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.¬†ūüėĒ¬†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.

 

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Too much sugar? Even ‘healthy people’ are at risk of developing heart disease

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Healthy people who consume high levels of sugar are at an increased risk of developing cardiovascular disease. A ground-breaking study from the University of Surrey found that a subject group of otherwise healthy men had increased levels of fat in their blood and fat stored in their livers after they had consumed a high sugar diet. The study, which has been published in Clinical Science, looked at two groups of men with either high or low levels of liver fat, and fed them a high or low sugar diet to find out if the amount of liver fat influences the impact of sugar on their cardiovascular health. The low sugar diet contained no more than 140 calories a day worth of sugar, an amount close to the recommended intake, while the high sugar diet contained 650 calories worth.

After 12 weeks on the high sugar diet, the men with a high level of liver fat, a condition known as non-alcoholic fatty liver disease (NAFLD), showed changes in their fat metabolism that are associated with an increased risk of cardiovascular disease, heart attacks and strokes. Fat metabolism is the biochemical process by which fats are transported and broken down in the blood, and used by the cells of the body. The results also revealed that when the group of healthy men with a low level of liver fat consumed a high amount of sugar, their liver fat increased and their fat metabolism became similar to that of the men with NAFLD.

Professor of Nutritional Metabolism, Bruce Griffin, said: “Our findings provide new evidence that consuming high amounts of sugar can alter your fat metabolism in ways that could increase your risk of cardiovascular disease.¬†“While most adults don’t consume the high levels of sugar we used in this study, some children and teenagers may reach these levels of sugar intake by over-consuming fizzy drinks and sweets. This raises concern for the future health of the younger population, especially in view of the alarmingly high prevalence of NAFLD in children and teenagers, and exponential rise of fatal liver disease in adults.”

Adapted from: A. Margot Umpleby, Fariba Shojaee-Moradie, Barbara Fielding, Xuefei Li, Andrea Marino, Najlaa Alsini, Cheryl Isherwood, Nicola Jackson, Aryati Ahmad, Michael Stolinski, Julie Anne Lovegrove, Sigurd Johnsen, Jeewaka Mendis, John Wright, Malgorzata E Wilinska, Roman Hovorka, Jimmy Bell, Louise E Thomas, Gary Frost, Bruce Arthur Griffin. Impact of liver fat on the differential partitioning of hepatic triacylglycerol into VLDL subclasses on high and low sugar diets. Clinical Science, 2017; CS20171208 DOI: 10.1042/CS20171208

Nutrition Tip of the Day

Use fresh or dried herbs and spices or a salt-free seasoning blend in place of salt when cooking. Add a squeeze of fresh lemon or lime to add flavor to cooked foods.

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Lowering Fat, Increasing Carbs Better for Type 2 Diabetes

Reducing dietary fat while increasing carbohydrate intake is best for type 2 diabetes, according to a study published online in the European Journal of Nutrition. Researchers followed the diets of 1,785 type 2 diabetes patients as part of the TOSCA.IT Study. An increase from less than 25 percent to 35 percent or more in dietary fat intake raised triglycerides, LDL cholesterol, and HbA1c levels, while an increase from less than 45 percent to 60 percent or more in complex carbohydrate intake lowered all of these levels. Increasing fiber and lowering added sugar intakes also had positive effects on cholesterol and blood sugar levels. This is the first study to show that small changes in fat and carbohydrate intake affect metabolic risk factors in a large population of type 2 diabetes patients.

Reprinted from The Physicians Committee for Responsible Medicine

Tip of the Day

What makes it a whole grain? Whole grains contain the entire grain kernel: the bran, germ, and endosperm. Examples of whole grains include oatmeal, brown rice, bulgur, and whole cornmeal.

