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Is Childhood Obesity Driven By Genetic Differences in Appetite?

sharma-obesity-dna_molecule9Genetics plays a big part in the development of childhood (and, for that matter, adult) obesity – some folks are simply more genetically prone to weigh gain than others.

Now a study by Silje Steinbeckk and colleagues from Norway, published in JAMA Pediatrics, suggests that while genetic factors are important, these may not act through an effect on appetite or eating behaviour.

The longitudinal study was conducted in a representative birth cohort at the Trondheim Early Secure Study, enrolled at age 4 years during 2007 to 2008, with follow-ups at ages 6 and 8 years. Analyses included 652 children with genotype, adiposity, and appetite data.

While there was clear effect of genetic risk (measured as a composite score of 32 genetic variants) on increase in body weight and fat mass), there was no clear relationship to appetite traits measured at age 6 years with the Children’s Eating Behavior Questionnaire.

Thus, the authors conclude that while genetic risk for obesity is associated with accelerated childhood weight gain, appetite traits may not be the most promising target for preventing excessive weight gain.

So if not through appetite, how do these genes increase the risk for weight gain. Obviously there are a number of possibilities ranging from subtle effects on energy metabolism, adipocyte differentiation or other factors that may not directly be related to eating behaviour.

Another possibility may well be that the instrument used to assess appetite traits may simply not be sensitive and reliable enough to capture subtle changes in ingestive behaviour.

Thus, while there is no doubt that genetic risk may well be a key determinant of childhood obesity, exactly how this effect is mediated remains unclear.

@DrSharma
Kelowna, AB

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Can Metformin Reduce Weight Gain In Pregnancy?

sharma-obesity-pregnancy5Excessive weight gain during pregnancy is a well-established risk factor for both mother and child.

Now a paper by Argyro Syngelaki and colleagues from the UK, published in the New England Journal of Medicine, suggests that the anti-diabetes drug metformin may limit weight gain in pregnant non-diabetic women with obesity and also reduce the incidence of pre-eclampsia.

The researchers randomised 450 pregnant women with a BMI greater than 35 and no diabetes to either metformin (3 g/day) or placebo from weeks 12-18 weeks of gestation till delivery in a double-blind fashion.

Among the 400 women who completed the study, those on metformin gained about 2 Kg less weight than the placebo group.

There was also an almost 75% decrease in the risk of developing preeclampsia.

Despite these effects, metformin did not significantly reduce the incidence of large-for-gestational-age babies or other adverse neonatal outcomes.

While these findings may be somewhat disappointing with regard to outcomes in the offspring, the reduction in pre-eclampsia is impressive and, if confirmed, could well be an interesting use of this compound in high-risk pregnancies.

@DrSharma
Kelowna, BC

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Childhood Obesity: Does Targeting Parents Work?

sharma-obesity-active-kidsIt is now widely recommended that addressing childhood obesity requires a whole-family approach with a focus on educating and helping parents provide a healthier environment for their children. This has sometimes resulted in the slogan, “treat the parents”.

But just how effective is this approach?

Now a study by Gisela Nyberg and colleagues from the Karolinska Institute in Stockholm, Sweden, published in the International Journal of Behaviour, Nutrition and Physical Activity, suggests that even this strategy may not be quite as effective as one would hope.

The study was designed to study the effectiveness of a universal parental support programme to promote health behaviours and prevent overweight and obesity in 6-year-old children in disadvantaged areas in Stockholm.

The cluster-randomised controlled trial involved 31 school classes with 378 six-year-old children. The 6 month interventions were 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children.

Overall, while there was some effect of the intervention on eating behaviour, there was no overall impact on physical activity levels.

There was also no change in BMI for the whole group, although there was small drop in BMI in kids at the higher range of the BMI spectrum, which disappeared at 5-months post-intervention.

The authors grasp at the fact that the effects of the intervention were short-lived to recommend that the programme needs to be prolonged and/or intensified in order to obtain stronger and sustainable effects.

Just how much longer or how much more intense the intervention would need to be is unclear.

These findings certainly reflect the real-life problem that we currently have no universally effective approach to dealing with childhood obesity (with parents or without).

Sadly, no one has yet demonstrated that any type of intervention for childhood obesity, whether individual, family, shool or community based, despite occasional short-term improvements in health behaviours and body weight, ultimately translates into fewer adults with obesity.

Perhaps, the best time to intervene to prevent childhood obesity is even before the kids are born.

