Obesity Epidemic Research Articles

Physical and Psychological Effects of Bariatric Surgery on Obese Adolescents: A Review.

The worldwide obesity crisis is not isolated to adults; rather, obesity in adolescents has reached epidemic levels as well. Bariatric surgery continues to be one of the most effective treatments for obesity, both in adults and adolescents, with new evidence continually emerging; however, research surrounding outcomes of these procedures in younger patients is limited in comparison with data available for adults. Further, it is important to examine psychological aspects of obesity in adolescents, as well as effects of surgery on mental health endpoints. Conditions such as anxiety, depression, anger, and disruptive behavior show increased prevalence among obese adolescents, but minimal research exists to examine changes in such conditions following bariatric surgery. Additionally, there is growing evidence of a bidirectional relationship between sleep (quality; disorders) and the development of obesity, and the effects of this relationship are particularly pronounced in the vulnerable adolescent population. This review aims to compile and discuss the results of literature within the last 5 years with regard to overall efficacy of bariatric surgery specifically in adolescent patients in terms of weight and body mass index (BMI) reduction, hormonal changes, and co-morbidity resolution, as well as data surrounding sleep and psychological outcomes. Race, ethnicity, and socioeconomic status were also examined. From this review, we conclude that current research supports bariatric surgery in adolescents as an effective method of treatment for obesity and related co-morbidities; however, minimal long-term data exists to adequately assess efficacy and trends into adulthood. These areas are ripe for future study.

Cirurgias bariátricas realizadas no Sistema Único de Saúde brasileiro entre 2010 e 2019

A cirurgia bariátrica é um procedimento alternativo para controle da obesidade. Foi incluído no Sistema Único de Saúde em 1999 e, depois de vinte anos, ainda não supre a demanda de atendimento que cresce com as mudanças de hábito de vida da população. O presente estudo teve como objetivo levantar o número de bariátricas realizadas pelo sistema público brasileiro entre 2010 e 2019, quantificar os procedimentos por região, custo, complicações e taxa de mortalidade; além de promover visão crítica na academia. Através de dados secundários do Sistema de Informações Hospitalares do Sistema Único de Saúde, foi realizada análise quantitativa e descritiva das cirurgias bariátricas dentro das variáveis objetivadas, utilizando software estatístico para testes qui-quadrado de independência e regressão logística. Em dez anos, foram realizadas 79.961 cirurgias e investido R$ 49.186 milhões em bariátricas. A distribuição das cirurgias nas regiões brasileiras não foi igualitária, sendo o sul e sudeste os locais que mais realizaram procedimentos e receberam investimentos. O crescimento das cirurgias não demonstrou diferença estatística para o número de óbitos, mas evidenciou concomitância nas complicações clínicas e cirúrgicas, com aumento de 266,66% e 800%, respectivamente. A técnica cirúrgica mais executada foi a gastroplastia com derivação intestinal (94,15%), variando 4,7% dentro do observado. Apesar do quantitativo de cirurgias praticamente ter triplicado dentro do período avaliado, constata-se insuficiência para suprir a demanda gerada pela epidemia de obesidade, sendo necessário equidade dos investimentos nesse setor. Assim, percebe-se urgência do combate legítimo da problemática no país, com políticas públicas e educação em saúde efetivas.

Neural Correlates of Attentional Bias to Food Stimuli in Obese Adolescents

Adolescent obesity is an increasingly prevalent problem in several societies. Researchers have begun to focus on neurocognitive processes that may help explain how unhealthy food habits form and are maintained. The present study compared attentional bias to food stimuli in a sample of obese (n = 22) and Normal-weight (n = 18) adolescents utilizing an Attention Blink (AB) paradigm while electroencephalography (EEG) was recorded. We found lower accuracy and Event-Related Potential (ERP) P3 amplitudes during the presentation of food stimuli in AB trials for obese adolescents. These findings suggest an impaired ability of their brains to flexibly relocate attentional resources in the face of food stimuli. The results were corroborated by lower P3s also being associated with higher body mass index (BMI) values and poorer self-reported self-efficacy in controlling food intake. The study is among the few examining neural correlates of attentional control in obese adolescents and suggests automatic attentional bias to food is an important aspect to consider in tackling the obesity crisis.