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Black Women, Older Patients Unlikely to Hit Diabetes Targets

Most older Americans struggle to keep their diabetes under control, and serious racial disparities remain in hitting targets, according to a new study. Most of the more than 5,000 patients in the study met targets for hemoglobin A1c levels (72%), for LDL cholesterol levels (63%), and for blood pressure (73%), but only 35% met all three, reported Christina Parrinello, MPH, a PhD candidate at Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues. In addition, a higher proportion of whites than blacks met the targets, and among patients treated for risk factors, there were disparities in terms of race (strong but nonsignificant trends in some cases): Prevalence ratios were 1.03 for HbA1c (95% CI 0.91-1.17), 1.21 for LDL cholesterol (95% CI 1.09-1.35), 1.10 for blood pressure (95% CI 1.00-1.21), and 1.28 for all three (95% CI 0.99-1.66).
The findings appeared in the July issue of Diabetes Care.¬†“Many older adults with diabetes are not meeting recommended treatment targets for hemoglobin A1c, blood pressure, and cholesterol,‚ÄĚ according to Parrinello.

“However, a one-size-fits-all approach may not be ideal for this heterogeneous population,” she added. “We need to think about whether older adults are currently being over- or under-treated, and whether individualized targets may be more appropriate.‚Ä̬†The targets for risk factor control among older adults have been controversial, noted the authors, partly because the evidence for the targets comes from trials of middle-aged adults.¬†“These findings may not apply to older adults with diabetes who may not live long enough to experience the full microvascular benefits of tight glycemic control,” wrote the authors. Alternative, less stringent targets have been proposed. For those, 90% of patients met the target for HbA1c, 86% for LDL cholesterol, 87% for blood pressure, and 68% for all three.

The racial disparities remained with the relaxed targets, however. Data were taken for the Atherosclerosis Risk in Communities Study, which began in 1987. About a third of the patients had diagnosed diabetes, of which the mean age was 75; 44% were male, and 29% were black. In addition, among those with diabetes, those who were taking glucose-lowering medication were more likely to be black, male, and obese and have lower education and income than those not taking medication. About a quarter of those with diabetes were taking insulin. The American Diabetes Associations has established risk factor targets for people with diabetes: HbA1c at <7% (or <53 mmol/mol), LDL cholesterol at <100 mg/dL, systolic blood pressure at <140 mm Hg, and diastolic blood pressure at <90 mm Hg.

The alternative guidelines are less stringent: HbA1c <8% (<64 mmol/mol), LDL cholesterol <130 mg/dL, systolic blood pressure <150 mm Hg, and diastolic blood pressure <90 mm Hg. (These blood pressure targets are those recommended — controversially — by the experts appointed to the Eighth Joint National Committee.) In the study, HbA1c and cholesterol were measured in the laboratory during visits.The authors found that black women were the least likely of the group divided by race and sex to have risk factors that were at or below the treatment targets. Those with diabetes for more than 15 years were less likely to hit the HbA1c and blood pressure targets compared to those who had diabetes for a shorter period.
White and black men had similar rates of hitting all three of the targets (prevalence ratio 0.95, 95% CI 0.69-1.32) but white women were more likely than black women to meet all three (1.58, 95% CI 1.08-2.32). Similarly, there was no significant difference by race in who met the blood pressure targets, but there was in women.

When the less stringent targets were taken into account, many of the same patterns held.¬†The authors noted that educational differences could not entirely explain the racial disparities in controlling of risk factors. “There could be racial differences in access to health care or treatment approaches, as well as medication adherence, which could contribute to the observed racial disparities in risk factor control,” they wrote.¬†They added that it’s still not clear whether alternative, less strict targets should be considered. “There is growing emphasis on the need for individualized treatment targets but it is unclear how to optimize treatment in older adults to maximize health benefits and minimize adverse outcomes,” they said.

Elizabeth Selvin, MPH, PhD, of Johns Hopkins University and senior author of the study, added in a press release that more research needs to be done. “Are some older adults being over-treated? Are some being undertreated? These are questions for which we don’t have answers,” she said.¬†Researchers noted that the blood pressure guidelines have changed over time, and they were different at the time the data began to be collected, which may be an important limitation to the study. Another limitation is that most of the black patients were recruited from only two sites. In addition, those with poorly controlled diabetes may have been less likely to make an appointment, thus eliminating themselves from the data pool.

