Category: Obesity

I am once again drawn to research from a team at the University of Westminster, a renowned institution that doles out so-called science degrees in homeopathy. This time the paper in question, published in the inaugural issue of the International Journal of Food Safety, Nutrition and Public Health (2008, vol 1, issue 1, pp 16-32) is on that perennial favourite: what to do about the obesity epidemic.

Ihab Tewfik, a senior lecturer in the School of Biosciences, at Westminster, reports that “the prevalence and severity of people suffering from obesity has increased markedly worldwide,” and adds that “The WHO declared obesity a ‘crisis of epidemic proportion’.” Nothing of which I can be too critical in those statements, except for one small point.

While obesity and the diseases and disorders for which it is purportedly a risk factor – type II diabetes, hypertension, hyperlipidemia, atherosclerosis, cardiovascular disease, stroke, and heart attack – are almost certainly on the increase in North America, Western Europe, and pockets of the Pacific Rim, the use of the term “worldwide” is rather ironic. This is especially true given that the WHO and other international organizations consistently report massive cases of disease, malnourishment and poor water supply across great tracts of the earth’s surface from Africa and South America to Asia and the former Soviet Union.

Anyway, Tewfik and colleagues have proposed a conceptual framework for a three-year intervention programme that could be adapted to the prevention of childhood obesity, which is a growing problem in many parts of the world, if not quite worldwide.

Ironically, they have named the framework, with one of those shoehorned acronyms, as CHOP, for Childhood Obesity Prevention and explain their approach as follows:

The approach is based on a behaviour modification model without giving foods. Family, school and children are essential counterparts to achieve meaningful improvement. Advocated by policies makers and embraced with favourite environmental factors, CHOP programme could be the conceptual framework for nutrition intervention that can be effectively integrated within the national health framework to attain public health goals.

Apparently, what this boils down to is giving children healthy foods, increasing physical activity and workout limits, limited TV and other screen times, implementing a non-food reward system, and allowing self-monitoring. As part of this approach schools will intervene in teaching children that they should eat five portions of fruit and vegetables each day, that they should cut the amount of fat they eat, limit their screen time and be active every day.

It all sounds like good, solid advice. Indeed, it’s the kind of advice the medical profession, nannyish governments, and even grandparents, have been offering for decades. Unfortunately, growing children are notoriously reluctant to take advice, especially when it comes to avoiding sweets and crisps, eating their greens, and switching off the Playstation (other gaming consoles are available).

The Westminster researchers, however, suggest their CHOP system would be convenient once the appropriate team, policies and resources have been successfully assembled. One has to wonder at a cost to whom these resources might be assembled. They do concede that, “In some circumstances this conceptual framework may be regarded to be too ambitious to attempt de novo within three years especially in some developing countries, where lack of access to health care, to drinkable water, to food, to education and housing is prevalent.”

It’s probably not necessary to implement it in places where food is in limited supply, surely. But, even in apparently developed nations, I’d suggest that costs will be severely prohibitive while children will be reluctant to partake (what positive rewards will replace treats and screen time?). Moreover, by their own admission, obesity is on a rapid climb among adults too and one has to wonder how these resources will be applied to persuade parents and carers of increasingly obese children will themselves be persuaded to take part if they do not appreciate the potential benefits.

Tewfik, I. (2008). Childhood Obesity Prevention (CHOP) programme: a conceptual framework for nutrition intervention. International Journal of Food Safety, Nutrition and Public Health, 1(1), 16. DOI: 10.1504/IJFSNPH.2008.018853

We all know we’re all getting fatter, don’t we? Obesity has become the latest plague of the developed world. And, body mass index has become the vital statistic your GP is most interested.

Well, I’ve actually lost a few pounds from my Adonis-like physique* over the last few months, it must be the daily dog walking. Nevertheless, my BMI is high, but then so is that of at least half of the England rugby team – it’s big bones and muscular hypertrophy that do it. You cannot visit a health-related website or pick up a medical newsfeed these days without seeing some bizarre news related to obesity and overweight. [*Yeah, right!]

The research results are often contradictory, one day we’re told it is high saturated fat content that we must worry about. The next we hear that Gary Taubes has resurrected almost forgotten research that suggests carbohydrates are to blame for boosting insulin production and it is high insulin levels that make us fat. It sounds like a 1950s notion, too many potatoes will make you fat, but he could have a point. The link between insulin and obesity is very strong, but does one cause the other or do they operate synergistically to the detriment of our health. Who knows? Certainly not the headline writers were see, as I say apparently contradictory and at best confusing statements day in, day out.