Childhood Obesity Interventions by Setting

Background: To combat the global health crisis of obesity, many interventions have been implemented, including in children and adolescents. This age range is uniquely important because health behavior continues into adulthood, resulting in lifelong health risks or benefits. This narrative review aims to provide a cross section of the scientific literature regarding obesity interventions by setting, including school-based, daycare-based, home-based, healthcare-based, and digital-based, as well as to highlight gaps in research. Methods: Articles written in English addressing childhood and adolescent obesity interventions were sought online using PubMed and Google Scholar searches. Although some articles were from a global perspective, the majority focused on children in the United States. This search included reviews, individual studies, and other related papers. Results: School-based interventions are accessible to many, but there is limited evidence of long-term benefits. Home-based interventions were the only setting to have compelling evidence of long-term benefits, although there are several barriers to participation. Healthcare-based interventions are often successful when specific strategies and unique advantages of healthcare settings are utilized. Digital interventions have limited success now, but show potential for cost-effective scaling up as technology improves. Conclusion: The clearest gap in research is the lack of long-term studies, especially of school-based and healthcare-based interventions. Thus, it is imperative that investments are made into studies that include follow-up components continuing at least 1-2 years after the intervention. Additionally, home-based interventions have been more successful during early childhood while school-based interventions tend to be more successful during adolescence.

Inter-Organ Crosstalk in the Development of Obesity-Associated Insulin Resistance.

The epidemics of obesity and type 2 diabetes have led to intensive investigation of the underlying mechanisms of these diseases and their main complications such as cardiovascular diseases and non-alcoholic fatty liver disease. This search has contributed to better understand how organs and tissues communicate with each other in the so-called inter-organ crosstalk. Adipose tissue, the liver, or skeletal muscle can actively release secreted factors termed "organokines" which can interact with other distant targets in complex networks. More recently, other novel mediators of inter-organ crosstalk such as extracellular vesicles and their non-traditional cargoes as miRNAs and lncRNAs are gaining importance and represent potential therapeutic targets. In the present chapter we summarize some of the current knowledge on inter-organ communication with a focus on adipose tissue-released factors and their modulation on other organs and tissues like pancreas, liver, skeletal muscle, the cardiovascular system, and the gut in the context of obesity and its progression to insulin resistance. We also provide a perspective on mediators of inter-organ crosstalk as potential therapeutic targets.

Nutrition Transition Between Hunger and Obesity

In the course of global nutritional change, traditional dietary patterns are increasingly being replaced by an urban-industrial dietary style. The proportion of animal-based and, above all, ultra-processed foods is increasing sharply, with dramatic consequences for climate and public health. The epidemics of obesity, malnutrition and climate change are combining to form a ›Global Syndemic‹ that particularly affect low-income countries, where women are especially affected by a double burden of underweight and obesity over their lifetime. The COVID-19 pandemic has further exacerbated the situation and shown how fragile food security is.

Detection and Diagnosis of Overt Diabetes During Pregnancy

The International Workshop-Conferences on GDM have defined the condition as “any degree of glucose intolerance with onset or first recognition during pregnancy”. The definition has applied whether or not insulin is used for treatment or hyperglycemia persists after pregnancy. The possibility that unrecognized glucose intolerance antedated the pregnancy is not excluded. This facilitates a uniform strategy for detection and classification of GDM but has limitations. As ongoing epidemics of obesity and diabetes result in more type 2 diabetes in young women, the number who are undiagnosed (before pregnancy) is increasing. The need to identify these women and address perinatal risks that may be particular to their greater degree of hyperglycemia is becoming more important. The IADPSG Consensus Panel reviewed the current knowledge base during the IADPSG meeting.

Dietary Balance Across the Life Course: An Integrative Approach

Animals require specific blends of nutrients that change across the life-course, with health status, and according to environmental conditions. Underpinning and complicating these requirements is the fact that individual traits may be optimised on different dietary compositions leading to trade-offs between developmental, health and life-history outcomes. Additionally, the food environment may constrain whether the required optimal nutrient mixture is achievable. Natural selection has equipped animals for solving the multidimensional, dynamic challenge of nutrition, but considerable work remains to understand the theoretical and practical implications. In this review we present the integrative framework of nutritional geometry, which models complex nutritional interactions in the context of multiple nutrients. Illustrative exemplars are given from across the life cycle and in both the laboratory, and the wild. We conclude by relating this ecological conception of dietary balance to the human obesity crisis.