Medpage Today

Tip of the Day

Foods to eat more often. Eat more vegetables, fruits, whole grains, and fat-free or 1% milk and dairy products. These foods have the nutrients you need for health including potassium, calcium, vitamin D, and fiber. Make them the basis for meals and snacks.

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Red and Process Meats Increase Risk for Type 2 Diabetes

Various components found in red and processed meat products increase your risk for developing type 2 diabetes, according to a review published in Metabolism: Clinical and Experimental. Saturated fat, high sodium levels, carcinogens, nitrates, heme iron, and other compounds in red and processed meats may all contribute to decreased insulin sensitivity and other risk factors for type 2 diabetes. While the study calls for more research on specific mechanisms, the authors suspect some combination of these components may increase risk for disease. Preventive measures suggested include increased exercise and a high-fiber, low-fat diet.

Physicians Committee for Responsible Medicine 

Tip of the day

We’ll drink to that!¬†Keep water in your fridge. Investing in a water-filter pitcher is a great way to store water at home. Drinking water instead of sugary drinks is a healthy choice.

Daily Inspiration

The early church had no church buildings, no bibles, no automobiles, no planes, no trains, no television, no radio. Yet they turned their world ‚Äúupside down‚ÄĚ ¬†for Christ. They instituted a spiritual revolution simply because they were filled with the spirit.

‚ÄúThey were all filled with the Holy Spirit.‚ÄĚ

~ Acts 2:4

Expert Care in Treatment and Prevention of Diabetes

In wake of new data showing more than 29 million Americans have diabetes and 86 million adults have prediabetes, the Academy of Nutrition and Dietetics is reinforcing the importance of a lifelong healthful eating plan, developed with a registered dietitian nutritionist, in the prevention and treatment of diabetes.¬†“The figures released from the Centers for Disease Control and Prevention are a good reminder of the importance of eating healthfully and getting plenty of physical activity to help prevent and manage serious diseases like diabetes,” said registered dietitian nutritionist and Academy President Sonja Connor.¬†Also highlighted in the report is the economic impact of the diabetes epidemic. In 2012, diabetes and its related complications cost $245 billion in total medical costs and lost work and wages.¬†“The CDC’s data underscore the importance of registered dietitian nutritionists and dietetic technicians, registered in preventing disease and improving the health of people with diabetes. It also reinforces the Academy’s advocacy work to improve care for people with diabetes and prediabetes by supporting initiatives and legislation like the proposed National Diabetes Clinical Care Commission Act,” Connor said.

This legislation, now before Congress, creates a commission comprised of diabetes experts, including registered dietitian nutritionists and other specialists who treat the complications of diabetes. The goal of the commission is to streamline federal investments to improve the coordination and clinical care outcomes for people with diabetes and pre diabetes.¬†The Academy is determined to move the National Diabetes Clinical Care Commission Act forward to improve care for people with diabetes and prediabetes. Today, the Academy is asking its 75,000 members to send letters to their members of Congress urging them to cosponsor this bill.¬†“Academy members understand the importance of prevention, which is why we also support the Preventing Diabetes in Medicare Act to help stop cases of diabetes in the Medicare population,” Connor said. “By increasing patients’ access to medical nutrition therapy provided by a registered dietitian nutritionist, individuals with prediabetes or those at risk for diabetes can finally receive the treatment they need.‚Ä̬†“We look forward to working with our nation’s political leaders to ensure patients have access to effective, coordinated care for better health,” Connor said.

Academy of Nutrition and Dietetics 

Tip of the day

One day at a time! Increase physical activity by picking activities you like and start by doing what you can, at least 10 minutes at a time. Every bit adds up, and the health benefits increase as you spend more time being active. The point is to get out there and move!

Choose My Plate 

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At night my soul longs for You, Indeed, my spirit within me seeks You diligently; For when the earth experiences Your judgments The inhabitants of the world learn righteousness.

~ Isaiah 26:9