• Study firmly links obesity, cancer
• Diabetes up amid rising obesity
• Obesity ‘fuels cancer in women’
• Obesity ‘epidemic’ turns global
• Obesity May Be Protective in Progressive Prostate Cancer
• Obesity and overweight linked to higher prostate cancer mortality
• Little bit of fat not so bad: new study
• Diabetes up amid rising obesity
• Obesity ‘not individuals’ fault’
• Gyms ‘little help’ in obesity
• Inflammation, Not Obesity, Cause Of Insulin Resistance
• Study finds some overweight people live longer
• Little extra weight may not be bad

That’s just an almost random sample from this week’s news. But, the message is clear – we don’t really know what’s going on. The conventional wisdom has it that the more calories you take in and the fewer you use, the more overweight you will become. But, the type of calories do matter, as Taubes points out, we don’t tend to talk about middle-aged guys with burger guts, the more usual description of choice is a beer belly. The calorific content of beer, of course, arising from carbohydrates as opposed to fat.

There are also issues with the public health statements that tell us to reduce our saturated fat intake and to keep our (bad) cholesterol levels low. But, did you know there isn’t just one form of low-density lipoprotein, there are two – a dense form and a diffuse form. New evidence points to the dense form of LDL as being the bad form and not the nice fluffy type, but related research also hints that the presence of cholesterol is not actually a relevant risk factor for cardiovascular disease. It’s the dense LDL itself. So, is there any point your GP measuring your blood cholesterol and putting you on statins? Possibly not.

And, what of the possibilities that obesity is down to genetics, viral infection, bacterial infection, (fungal infection?), hormonal imbalances, pancreatic problems, missing out on breastfeeding as an infant, getting too much breast milk as an infant, a throwback to our grandparents’ diet, an evolutionary aberration, too much TV, not enough sleep, too much carbohydrate, too much protein, too much fat, too little exercise, too much walking and not enough running…

Taubes comes to 11 critical conclusions in Good Calories, Bad Calories, based on substantial literature research and interviews, summarised below:

1. Dietary fat does not cause heart disease
2. Carbohydrates do, because of their effect on insulin
3. Sugars are particularly harmful
4. Refined carbohydrates, starches, and sugars are the most likely dietary causes of cancer, Alzheimer’s Disease, and the other common chronic diseases
5. Obesity is a disorder of excess fat accumulation, not overeating and not sedentary behaviour
6. Consuming excess calories does not make us fatter any more than it makes a child grow taller
7. Exercise does not make us lose excess fat; it makes us hungry
8. We get fat because of an imbalance between hormonal regulation of fat tissue and fat metabolism.
9. Insulin is the primary regulator of fat storage
10. Carbohydrates make us fat by stimulating insulin secretion
11. The fewer carbohydrates we eat, the leaner we will be

Confused? It’s enough to make you head for the donut bar. Or, maybe not. Next week, “Cardiovascular Disease News Epidemic”. Incidentally, I was going to call this post Bingo Wings and Muffin Tops, but thought better of it. You can look up definitions in the Urban Dictionary.

Grandma always said, “Everything in moderation”, but then she always used to take her teeth out to eat soup, so what does she know? Apparently, even moderation can be dangerous, particularly when it comes to high fat food.

Tavis Campbell and colleagues at the University of Calgary have found that just one high-fat meal, a fast-food breakfast for instance, makes you prone to suffer the physical consequences of stress compared with someone eating a low-fat meal.

The team looked at the stress responses of two groups of students: fifteen students were fed a fatty breakfast meal (42 g fat) from a burger bar while the second group of fifteen got to dine on dry cereal with low-fat milk, cereal bars and non-fat yogurt (1 g fat). Both meals had the same number of calories and the low-fat breakfast included supplements to balance it for sodium and potassium, but the total fat content was very different.

Two hours later, the researchers carried out standard physical and mental stress tests and recorded the students’ cardiovascular responses. They performed a mathematical test designed to be stressful, completed a public speaking exercise about something emotionally provocative, held an arm in ice water, and had a blood pressure cuff inflated around an arm, which gradually causes a dull ache.

Regardless of the task, greater CV reactivity was seen in the high-fat group, including raised blood pressure, heart rate and blood vessel resistance. “What’s really shocking is that this is just one meal,” says Campbell.

“It’s been well documented that a high-fat diet leads to atherosclerosis and high blood pressure, and that exaggerated and prolonged cardiovascular responses to stress are associated with high blood pressure in the future,” he says, “So when we learn that even a single, high-fat meal can make you more reactive to stress, it’s cause for concern because it suggests a new and damaging way that a high-fat diet affects cardiovascular function.”