Methodological Challenges in Estimating the Lifetime Medical Care Cost Externality of Obesity.

There is a great deal of variability in estimates of the lifetime medical care cost externality of obesity, partly due to a lack of transparency in the methodology behind these cost models. Several important factors must be considered in producing the best possible estimate, including age-related weight gain, differential life expectancy, identifiability, and cost model selection. In particular, age-related weight gain represents an important new component to recent cost estimates. Without accounting for age-related weight gain, a study relies on the untenable assumption that people remain the same weight throughout their lives, leading to a fundamental misunderstanding of the evolution and development of the obesity crisis. This study seeks to inform future researchers on the best methods and data available both to estimate age-related weight gain and to accurately and consistently estimate obesity's lifetime external medical care costs. This should help both to create a more standardized approach to cost estimation as well as encourage more transparency between all parties interested in the question of obesity's lifetime cost and, ultimately, evaluating the benefits and costs of interventions targeting obesity at various points in the life course.

Growing fast food consumption and obesity in Asia: Challenges and implications.

It is widely believed that better access to fast food (FF) outlets increases FF consumption and thus the risk of obesity; yet, thus far, there are limited results to support this conclusion in Asian countries. A recent study by Hall and his colleagues (in press) examined the cross-sectional relationship between FF restaurant density and the likelihood of being overweight or obese among 1388 female Filipino migrant workers living in Macao, China. It found that FF restaurant density within a 0.5-mile buffer zone around one's home was significantly associated with a 7% increase (95% CI: 1%-14%) in the odds of being overweight or obese in this population. Based on these findings, the authors suggested improving access to healthy foods as one of the means to fight the obesity epidemic. The current article examines literature 1) on the relationship between obesity, FF consumption, and access to FF outlets; 2) on different measures of access to FF outlets; 3) on potential confounders and effect modifiers such as neighborhood deprivation and transportation; and 4) on challenges and implications for researchers and policymakers. Considering the growing consumption of FF and obesity rates in many countries especially in developing countries, it is important to regulate the FF industry and help consumers improve their related knowledge and behaviors. We also recommend that government policies abate obesogenic environments and thus curb the obesity epidemic in the future.

Ganho de peso na gestação, segundo estado nutricional prévio e idade de puérperas atendidas na maternidade de um hospital público de Macaé, Rio de Janeiro

Introdução: A gestação é uma etapa fisiológica que requer acompanhamento de saúde adequado, com vistas ao desfecho positivo para mãe e bebê. Dentre outros cuidados previstos no acompanhamento pré-natal, o ganho de peso é parâmetro a ser monitorado sistematicamente, diante de sua relevância para a saúde materno-infantil e da relação entre ganho de peso inadequado e intercorrências na saúde. Objetivo: Descrever o perfil de ganho de peso gestacional de puérperas assistidas em uma maternidade pública, segundo estado nutricional prévio e idade materna. Método: Estudo epidemiológico transversal descritivo, de base primária (prontuário hospitalar) e secundária (entrevista), realizado em 2014, com amostra de 113 mulheres de 20 a 40 anos com até 48h pós-parto. O estado nutricional pré-gestacional foi avaliado por meio do Índice de Massa Corporal (IMC) e a avaliação da adequação do ganho de peso gestacional considerou as recomendações do Institute Of Medicine (IOM). Resultado: 73,5% tinham idade entre 20-29 anos; 69,9% realizaram seis ou mais consultas de pré-natal e 42,2% tinham excesso de peso (sobrepeso ou obesidade) prévio à gestação. O estado nutricional pré-gestacional, segundo idade, revelou que 35,5%(n=79) daquelas entre 20-29 anos e 60%(n=30) das entre 30-40 anos apresentavam excesso de peso prévio. Houve associação significativa (p<0,01) entre as variáveis “ganho de peso gestacional” e “estado nutricional prévio”. Dentre as que tiveram ganho de peso excessivo, 73,1% tinham excesso de peso prévio. Conclusão: Parte expressiva das puérperas já possuía excesso de peso e teve ganho ponderal excessivo na gestação, sobretudo as mais velhas. Sugerem-se a idade materna e o estado nutricional prévio como fatores determinantes do ganho de peso e recomendam-se maior capilaridade e cobertura do acompanhamento nutricional pré-natal no sistema público de saúde como possibilidade de enfrentamento do ganho de peso excessivo, que contribui para o agravamento da epidemia de obesidade no Brasil.

