Weight loss after bariatric surgery can improve heart health

In overweight and obese people, fat often gets deposited into the midsection of the body. Large amounts of this belly fat can lead to unhealthy changes in a heart’s function and size. However, according to new findings presented at the American College of Surgeons Clinical Congress 2017, a bariatric surgical procedure, and the weight loss that follows it, actually may allow the heart to return to its natural shape and function.

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When a person lifts weights, pushing against resistance, their muscles eventually get bigger. The same is true for the heart muscle. When a person is overweight, the heart has to generate more force to pump even more blood throughout the body. This extra workload causes the heart muscle to grow bigger, but contrary to what some people think, a bigger heart muscle does not mean a stronger heart. In fact, the larger the heart, the less efficacious it is in fulfilling its functions.

“We know that obesity is the most prevalent disease in the United States. And that the cardiovascular system is significantly affected by this disease process,” said lead study author Raul J. Rosenthal, MD, FACS, chairman, Department of General Surgery at the Cleveland Clinic in Weston, Florida. “But we wanted to know to what degree the shape of the heart changes in someone who is obese, what the heart looks like in someone after having bariatric surgery and losing weight, and how that change in geometry affects heart functionality.” For this study, researchers at the Cleveland Clinic reviewed data on 51 obese men and women who underwent bariatric surgery between 2010 and 2015. The analysis included factors such as body mass index (BMI) and coexisting health problems. The average age of the patients was 61 years, and the average BMI was 40; approximately 100 pounds overweight.

To better understand the impact of a bariatric operation and weight loss on heart health, the researchers compared preoperative and postoperative echocardiography readings. An echocardiogram is an ultrasound of the heart that measures not only its size and geometry but also its function. An echocardiogram measures how much blood is in the heart, how much blood goes out of the heart, and how much blood remains in the heart. One year after bariatric surgery, the researchers found significant improvements in patients’ heart health. Nearly half of the patients had hearts that had gone back to their natural shape or geometry. They also found that there was a significant improvement in the size of the ventricles: On average these chambers of the heart decreased in size by 15.7 percent (left ventricle mass: 229 grams before surgery; 193 grams after surgery. Left ventricular wall diameter: 60.1 mm before surgery; 53.7 mm after surgery.)Related image

Larger chambers lose some of their pumping power. This loss means that more blood stays in the heart, and ultimately increases a person’s risk of heart failure. “When the size of the chambers gets bigger, and the walls of the heart get thicker, the blood flow to the heart is not as good, the functionality of the heart is not as good, and the heart itself doesn’t get enough blood,” Dr. Rosenthal said. “The whole body suffers because there is less blood going to your feet and to your toes and to your brain.” This study is the beginning of a series of studies that will be conducted by these researchers over the next few years. They will perform follow up studies to find out what the window is in which losing weight allows the heart to go back to its normal geometry.

“We don’t know if being obese for 20 years and having changes in your heart geometry is different from being obese for 10 years,” Dr. Rosenthal said. “The question is: Will the heart always come back to normal? It could be if you wait too long, the changes in your heart are irreversible.”

Adapted by: American College of Surgeons. “Weight loss after bariatric surgery can improve heart health: Significant improvements in heart shape and function can happen one year after an operation for weight loss.” ScienceDaily. ScienceDaily, 24 October 2017. <www.sciencedaily.com/releases/2017/10/171024232822.htm>

Nutritional Nugget

Take a walk instead! Replace a coffee break with a brisk 10-minute walk. Ask a friend or colleague to join you.

WOD Nugget

Relume: Relight or rekindle (a light, flame, etc.)

Inspirational Nugget

I smile because I have survived everything the world has thrown at me. I smile because when I was knocked down I got back up.

“Ego could be defined as whatever covers up basic goodness. From an experiential point of view, what is ego covering up? It’s covering up our experience of just being here, just fully being where we are so that we can relate with the immediacy of our experience. Egolessness is a state of mind that has complete confidence in the sacredness of the world. It is unconditional well-being, an unconditional joy that includes all the different qualities of our experience.”

~Pema ChÖdrÖn

 

 

Genetics may put a person at risk of high triglycerides, but adopting a healthy diet can help

Triglycerides, a type of fat in the blood, are essential for good health. However, having high triglycerides might increase a person’s risk of heart disease, and could be a sign of metabolic syndrome, a combination of high blood pressure, high blood sugar, and too much fat accumulation at the waist. People with metabolic syndrome have increased risks for heart disease, diabetes, and stroke.

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A new study from nutrition researchers at the University of Illinois shows that some individuals with variations of a “gene of interest” may be at an even higher risk of developing high triglycerides. Specifically, researchers looked at genetics and risk in a group of young Mexican adults. Despite genetic predisposition, the study shows that maintaining healthy body weight or changing diet can help reverse the risk. Katie Robinson, a former doctoral student in the U of I Division of Nutritional Sciences and fellow of the I-TOPP program, explains that the study is a collaboration between the University of Illinois and the Autonomous University of San Luis Potosi in Mexico (UASLP), also known as UP AMIGOS. “Obesity is a growing problem in the U.S. and Mexico. In the U.S., obesity affects over a third of our population. We’re concerned because obesity is associated with other diseases such as diabetes, heart disease, and high triglycerides,” Robinson explains. Compared to Caucasian groups, Hispanics in the U.S. have higher rates of type 2 diabetes and other obesity-related diseases. Of all Hispanic subgroups, those of Mexican heritage have one of the highest risks for obesity and associated diseases.”

