Thursday, July 17, 2014

Infant Antibiotic Exposure and Obesity Risk

sharma-obesity-gut-buts1With all the interest in the role of the gut bacteriome in the development of obesity, it was only a matter of time before someone examined the relationship between antibiotic use and obesity risk.

This is exactly what Anita Kozyrskyj and colleagues from the University of Alberta, Edmonton, Canada, explored in a paper now published in the International Journal of Obesity.

For their study they linked rovincial healthcare records to clinical and survey data from a Canadian longitudinal birth cohort study, whereby antibiotic exposure during the first year of life was documented from prescription records.

Overweight and central adiposity were determined from anthropometric measurements at ages 9 (n=616) and 12 (n=431) years.

According to this analysis, infants receiving antibiotics in the first year of life were about twice as likely to be overweight later in childhood compared to those who were unexposed.

However, after adjustment for birth weight, breastfeeding, maternal overweight and other potential confounders, this association persisted in boys but not in girls. The reason for this discrepancy is not clear.

Although these findings are in line with the notion that early use of antibiotics may predispose to obesity, it is important to not that these type of studies cannot prove causality.

It may well be that other non-measured factors could explain this association (e.g. overprotective or lower SES parents may be more likely to use antibiotics in their infants – both factors are independently associated with higher rates of obesity).

Nevertheless, given the rather high rates of antibiotic exposure in infants it appears that this may well be a promising area for further research not just in the context of obesity but also for many of the other conditions that are now believed to be influenced by intestinal flora.

@DrSharma
Edmonton, AB

ResearchBlogging.orgAzad MB, Bridgman SL, Becker AB, & Kozyrskyj AL (2014). Infant antibiotic exposure and the development of childhood overweight and central adiposity. International journal of obesity (2005) PMID: 25012772

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Wednesday, June 18, 2014

4th Canadian Obesity student Meeting (COSM 2014)

Uwaterloo_sealOver the next three days, I will be in Waterloo, Ontario, attending the 4th biennial Canadian Obesity Student Meeting (COSM 2014), a rather unique capacity building event organised by the Canadian Obesity Network’s Students and New Professionals (CON-SNP).

CON-SNP consist of an extensive network within CON, comprising of over 1000 trainees organised in about 30 chapters at universities and colleges across Canada.

Students and trainees in this network come from a wide range of backgrounds and span faculties and research interests as diverse as molecular genetics and public health, kinesiology and bariatric surgery, education and marketing, or energy metabolism and ingestive behaviour.

Over the past eight years, since the 1st COSM was hosted by laval university in Quebec, these meetings have been attended by over 600 students, most presenting their original research work, often for the first time to an audience of peers.

Indeed, it is the peer-led nature of this meeting that makes it so unique. COSM is entirely organised by CON-SNP – the students select the site, book the venues, review the abstracts, design the program, chair the sessions, and lead the discussions.

Although a few senior faculty are invited, they are largely observers, at best participating in discussions and giving the odd plenary lecture. But 85% of the program is delivered by the trainees themselves.

Apart from the sheer pleasure of sharing in the excitement of the participants, it has been particularly rewarding to follow the careers of many of the trainees who attended the first COSMs – many now themselves hold faculty positions and have trainees of their own.

As my readers are well aware, I regularly attend professional meetings around the world – none match the excitement and intensity of COSM.

I look forward to another succesful meeting as we continue to build the next generation of Canadian obesity researchers, health professionals and policy makers.

You can follow live tweets from this meeting at #COSM2014

@DrSharma
Waterloo, Ontario

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Tuesday, June 17, 2014

US Obstetricians and Gynecologists Weight In On Ethical Obesity Care

ACOG_Logo.svg_This month the the Committee on Ethics of the American College of Obstetricians and Gynecologists released a position statement on obesity that advices its fellows to be prepared to meet the challenges of women with obesity with compassion and without bias.

The statement offers the following recommendations and conclusions:

  • Physicians should be prepared to care for obese patients in a nonjudgmental manner, being cognizant of the medical, social, and ethical implications of obesity.
  • Recommendations for weight loss should be based on medical considerations.
  • An understanding that weight loss entails more than simply counseling a woman to eat less and exercise more and a willingness to learn about the particular causes of a patient’s obesity will assist physicians and other health care professionals working with them in providing effective care.
  • Physicians can serve as advocates within their clinical settings for the necessary resources to provide the best possible care to obese women.
  • It is unethical for physicians to refuse to accept a patient or decline to continue care that is within their scope of practice solely because the patient is obese. However, if physicians lack the resources necessary for the safe and effective care of the obese patient, consultation or referral or both are appropriate.
  • Physicians should work to avoid bias in counseling regardless of their own body mass index status.
  • Obesity education that focuses on the specific medical, cultural, and social issues of the obese woman should be incorporated into physician education at all levels.

The entire statement is available here.

It would certainly be nice to see similar statements from other professional bodies (e.g. orthopedic surgeons).