Corporate Purpose Needs Democracy

AbstractThe British Academy proposes that some of the manifest failures of shareholder capitalism can be addressed by requiring corporations to declare a purpose – a profitable solution to the problems of people and planet that does not cause additional problems – and creating a set of supporting mechanisms to ensure the pursuit of purpose. Shareholder capitalism has a lot to answer for, arguably including the opioid and obesity epidemics, the hazards to people and democracy posed by profit‐driven tech firms, and catastrophic climate change. Moreover, the forces that orient public corporations toward share price are powerful and pervasive, while public corporations are disappearing in the USA and the UK under the weight of outside pressures. If we want the corporations that remain to behave themselves, the surest path is more democracy: greater worker control from below, and more effective state regulation from above.

Testing a load theory framework for food-related cognition.

The way we process rewarding stimuli is widely held to play a key role in normal and abnormal behavior. Biased processing of food-arguably the most primal form of reward-has been strongly implicated in the obesity crisis. Paradoxically, however, existing evidence suggests that both too much and too little attention can potentially lead to overeating. Here we sought to explain this contradiction within the framework of the load theory of attention, while also elucidating the relatively understudied role of memory biases. In 3 experiments, we presented food and nonfood images as irrelevant distractors during a letter search task with high and low levels of perceptual load, followed by a forced choice recognition task. As predicted, increasing perceptual load consistently powerfully reduced distraction by food and nonfood images alike. Similarly, food images encountered under high perceptual load were less likely to be recognized in a surprise memory test. Unexpectedly, however, there was a striking absence of attentional bias to food above and beyond salient nonfood stimuli, either within-subjects or in relation to traits implicated in food-biases. By contrast, a food memory bias was consistently observed across participants, and appeared independent of attentional biases. Food memory was consistently heightened in individuals with high levels of trait disinhibition (a measure of opportunistic eating). Our findings suggest that attention and memory for food and nonfood are similarly impacted by perceptual load. We discuss implications of the load theory framework for the wider literature on food-related cognition and for real world eating behaviors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Insulin resistance dysregulates CYP7B1 leading to oxysterol accumulation: a pathway for NAFL to NASH transition

NAFLD is an important public health issue closely associated with the pervasive epidemics of diabetes and obesity. Yet, despite NAFLD being among the most common of chronic liver diseases, the biological factors responsible for its transition from benign nonalcoholic fatty liver (NAFL) to NASH remain unclear. This lack of knowledge leads to a decreased ability to find relevant animal models, predict disease progression, or develop clinical treatments. In the current study, we used multiple mouse models of NAFLD, human correlation data, and selective gene overexpression of steroidogenic acute regulatory protein (StarD1) in mice to elucidate a plausible mechanistic pathway for promoting the transition from NAFL to NASH. We show that oxysterol 7α-hydroxylase (CYP7B1) controls the levels of intracellular regulatory oxysterols generated by the "acidic/alternative" pathway of cholesterol metabolism. Specifically, we report data showing that an inability to upregulate CYP7B1, in the setting of insulin resistance, results in the accumulation of toxic intracellular cholesterol metabolites that promote inflammation and hepatocyte injury. This metabolic pathway, initiated and exacerbated by insulin resistance, offers insight into approaches for the treatment of NAFLD.

Complications of Non-Alcoholic Fatty Liver Disease in Extrahepatic Organs.

Non-alcoholic fatty liver disease (NAFLD) is now recognized as the most common chronic liver disease worldwide, along with the concurrent epidemics of metabolic syndrome and obesity. Patients with NAFLD have increased risks of end-stage liver disease, hepatocellular carcinoma, and liver-related mortality. However, the largest cause of death among patients with NAFLD is cardiovascular disease followed by extrahepatic malignancies, whereas liver-related mortality is only the third cause of death. Extrahepatic complications of NAFLD include chronic kidney disease, extrahepatic malignancies (such as colorectal cancer), psychological dysfunction, gastroesophageal reflux disease, obstructive sleep apnea syndrome, periodontitis, hypothyroidism, growth hormone deficiency, and polycystic ovarian syndrome. The objective of this narrative review was to summarize recent evidences about extrahepatic complications of NAFLD, with focus on the prevalent/incident risk of such diseases in patients with NAFLD. To date, an appropriate screening method for extrahepatic complications has not yet been determined. Collaborative care with respective experts seems to be necessary for patient management because extrahepatic complications can occur across multiple organs. Further studies are needed to reveal risk profiles at baseline and to determine an appropriate screening method for extrahepatic diseases.