The UP AMIGOS project addresses genetic and environmental factors associated with obesity and related conditions among younger adults in Mexico. “A lot of existing data are from Caucasian cohorts, which means we needed to replicate and better understand those findings in groups with different ethnicities. That’s the main goal of the UP AMIGOS project. “It was a great opportunity that we were able to look at this rich data set from young Mexican adults because we know that this population has a greater likelihood of developing not only obesity but also high triglycerides and diabetes,” Robinson adds. For the current study, Robinson was interested in a protein made in the liver called fetuin-A (FetA). “It’s an interesting marker connecting inflammation with obesity and its associated diseases,” she says. “FetA is a protein that is released from adipose tissue and also the liver. We know FetA is integral to insulin sensitivity, and that’s where most of the research has been done to look at its function.

“We also know that FetA is elevated in obesity and diabetes. Therefore, we were interested in looking at the genetic implication. If there are alterations or single nucleotide polymorphisms within the gene that codes for FetA, does that change somebody’s risk for obesity or the associated diseases?” To answer that, the researchers looked at bloodwork from 641 young Mexican adults to analyze biomarkers and genotypes. They also checked body mass index (BMI), took measurements of fasting glucose levels, and had the participants report on their dietary habits. From the genotyping, they were explicitly looking for occurrences of two mutations of the gene, AHSG, a gene that influences the protein FetA. They were interested in the association of those gene mutations with dietary intake, weight, and also biological markers of health.

The AHSG polymorphisms were found to be associated with triglycerides. Robinson explains the most critical finding is that one of these polymorphisms, or mutations, was associated with higher circulating triglycerides, but that correlation was very dependent on BMI and dietary intake, the relationship was exaggerated in individuals who were overweight. “So with an elevated BMI, we saw greater disorder within those carrying the risk genotype. But if these individuals who had the high-risk AHSG genotype had a lower BMI, their triglycerides were lower. It suggests that even if you carry the high-risk genotype, you don’t have a greater risk of high triglycerides if you can maintain a normal BMI or a lower BMI, which I think is a positive finding when we look at genetics.”

Robinson says diet also played a role in higher triglycerides. “Higher carbohydrate intake, specifically sugar or sucrose intake, was associated with elevated triglycerides. This association was mainly in one genotype group. The thought was perhaps these individuals are more sensitive to certain diets than the other genotype groups.” Regardless of genotype, elevated BMI was associated with higher triglycerides. Due to the relationship between FetA and diabetes, the researchers also wanted to see if there was an association with AHSG mutations and glucose, but surprisingly, they did not find any.

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While the study looked at relatively healthy young adults in a Mexican population, results were different than what has been observed in previous research from Caucasian groups. Robinson explains that they might have seen different results if they had looked at older Mexican adults with poorer health. Some good news from the study’s findings is that maintaining a healthy body weight often can overcome the effects of gene related metabolic disease and type 2 diabetes. “We know that genes aren’t everything,” Robinson says. “There are a lot of things we can do, behaviorally, to change our individual risk. It’s a silver lining in our research. We can’t modify our genetics, but we can modify our epigenomes and some behaviors. You can still have positive health outcomes.”

The results are also significant for the future of developing personalized nutrition as interventions for disease, Robinson says. “In practical terms, it would be ideal to start by understanding someone’s basic biology, which may influence how they’re metabolizing and utilizing the nutrients they are eating. It would be great to bring people in, find out where their biology is at, and then tailor a diet for them, but we need a lot more research before we get to that point.” Margarita Teran-Garcia, assistant professor in the Division of Nutritional Sciences and the Department of Human Development and Family Studies at U of I adds, “In order to advance the full potential of precision medical and nutritional sciences, there is a need to invest and create new sustained resources, financial and technological, to build the evidence base needed to guide clinical practice and strategic planning in public health.”

Adapted from:  Katie N. Robinson, Itzel Vazquez-Vidal, Courtney Marques, Flavia Cristina Drumond Andrade, Celia Aradillas-Garcia, Margarita Teran-Garcia. Circulating Triglycerides and the Association of Triglycerides with Dietary Intake Are Altered by Alpha-2-Heremans-Schmid Glycoprotein PolymorphismsJournal of Nutrigenetics and Nutrigenomics, 2017; 75 DOI: 10.1159/00047

Nutrition Nugget

Model healthy habits! Adults who choose low-fat or fat-free milk or yogurt show kids that dairy is an important part of a healthy eating style. When kids model this behavior, their growing bones will thank you.

WOD Nugget

Bitts: A pair of posts on the deck of a ship for fastening mooring lines or cables.

Inspiration Nugget

Sometimes all it takes is one small prayer to change someone's life.

