Dr. Sharma's Obesity Notes

Visualising vast epidemiological datasets as meaningful graphics is not always simple or straightforward.

Today, I would like to share with you a link to the Public Health Agency of Canada’s Chronic Disease Infobase.

It allows anyone to produce charts and graphics that profile the epidemiology of major non-communicable diseases in Canada, including obesity, cancers, and cardiovascular and respiratory diseases - by province/territory and by regional health unit.

The data sets include demographic, mortality, morbidity, risk factor and related health care data.

According to the Agency: “Chronic Disease Infobase uses advanced information technology to provide dynamic access to an extensive database.”

Every page that is generated retrieves data from the database on the fly, which means that every time you come back to Chronic Disease Infobase, you may get new information; since the database is updated as data become available.

Chronic Disease Infobase provides several display options. Multiple area comparisons, morbidity and mortality time trends, birth cohort mortality trends and proportional mortality trends are just some of the options. Thematic mapping with user friendly options is also available.

For readers more interested in global data, check out the WHO’s Global Infobase, which has similar tools for a global perspective.

Warning: These sites can be tremendous time killers - perfect for fellow procrastinators!

Enjoy!

AMS
Edmonton, Alberta

Hat Tip to Reader Billie-Jean for bringing this great tool to my attention!

Yesterday, I attended the annual Spring Meeting of CANNeCTIN (Canadian Network and Centre for Trials Internationally), a national network funded by the CIHR/CFI Clinical Research Initiative program to improve the prevention and treatment of cardiac and vascular diseases and diabetes.

CANNeCTIN is jointly led by Dr. Salim Yusuf, from Hamilton Health Sciences and McMaster University, and Dr. John Cairns, from the University of British Columbia. CANNeCTIN facilitates the development, conduct and leadership of large international clinical trials, registries and epidemiologic studies across Canada and the world.

As it so happens, yesterday, also saw the online publication in Diabetes Care of a paper I was involved in during my time in Hamilton on the ethnic variation of risk factors associated with obesity.

In this paper, we looked at the relationship between body weight (BMI), adipokines, and insulin resistance in 1,176 South Asian, Chinese, Aboriginal, and European Canadians in the SHARE study (Study of Health Assessment and Risk in Ethnic groups).

Adjusted mean adiponectin (a protein secreted by fat cells that improves insulin sensitivity) concentration was significantly higher in Europeans [12.9] and Aboriginals [11.8] compared to South Asians [8.8] and Chinese [8.5].

Serum leptin levels were also significantly higher in South Asians [11.8] and Aboriginals [11.1] compared to Europeans [9.2] and Chinese [8.3].

BMI and waist circumference were inversely associated with adiponectin in every group except the South Asians.

The increase in HOMA-IR (a measure of insulin resistance) for each given decrease in adiponectin was larger among South Asians and Aboriginals compared to Europeans.

Interestingly, a high glycemic index diet was associated with a larger decrease in adiponectin among South Asians and Aboriginals, and a larger increase in HOMA-IR among South Asians relative to other groups.

This study clearly shows that South Asians have the least favourable adipokine profile of the studied ethnic groups, and like the Aboriginal people, display a greater increase in insulin resistance with decreasing levels of adiponectin.

The reasons for these differences are not clear but we are studying possible mechanisms to explain these findings in South Asians in a “molecular” version of this study.

AMS
Hamilton, Ontario

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Mente A, Razak F, Blankenberg S, Vuksan V, Davis AD, Miller R, Teo K, Gerstein H, Sharma AM, Yusuf S, Anand SS, & for the SHARE, SHARE-AP investigators (2010). Ethnic variation in adiponectin and leptin levels and their association with adiposity and insulin resistance. Diabetes care PMID: 20413520

The link between lower socioeconomic status and obesity has been well documented (at least for Western women). While this is often attributed to the increased expense of healthy foods, it may well be that increased psychosocial stressors including food insecurity, low-walkability neighbourhoods, higher density of fast-food outlets, anxiety, depression and other mental health problems also contribute.

A new study by Eva Münster and colleagues from the University of Mainz, Germany, just published in BMC Public Health suggests that over-indebtedness may be a further factor in promoting weight gain. Over-indebtedness can be defined as lack of possible debt redemption in due time due to the relation of income and cost of living even after a remarkable cutback in standard of living.

Münster and colleagues examined data from a cross-sectional study on over-indebtedness and health including 949 over-indebted subjects from 2006 and 2007 and an independent representative telephone health survey of 8318 subjects.

