action. Specifically, presenters will demonstrate how using the map can help think about the consequences of healthy weight interventions. The participants’ feedback will also be used to further support the development of intuitive tools from the map that can assist with thinking and planning for obesity and well-being.

Abstract 192: Role of adipose tissue in bladder cancer progression

Abstract Introduction: Obesity has been found to be associated with increased risk of bladder cancer, worse-cancer-specific outcomes and increased risk of recurrence. Moreover, bladder cancers that involve macroscopic extravesical invasion of the perivesical fat are highly predisposed to lymph node metastases and local recurrence. The objective of our study is to elucidate the mechanism by which adipose tissue contributes to bladder cancer progression. We hypothesize that adipose tissue in bladder cancer patients has the potential to modulate the tumor microenvironment by inducing pro-tumorigenic pathways in bladder cancer progression. Methods: Human adipose tissue fragments (bladder, urachal, subcutaneous and prostate when applicable) were collected from muscle-invasive bladder cancer (MIBC) patients undergoing cystectomy. Information on patient Body Mass Index (BMI), diabetes diagnosis, medications and gender were used in analysis. BMI status was classified into normal (under 25 kg/m2), overweight (25-29.9 kg/m2) and obese (≥30 kg/m2). Gene expression was profiled from total RNA isolated from 100mg of fat using the Illumina Human HT12 whole genome expression BeadChips. Fat conditioned media (CM) was prepared from 500 mg of the patient fat processed as primary adipose tissue explant cultures for 16 hours. Secreted factors from CM were measured using MILLIPLEX MAP 41-plex Human Cytokine/Chemokine Panel. Migratory potential was assayed by Transwell (BD falcon) migration. T24 human bladder cancer cells were placed in the upper chamber with patient fat CM or control serum free media in the lower chamber. Cells were allowed to transmigrate across the porous membrane for 18 hours. Results: At the genomic level in fat specimens from twelve cancer patients with different BMI status indicated a number of differentially expressed genes previously implicated in cancer progression. The expression of CCL3/macrophage inflammatory protein-1α (a secreted protein) and matrix metalloproteinase-9 are significantly upregulated in fat samples from obese and overweight patients relative to normal. At the protein level in CM, three factors: interleukin-8, growth regulated oncogene-alpha and monocyte chemotactic protein-1, are found in high levels across all patient tissue depots. Surprisingly, exposing T24 cells to CM from bladder fat depots increased their migratory potential. Ongoing studies are evaluating the specific factors involved in this difference. Conclusions: The identified differentially expressed genes and secreted factors provide a possible mechanism to explain the effects of obesity on tumor progression in bladder cancer. In addition to BMI, the migratory potential of T24 cells was also differentially modulated by the different fat deposit types. Ongoing studies are investigating the effect of adipose tissue-derived factors on bladder cancer to help improve outcome in advance bladder cancer patients with added complexities of obesity. Citation Format: Nisha Hariharan, Robert S. Svatek, Carolina B. Livi, Jonathan A.L. Gelfond, Teresa L. Johnson-Pais, Robin J. Leach. Role of adipose tissue in bladder cancer progression. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 192. doi:10.1158/1538-7445.AM2014-192

Offspring of parents with obesity complex investigations: risk of carbohydrate disturbances and diabetes

Offspring of parents with obesity complex investigations: risk of carbohydrate disturbances and diabetes

The complexity of obesity in UK adolescents: relationships with quantity and type of technology, sleep duration and quality, academic performance and aspiration

SummaryWhat is already known about this subject Technology use and ownership is highly prevalent in adolescents and has been previously linked to obesity, but bedtime use of contemporary, original and multiple device use is currently unexplored. Sleep duration is a potentially important contributor to obesity development, but other sleep parameters may be crucial and may contribute to a better understanding of obesity, although these are currently limited in adolescent samples. Adolescent obesity may have a negative impact on academic performance, but data are heterogeneous. Body mass index may also influence academic aspiration, but little is known about this potential relationship. What this study adds Frequent use of contemporary (video games) and long‐standing technologies (television) as well as multiple quantities of technology during the week at bedtime is positively associated with body mass index emphasizing the complex relationships between lifestyle choices during adolescence and obesity. We show that sleep duration and sleep onset latency are important aspects associated with elevated body mass index. Considering the physiological changes commonly associated with sleep alterations during adolescence, it is possible that incorporating sleep education into the curriculum and improving sleep hygiene may help to improve the current obesity epidemic, which impacts on many aspects of an individual's life. Increased body mass index is negatively associated with academic performance, but not aspiration, demonstrating the importance of tackling adolescent obesity for future health, well‐being and success. BackgroundContemporary technology and multiple device use may link to increased body mass index (BMI). The sleep–obesity relationship is inconsistent in adolescents. Sleep duration and quality may have crucial connections to obesity development, particularly in adolescents where sleep alterations are common. Elevated BMI in adolescents may influence academic performance and aspiration, but data are limited.ObjectivesThe objectives of this study was to assess the linear associations between BMI z‐score and (i) quantity/type of technology used; (ii) sleep quantity/quality and (iii) academic performance/aspiration.MethodsConsenting adolescents (n = 624; 64.9% girls, aged 11–18 years) were recruited. The Schools Sleep Habits Survey and Technology Use Questionnaire were administered. Objective measures of height/weight were obtained.ResultsQuantity of technology was positively associated with BMI z‐score β = 0.10, P &lt; 0.01. Those who always engaged in video gaming had significantly higher BMI z‐score vs. never‐users, β = 1.00, P &lt; 0.001. Weekday sleep duration and sleep onset latency were related to BMI z‐score, β = −0.24, P &lt; 0.001 and β = 0.01, P &lt; 0.001, respectively. An inverse linear association was observed between BMI z‐score and academic performance, β = −0.68, P &lt; 0.001.ConclusionsIf confirmed prospectively, reducing bedtime use of technology and improving sleep hygiene in adolescents could be an achievable intervention for attenuating obesity with potentially positive effects on academic performance.

Obesity, Integral Leadership, and Health Policy

Combating the complexities of obesity requires an integral leadership approach at national, state, and local levels. Policies at each of these levels must employ ethical humanistic care that incorporates understanding of the social determinants of health. The aim of this paper is to examine the potential policy influences that the interrelated causes and effects of obesity have at individual and population levels. Further, the aim is to increase health professional awareness of how they can serve as integral leaders in health reform to alleviate the obesity epidemic.