 “When you come from the view that you’re fundamentally good rather than fundamentally flawed, as you see yourself speak or act out, as you see yourself repress, you will have a growing understanding that you’re not a bad person who needs to shape up but a good person with temporary, malleable habits that are causing you a lot of suffering. And then, in that spirit, you can become very familiar with these temporary but strongly embedded habits. We all carry around trunk loads of old habits, but very fortunately for us, they’re removable.”

~Pema ChÖdrÖn

 

 

Sugary drink sales plummeted after price increase, study says

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From Colombia to South Africa, France to India, governments around the globe are exploring whether taxes on sugar-sweetened beverages (SSB) might curb obesity rates. Do these fines actually work to prevent people from choosing sweet drinks? Adding a small fee to the price tag of SSB’s at one UK restaurant chain most likely contributed to a decline in their sales, according to a study (published Oct. 2017) in the Journal of Epidemiology & Community Health. Jamie’s Italian, a chain created by celebrity chef Jamie Oliver, launched its own health campaign in September 2015. Along with adding 10 pence (about 13 cents) per drink to SSB, the chain offered new lower-sugar beverages and redesigned its menus.

After the fee was introduced, the chain observed an 11% decline in the number of sugar-sweetened beverages sold per customer during the first 12 weeks, according to the researchers. Over a six-month period, after the levy was charged, the number of sugary drinks had declined by 9.3% per customer. “Sugar taxes are currently prevalent policies to curb obesity rates and improve population diet,” said Steven Cummins, senior author of the study and a professor of population health at the London School of Hygiene & Tropical Medicine. “There’s actually very little evidence that they work in practice. There’s only a couple of studies that assess the impact of these kinds of (taxes) in real life on real customers.” Cummins and his colleagues analyzed Jamie’s Italian health campaign to add to this knowledge base.

‘Fat man of Europe’

Drinking sugar-sweetened beverages, including non-diet sodas, flavored juices, and some sports drinks, is associated with obesity, type 2 diabetes, cardiovascular disease, and cavities. In the UK, sugar-sweetened drinks may account for half of the excess calories consumed per day by children (two-thirds by U.S. children) while one in four British adults (one in three U.S.) are obese, according to a 2013 report from the United Nations.  The same report also found that obesity rates among adults have more than tripled in the past three decades. In 2015, the National Health Service made public its worries that the UK has become the “fat man of Europe.” Shortly after that, Jamie’s Italian decided, according to its website, to “raise awareness of how much sugar is present in certain soft drinks and make people think about their sugar intake, particularly that of their children” by adding 10 pence to the price tag.
Any profits raised by the fee were to be donated to The Children’s Health Fund in support of programs aimed at improving children’s health and food education, the campaign made clear. Cummins said he and his colleagues “had no control over the design or delivery” of Jamie’s Italian health intervention. Independently, the restaurant chain created and implemented the fee, made changes to its menu to explain the new price, introduced fruit spritzers (fruit juice mixed with water) and created promotional materials. “Jamie Oliver also broadcasted an hourlong documentary just a few days before the levy was introduced,” Cummins added. “So there was quite a lot of media coverage.”
The price increase can be seen as a complex “intervention” including a financial element in combination with non-fiscal components, the researchers said. Analyzing sales data from before and after the intervention, Cummins and his colleagues calculated the average number of sugar-sweetened beverage sales per customer in 37 Jamie’s Italian restaurants. In the 12 months prior, a total of 2,058,581 non-alcoholic beverages were sold in the restaurants, and 38% (775,230) of them were sugar-sweetened drinks. Adding a 10-pence fee to SSB was associated with significant declines (11.04%) in sales per customer, with the highest reductions in restaurants with higher SSB sales per customer (18.77%), the results indicated.
It could be that customers switched to water or other kinds of beverages, potentially fruit juices, or the adults might even choose alcoholic drinks, Cummins said. “We don’t exactly know what they’re substituting for; my guess is primarily water.”A longer follow-up period is required to assess whether the effects will be sustained, the researchers noted. “It’s a straightforward intervention, actually, and there’s no reason why other commercial restaurant chains cannot implement this kind of intervention,” Cummins said. “It wouldn’t require major changes or costs.”
That said, his experience of working with Jamie’s Italian suggested no harm regarding negative financial consequences. “There may be some financial impact, and we don’t know what it might be, but it’s likely not large,” Cummins said. “It may be that other types of chains that sell different types of food might have a larger impact economically” — but this is “fairly unlikely.”