@DrSharma
Edmonton, AB

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Guest Post: Assessing Tools For Preventing Childhood Obesity in Primary Care

Jillian Avis, PhD Candidate, University of Alberta, Edmonton

Jillian Avis, PhD Candidate, University of Alberta, Edmonton

Today’s guest post comes from Jillian Avis, PhD Candidate, Department of Paediatrics, University of Alberta, Edmonton

Primary care providers (e.g., family doctor, kinesiologist, registered dietitian) play a key role in preventing childhood obesity. To assist with obesity prevention, providers use a variety of tools and resources in clinical practice to (i) assess and monitor children’s weight status (e.g., body mass index growth charts), (ii) communicate children’s weight status with families (e.g., 5As of Pediatric Obesity), (iii) educate families on healthy lifestyle behaviors (e.g., Canada’s Food Guide), and (iv) facilitate behavior change (e.g., magnetic place models).

Although such tools are regularly used by providers, little is known regarding their use and suitability in practice. Thus, in a recent publication, our team pilot‐tested a mixed methods study to preliminary assess these tools – Do they work? Do providers like them? How are they used?

We conducted one‐on‐ one interviews with multidisciplinary primary care providers (n=19) from 10 primary care clinics in Edmonton and Calgary. Following the interviews, we compiled a comprehensive list of all tools used by providers, which were subsequently evaluated using three assessment checklists (e.g., Suitability Assessment of Materials).

Our findings show that most tools score ‘average’, and criteria on the checklists (e.g., readability level, layout, graphics) overlap with providers’ perceptions of tool suitability.

However, the checklist criteria do not reflect providers’ views regarding the logistical factors that impact accessibility, such as cost, distribution, and production.

Conclusions from our research highlight that to assess the overall suitability and assist those developing tools for childhood obesity prevention, objective scoring using checklists should be considered in conjunction with contextual factors and providers’ perceptions of suitability.

If you’re interested in following Jill’s research, visit her blog

@DrSharma
Edmonton, AB

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A Call To Action: Obesity In Children With Physical Disabilities

special needs kidsThere is no doubt that children growing up in today’s obesogenic environment are at greater risk of developing obesity than previous generations.

This is even more true for children with physical disabilities, who face even greater challenges when it comes to preventing or managing excessive weight gain. Unfortunately, not much is known about the extent of this problem or possible solutions.

Now a group of Canadian experts in paediatrics and rehabilitation have put out a Call to Action, published in Childhood Obesity, for a research agenda that focuses on this important sub-group of kids.

The call is the result of a Canadian multistakeholder workshop on the topic of obesity and health in children with physical disabilities that was held in October 2014.

The participants in the workshop included researchers, clinicians, parents, former clients with disabilities, community partners, and decision makers.

Given the paucity of research in this area, it is not surprising that the participants identified over 70 specific knowledge gaps that fell into 6 themes: (1) early, sustained engagement of families; (2) rethinking determinants of obesity and health; (3) maximizing impact of research; (4) inclusive integrated interventions; (5) evidence-informed measurement and outcomes; and (6) reducing weight biases.

Within each theme area, participants identified potential challenges and opportunities related to (1) clinical practice and education; (2) research (subareas: funding and methodological issues; client and family engagement issues; and targeted areas to conduct research); and (3) policy-related issues and topic positioning.

Recommendations emerging from the workshop’s multistakeholder consensus activities included: 

  1. Children’s and families’ needs must be integrated into prevention and treatment programs, taking into account the additional caring commitments and environmental challenges often experienced by families of children with physical disabilities. Guidelines need to be developed regarding how best to engage children/families meaningfully in designing both clinical interventions and health promotion research initiatives.

  2. Research in obesity and health in children with physical disabilities should be guided by a conceptual model, determining both common and unique determinants of health and obesity compared with their typically developing peers. A conceptual model enables existing knowledge about obesity prevention and management from other populations to be integrated into approaches for children with physical disabilities where appropriate, as well as the identification of areas where disability-specific knowledge is still needed. It is critical that any such model incorporates social and environmental factors that can affect both weight and health, rather than locating responsibility within the individual by default.45 The alignment of our model with the ICF ensures that our approach remains truly biopsychosocial.

  3. Valid, reliable, clinically appropriate, and acceptable outcome measures are urgently needed in order to monitor children’s weight and health, and identify overweight and obesity, where conventional outcomes (e.g., BMI) alone have been shown as suboptimal.

As the authors note,

“Canadian researchers are now well positioned to work toward a greater understanding of weight-related topics in children with physical disabilities, with the aim of developing evidence-based and salient obesity prevention and treatment approaches.”

Hopefully, they will now find the funding required to do the work.

@DrSharma
Edmonton, AB

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