Depression in Kids Predicts Obesity in Adulthood
Mental health assessment should be part of every assessment for adult obesity. But how well does a history of mental problems as a kid or teenager predict adult obesity? This question was recently addressed by Eryn Liem and colleagues from the University of Groningen, Groningen, the Netherlands, published in last month’s issue of the Archives of Pediatrics and Adolescent Medicine. Liem and colleagues reviewed the recent literature regarding the association between depressive symptoms in childhood and adolescence and overweight in later life. In total, 32 articles were reviewed including 21 cross-sectional and 11 longitudinal reports. Of these, four cross-sectional studies that satisfied their quality criteria revealed an association between depressive symptoms and overweight in girls aged 8 to 15 years. Four longitudinal studies that met their quality criteria suggest that depressive symptoms in childhood or adolescence are associated with a 1.90- to 3.50-fold increased risk of subsequent overweight. Thus, these results suggest that having depressive symptoms at age 6 to 19 years may lead to overweight and obesity in later life. Obviously, the study does not address the issue of whether or not recognizing and managing depression in kids and adolescents will actually help prevent adult obesity. Whatever the case, I do believe that mental health aspects of weight management are likely as important in kids as they are in adults and that early detection of mental health issues, that can lead to obesity later in life, need to be addressed in high-risk kids and adolescents. AMS Alberta, Canada
Weight Gain in the Elderly is OK?
As blogged yesterday, excess weight is a well-established risk factor for mortality. But does this relationship hold across the lifespan? – or in other words – does it matter at what age you first gain weight? This was the question addressed by Ian Janssen and Eric Bacon from Queen’s University, Kingston, Ontario, who examined the effect of current and midlife obesity status on mortality risk in the elderly, in a paper just out in OBESITY. Analyses were based on 3,238 participants from the original Framingham Heart Study (FHS) cohort who lived to at least 70 years of age and who had BMI measures from when they were in their 50s. Within this group of 70-year olds, obesity based on current BMI was associated with a 21% increased risk of mortality (P = 0.019) whereas obesity in 70-year olds based on BMI measures obtained at around 50 years of age was associated with a 55% increased risk of mortality (P < 0.0001). However, and perhaps more importantly, compared to 70-year olds who were nonobese at both 50 and 70 years of age, mortality risk was increased by 47% (P < 0.001) in those who were obese at both 50 and 70 years of age, increased by 56% (P < 0.001) in those who were obese at 50 years of age and nonobese at 70 years of age, but not significantly different (P > 0.9) in those who were nonobese at 50 years of age and obese at 70 years of age. Thus, although mortality risk was increased in obese older adults who were already obese at midlife, this was not the case for newly obese older adults. In practical terms this means that if you are lean most of your life but only gain weight when you get to 70 – you are probably OK. On the other hand, if you were obese at age 50, but somehow lost the weight by the time you got to 70, your risk was still higher than someone who was never obese. Remember, as with the obesity paradox for individuals with chronic disease, (unintentional) weight loss in the elderly is never a good prognostic sign. So, if you make it to 70 without gaining too much excess weight – apparently, it’s time to eat, drink and be merry – and don’t sweat the waistline. AMS Edmonton, Alberta
Obesity and Risk of Death in Europeans
This week’s New England Journal of Medicine, features an article by Tobias Pischon on behalf of the EPIC (European Prospective Investigation into Cancer and Nutrition) investigators on the relationship between BMI, waist circumference, waist-to-hip ratio and mortality. To me, this paper is of considerable interest – not least, because Tobias was one of my students back in Germany, who did his MD thesis on the effect of salt intake and obesity on chronic kidney transplant rejection under my supervision. Of course, this paper also deals with a topic that I have often blogged about – i.e. the relationship between anthropometric measures and morbidity and mortality. Pischon and colleagues studied 359,387 participants from nine countries during a mean follow-up of 9.7 years. After adjustments for age, educational level, smoking status, alcohol consumption, and physical activity, the lowest risks of death related to BMI were observed at a BMI of 25.3 for men and 24.3 for women. After adjustment for BMI, relative risks among men and women in the highest quintile of waist circumference were 2.05 and 1.78, respectively, and in the highest quintile of waist-to-hip ratio, the relative risks were 1.68 and 1.51, respectively. BMI remained significantly associated with the risk of death in models that included waist circumference or waist-to-hip ratio (P<0.001). This study, essentially confirms what was already known, namely that the impact of excess body fat on mortality depends not only on the amount of excess fat (BMI) but also on its distribution (waist circumerence, waist-to-hip ratio). Importantly, the measures of fat distribution are predictive of risk even in normal weight individuals with lower BMI’s, which challenges the use of cutoff points to define abdominal obesity. On the other hand, as BMI increases, measuring fat distribution adds little to determining obesity-related risk. (which is why obesity guidelines do not recommend measuring waist cirumference in individuals with a BMI>40). AMS Edmonton, Alberta
Eating Quickly Till You’re Full Trebles Obesity Risk