Small changes

“A lot is going on here in this study,” said Jayson L. Lusk, a professor and head of the Department of Agricultural Economics at Purdue University, who did not participate in the research or the analysis. “It’s hard to conclude that the price change in sugar-sweetened beverages is the main cause of the changes being observed,” Lusk said, noting that bottled water and diet cola consumption fell at about the same rate as the increased-price sugary beverages after the intervention began. Meanwhile, the beverages introduced after the price increase introduce a “confound” into the experiment: an element that disrupts and adds confusion to the results. Overall, previous research on this topic suggests that such taxes will probably have small effects on consumption of taxed beverages and that people will merely substitute other high-calorie, non-taxed drinks and foods, Lusk said.
So, can sugar-sweetened beverage taxes lower SSB consumption? “Yes, by a small amount,” he said. “But that’s different than saying sugar-sweetened beverage taxes reduce caloric intake. “There’s also literature showing these taxes tend to be regressive, affecting lower-income households more than higher-income households,” Lusk said. Jason M. Fletcher, a professor of public affairs and sociology at the University of Wisconsin-Madison, said some of the results from the new study suggest a “general weakness in the analysis.” Fletcher did not participate in the new study.
After the intervention, there was a reduction in sales of all types of beverages compared with before the intervention, Fletcher noted, and the authors did not adequately estimate the effects of the 10-pence levy for each beverage in their analysis. “In our own work, we find support for substitution effects in the U.S., where higher taxes on soda lead to two effects: (1) less consumption of soda and (2) more consumption of other high-calorie drinks,” Fletcher said. “Combining these effects can lead to no increase in health.” Americans consume more than 40 gallons of sugary drinks per capita each year, on average.
“Sugar taxes in England have not been proposed, but there is in legislation to be implemented next year as a proposal from Her Majesty’s Treasury on implementing a sugar tax of 20% on producers and manufacturers of sugar-sweetened beverages — so not to the consumer but to the producers themselves,” Cummins said. Some of the major manufacturers have announced that they are going to reformulate their products to avoid the tax. “So in one sense, the policy has already had an effect regarding persuading companies to reformulate their products to avoid the extra costs that will be levied upon them,” Cummins said. “Within the whole of the food system, there are a variety of different types of responses,” he said, adding that he hopes to study these responses. “We’re interested in capturing these kinds of systemwide effects.”
Nutrition Nugget
Eat Your Chocolate! Yes, you read that right! Having a small amount of dark chocolate – 70-85% cocoa – is rich in fiber, iron, and magnesium, among other minerals. Plus, it’s a great source of antioxidants which reduces free radicals in your body.
Word of the Nugget
 Analects: A collection of short literary or philosophical extracts.
Inspiration Nugget
People have to pretend you're a bad person so they don't feel guilty about the things they did to you.

GP referral to Weight Watchers avoided type 2 diabetes in third of patients (UK)

More than a third of patients at risk of developing type 2 diabetes who reside in the UK avoided developing the condition after they were referred by their family doctor (GP) to a diabetes prevention program delivered by the commercial weight management provider, Weight Watchers, finds research published in BMJ Open Diabetes Research & Care.

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The initiative also helped more than half of those referred either to reduce their risk of developing diabetes or to get their blood sugar levels back to normal. The number of people diagnosed with type 2 diabetes in the UK has increased from 1.4 to 2.9 million since 1996. An even more substantial increase can be seen in the United States (U.S.) with a rise from 7.6 to 23.4 million. A new diagnosis is made every 2 minutes, and by 2025, an estimated 5 million people in the UK and 53 million in the U.S. will have the condition. Horrifying statistics! Risk of developing type 2 diabetes is strongly influenced by lifestyle factors but can be significantly reduced by weight loss, achieved by eating less and exercising more.

The UK’s national health and social care guidance organization, the National Institute for Health and Care Excellence (NICE) says that certain commercial weight management providers, such as Weight Watchers, can help obese people shed pounds. A U.S. study showed that participation in a commercial weight management program succeeded in reversing progression to type 2 diabetes. However, the effectiveness of this approach in UK primary care has not been thoroughly evaluated. Therefore, the researchers identified 166 patients from 14 general practice surgeries at high risk of developing type 2 diabetes: Those with impaired glucose regulation known as pre-diabetes or non-diabetic hyperglycemia and with a body mass index (BMI) above 30 kg/m2.

These patients were then invited to contact Weight Watchers to book a place on their diabetes prevention program, which included a 90-minute induction session followed by 48 weekly group meetings. From among the 166 primary care referrals, 149 patients were eligible. Some 117 attended the induction, and 115 started the weekly sessions, representing a take-up rate of 70%, which is high for a lifestyle intervention, according to the researchers. The program focused on improving diet quality, reducing portion size, increasing physical activity levels, as well as boosting confidence in the ability to change and a commitment to the process.

Blood tests were repeated at 6 and 12 months to check risk factors, and any changes in weight were recorded by trained Weight Watcher staff. Analysis of the results showed that the initiative led to an average fall in HbA1c (a measure of average blood glucose levels over several weeks) of 2.84 mmol/mol after 12 months to levels regarded as standard. Blood glucose levels also returned to normal in more than a third (38%) of the patients and only 3% developed type 2 diabetes after 12 months. The average weight loss amounted to 10 kg (22lb) at the 12 month time point (a reduction in BMI of 3.2kg/m2).

The researchers acknowledge that not all patients at high risk go on to develop type 2 diabetes, added to which the referral numbers were low, based on the funding available, with few black or minority ethnic participants, men, or those on low incomes. Nevertheless, they conclude that the initiative has the potential to have considerable impact. “A UK primary care referral route partnered with this commercial weight management provider can deliver an effective diabetes prevention programme,” they write. “The lifestyle changes and weight loss achieved in the intervention translated into considerable reductions in diabetes risk, with an immediate and significant public health impact.”

