Tuesday, July 31, 2012

Medication (Over?) Use in Overweight Canadian Kids

Excess weight is often (but not always) associated with health problems, and the latter can certainly often contribute to weight gain – even in kids!

A study by Stefan Kuhle and colleagues from the University of Alberta, published in the Archives of Diseases of Childhood, shows that overweight and obese Canadian kids use more medications than do normal weight kids.

The authors compare medication use between normal weight and overweight children (n=2,087) in a nationally representative sample from the Canadian Health Measures Survey 2007/2009, a cross-sectional survey assessing indicators of health and wellness in Canadian.

While there was no difference in the frequency of prescription, over-the-counter and natural health product (NHP) medication use between normal weight and overweight/obese 6-11 year olds, overweight/obese 12-19 year olds reported the use of prescription medication about 60% more often than their normal weight peers, especially for nervous system and respiratory problems. On the other hand, they were about 50% less likely to report the use of NHP medications.

As the authors note,

“With an overweight/obesity prevalence of 28% in the sample and 59% higher medication costs, approximately 14% of drug expenditures in this age group may be attributed to overweight and obesity.”

Less concerning than the cost associated with this increased use of medications is the question of why these kids develop obesity and related health problems in the first place.

It is particularly noteworthy that the use of drugs for the treatment of obstructive respiratory disorders was almost twice as high in the overweight/obese kids than in their normal weight peers.

Given that asthma is notoriously overdiagnosed in obese adults, I wonder how much of these drugs may be overprescribed in these kids.

In my own experience in adults, many admit that symptoms of ‘asthma’ were often a convenient way of getting out of gym class (as were ‘menstrual’ cramps). Anecdotally, I have the impression that this was more commonly reported in my female patients, who often recall gym class during their peri-pubertal years as particularly unpleasant (the fact that they often had to wear bras before any of the other girls in their class did not exactly help).

Nevertheless, the numbers are concerning and certainly an indicator that overweight and obese kids may have more health problems than their peers.

I wonder how many of my readers can remember having to take asthma or other meds as kids and how these problems may have contributed to their current health status.

AMS
Edmonton, Alberta

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ResearchBlogging.orgKuhle S, Fung C, & Veugelers PJ (2012). Medication use in normal weight and overweight children in a nationally representative sample of Canadian children. Archives of disease in childhood PMID: 22833408

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Monday, July 30, 2012

Alcohol, Sleep Deprivation and TV Watching Drive Overeating

Regular readers are well aware that I am more interested in the ‘whys’ of why people eat than in the ‘whats’ of what they eat.

Now a paper by Colin Chapman and colleagues from Upsalla University, Sweden, published in the American Journal of Nutrition, looks at the key lifestyle drivers of overeating, with a particular focus on TV watching, sleep deprivation and alcohol consumption as studied in controlled laboratory settings with healthy volunteers.

Their search of the literature yielded 8 television studies, 5 sleep studies, and 10 alcohol studies.

All three of these factors had significant effects on food intake in the laboratory setting with alcohol having the strongest effect, followed by sleep deprivation and TV viewing.

With regards to the possible mechanisms on how these behaviours affect food intake, the authors have the following to offer:

Alcohol consumption:

“Alcohol is known to induce alterations in circulating ghrelin, a peptide implicated in food reward. In addition, alcohol affects g-aminobutyric acid and opioid systems. The alteration of g-aminobutyric acid signaling in reward centers of the brain stimulates appetite, and opioid signaling has been implicated in regulating the orosensory reward components of eating. These pharmacologic findings are consistent with human studies that showed a greater increase in hunger during the early phase of a test meal after an alcohol preload compared with an energymatched carbohydrate preload. This mimics the pattern of response shown when the palatability of food is enhanced through flavor manipulation.”

Sleep Deprivation:

“There is similar evidence that links sleep deprivation to an increase in the hedonic value of food. Sleep loss causes a constellation of metabolic and endocrine changes, including an increase in circulating ghrelin. Interestingly, recent studies on sleep deprivation have found that it increases overall brain response to palatable food image. In particular, short sleep increased activation in brain areas involved in reward processing, such as the putamen, nucleus accumbens, thalamus, insula, and anterior cingulate cortex. This strongly suggests that sleep deprivation, like alcohol, leads to deregulation of reward system activation in response to food.”

TV Watching:

“Several of the studies included in the meta-analysis found that the effect of television viewing on food intake was most pronounced with high-calorie foods, which suggests that television viewing alters the saliency of food reward. Epidemiologic studies have shown a similar trend, in that those who watch more television tend to snack more while watching and to consume more energy-dense snacks. Additional evidence suggests that watching images of palatable food increases plasma ghrelin concentrations.”

The implications of all of this, when seen in the context of habitual reinforcement and perpetuation of such behaviours are worth noting:

“With regard to the lifestyle factors analyzed, all three, when experienced habitually, should strengthen memory traces that trigger reward expectancy to food cues: that is, when presented with rewarding food or food cues, people who often suffer from sleep deprivation or who often watch television or drink alcohol while eating are more likely to experience a greater reward response as a result. In addition, both alcohol and television likely become their own conditioned cues for those who consume food in conjunction with these factors.”

The authors are optimistic that addressing these factors early on (especially in kids and young adults) may be important measures to reduce the risk of obesity. Thus, they cite evidence that curbing alcohol consumption, increasing sleep time and reducing TV viewing may all lead to decreased accumulation of body fat.

