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Should Prevention of Childhood Obesities Start In The Womb?



Regular readers will recall the accumulating evidence that maternal health and weight before and during pregnancy may have a substantial influence on the risk of excessive weight gain in their offspring, most likely resulting from epigenetic programming in utero.

A study by Mina Desai and colleagues from the University of California Los Angeles, just published in Brain Research, now suggests that intra-uterine genetic adaptation may have a substantial influence on the growth and development neurons that regulate appetite and energy homeostasis.

The researchers examined the hypothesis that a programmed impairment of neural progenitor cells (NPC) may contribute to altered hypothalamic neural pathways that control feeding behaviours in the development of low-birth-weight (LBW) offspring.

In their study, they examined hypothalamic NPCs in the brains of pups born to food restricted and unrestricted mice and showed that the LBW offspring born to the former had impaired in vivo evidence of NPC division and migration, and reduced in vitro evidence of proliferation and differentiation to neurons and astrocytes, under basal and when stimulated with the appetite-regulating hormones insulin and leptin.

These studies show that the environmental exposure of the mother can significantly affect the brain development of offspring in areas essential for appetite and energy control.

Although these findings come from animal studies, the association between adverse in utero factors, resulting in either low or too-high birth weight babies, and excess weight gain in kids, youth and adults has been accumulating in human studies.

Thus, these findings, add considerable plausibility to the postulated relationship between maternal health and fetal programming of appetite and energy regulation increasing the propensity to obesity later in life.

AMS
Edmonton, Alberta

Desai M, Li T, & Ross MG (2011). Hypothalamic neurosphere progenitor cells in low birth-weight rat newborns: Neurotrophic effects of leptin and insulin. Brain research, 1378, 29-42 PMID: 21215735

14 Comments

  1. In their study, they examined hypothalamic NPCs in the brains of pups born to food restricted and unrestricted mice and showed that the LBW offspring born to the latter had impaired in vivo evidence of NPC division and migration, and reduced in vitro evidence of proliferation and differentiation to neurons and astrocytes, under basal and when stimulated with the appetite-regulating hormones insulin and leptin.

    So, you’re saying that low birth weight pups born to mice with an unrestricted diet have an abnormal response to appetite-regulating hormones, possibly contributing to later obesity?

    I’m struggling with how to interpret that. First, it seems counterintuitive that mice with unrestricted diets would have low birth weight pups. Does this indicate some unrelated problem? Wouldn’t mice with restricted diets be more likely to have low birth weight pups? Do those pups have the same issues?

    Also, what about normal and high birth weight pups born to mice with unrestricted diets?

    I know that this isn’t my area of expertise, but that piece of information seems impossible to interpret out of context, as it’s presented here and in that study’s abstract.

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  2. “low birth weight pups born to mice with an unrestricted diet have an abnormal response to appetite-regulating hormones, possibly contributing to later obesity?”

    oops, thanks for spotting the typo – the LBW pups were of course born to the ‘restricted’ mice.

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  3. One minor quibble … you may mean to include diet in the concept of “maternal health and weight before and during pregnancy” but I think it’s worth being explicit about it.

    It’s probably not just folic acid that pregnant women need in their diets to have healthy babies!

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  4. Maternal health and weight before and during pregnancy is essential for children prenatal health.

    Maternal weight before and during pregnancy isn’t so important as long as there is not too much excessive fat mass.

    Too much excessive fat mass before and during pregnancy may affect prenatal health.

    It is still debatable to which extent excessive gain of the fat mass during pregnancy affects prenatal health and prenatal child development.

    The only fact that shouldn’t be debatable is; any known program for weight loss negatively affects maternal health before and during pregnancy.

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  5. “The only fact that shouldn’t be debatable is; any known program for weight loss negatively affects maternal health before and during pregnancy.”

    It is important not to confuse “weight-loss” with “weight-management”, which includes prevention of excessive weight, weight stabilisation, and/or modest weight loss as indicated.

