Friday, November 30, 2012

Pediatric Obesity Stories

Usually, the most powerful stories come from the people (in this case kids) living with the issue.

A new website feature some of the work by pre-med and public policy students on the kids participating in Duke University’s Healthy Lifestyles program (Dr. Sarah Armstrong).

Eight short multimedia pieces feature the first-person stories of the kids and their families.

These efforts are part of the “Documenting Medicine Program” at the Duke University Center for Documentary Studies.

A very powerful document on childhood obesity and how kids and their families are trying to deal with this problem.

AMS
Edmonton, Alberta

Hat tip to Pamela Brett-MacLean, Director, Arts & Humanities in Health & Medicine at University of Alberta

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Tuesday, November 20, 2012

Do Child Care Centres Promote Obesity?

One of the often ignored factors in the childhood obesity epidemic is the fact that working parents have less time to devote themselves to the nutritional and emotional needs of their children than in families with at least one stay-at-home parent.

This has, in some circles led to discussions whether such parental home care can be replaced by putting the kids in childcare centres.

A study by Marie-Claude Geoffroy and colleagues from the University College London, UK, published in the Journal of Pediatrics now reports that preschool daycare may substantially increase the risk for overweight and obesity in kids.

The study looks at 1600 kids enrolled in a prospective birth cohort in Quebec, Canada with information on child care arrangements (center-based/family-based/care by a relative/nanny) and other relevant variables at ages 1.5, 2.5, 3.5, and 4 years in relationship to measured weights and heights at ages 4, 6, 7, 8, and 10 years of age.

Despite adjusting for several potential confounding factors (including socioeconomic position, breastfeeding, maternal employment, and maternal body mass index), children who attended a center-based childcare were about 65% more likely to be overweight or obese in childhood (4-10 years) than kids in parental care.

Similarly, kids cared for by a relative were about 50% more likely to be overweight or obese.

Further analyses suggested that for each increment of 5 hours spent in either center-based or relative childcare, the odds of overweight/obesity in the first decade of life increased by 9%.

As the authors point out, it may be time to carefully scrutinize the “obesogeonic” features of childcare arrangements in comparison to parental care.

As noted previously on these pages, when parents have more important issues to deal than being home to raise their kids, their offspring may well be at increased risk of obesity – a fact that is often lost (or rather ignored) in public health discussion on the the root causes of the childhood obesity epidemic.

I wonder how my readers feel about the impact of non-parental childcare on childhood weight management.

AMS
Edmonton, Alberta

ResearchBlogging.orgGeoffroy MC, Power C, Touchette E, Dubois L, Boivin M, Séguin JR, Tremblay RE, & Côté SM (2012). Childcare and Overweight or Obesity over 10 Years of Follow-Up. The Journal of pediatrics PMID: 23140878

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Monday, November 19, 2012

Sexual Function and Obesity

Excess weight can have a significant effect on sexual function.

A recent paper by Ronnie Kolotkin, Durham, NC, published in OBESITY, presents a systematic review of the literature on the relationship between obesity and sexual functioning.

Based on 11 population studies, 20 cross-sectional, and16 weight-loss studies the authors find a robust and consistent negative impact of obesity on sexual functioning.

Thus, in men, erectile dysfunction (ED) is most commonly associated with excess weight.

On the other hand, women with excess weight tend to generally report greater problems with various aspects of sexual desire, arousal and function.

Most weight loss studies have shown significant improvements in sexual function despite, as the authors note, varying study designs, weight loss methods, and follow-up periods.

Based on their review, the authors recommend that future studies

1) investigate differences and similarities between men and women with respect to obesity and sexual functioning,

2) use instruments that go beyond the assessment of sexual dysfunction to include additional concepts such as sexual satisfaction, interest, and arousal and,

3) assess how and the degree to which obese individuals are affected by sexual difficulties.

The authors also recommend that sexual functioning should be more fully addressed by clinicians, both in general practice and in weight loss programs.

AMS
Edmonton, Alberta

ResearchBlogging.orgKolotkin RL, Zunker C, & Ostbye T (2012). Sexual Functioning and Obesity: A Review. Obesity (Silver Spring, Md.) PMID: 22522887

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Sunday, November 18, 2012

Weekend Roundup, November 16, 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, AB

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Saturday, November 17, 2012

Hindsight: Retinol-Binding Protein 4 in Adipose Tissue

With good access to both adipose tissue biopsies and primary cultured human adipocytes, in the early 2000s, my lab in Berlin continued to conduct a number of exploratory studies on protein expression in human fat tissue.

In 2006, we published a paper in Diabetes, in which we reported the expression of retinol-binding protein 4 in human adipose tissue and showed that it behaved differently than in rodents.

Previous studies in mice had suggested that adipocytes serve as glucose sensors and regulate systemic glucose metabolism through release of serum retinol-binding protein 4 (RBP4).

We did find that RBP4 was highly expressed in isolated mature human adipocytes and secreted by differentiating human adipocytes, however, in contrast to the animal data, RBP4 mRNA was downregulated in subcutaneous adipose tissue of obese women, and circulating RBP4 concentrations were similar in 74 normal weight, overweight, and obese women.

We also found that RBP4 was positively correlated with GLUT4 expression in adipose tissue, independent of any obesity-associated variable.

Five percent weight loss slightly decreased adipose RBP4 expression but did not influence circulating RBP4.

In another set of experiments, we stratified 14 volunteers by low or high basal fasting interstitial glucose concentrations, as determined by in-vivo microdialysis technique. Venous glucose concentrations were similar throughout oral glucose tolerance testing, and basal RBP4 expression in adipose tissue and serum RBP4 concentrations were similar in the groups with higher and lower interstitial glucose levels.

Thus, our findings revealed profound differences between what was previously reported in rodents and what we found in humans in the regulation of adipose or circulating RBP4 – in contrast to rodents, it appears that glucose uptake by human adipocytes is not an important determinant in the regulation of RBP4.

Since then, extensive work on the role of RBP4 in glucose homeostasis has continued, which probably explains why this paper has been cited over 240 times.

Edmonton, AB

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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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