After adjusting for socio-economic (age, sex, education, income) and health factors (depression, smoking), the over-indebted individuals were almost twice as llikely to be overweight and almost 2.5-times as likely to be obese than non-over-indebted individuals.

It is estimated that, as a result of the recent financial turmoil, about 3 million German households (7.6 %) corresponding to more than 6 million residents are currently over-indebted.

In their discussion, the authors focus heavily on the possible contribution of the expense of healthy foods, although they do acknoweldge the fact that at times of financial distress, individuals may be more preoccupied with issues other than living healthy lifestyles.

I would further suggest that the very same psychosocial behaviours that promote over-indebtness (risk-taking, impulsiveness, poor-planning, etc.) may also promote weight gain, especially in our current obesogenic environment.

At least the study suggests that there is little reason to assume that financial distress will result in people eating less - if at all, the opposite appears true.

AMS
Edmonton, Alberta

Just, when we thought things could not possibly get any worse, the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) on July 1 released a report, with the rather unfortunate name F as in Fat: How Obesity Policies Are Failing in America 2009.

According to this report, adult obesity rates increased in 23 states and did not decrease in a single state in the past year, while the percentage of obese and overweight children is now at or above 30 percent in 30 states.

Mississippi with its 32.5% rate of adult obesity, has the dubious honor of topping the list for the fifth year in a row. This brings the total number of states with obesity rates greater than 30% to four, including Mississippi, West Virginia (31.2 percent), Alabama (31.1 percent) and Tennessee (30.2 percent) - not that surprising, considering that 8 of the 10 states with the highest percentage of obese adults are in the South. Overall adult obesity rates now exceed 25 % in 31 states and exceed 20% in 49 states and Washington, D.C.

Colorado continues to have the lowest percentage of obese adults at 18.9 percent (this is not far from the Canadian average).

For the full News Release click here

For the Executive Summary of the Report (8 pages) click here

For the Full Report (108 pages) click here

Remember, the obesity epidemic is a health tsunami in slow motion!

AMS
Edmonton, Alberta

I’ve previously blogged on how research on social networks suggests that obesity may well be socially contagious!

So what about obesity in people who actually live together?

This question was now addressed by Natalie The and Penny Gordon-Larsen from the University of North Carolina, Chapel Hill, NC, USA, in a paper published this month in OBESITY.

The objective of this study was to examine whether romantic partnership and duration of living together are related to incident obesity and obesity-promoting behaviors, by which the development of obesity in one individual increases the risk of obesity in his/her spouse.

The researchers examined two large data sets from the National Longitudinal Study of Adolescent Health: (i) 6,949 US adolescents (wave II, 1996) followed into adulthood (wave III, 2001-2002) and (ii) 1,293 dating, cohabiting, and married romantic couples from wave III, including measured anthropometry and self-report behavior data.

Perhaps not surprisingly, the analysis clearly showed that individuals who transitioned from single/dating to cohabiting or married were markedly more likely to become obese than those who were just dating. 

For both men and women, living with a romantic partner for 1 year or more increased the likelihood of incident obesity by up to 3-fold compared to single/dating individuals. This risk became even stronger for couples who lived together more than 2 years.

Cohabiting/married couples reported less physical activity, more screen time and other sedentary behaviours that may promote weight gain. The authors also speculate about possible impact on portion size (the lean person gradually adapting to the obese partner’s eating habits and requirements).

From my own clinical practice, I can only confirm that a partner’s lifestyle is often reported as a significant barrier for weight control. In fact it is not at all unusual to find that the efforts of one partner struggling to control their own weight is blatantly sabotaged by the other (intimate saboteurs). This can take the form of continuing insistence on bringing home or preparing excessive amounts of high-caloric foods, preference of social activities that involve sedentary behaviours and excessive eating (and/or drinking), reluctance to use active transportation for social outings or to engage in regular shared physical activity,  etc.. 

In more than a few cases, I have seen longstanding romantic relationships breakup, when one partner ultimately insists on changing their own lifestyle, despite the complacency or sabotage from their spouse.

On the other hand, it is generally not easy to bring up the subject of weight in a relationship without this being seen as a personal attack (not unlike the difficulty of addressing excessive alcohol consumption, smoking, or mental health problems in a partner). It is often up to the obese partner to make the first move. 

Marriage-induced weight gain - certainly an interesting topic for family medicine!

AMS
Edmonton, Alberta