    As reported in previous posts – there is now clear evidence that weight management in pregnancy can reduce maternal and fetal risk.

    Also, so far, believe it or not, the best outcomes with regard to reducing offspring risk in this context interestingly come from long-term observations in mothers who have undergone bariatric surgery!

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  6. Just my own anecdote: I was born 10 1/2 months after my sister, and I suspect that my mother hadn’t recovered nutritionally from the pregnancy. She was proud that she only gained 30 lb. during my pregnancy. I weighed 4 lb. I’m not obese, but I’ve ranged the whole degree of the overweight scale, and I have diabetes, which neither my parents nor anyone else in my generation has. I just wonder whether there actually is a relation.

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  7. Arya M.Sharma, MD says: March 14th 2011 at 4:08 pm
    “It is important not to confuse “weight-loss” with “weight-management”, which includes prevention of excessive weight, weight stabilisation, and/or modest weight loss as indicated.”

    I think that I have been misunderstood. I was referring to any known weight loss program before and during pregnancy. Weight loss and weight gain before and during pregnancy happens by women without practicing any program for weight loss.

    Many women, obese and not obese, are affected with negative health conditions during pregnancy. The fact that negative health conditions during pregnancy is more prevalent among obese women doesn’t mean that it is caused by weight gain during pregnancy or before pregnancy, but this all points out that it is caused by weight loss programs like diet pills, restriction of food intake, excessive physical activity or combination of those factors.

    Arya M.Sharma, MD says: March 14th 2011 at 4:08 pm
    “As reported in previous posts – there is now clear evidence that weight management in pregnancy can reduce maternal and fetal risk.”

    I may be wrong but your previous post refers to the study on rats that claim that weight management based on restriction of food intake in pregnancy can reduce maternal risk. In the case that I am right, I have one question; is the study on rats the only study which is based on the belief that a restriction of food intake during pregnancy can reduce maternal and fetal risk?

    Arya M.Sharma, MD says: March 14th 2011 at 4:08 pm
    “Also, so far, believe it or not, the best outcomes with regard to reducing offspring risk in this context interestingly come from long-term observations in mothers who have undergone bariatric surgery!”

    Sorry, I don’t believe that undergoing bariatric surgery before pregnancy reduces offspring risk, but I believe that undergoing bariatric surgery negatively effects prenatal development and may have serious consequences for postnatal and early child health and development.

    It is dangerous even to think to undergo bariatric surgery during pregnancy and I hope that no one will come to idea to even suggest pregnant women to undergo bariatric surgery.

    There are plenty of questions about post bariatric surgery health outcome, but I think that most important questions are;
    1. Why people lose some percentage of excessive weight loss on bariatric surgery when they couldn’t lose by trying everything else.
    2. What is the underlining mechanism of weight loss induced by bariatric surgery?

    I think that people does not lose weight after bariatric surgery because of possible decreased food intake but for some other reason.

    The mechanism of weight loss induced by any WLS I have explained in the article “Weight Loss Surgeries, Weight Loss, Diabetes and the Biomechanics of Sitting and Walking” The link to the article is: http://www.biomechanicsandhealth.com/wlsandtype2diabetes.htm

    Please take a look, and if you or anybody else has any question I will be glad to give an answer.

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  8. No one advocates WLS during pregnancy and we certainly advise all patient to avoid pregnancy during the first 2 years following bariatric surgery. But thereafter – the advantages for both mom and kids appear to be quite significant.

    See: http://www.drsharma.ca/obesity-research-pregnancy-and-fertility-after-bariatric-surgery.html

    The basic mechanism of weight loss after bariatric surgery is a marked reduction in ‘effective’ caloric intake – a caloric intake that low would be very hard to sustain for most people without surgery (which is why they put the weight back on). The reason this low caloric intake is sustainable is because of profound changes to hormones that regulate hunger, satiety and metabolism.