Thankfully, it is not all bad news. Campbell says more research is needed to fully understand how the mechanisms work. “Telling people to never eat something is probably not a good way to promote a better diet,” he says. “At the same time we do have an epidemic of obesity in North America and it’s important that people try to make informed choices.”

Science always hedges its bets in this way. If the argument were about whether to vote left or right, the politicians and lobbyists would make full-on assertions as to even the acute effects of a one-off high-fat vote. Yes, Campbell’s team has only carried out a small preliminary trial, and perhaps underfed and stressed students are not the best control group, but there findings do hint at yet another reason why we should side-step a high-fat diet.

The case is essentially closed on cigarettes in this sense, but individuals can make their own choice. Is it not about time, that the health message were made more forcefully. Maybe one burger is not going to kill you, but some people spend a fortune on finding ways to reduce stress and warding off the effects of aging, if even an occasional high-fat meal inverts all that effort, then perhaps it is time burgers carried a health warning too.

Details of the study are published today in the Journal of Nutrition, 2007, 137, 935-939

The fairies at the bottom of my garden have been digging up the pot of gold at the end of the rainbow. A spokesdog for the Society of Wolves tells me that Canis Lupus is no longer dining on geriatric homeowners nor juvenile females in crimson headgear. Oh, and there is no link between sugar in the diet and diabetes.

The first two statements may seem a little far-fetched but that last one, surely it’s a fairy story…

Well, apparently not. In a press release posted on AlphaGalileo by the UK’s Sugar Bureau, new evidence from researchers at the Royal Victoria Hospital and Queen’s University Belfast suggests that receiving a quarter of daily calories from sucrose (sugar) as part of a balanced, weight-maintaining diet does not result in any difference in insulin resistance compared to getting 10% of the same number of calories from sucrose.

The press release states, that “It has long been suspected that a high sugar diet over a long term period may lead to an increased risk of developing diabetes. But there has been little or no evidence to support this idea, with studies on the role of any aspect of the diet in the development of diabetes difficult to conduct.”

So, is this the evidence we’ve all been waiting for?

The research, published by Steven Hunter and colleagues in the journal Diabetes points to sugar’s innocence. “Sugar has traditionally been linked to the development of diabetes,” he says, “These findings challenge that thinking, and show that intakes of more than double that currently recommended do not appear to have an adverse effect on markers of diabetes risk.”

But, let’s take a closer look at this little story from the Sugar Bureau. The trial studied the effects of different amounts of sucrose in the diets of 13 healthy men without diabetes over a period of six weeks.

Thirteen volunteers? Six weeks?

How can they draw any serious conclusions from such a tiny sample tested over such an incredibly short period? Where is the data on sucrose intake for hundreds if not thousands of people over several years of sucrose abuse? While there is evidence that saturated fat intake and obesity are closely linked to diabetes risk, this single very small study cannot seriously claim that sugar intake has no effect on diabetes risk. How can they tell in a month and a half with just 6 or 7 men being fed a larger amount of sugar in their diet?

I don’t doubt the researchers’ integrity, but this news, coming as it does from the Sugar Bureau, does smack of sickly sweet spin to my cynical eye. It doesn’t tell us anything about the long-term effect of repeated blood sugar spikes caused by excessive intake nor about the effects of aging on sucrose processing and the harmful cross-links it can form with body proteins.

It’s a story that will have the tooth fairy rubbing its hands in glee as well as giving anyone with a penchant for two desserts the impression that they can get away with a large amount of sugar in their diet without having to worry about diabetes. I find it hard to imagine a happy ever after for this story.

What do you think? Should organisations or companies that promote a particular product be allowed to fund scientific research into the benefits or otherwise of that product?

This southern African succulent plant tastes nasty but generations of San bushmen in the Kalahari Desert have eaten it to suppress their appetites on countless hunting trips. As such, it has become a focus of quick-fix weight loss programs.

What is Hoodia gordonii?
It’s a prickly succulent plant that grows in southern Africa and resembles a cactus but isn’t one.

What can it do?
Hoodia gordonii can apparently reduce calorie intake and lower body fat. A patented extract known as p57 and owned by Phytopharm is currently undergoing clinical safety and efficacy tests.

Why do the San bushmen use it?
They eat it for food, althouh H gordonii itself is bitter tasting and only eaten when the going gets really tough.

How was Hoodia’s appetite suppressing properties discovered?
It was investigated as part of a scientific research project established by the South African Council for Scientific and Industrial Research, which tested lots of bush foods and discovered that surprisingly Hoodia extracts made you feel fuller than you really were as well as lowering body weight without toxicity.