Adapted from: Carolyn Piper, Agnes Marossy, Zoe Griffiths, Amanda Adegboye. Evaluation of a type 2 diabetes prevention program using a commercial weight management provider for non-diabetic hyperglycemic patients referred by primary care in the UKBMJ Open Diabetes Research & Care, 2017; 5 (1): e000418 DOI: 10.1136/bmjdrc-2017-000418

*If you are looking to knock $30.00 off of your next wine purchase, check out Bright Cellars! You can also find the link posted on the right side of the blog. Happy sippen! 

Daily Nutrition Nugget

Add Protein To Your Breakfast! A protein-packed breakfast will reduce hunger later in the day. This doesn’t mean load up on three kinds of breakfast meats, instead add a hard-boiled egg or some Greek yogurt to your first meal of the day. Try a cup of plain Greek yogurt with some sliced almonds, mixed berries, honey and chia seeds mixed together.

Daily Inspiration Nugget 

People change for two main reasons: either their minds have been opened, or their hearts have been broken.

 

Neutrons observe vitamin B6-dependent enzyme activity useful for drug development

B6-dependent protein, potentially opening avenues for new antibiotics and drugs to battle diseases such as drug-resistant tuberculosis, malaria, and diabetes.

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Specifically, the team used neutron crystallography to study the location of hydrogen atoms in aspartate aminotransferase, or AAT, an enzyme vital to the metabolism of certain amino acids. “We visualized the first neutron structure of a vitamin B6 enzyme that belongs to a large protein family with hundreds of members that exist in nature,” said Oak Ridge National Laboratory’s (ORNL) Andrey Kovalevsky, a senior co-author of the study, which was published in Nature Communications. Vitamin B6-dependent proteins are part of a diverse group of enzymes that conduct over a hundred different chemical reactions in cells. The enzymes are of interest to biomedical, as well as bioenergy, researchers because of their role in metabolizing amino acids and other cell nutrients.

“These enzymes are unique in that each one performs a specific chemical reaction with exquisite accuracy while suppressing other viable chemical transformations,” Kovalevsky said. “How they accomplish this is not well understood, but it is of great significance for drug design.” The team’s previous research predicted that hydrogen atoms move in and around the enzyme’s active site, where the chemical reaction takes place, indicating that the hydrogen atoms’ positioning controls the reaction type. Knowing the precise location of hydrogen atoms can explain why the behavior of these enzymes is so specific, but hydrogen is hard to detect with standard methods such as X-ray crystallography.

To directly determine the positions of hydrogen atoms within AAT, the ORNL-led team turned to neutron diffraction techniques. The researchers exposed fine protein crystals to neutrons using the IMAGINE beamline at ORNL’s High Flux Isotope Reactor and the LADI-III beamline at the Institut Laue-Langevin in Grenoble, France. Surprisingly, the team observed a reaction within one AAT protein biomolecule while another AAT biomolecule was unchanged, providing a before-and-after perspective of the enzyme-catalyzed chemical reaction. “The data revealed that in one of the enzyme’s biomolecular structures the covalent bonds reorganized after a chemical reaction occurred in the active site and, in another, the reaction had not taken place,” Kovalevsky said. “Essentially, we were able to obtain two structures in one crystal, which has never been done before for any protein using neutrons.”

With this knowledge, the team will run molecular simulations to determine the hydrogen atoms’ specific behavior when interacting with the enzyme. The results could be useful in guiding the future design of novel medicines against multidrug-resistant tuberculosis, malaria, diabetes and antibiotic-resistant bacteria. “This study highlights how neutrons are an unrivaled probe for identifying the location of hydrogen atoms in biological systems, providing us with an unprecedented level of structural detail for this important enzyme,” LADI-III beamline scientist Matthew Blakeley said.

Adapted from: Steven Dajnowicz, Ryne C. Johnston, Jerry M. Parks, Matthew P. Blakeley, David A. Keen, Kevin L. Weiss, Oksana Gerlits, Andrey Kovalevsky, Timothy C. Mueser. Direct visualization of critical hydrogen atoms in a pyridoxal 5′-phosphate enzymeNature Communications, 2017; 8 (1) DOI: 10.1038/s41467-017-01060-y

Nutrition Daily Nugget

Eat the rainbow! A fun and tasty way to make sure your family is eating a good variety of fruits and vegetables is to eat as many different colors as you can each day.

Daily Inspiration Nugget

Why do we close our eyes when we pray, cry, kiss, dream? Because the most beautiful things in life are not seen but felt only by the heart.

 

 

World will have more obese children and adolescents than underweight by 2022

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The number of obese children and adolescents (aged 5 to 19 years) worldwide has risen tenfold in the past four decades, according to a new study led by Imperial College London and the World Health Organization (WHO). If current trends continue, more children and adolescents will be obese than moderately or severely underweight by 2022. The study is published in The Lancet. It analyzed weight and height measurements from nearly 130 million people aged over five (31.5 million people aged 5 to 19, and 97.4 million aged 20 and older), the largest number of participants ever involved in an epidemiological study. More than 1000 researchers contributed to the study, which looked at body mass index (BMI) and how obesity has changed worldwide from 1975 to 2016.