    Of course, as with any treatment, not every patient is successful with bariatric surgery but the statistical chances of success are far greater than with diet and exercise alone.

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  9. I find it REALLY hard to believe that women with damaged digestive systems and the resulting nutritional deficiencies would have better pregnancy outcomes than healthy fat women. Were they using a clinical population as the control group or something?

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  10. There are many factors that impact fetal health during pregnancy — I am more worried about low birth weight and prematurity than eventual obesity, and women worrying about eating too much during pregnancy can have the impact of babies that are too small or born too soon.
    It’s my understanding that the quality of the diet of pregnant mothers, and sufficient nutritional quality are most important. Insuring that women have access to foods that provide appropriate nutrition are what I am most concerned about.
    Women are already under so many pressures when they are pregnant, adding a worry about whether what they eat during pregnancy will produce a “fat child” is a bit too much.
    I think about the “hunger winter” studies and again think that we need to worry about women getting sufficient nutrition in order to prevent health problems in the children that they will have once those children grow up.

    DeeLeigh — I think that the studies have shown that for women who get pregnant relatively soon after having had the surgery — their bodies can “handle it” without a negative impact on the fetus and eventual baby that is born. I don’t know what the long-term impact is on their own nutritional status. I think that during pregnancy, a whole different metabolism enters the picture that makes sure the fetus gets what it needs, often to the detriment of the mother’s own nutritional needs. So, it’s possible that the babies are healthy but I don’t know about the moms’ health.

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  11. Arya M.Sharma, MD says: March 15th 2011 at 6:57 pm
    “But thereafter – the advantages for both mom and kids appear to be quite significant. See: http://www.drsharma.ca/obesity-research-pregnancy-and-fertility-after-bariatric-surgery.html

    There are a few studies relating to mothers who have undergone bariatric surgery involving laparoscopic adjustable gastric band surgery or widely known as a lap band surgery. Taking into account that lap band surgery is mostly effective by moderate obesity. It seems to me that the women who have undergone bariatric surgery involving laparoscopic adjustable gastric band surgery were far less obese at the time of surgery than women who didn’t undergo bariatric-lap band surgery.

    It seems to me that the level of obesity is the main reason for the difference in maternal complication rates, because women who become pregnant after having had bariatric-lap band surgery where affected with moderate obesity, and women who didn’t undergo a type of bariatric-lap band surgery they were affected with serious obesity before and during pregnancy.

    Furthermore, it seems to me that very likely those women who have undergone bariatric surgery involving laparoscopic adjustable gastric band surgery weren’t affected with adverse health consequences caused by obesity, and women who didn’t underwent a type of bariatric-lap band surgery very likely due to obesity level, were affected with adverse health conditions.

    That is my opinion based on inconclusive data from that study (JAMA. 2008 Nov 19;300(19):2286-96.). To have a more productive discussion related to bariatric surgery involving laparoscopic adjustable gastric band surgery and maternal complication rates requires a rigorous study about that subject.

    However, bariatric surgery involving laparoscopic adjustable gastric band surgery alters digestive organ (stomack) but does not do permanent damage and it is reversible. On the other hand, there is quite a different story with other types of bariatric surgery that damage and permanently alter the digestive system and are irreversible.

    At this stage of knowledge, it should be clear that women at a reproductive age shouldn’t undergo any kind of irreversible types of bariatric surgery.

    Arya M.Sharma, MD says: March 15th 2011 at 6:57 pm“
    The basic mechanism of weight loss after bariatric surgery is a marked reduction in ‘effective’ caloric intake- ..”

    I don’t agree with that explanation but I already wrote a long post and because of that, I will post my comment on that subject tomorrow.

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  12. Arya M.Sharma, MD says: March 15th 2011 at 6:57 pm“The basic mechanism of weight loss after bariatric surgery is a marked reduction in ‘effective’ caloric intake- ..”