COVID-19: a one-way ticket to a global childhood obesity crisis?

Obesity is a global epidemic based on three major pillars of (i) genetic (ii) behavioural and (iii) environmental determinants. The latter two pillars have been challenged during the course of the COVID-19 pandemic across all population age groups including children. The closure of schools resulted in decreased organised physical activity, increase in sedentary lifestyle and screen time with the possibility of stress-induced indulgence in high calorie dense and sugary foods, resulting in higher susceptibility to weight gain. The uncertainty faced by many Northern Hemisphere governments as the new scholastic year looms closer whether to open schools again or not further enhances the stress on the children and their family. Re-opening of schools is beneficial for children’s mental and physical health, and general wellbeing including the ‘combating’ of the childhood obesity epidemic. The family unit has also been challenged during this pandemic especially if the parent/s suffered redundancy. There have been attempts at seeing a silver lining as some families have embraced lockdowns as a means to strengthen their family bonds, increase homemade meals apart from the various virtual opportunities that were streamed on social media to encourage children to perform physical activity at home or in safe environments. However, curbing the viral spread while protecting population health will remain top priority until an effective COVID-19 vaccine is available. It is imperative to address other co-existing problems such as childhood obesity, which if uncontrolled may have a long-term profound health and economic consequence of higher eminence than the actual COVID-19 infection. The prevention and management of childhood obesity should be set as a priority at an individual, community and population level during this pandemic.

Obesity crisis: comprehensive, committed and robust action needed

2020 is a year that will forever be defined by the Covid-19 pandemic. Here in the UK, infection rates decreased in the summer and social restrictions were partially relaxed. In September infection ...

Lysyl oxidase inhibition enhances browning of white adipose tissue and adaptive thermogenesis

Accumulating evidence from both animal and human studies suggests that activation of beige fat increases cellular energy expenditure, ultimately reducing adiposity. Here, we report the central role of adipocyte-derived lysyl oxidase (Lox) in the formation of thermogenic beige fat. Mice exposed to cold or a β3 agonist showed drastically lower Lox expression in thermogenically activated beige fat. Importantly, inhibition of Lox activity with BAPN stimulated biogenesis of beige fat in inguinal white adipose tissue (iWAT) under housing conditions and potentiated cold-induced adaptive thermogenesis and beiging in both iWAT and epididymal white adipose tissue (eWAT). Notably, white adipocytes with Lox repression undergo transdifferentiation into beige adipocytes which can be suppressed by tumor necrosis factor-α (TNFα) via ERK activation. This work provides new insight into the molecular control to expand beige fat by Lox inhibition and suggest the potential for utilizing inhibitor of Lox to treat the emerging epidemics of obesity and diabetes.

S2753 The New Face of Malnutrition in the Era of Obesity Epidemic

S2753 The New Face of Malnutrition in the Era of Obesity Epidemic

Magnetic resonance imaging for the assessment of pathological hepatic findings in nonalcoholic fatty liver disease.

The prevalence of nonalcoholic fatty liver disease (NAFLD) is expected to increase because of the current epidemics of obesity and diabetes, and NAFLD has become a major cause of chronic liver disease worldwide. Liver fibrosis is associated with poor long-term outcomes in patients with NAFLD. Additionally, increased mortality and liver-related complications are primarily seen in patients with nonalcoholic steatohepatitis (NASH); however, nonalcoholic fatty liver (NAFL) is believed to be benign and non-progressive. Therefore, distinguishing between NASH and NAFL is clinically important. Liver biopsy is the gold standard method for the staging of liver fibrosis and distinguishing between NASH and NAFL. Unfortunately, liver biopsy is an invasive and expensive procedure. Therefore, noninvasive methods, to replace biopsy, are urgently needed for the staging of liver fibrosis and diagnosing NASH. In this review, we discuss the recent studies on magnetic resonance imaging (MRI), including magnetic resonance elastography, proton density fat fraction measurement, and multiparametric MRI (mpMRI) that can be used in the assessment of NASH components such as liver fibrosis, steatosis, and liver injury including inflammation and ballooning.