Do all Hoodia species reduce appetite?
Only Hoodia gordonii extract has been tested clinically on human volunteers, but that doesn’t necessarily mean that whole plant extract or other products won’t work.

So it definitely works?
Phytopharm’s 2001 double-blind, placebo-controlled clinical trial of overweight, but healthy volunteers showed a statistically significant fall in daily calorie intake as well as a drop in body fat percentage. [There is anecdotal evidence that products obtained from the plant (rather than isolated extract) can reduce body weigth]

Does it work quickly?
Large doses are needed but it takes just 15 days to see a calorie reduction on average of 1000 (kcal) per day.

What are the side-effects?
None have been found so far, but that does not mean that safety studies are not needed before it can get the green light for safety and efficacy.

Will the San bushmen benefit from the sales of Hoodia?
CSIR has entered a “benefit-sharing agreement” with a San representative organisation to ensure they benefit financially from the commercialisation of patented Hoodia gordonii extract. (Actually CSIR did not, allegedly, enter this agreement voluntarily but did so as a result of legal action).

Hoodia is CITES listed, what does that mean?
It means if you visit southern Africa and steal the succulent plant and try and take it out of the country or otherwise gain from it, you’ll get fined massively and face a jail sentence under the Convention on International Trade in Endangered Species of Wild Fauna and Flora.

The BBC reported on the Phytopharm trials in May 2003 and was saying then that potential users should be patient. In their report, they pointed out that the Hoodia tablets available via the internet that they had tested did not contain any of the active ingredient. A natural pill for obesity that really works will come, it just may be another few years in the making.

The original Phytopharm FAQ can be found here. More information on the various Hoodia species is available here.

Phytopharm has, I have been told, sold their licence to Unilever.

Steve Feld, Editor of the ThinkQuest NYC Newsletter emailed to tell me about a multilingual collaboration going by the name of “Ten Best Foods Ten Worst Foods”. The site has been designated a Learning Fountain and a USA Today Educator’s Best Bet, and for good reason. It was also featured as a Good HouseKeeping Site of the Day and was selected as a Seven Wonders of the Web and featured in the Edutopia Newsletter!

The site, created by inner students, tackles the growing problem of childhood obesity head on by providing children with information on foods that are healthy and those to avoid. Childhood obesity has more than doubled in the past 20 years, and leads to a variety of health problems as a result of dangerous diets.

Children need to switch to healthy foods in order to avoid heart disease and raised blood pressure. This project looks at the best foods to eat to manage weight and cure common ailments and then identifies the worst foods which have become all to prevalant in society.

“The students involved in this exploration were fascinated to learn how their lives could be enhanced by selecting natural foods and be able to prevent common ailments,” Feld told me, “They were also delighted to learn how to create a self-scoring quiz to provide site visitors with a vehicle to demonstrate acquired knowledge.”

The two side by side top-tens make interesting reading with watermelon and pine nuts the top two foods, apparently, followed by lean meat. In the worst foods are the usual french fries, hamburgers, and cheesecake. But, they also single out a specific brand of chicken soup, of which I’m a bit dubious, I’m sure any brand of canned soup is going to have just about the same level of health effects as any other give or take a pinch of salt. I’m also curious as to why lean meat is listed, by that do they mean roast chicken as opposed to a fatty lamb cutlet or something else?

One of the foods they list is specific by brand – Campbell’s “red-and-white-label” condensed soups. These are rather high in salt, with half a can providing a person’s daily quota of sodium chloride. Of course, you don’t eat the soup undiluted, so it’s a bit unfair that this company is being singled out for their condensed soups. That said, public awareness has persuaded Campbell to offer a healther option, so the company must have been concerned to some degree themselves.

It’s the foods that heal page with which I am a little more concerned and it seems the students obtained their background information on this from a book on nutrition!

The claims for apples, for instance, would certainly suggest the fruit has a role in daily physician attendance, saying that they protect your heart, prevent constipation, block diarrhoea, improve lung capacity, and cushions joints. Similar claims are made for a whole range of other “natural” foods from peanuts to yogurt. Do strawberries really improve memory and mangoes protect against Alzheimer’s disease? Certainly, prunes are renowned for preventing constipation, but to a susceptible bowel they can achieve the other extreme! But, “olive oil protects your heart”, is not an unequivocal scientific research. There is evidence that the phenols in red wine beloved of the Mediterranean regions that purportedly have lower heart disease could explain the lower incidence of heart disease in France, for instance, but it might just be down to garlic, or olive oil, or hard water, or that more people die younger of liver disease before their hearts pack up!