Hopefully, these recommendations will soon be reflected in clinical practice.

@DrSharma
Edmonton, Alberta

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Monday, June 2, 2014

There Has Not Been A Single Success Story in National Obesity Prevention in The Past 33 Years

sharma-obesity_global_obesity_mapJust back from the 21st European Congress on Obesity, I missed out on 100s of media interviews I could have done last week as the media were abuzz with the latest obesity statistics from around the world.

In what will clearly be considered a “landmark” paper by ~150 authors published in The Lancet, we now have the latest summary of global, regional and national data on obesity.

Based on the analyses of almost 1800 surveys, reports, and published studies, the worldwide prevalence of adults with a body-mass index (BMI) of 25 kg/m2 or greater increased between 1980 and 2013 from 29 6o 37% in men and from 30 to 38% in women.

In 2013, 23% of children and adolescents in developed countries were overweight or obese while the same is true for about ~12% of kids in developing countries.

Together, this leave about 2.1 billion of the world populations as currently overweight or obese with numbers growing in virtually every region of the world (albeit with a bit of a slow down in developed countries).

Thus, the authors conclude that,

Not only is obesity increasing, but no national success stories have been reported in the past 33 years.

Obviously, there are many reasons why we lack success stories.

No doubt, one could point to governments that have not tried hard enough, or the food and leisure industry that sustains its overwhelming influence on consumer “choices”, or the continuing “westernization” of global lifestyles.

No doubt, many policies have been tried (e.g. fat taxes, menu labelling, school food programs, fitness taxes, BMI report cards as well as more drastic “shame and blame” tactics) but conclusive evidence that any such measures are working to reverse the tide remains elusive.

It may well be that the flattening of obesity (but not severe obesity) rates in developed countries may have more to do with the “natural” history of this epidemic, than with any public health measures.

On the other hand, perhaps the reason so little progress has been made in preventing obesity is that we are not going after the right targets, namely to change the actual life experiences of overworked, sleep deprived, stress-out families living in a culture of “grabbing a bite” and “working lunches” at one end and the millions living with poor education and food insecurity at the other. No amount of fiddling with menu labelling is about to change that.

What is sad in all of this is the simple fact that virtually no government has yet developed a comprehensive plan on how to improve access to obesity treatments for its populations. Rather, overweight and obese people the world over continue to be denied medical care for this disease on the simple basis that it is their own “fault”.

So while the world awaits the wonder of “prevention” to hopefully one day work its magic, millions of people around the world continue struggling on their own with no help in sight.

Let me guess what will happen as a result of these new numbers – not much!

@DrSharma
Edmonton, Alberta

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Monday, May 26, 2014

Does Short-Term Weight Loss Reduce Cardiovascular Risk?

sharma-obesity-weight-gainIf you believe recent media headlines describing the findings of a paper published in The Lancet last week, you may be convinced that any weight loss – even if you don’t keep the weight off – reduces your risk for cardiovascular disease.

The study, reports on the relationship between lifelong patterns of BMI and cardiovascular risk a 60-64 year-old British  birth cohort born in 1946.

Participants were classified as normal weight or overweight or obese based on heights and weights measured during childhood (at ages 2, 4, 6, 7, and 11 years) and adulthood (at ages 36, 43, 53 and 60–64 years).

As may be expected, various measures of cardiovascular and metabolic risk factors were positively related to extent and duration of adiposity.

There were, however, two findings that may seem rather unexpected:

Firstly, adiposity in childhood did not seem to matter as a predictor of CV risk in adulthood.

Secondly, it appeared that individuals who dropped at least one BMI category at any time during adulthood, irrespective of whether or not this weight loss was maintained, had lower cardiovascular (but not diabetes) risk than did those who never lost weight.

From these findings the authors conclude that,

…cardiovascular benefit might arise from weight loss in adulthood, irrespective of when this weight loss is achieved, and support public health policies for lifestyle modifications for prevention and management of overweight and obese individuals at all ages.

While it is easy to see why sustaining weight-loss as an adult (particularly if you have risk factors for cardiovascular disease) may well be beneficial, it is hard to imagine a plausible biological pathway that would link a “short-term” weight loss to long-term improvements in cardiovascular risk.

Indeed, the authors provide no explanation for their findings. They also provide no further information on the people who lost weight compared to the people who did not.

My first response would be to look for biological plausible confounders – were people who lost weight at anytime as adults perhaps more conscious or concerned about their health than those who did not? Or, were they more metabolically healthy to start with?

Let us also not forget that this was merely an observational study – association does not prove causality.

This is not to say that the findings are entirely implausible. There is some literature on the long-term “legacy effect” of lifestyle interventions on metabolic risk factors – but the biological basis for this is unknown and some colleagues doubt wether this effect really exists.

Given that weight regain is rather common after weight loss, it will be interesting to see if other studies can demonstrate lasting benefits of short-term weight loss.

At this time some scepticism may well be warranted.

@DrSharma
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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