    I wrote a reply, but I realised that you mentioned the words ‘effective’ caloric intake.
    It is the first time that I hear for “effective caloric intake”, and I am not sure what it means. It seems to me a new theory about fat mass formation. To explain more why I am confused, I will point out a few facts about the science of obesity.

    Weight loss treatment involving dieting, increased physical activity, diet pills and bariatric surgeries was invented when obesity scientists believed that every single calories in food intake if not spent will be stored. Those believe was in line with the anabolism and catabolism theory. At those times, the theory “calories in – calories out was unquestioned scientific dogma.

    A few years back, it was realized that a significant amount of food intake lives in the body as metabolic waste. There was a little confusion, but another theory was quickly invented. It was a “calories in – calories out over a prolonged period of time”. This theory is widely known as “the energy balance”.

    In 2007 I have debunked the “energy balance paradigm”.

    I would like very much to continue this discussion about the mechanism underlining weight loss induced by bariatric surgery, but it will be very productive beforehand to know what ‘Effective’ Caloric intake means.

    I was searching the internet for some time and I couldn’t find anything that mentions “effective calories” or “effective caloric intake”. I would very much appreciate if you find the time to explain what ‘Effective’ Caloric intake means.

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  13. “it will be very productive beforehand to know what ‘Effective’ Caloric intake means.”

    In the context of malabsorbtive bariatric surgery, the term “effective” refers to the proportion of ingested calories that are actually available to the organism. If you eat 1700 calories, but 300 of those calories (e.g. 35 g of fat) are undigested and unabsorbed (and excreted in your stool), your ‘effective’ caloric intake is 1400 calories.

    With regards to your ‘debunking’ of the laws of physics, you may wish to read my previous posting: http://www.drsharma.ca/eating-more-calories-increases-weight-in-some-people-maybe-sometimes.html

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  14. Arya M.Sharma, MD says: March “…you may wish to read my previous posting: http://www.drsharma.ca/eating-more-calories-increases-weight-in-some-people-maybe-sometimes.html

    Somewhere around December of 2010 I found your blog and since then, I have been a regular reader. I find your approach to the problem of obesity very interesting, and in certain points very innovative. Because of that, I was looking to find a way to engage in a productive discussion with you. A public discussion is not the best way to discuss disagreements on certain points, but I don’t have any other opportunity.

    Arya M.Sharma, MD says: March
    “With regards to your ‘debunking’ of the laws of physics, ….”

    There must be a misunderstanding. I have never said that there is something wrong with the laws of physics. As I said in my previous post, “I have debunked the energy balance paradigm”as an intellectual model in an approach to understand fat mass formation and the cause of obesity.

    Please, take a look in the article “Misconception about Energy Balance and Weight Gain-Weight Loss”. The link to the article is: http://www.biomechanicsandhealth.com/energybalance.htm

    Since early 2010, “The Association for the Study of Obesity (ASO)”, the United Kingdoms foremost organisation dedicated to the understanding and treatment of obesity, has removed from their website everything that mentioned calories in – calories out and the energy balance. The ASO used to run the ORIC, the Obesity Resource and Information Centre. The ORIC disappeared from the internet in the early 2010.

    In your post from Tuesday, March 15, 2011,”Does Globalisation Lead to Obesities” you have mentioned the Foresight Map. Well, the UK Government’s Foresight Report ‘Tackling Obesities: Future Choices’, in 2007, 2008 and 2009 involving around 100 obesity scientists, was based on the “Energy Balance Paradigm”. It appears that all Foresight UK work related to the problem of obesity was not only fruitless, but it was also misleading. It seems that since early 2010, Foresight UK doesn’t do any work on the obesity problem.

    It appears that the “calories in – calories out” and the “energy balance paradigm” as a basis of understanding obesity have been abandoned by UK obesity researchers.

    I already wrote a long post and because of that, I will post my reply on the rest of your post on Monday. I am sorry that I will not be able to post earlier because I will be away from home on the weekend.

    I wish you and all the readers of this blog a good weekend.

    L. T.

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