During this period, obesity rates in the world’s children and adolescents increased from less than 1% (equivalent to five million girls and six million boys) in 1975 to nearly 6% in girls (50 million) and nearly 8% in boys (74 million) in 2016. Combined, the number of obese 5 to 19-year-olds rose more than tenfold globally, from 11 million in 1975 to 124 million in 2016. An additional 213 million were overweight in 2016 but fell below the threshold for obesity. Lead author Professor Majid Ezzati, of Imperial’s School of Public Health, said: “Over the past four decades, obesity rates in children and adolescents have soared globally, and continue to do so in low-and-middle-income countries. More recently, they have plateaued in higher income countries, although obesity levels remain unacceptably high.”

Professor Ezzati adds: “These worrying trends reflect the impact of food marketing and policies across the globe, with healthy nutritious foods too expensive for poor families and communities. The trend predicts a generation of children and adolescents growing up obese and also malnourished. We need ways to make healthy, nutritious food more available at home and school, especially in poor families and communities, and regulations and taxes to protect children from unhealthy foods.”

More obese than underweight 5 to 19-year-olds by 2022

The authors say that if post-2000 trends continue, global levels of child and adolescent obesity will surpass those for moderately and severely underweight for the same age group by 2022. Nevertheless, the large number of moderately or severely underweight children and adolescents in 2016 (75 million girls and 117 boys) still represents a major public health challenge, especially in the poorest parts of the world. This reflects the threat posed by malnutrition in all its forms, with there being underweight and overweight young people living in the same communities. Children and adolescents have rapidly transitioned from mostly underweight to mostly overweight in many middle-income countries, including in East Asia, Latin America, and the Caribbean. The authors say this could reflect an increase in the consumption of energy-dense foods, especially highly processed carbohydrates, which lead to weight gain and poor lifelong health outcomes.

Dr. Fiona Bull, the programme coordinator for surveillance and population-based prevention of noncommunicable diseases (NCDs) at WHO, said: “These data highlights, remind and reinforce that overweight and obesity is a global health crisis today, and threatens to worsen in coming years unless we start taking drastic action.”

Global data for obesity and underweight

In 2016, there were 50 million obese girls and 74 million obese boys in the world, while the global number of moderately or severely underweight girls and boys was 75 million and 117 million respectively. The number of obese adults increased from 100 million in 1975 (69 million women, 31 million men) to 671 million in 2016 (390 million women, 281 million men). Another 1.3 billion adults were overweight but fell below the threshold for obesity.

Regional/Country data for obesity, BMI and underweight

Obesity:

The rise in childhood and adolescent obesity in low- and middle-income countries, especially in Asia, has accelerated since 1975. Conversely, the rise in high-income countries has slowed and plateaued. The largest increase in the number of obese children and adolescents was seen in East Asia, the high-income English-speaking region (USA, Canada, Australia, New Zealand, Ireland and the UK), and the Middle East and North Africa. In 2016, obesity rates were highest overall in Polynesia and Micronesia, at 25.4% in girls and 22.4% in boys, followed by the high-income English-speaking region. Nauru had the highest prevalence of obesity for girls (33.4%), and the Cook Islands had the highest for boys (33.3%).

In Europe, girls in Malta and boys in Greece had the highest obesity rates, at 11.3% and 16.7% of the population respectively. Girls and boys in Moldova had the lowest obesity rates, at 3.2% and 5% of the population respectively. Girls in the UK had the 73rd highest obesity rate in the world (6th in Europe), and boys in the UK had the 84th highest obesity in the world (18th in Europe). Girls in the USA had the 15th highest obesity rate in the world, and boys had the 12th highest obesity in the world. Among high-income countries, the USA had the highest obesity rates for girls and boys.

BMI:

The largest rise in BMI of children and adolescents since 1975 was in Polynesia and Micronesia for both sexes, and in central Latin America for girls. The smallest rise in the BMI of children and adolescents during the four decades covered by the study was seen in Eastern Europe. The country with the biggest rise in BMI for girls was Samoa, which rose by 5.6 kg/m2, and for boys was the Cook Islands, which rose by 4.4 kg/m2.

Underweight:

India had the highest prevalence of moderately and severely underweight (BMI <19) throughout these four decades (24.4% of girls and 39.3% of boys were moderately or severely underweight in 1975, and 22.7% and 30.7% in 2016). 97 million of the world’s moderately or severely underweight children and adolescents lived in India in 2016.

Solutions exist to reduce child and adolescent obesity

In conjunction with the release of the new obesity estimates, WHO is publishing a summary of the Ending Childhood Obesity (ECHO) Implementation Plan. The plan gives countries clear guidance on effective actions to curb childhood and adolescent obesity. WHO has also released guidelines calling on frontline healthcare workers to actively identify and manage children who are overweight or obese. Dr. Bull added: “WHO encourages countries to implement efforts to address the environments that today are increasing our children’s chance of obesity. Countries should aim particularly to reduce consumption of cheap, ultra-processed, calorie dense, nutrient poor foods. They should also reduce the time children spend on screen-based and sedentary leisure activities by promoting greater participation in physical activity through active recreation and sports.”