Don’t get me wrong, the general message from the site is great and nicely put across, it really isn’t the fault of the students if their source of information makes general sweeping statements regarding individual foods. The general message of eat healthy and avoid the burgers is the crucial point. I just hope readers don’t leave the site with the feeling that an apple and a mango a day is all they need do to stay healthy, whereas the truth seems to lie, not in assuming specific foods can stave off ill health, but in having a varied diet that has excesses of no one food type, and generally avoids those associated strongly with particular problems such as fatty red meat with bowel cancer and cardiovascular disease.

Feld also tells me that, “The multi-lingual aspect of the site was translated into French and Romanian by our international peers to attract ESL learners.”

expectant mothers who are overweight or obese could be putting their own health and the health of their unborn child at risk, according to UK researchers published in a report today by researchers at the University of Teesside’s School of Health & Social Care. The report is available at http://www.tees.ac.uk/schools/SOH/obesity_maternal.cfm

Carolyn Summerbell, who heads the University of Teesside’s Centre for Food, Physical Activity and Obesity Research, reviewed some of the clinical issues related to caring for obese pregnant mothers. ‘We’re not trying to blame or stigmatize obese pregnant mothers and we would certainly not recommend that overweight mums-to-be go on crash diets. But our initial findings show reasons for concern with obese pregnant mothers, and there is a lack of weight management guidance and support readily available for them’

Lead researcher Nicola Heslehurst said the research team was alerted to the growing problem by anecdotal evidence from midwives and other staff in maternity units in the region who are increasingly concerned about the apparent increase in the number of women who were obese at the start of their pregnancy.

‘Doctors and midwives in the region have expressed concerns about the increase in complications that can arise when mums are obese. One of the problems is that sometimes you can’t see the ultrasound scan of the baby properly in obese pregnant women and this can lead to clinical problems as well as being upsetting for the parents who are not able to see a picture of their baby’.

Dr Judith Rankin, Associate Director of the Regional Maternity Survey Office (RMSO) and a partner in the study, said: ‘This research will help to inform the [UK’s National Health Service] NHS about the changes needed to the way service delivery is carried out and how the information is collected.’

‘While this is clearly a serious issue, we don’t want to do anything that will encourage pregnant women who are obese to go on a crash diet during pregnancy. What they should do is try to eat a healthy diet during pregnancy and then lose weight after their child is born and before they have their next child,’ she said.

Following on from Wednesday’s posting on the subject of an obesity stifling pill, health professionals have been told that they need to use more than tape measures and scales to define and tackle obesity. The claim appears in the British Journal of Advanced Nursing.

Maryanne Davidson of Yale University discovered that many women fail to make the link between high weight and poor health and that culture is to blame, playing a key role in how positively they see themselves. Davidson reviewed key papers published over a 10-year period to see how health professionals and black and white American women define obesity and to identify differences in attitudes.

The study revealed that while health professionals used quantitative methods, such as Body Mass Index (BMI) measurements based on the height to weight ratio, women are more likely to base their ideal weight on cultural criteria. “My review revealed that black American participants defined obesity in positive terms, relating it to attractiveness, sexual desirability, body image, strength or goodness, self esteem and social acceptability,” Davidson says, “In addition they didn’t view obesity as cause for concern when it came to their health.”

White Americans, on the other hand, expressed completely the opposite view: “They defined obesity in negative terms, describing it as unattractive, not socially desirable, associated with negative body image and decreased self-esteem and being socially unacceptable,” explains Davidson. Worryingly, she adds, “when it came to the links between body weight and health, this group was much more likely to voice mixed views, with some expressing concern and others feeling that weight wasn’t a health issue.”

From the clinical care perspective, Davidson has also discovered that there are variations in how health professionals define obesity. “Although most of them use BMI to actually measure obesity, we found different views about what level of BMI constitutes normal weight and what level indicates obesity,” she says. Such findings provide a real challenge for healthcare professions.

People have been obsessed with their weight since records began, Davidson adds. She points out that the “Spartans” reportedly ostracised a man for being too fat and Socrates danced every day to keep his weight within reason! Such apocryphal tales tell us nothing about the health implications of being overweight today.

People see this as a genuine issue and spend a lot of money on trying to reduce their weight. Others spend time in the gym and take the healthy option while others face the risks of going under the knife. Bariatric surgery and liposuction prices are just a few of the factors that potential patients must consider.

“Obesity is a major issue for health professionals as it is emerging as a worldwide healthcare epidemic,” says Davidson, “The World Health Organization estimates that there are at least 300 million obese people worldwide and a further one billion who are overweight.”