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Dietary Intervention For Polycystic Ovary Syndrome in Adolescents

sharma-obesity-pcos1While there is evidence that weight loss can be beneficial for the treatment of polycystic ovary syndrome (PCOS), there are few studies that have actually done this in a controlled fashion – even fewer in adolescents.

To test the feasibility of a dietary intervention aimed at weight loss in adolescents, Wong and colleagues from Boston Children’s Hospital, conducted a study, the results of which are published in Pediatric Obesity.

The study was conducted in 19 overweight and obese adolescents with PCOS and not using hormonal contraceptives, who were randomised either to a a low-glycaemic load or a low-fat diet.

In the 16 participants who completed the study, reduction in body fat on either diet was minimal (between 1.2 and 2.2%) with no changes in bioavailable testosterone (as the primary outcome of the study).

Not only did recruiting adolescents for this study pose a challenge (in part due to widespread use of hormonal contraception) but also the impact on weight and biochemical hyperandrogenism were marginal at best.

Clearly, as the authors note,

“Innovative strategies are needed to recruit adolescents for studies aimed at assessing independent effects of diet on features of PCOS.”

Exactly what those innovative strategies may look like, remains an open question.

@DrSharma
Vancouver, BC

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Weight-Based Bullying Is The Most Common Form of Bullying in Youth

sharma-obesity-bullyingAccording to a study conducted by a team of researchers from the US, Canada, Australia and Iceland, published in Pediatric Obesity, weight-based bullying in children and youth is the most prevalent form of youth bullying in these countries, exceeding by a substantial margin other forms of bullying including race/ethnicity, sexual orientation or religion.

According to the almost 3000 participants in this study, parents, teachers and health professionals were seen as those with the greatest potential of reducing weight-based bullying.

In addition, the majority of participants (65-87%) supported government augmentation of anti-bullying laws to include prohibiting weight-based bullying.

While these findings may not strike anyone living with obesity as surprising, they should be a reminder to the rest of us that weight-based bullying, with all of its negative consequences for mental, physical and social health, is something to be taken very seriously and needs to be opposed as much as we would oppose any other forms of bullying.

@DrSharma
Vancouver, BC

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Does Food Availability Have Much To Do With Obesity?

sharma-obesity-variety1Before you respond “of course” – you may wish to take a look at the systematic review by Laura Cobb and colleagues from Johns Hopkins University, published in OBESITY.

The authors looked at 71 Canadian and US studies that examined the relationship between obesity and retail food environments and concluded that,

“Despite the large number of studies, we found limited evidence for associations between local food environments and obesity. “

To be fair, the researchers also concluded that much of the research in this area lacks high-quality studies, that would lead to a more robust understanding  of this issue.

In fact, the authors had to slice and dice the data to tease out “positive” findings that included a possible relationship between fast food outlets and obesity in low-income children or an inverse trend for obesity with the availability of supermarkets (a supposed surrogate measure for availability of fresh produce).

Of course, not finding a robust relationship between the food environment and obesity should not be all that surprising, given the many factors that can potentially play a role in obesity rates.

(Readers may recall that there used to be similar enthusiasm between the role of the built environment (e.g. walkability) for rising obesity rates, till the research on this issue turned out to be rather inconclusive. )

None of this should be interpreted to mean that the food or built environments have nothing to do with obesity – however, we must remember that these type of studies virtually never prove causality and that the factors that determine food and built environments are in fact almost as complicated as the factors that determine individual body weights, so finding a robust relationship between the two would be rather surprising.

Allow me to predict that with the increasing trend of fast food outlets offering healthier (or rather less-unhealthy) choices and supermarkets offering ample amounts of “fast food” and a vast array of unhealthy packaged foods, any relationship between retail food environments and obesity (even if it does exist), will be even harder to prove that ever before (outliers are no better than anecdotal evidence and should generally be ignored).

Changing food environments to provide better access to affordable healthier foods should be a “no-brainer” for policy makers, irrespective of whether or not the current environment has anything to do with obesity or not (the same could be said for walkability of neighbourhoods and the prevention of urban sprawl).

@DrSharma
Edmonton, AB

 

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Mapping Pediatric Weight Management Programs in Manitoba.

Kristy_Wittmeier

Kristy Wittmeier, PhD, Director of Knowledge Translation at the Manitoba Centre for Healthcare Innovation, Winnipeg

Today’s guest post comes from Kristy Wittmeier, PhD (and CON Bootcamper), a physiotherapist at the Winnipeg Health Sciences Centre and Director of Knowledge Translation at the Manitoba Centre for Healthcare Innovation. She has a special interest in physical activity as a tool to prevent and manage obesity-related conditions in youth. Her current positions and affiliation with the Children’s Hospital Research Institute of Manitoba allow her to combine research and practice to improve patient outcomes. Twitter: @KristyWittmeier

If you were trying to build a coordinated provincial strategy to promote healthy weight in children and youth, where would you start? This has been a question on the minds of a team of healthcare providers and researchers in Manitoba for some time now.

Manitoba has the highest rate of type 2 diabetes in children in Canada, a condition that is in part related to obesity. In Manitoba, youth are diagnosed with type 2 diabetes at a rate 20 times higher than in any other province.