Dr. Sophie Hawkesworth, from the Population Health team at Wellcome Trust, which co-funded the study, said: “Global population studies on this scale are hugely important in understanding and addressing modern health challenges. This study harnessed the power of big data to highlight worrying trends of both continuing high numbers of underweight children and teenagers and a concurrent stark rise in childhood obesity. Together with global health partners and the international research community, Wellcome is working to help identify new research opportunities that could help better understand all aspects of malnutrition and the long-term health consequences.”

My thoughts: The unfortunate and sad reality is that I was not surprised when I read the research. 😔 However, this is just more proof that we have to work together as a world, not a country, to fight this epidemic…..and not only obesity but eating disorders as a whole. We can win!

Adapted from: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128*9 million children, adolescents, and adults. The Lancet, 2017 DOI: 10.1016/ S0140-6736(17)32129-3

Nutrition Tip of the Day

Schedule time each week to plan healthy meals! Keep your recipes, grocery list, and coupons in the same place to make planning and budgeting easier.

 

Daily Inspiration 

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Is an Anti-Inflammatory Diet the Best for You?

Fans of anti-inflammatory diets say they can transform you inside and out. Is this another  “health” fad…or do we all really need to go AI?

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An anti-inflammatory diet=less pain, happy gut, more energy, and more! This diet may be buzzy, but the tenets of an AI diet; more plants, less sugar, no refined stuff, is far from a passing fad. “Who needs to eat a more anti-inflammatory diet? Everyone,” says Barry Sears, PhD, creator of The Zone diet, who has spent decades studying chronic inflammation. Here’s the lowdown on inflammation, and how to fight it with food.

What the heck is inflammation, anyway?

Believe it or not, inflammation starts as a good thing. It happens when your immune system sends out white blood cells and “warrior” compounds, such as eicosanoids to attack invading viruses, bacteria, or toxins. A classic example of normal inflammation: Pain, heat, redness, and swelling around a wound or injury (think of a tender sprained ankle). “There’s a separate response called ‘resolution’ that brings the dogs of war back to their barracks and heals your tissues,” says Sears. “The first phase of inflammation causes cellular destruction, and the second phase, resolution, begins cellular rejuvenation. As long as those phases are balanced, you stay well.”

However, for most of us, the balance never happens. That’s because sugar, refined grains, and saturated fat can also trigger an inflammatory immune response, notes Sears, and the typical Western diet is packed with them, meaning we’re inflaming our bodies over and over, every time we eat. Meanwhile, guess what the average American gets way too little of? Fruits, non-starchy veggies, and fatty fish. Fruits and vegetables are packed with antioxidants that help cool things down and reduce the intensity of the initial inflammatory response and fatty fish, a great source of omega-3 fatty acids, can help your body move into the resolution phase.

Air pollution and environmental toxins also trigger your immune system in the same way, but “most of the chronic, extra inflammation in our bodies is diet-related,” says Sears. In arteries, chronic inflammation can lead to heart disease. In the brain, it’s linked to anxiety and depression. In your joints, it causes swelling and pain. In the gut, inflammation throws off the balance of helpful bacteria and causes direct damage to the lining of the intestines, says Mark Hyman, MD, director of the Center for Functional Medicine at the Cleveland Clinic and author of The Blood Sugar Solution: 10-Day Detox Diet. This may contribute to IBS, food sensitivities, autoimmune diseases, and even obesity, research suggests.

In contrast, research shows that following a more anti-inflammatory style of eating may reduce the risk of heart disease, obesity, and some cancers and may even extend your life, says Frank Hu, MD, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health. Other claims about anti-inflammatory diets, such as reversing autoimmune disease (the goal of the Autoimmune Protocol, an extremely restrictive AI diet) or improve mental health, have less solid proof, he says.

How to spot an anti-inflammatory diet

There isn’t just one specific “AI Diet,” unlike Atkins or South Beach. Sears’s Zone diet and Dr. Hyman’s Detox are both highly anti-inflammatory, as is the soy-heavy plan from integrative medicine guru Andrew Weil, MD. Paleo and Whole30 diets are both AI, as well. However, the plan with the most research-backed anti-inflammatory credibility is the traditional Mediterranean diet, emphasizing fruits, vegetables, whole grains, legumes, fish, and olive oil. Several very large studies, including the famed Nurses’ Health Study, have found that people who follow a Mediterranean pattern of eating have lower levels of the inflammatory markers C-reactive protein and interleukin-6 in their blood compared with those who do not. This may be one reason the Mediterranean diet is linked to so many health benefits, from keeping weight down to slashing heart and stroke risk, notes Dr. Hu.