Based on these findings I guess it is time to lay off the night cap, turn off the TV and go to bed.

AMS
Edmonton, Alberta

p.s. Hat tip to Carlene for pointing me to this article.

p.p.s. Maintaining this blog costs both time and money – if you have enjoyed these posts, please consider making a small donation to the upkeep of this site by visiting my website by clicking here.

ResearchBlogging.orgChapman CD, Benedict C, Brooks SJ, & Schiöth HB (2012). Lifestyle determinants of the drive to eat: a meta-analysis. The American journal of clinical nutrition PMID: 22836029

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Sunday, July 29, 2012

Weekend Roundup, July 27, 2012

As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts:

Have a great Sunday! (or what is left of it)

AMS
Edmonton, Alberta

p.s. I have chosen not to monetize my blog but maintaining it does cost both time and money. If you have enjoyed and benefitted from the content of these pages please consider making a small contribution to the upkeep of this siteDONATE HERE

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Saturday, July 28, 2012

Hindsight: Three Decades of Obesity Research in Canada

Upon my arrival in Canada to take on the position of Canada Research Chair (Tier 1) in Cardiovascular Obesity Research and Management at McMaster University in 2002, I needed to familiarize myself with the Canadian obesity research community.

This is why, in a paper published in Obesity Research, we undertook a systematic look at all of the Canadian published obesity research since 1970.

Our search of medline and International Pharmaceutical Abstracts databases revealed a total of 1186 relevant articles: 17, 136, 687, and 346 articles during the 1970s, 1980s, 1990s, and 2000 to 2003, respectively.

Of the articles, 816 were considered original studies and accepted for our analysis.

Twelve research areas were identified: basic science involving animal experiments (29%), human experiments (16%), populations surveys (14%), obesity-related comorbidities (13%), diagnostic/surgical issues (11%), nonpharmacological approaches (7%), drug-related issues (4%), anthropometrics (2%), impact of weight loss (2%), cost/healthcare use (1%), attitudes/perceptions (0.9%), and models/procedures (0.5%).

Two-thirds of all research was conducted in Quebec (34%) and Ontario (33%).

From this analysis, we concluded that,

“Given the multifactorial nature of obesity, Canadian obesity research covers a broad range of areas with a predominance of basic science but lesser emphasis on community and primary care studies. Furthermore, there was a paucity of research on either clinical management of medical conditions in obese patients or clinical aspects that go beyond weight loss. Thus, although Canada appears well represented in basic research, more attention to exploration of clinical issues and healthcare delivery for obese patients appears warranted.”

Since then much has changed – a similar search today would reveal almost 5000 papers. This means that in the decade since this analysis, Canadian have published almost four times as many studies as during the entire three previous decades (1970-2003).

A cursory search on PubMed reveals that in the first 7 months of 2012 alone, there were more than 370 published articles on obesity from Canada – about the same number of the total publications in 2000-2003. In fact, the total number of publications this year will almost equal, if not exceed, the number of publications in the entire decade 1990-1999.

Interest and growth in obesity research is also reflected in the fact that the Canadian Obesity Network now has over 2000 (out of 7500), who identify themselves as obesity researchers.

In addition, the recent Canadian Obesity Network’s Student Meeting and Bootcamps clearly illustrate the diversity and breadth of obesity research in Canada.

In the most recent competition of the Canadian Institutes for Health Research, over $22 million were awarded to obesity research just a fraction of the funding available for obesity related research in Canada (but still a low figure given the relative impact of obesity on the health of Canadian).

Clearly, Canadian researchers are significantly contributing to our understanding of obesity, its causes as well as its prevention and management.

I am proud to be part of this community.

AMS
Station touristique Duchesnay, QC

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Friday, July 27, 2012

Another Successful Obesity Bootcamp

Today is the last day of another successful Summer Obesity Bootcamp – the 7th thus far.

Participants included students and trainees from across Canada, including the Universities of Calgary, Sherbrooke, Memorial, Toronto, Laval, Ottawa, Montreal, British Columbia, Queen’s, Western Ontario, Waterloo, and Concordia with even a few participants from Michigan State (USA), and Maringa (Brazil).

The excellent hand-picked trainees (certainly among the brightest in Canada) work in a wide range of fields, from gut hormones, adipokines, genetics, immunology and amino acid metabolism to diabetes, bone health, epicardial fat, and psychology. Other topics include promoting physical activity in children, improving nutrition labelling, understanding growth and weight trajectories, and weight gain during pregnancy in First Nations women.

For me the excitement is less in the formal presentations or the excellent science but rather in the social interactions with the trainees where we discuss everything from career plans to future angst to topics of general interest (in fact, one of the presentations I give deals with career planning).

This newly minted group of bootcamp graduates is just another instalment in what is now a tightly knit Canada-wide network (with some international outliers) of over 160 young men and women who will significantly influence how Canada deals with its obesity problems – both in prevention and treatment.

Congratulations to all of the trainees on completing the over 70 hrs of course work – thank you to all of my co-faculty for taking the time to share their knowledge and wisdom with the students – special thanks also you to Paul Boisvert (Laval) and all of the CON staff for putting all of this together.

Although funding this initiative is sure to remain a challenge, I certainly do look forward to future camps.

AMS
Station touristique Duchesnay, QC

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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