I have previously blogged that the real problem with “fast food” is in the “fast” and not the “food” – if you take the time to slowly chew and savour your junk food, it may not be all that bad (remember: you can also get plenty of sodium, transfats, and extra calories with the best of gourmet cooking). The notion that eating too fast, especially till you actually feel full, drastically increases your risk for overweight and obesity was nicely demonstrated by Hiroyasu Iso and colleagues from Osaka University in a paper published last month in the British Medical Journal. Iso and colleagues studied 3287 Japanese adults (1122 men, 2165 women) aged 30-69 who participated in cross-sectional surveys on cardiovascular risk from 2003 to 2006. The questionnaires included validated measures of dietary habits including “eating until full” and “speed of eating”. 571 (50.9%) men and 1265 (58.4%) women self reported eating until full, and 523 (45.6%) men and 785 (36.3%) women self reported eating quickly. For both sexes the highest age adjusted mean values for body mass index and total energy intake were in the “eating-until-full” and “eating-quickly” group compared with the “not-eating-until-full” and “not-eating-quickly” group. The multivariable odds ratio of being overweight with both eating behaviours compared with neither was 3.13 (2.20 to 4.45) for men and 3.21 (2.41 to 4.29) for women. Importantly, the “eating-too-fast-till-full” group did not differ from the “not-eating-too-fast-and-not-eating-till-full” group in terms of other variable such as macronutrient composition of the diet, smoking or physical activity. Repeat questionnaires and other studies have shown that these eating behaviour traits stay stable over time – i.e. there appear to be “naturally” slow eaters and “natural” gorgers, the latter being at higher risk of obesity. Based on these “cross-sectional” data, the big question now is whether or not making a conscious effort to eat slowly (play with your food?) and pushing away the plate before you are entirely full will actually lead to sustained weight loss. That is, of course, assuming that these behaviours can indeed be changed (knowing what I do about behavioural genetics, I believe some skepticism may be in order). Obviously, both “eating too fast” and “eating till full” are behaviours that, just a few generations ago, would have had significant survival benefits – in fact, these behaviours are two of my six “Natural Laws of Weight Gain” (#3 and #4 to be precise). The problem… Read More »
LABG to Salvage Roux-en-Y Gastric Bypass
Earlier this week I posted on a couple of new articles describing technical complications of laparoscopic adjustable gastric banding (LABG) and how some patients, who fail LABG, may benefit from conversion to Roux-en-Y Gastric Bypass (RYGBP). These postings prompted a number of responses from surgeons around the country, including one from Christopher Cobourn (Toronto), who drew my attention to two publications in which LABG were used to salvage patients who had failed on RYGBP. In the first paper, published in Surgical Endoscopy (2007), Ryan Gobble and colleagues from the New York University School of Medicine reported on 11 patients (7 f, 4 m), who were referred to their program for failure to lose weight or weight regain after RYGBP (six open, five laparoscopic). Vanguard bands were successfully placed laparoscopically in 10 patients (one was converted to open) with a mean OR time of 76 mins. While there were no complications or mortalities, one patient required reoperation for a flipped port. Based on the weight loss observed over a median of 13 months, the authors concluded that LAGB is a safe and effective solution to failed RYGBP. In a second paper published earlier this year in Surg Obes Relat Dis, Philip Chin and colleagues from Fountain Valley, CA, reported on 8 out of 10 RYGBP patients (2 lost to follow-up) in whom they performed LABG due to poor weight loss or weight regain. Three minor complications developed: 2 port-related complications requiring port revision and 1 postoperative wound hematoma requiring evacuation. No band erosions or band slippages occurred, and no major complications developed. Weight loss following LABG was adequate. Thus, not only (as reported previously) can RYGBP be used to salvage patients who fail on LABG, but, as illustrated by these reports, the opposite is also true. Overall, this discussion shows that bariatric surgery is a complicated business, with no procedure being perfect and that a certain proportion of patients undergoing any of the current procedures is likely to fail and require conversion to another option. Together, these reports reinforce what I have said before: patients undergoing any bariatric procedure should be warned of potential failure and the possible need for reoperation and conversion if things don’t go as planned. Clearly, these reports also reinforce the notion that bariatric surgeons need the versatility of not only performing the primary procedure but should be comfortable offering revisional surgery when necessary. Obviously, these “technical”… Read More »
Text Messaging Helps Kids Live Healthy?
Hard to imagine a few years ago, but a surprising number of kids today have their own mobile phones. One of the most popular use of these phones is text messaging. A new study by Shapiro and colleagues from the University of North Carolina, Chapel Hill, published in J Nutr Educ Behav looks at the use of text messaging for monitoring sugar-sweetened beverages, physical activity, and screen time in children. Following a brief psychoeducational intervention (1 session weekly for 3 weeks), 58 children (age 5-13) were randomised to SMS with feedback, use of paper diaries (PD) or to a no-monitoring control (C) for 8 weeks. The education sessions aimed to encourage the kids to increase physical activity, decrease “screen time” and reduce consumption of sugar-sweetened beverages. All of the children were given pedometers to track the number of steps they took each day, as well as goals to meet for the number of steps taken, minutes of screen time and number of sugar-sweetened beverages consumed per day. The text messaging and paper diary groups answered three questions each day: (1) what was the number on your pedometer today?; (2) how many sugar-sweetened beverages did you drink today?; and (3) how many minutes of screen time did you have today? Unfortunately, only 31 kids (53%) completed the study (SMS: 13/18, PD: 7/18, C: 11/22). Children in SMS had somewhat lower attrition (28%) than both PD (61%) and C (50%), and significantly greater adherence to self-monitoring than PD (43% vs 19%, P < .02). While the authors conclude that text messaging may be a useful tool for self-monitoring healthful behaviors in children, I remain skeptical. Indeed, I am yet to be convinced that childhood obesity can be effectively addressed by targeting individual behaviours – a far more promising approach would be to change the overall environment (fewer pizza days, neighbourhoods that are condusive to walking to school and playing outside (less screen time), parents who have time to sit down with their kids for a home-cooked meal, etc.). Texting kids (or for that matter adults) to promote healthy living strikes me as little more than a gimmick, with minimal long-term impact, if at all. AMS Edmonton, Alberta
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