The goals of an AI plan are simple: Cut back on foods that trigger an inflammatory response and eat more of the foods that heal damage. While there are some variations in what’s allowed and what isn’t, most AI plans share an emphasis on eating whole, minimally processed foods, non-starchy vegetables, monounsaturated fats, such as olive and avocado oil, colorful berries and other fruits, omega-3s from fatty fish (or supplements), and avoiding added sugar and refined grains. That said, your plate may look a little different from your friend’s or coworker’s, and that’s the way it should be, says Dr. Hyman. Some people thrive on a grain-free Paleo plan, while others would rather die than give up bread. Food sensitivities also play a role: “People react to foods differently, and if someone has a sensitivity to a particular food, it will lead to cytokine production and an increase in other inflammatory chemicals,” says Dr. Hyman. If you suspect you have a sensitivity, talk to your doctor or a dietitian, who can design an elimination diet to help ID the culprit.

What’s off the menu?

While all AI plans give a thumbs-up to veggies, fatty fish, and olive oil, the foods you can’t eat vary. Women with a history of eating disorders take note: “Restricting whole food groups can be triggering,” says Sonya Angelone, RDN. Here is what’s not allowed in four different diets:

Autoimmune protocol: Nightshade vegetables (tomatoes, eggplants,peppers), nuts, seeds, eggs.

Paleo: All grains, dairy, legumes, (chickpeas, lentils, beans, peanuts).

The Zone Diet: All refined grains, white potatoes.

Mediterranean Diet: Added sugar, refined sugar.

So what exactly do you eat?

You don’t have to follow any AI diet perfectly to make a big impact. A healthy body is built to handle the occasional onslaught of inflammation (like having a cupcake at a party); it’s the regular, consistent consumption (and overconsumption) of inflammatory foods, such as sugar and saturated fat that’s linked to serious disease, says Sonya Angelone, RDN, a spokesperson for the Academy of Nutrition and Dietetics. A 2012 study of nearly 2,000 people, for example, found that those who ate the most sweets over two years had significantly higher levels of interleukin-6 than people who ate more veggies, fruits, and whole grains. That’s why it’s more important to eat an overall “super” diet rather than focus on individual superfoods, says Angelone. “If you’re regularly eating a bunch of doughnuts along with a bunch of anti-inflammatory veggies, you’re still harming your body,” adds Dr. Hyman. Follow these AI guidelines on most days:

1. Aim for half to two-thirds of your plate to be nonstarchy vegetables. Greens of all kinds, mushrooms, summer squash, beets, cauliflower…the list goes on and on, as well as at breakfast, too, says Dr. Hyman. They’re packed with gut-balancing fiber and powerful antioxidants.

2. Limit added sugar and sweet drinks. That includes fruit juices and natural sweeteners, such as honey, says Dr. Hyman. In a small 2005 study, people who were fed a high-sugar diet for 10 weeks had significantly elevated blood levels of haptoglobin, an inflammatory marker that in high concentrations is associated with diabetes, heart attack, stroke, and obesity, compared with controls.

3. Eat fish. Especially fatty kinds, such as salmon, mackerel, herring, and anchovies, or take omega-3 supplements, at least 1,000 milligrams daily, says Dr. Hyman.

4. Nix white flour and limit other flour-based foods. Focus on whole, intact grains, such as quinoa, brown rice, and bulgur wheat instead of loading up on whole-grain crackers, breads, and tortillas. Even 100% whole-grain flour will cause a spike in blood sugar that exacerbates inflammation, especially for people with insulin resistance, metabolic syndrome (i.e., prediabetes), or diabetes, so use them moderately, says Sears.

5. Choose fats carefully. The most abundant saturated fats in our diet contain the same fatty acids as do fragments of the cell walls of many bacteria. No wonder our immune system sees a bacon cheeseburger as a threat! Limit saturated fats and skip vegetable oils that are high in omega-6 fats, such as safflower and corn oils. Opt instead for olive, avocado, or walnut oil. “It might sound tough, but if you think about it, it’s exactly how your grandmother probably told you to eat!” says Sears, and a diet endorsed by your nana? Now that sounds like a plan.

Yes, you might lose some weight

Going AI doesn’t automatically mean you’ll drop pounds, says Angelone, especially if your weight is in a healthy range to begin with. However, research does suggest that an AI diet packed with veggies and low in sugar and refined carbs can help with weight loss goals. “You feel fuller on fewer calories because the high-fiber foods have so much more volume,” she says. The healthy fats in an AI plan may also play a role: A large, five-year study published in 2016 found that people who ate a veggie-and fat-rich Mediterranean diet lost more weight than those who went on a low-fat plan.

The 10 best foods for fighting inflammation

These are foods that research has shown to have exceptionally strong effects on inflammation:

• Berries

• Dark green Leafy vegetables (like kale, spinach, Swiss chard)

• Fatty fish

• Garlic and onions

• Green tea

• Ginger

• Turmeric

• Nuts

• Oranges

• Tart cherries

What are your thoughts on an AI diet? Can it transform you from the inside out?

Nutrition Tip of the Day

Cook vegetables in healthy ways that will help bring out their natural flavors, including roasting, grilling, steaming and baking. You’ll need less salt (if any) and may even turn the most anti-veggie kid into a fan!

Daily Inspiration 

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