There are well-established, multidisciplinary clinical programs in our province that work with youth living with type 2 diabetes. For example, the Diabetes Education Resource for Children and Adolescents, which has existed since 1985, runs two weekly clinics and an outreach program for youth affected by type 2 diabetes.

Recently, the diabetes care team joined forces with pediatric kidney specialists in the province to provide a combined clinic for youth affected by both type 2 diabetes and kidney complications.

Manitoba is also home to the Maestro Project, which helps teens living with type 2 diabetes navigate what could otherwise be a difficult transition from pediatric to adult health care services and teams.

Similarly, research teams that include community advisors and families are tackling important questions related to the origins of type 2 diabetes and exploring innovative interventions to improve the health and quality of life for kids with this diagnosis.

Members of the DREAM (Diabetes Research Envisioned and Accomplished in Manitoba) Theme at the Children’s Hospital Research Institute of Manitoba are studying important biological, social and psychological factors linked with early kidney disease in youth with type 2 diabetes in a study called iCARE (Improving renal Complications in Adolescents with type 2 diabetes through REsearch).

While we have made significant progress in the area of type 2 diabetes care and research, we have made less progress in the areas of prevention and treatment of obesity in children and youth. We are one of the few provinces in Canada without a specialized clinical team dedicated to pediatric obesity. We lack a comprehensive provincial strategy that can link health care providers to each other, or to existing community programs that might help families. Gaps in services can leave families without access to care that could help their children. This is the issue that we have decided to tackle in a study that was recently funded by the Children’s Hospital Research Institute of Manitoba.

Our study is called “Mapping the state of pediatric weight management programs in Manitoba.” We will start with a survey within Manitoba, to identify existing programs that are available to families affected by obesity in our province. We want to know what is currently available. Where can health care providers refer families? And importantly, what resources are missing in our province to be able to provide an evidence-based approach to pediatric weight management?

While the title suggests we are solely focused on Manitoba, we are in fact looking to shape our provinces’ approach by learning from others across Canada and the United States.

To do this, the second part of the study will involve updating a 2010 study that mapped Canadian pediatric weight management programs to understand what has changed on the national landscape. What new programs exist and where? What programs are no longer offered and why?

Then we will move on to more in-depth conversations with members of the eight clinics involved in the Canadian Pediatric Weight Management Registry (CANPWR), and an additional eight clinics in the United States to better understand how their approaches evolved, barriers and successes that they have experienced and other key learnings that they can share to help inform a Manitoba approach.

Once we have brought the information from these activities together, we will hold a meeting for families, community members, clinicians, researchers, healthy living organizations and policy makers in the province. We will look at the data together and prioritize the next important steps on this journey.

We all need to work together to build healthier families, healthier communities and healthier populations. This novel approach that integrates the experiences and priorities of others will ensure that when we launch a new direction for pediatric obesity management in Manitoba, it will be relevant and targeted to everyone’s needs.

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The Health And Social Benefits Of Risky Play

sharma-obesity-active-kidsThe recent report card on physical activity released by Participaction strongly recommends (unsupervised) free play as a means to increase physical activity in kids.

But free play has far greater benefits on children’s development than just physical fitness, especially when there is an element of risk involved.

That is the conclusion of a paper by Marianna Brussoni and colleagues, published in the International Journal of Environmental Research and Public Health.

For their paper, risky play was defined as play that involves an element of danger, including the possibility of physical injury.  Such types of play include play at height, speed, near dangerous elements (e.g., water, fire), with dangerous tools, rough and tumble play (e.g., play fighting), and where there is the potential for disappearing or getting lost.

This systematic review of 21 relevant research studies shows that risky outdoor play not only improves physical health (despite the inherent risk of injuries and even death), but also social health and behaviours, risk for injuries, and reduced aggression.

Specifically, studies have shown improvements in risk detection and competence, increased self-esteem and decreased conflict sensitivity and conflict resolution, better developed motor skills, enhanced social behaviour, greater independence, improved risk management strategies, and the ability to negotiate decisions about substance use, relationships and sexual behaviour during adolescence.

Obviously, risky behaviour is risky – according to the researchers,

“In Canada, approximately 2,500 children age 14 and under are hospitalized annually as a result of playground falls (play at height)—81% are for fractures.”

Nevertheless, weighing all of the available evidence, the researchers came to the following conclusions:

“Although these findings are based on ‘very low’ to ‘moderate’ quality evidence, the evidence suggests overall positive effects of risky outdoor play on a variety of health indicators and behaviours in children aged 3-12 years. Specifically, play where children can disappear/get lost and risky play supportive environments were positively associated with physical activity and social health, and negatively associated with sedentary behaviour.

Play at height was not related to fracture frequency and severity. Engaging in rough and tumble play did not increase aggression, and was associated with increased social competence for boys and popular children, however results were mixed for other children.

There was also an indication that risky play supportive environments promoted increased play time, social interactions, creativity and resilience.

These positive results reflect the importance supporting children’s risky outdoor play opportunities as a means of promoting children’s health and active lifestyles.”

Clearly, these finding go against the popular policies that focus on harm reduction and making kids’ play environments as safe as possible.

Perhaps these policies are doing more harm than good – as always, you never know where the unintended consequences of well-meant public policies rear their ugly head.

@DrSharma
Edmonton, AB

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