We Can’t Prevent Childhood Obesity By Education Alone: Lessons From The Evidence Base

 This briefing examines randomised control trials across a range of countries and settings. It analyses the focus of the trials through a wider determinants of health lens, and compares the focus of interventions against previously-mapped causes of obesity - which show that approximately 60 per cent of the causes come from living and working conditions, such as housing or transport, or wider conditions, such as income equality or land-use.

Click here to access King's fund blog

Psychological Perspectives On Obesity: Addressing Policy, Practice And Research Priorities

This report calls for government to ensure every initiative aimed at promoting a healthy weight is informed by psychological evidence. It says weight management services are best delivered by multidisciplinary teams that include psychologists. Click here to read King's Fund blog

Childhood obesity: applying All Our Health

Evidence and guidance on childhood obesity, to help families and communities intervene and help change eating and activity habits. Click here to access guidance

Excess body fat increases the risk of depression

Carrying ten kilograms of excess body fat increases the risk of depression by seventeen per cent. The more fat, the greater the probability of developing depression. This is the main conclusion of a new study carried out by researchers from Aarhus University and Aarhus University Hospital, Denmark. Click here to read ScienceDaily article

Adult obesity: applying All Our Health

Evidence and guidance for healthcare professionals, to help people change their eating and activity habits. Click here to read government page

Integrated therapy treating obesity and depression is effective

An intervention combining behavioral weight loss treatment and problem-solving therapy with as-needed antidepressant medication for participants with co-occurring obesity and depression improved weight loss and depressive symptoms compared with routine physician care. read ScienceDaily article here

'Strongest evidence yet' that being obese causes depression

New research released today from the University of South Australia and University of Exeter in the UK has found the strongest evidence yet that obesity causes depression, even in the absence of other health problems. Click here for ScienceDaily article

NIHR Signal Hospital admission rates and costs increase in line with BMI

Each 2kg/m² rise in body mass index (BMI) above the normal-weight threshold in women aged 55-79 leads to a 5% rise in annual hospital admissions and 7% rise in healthcare costs. In England, £662 million of the annual hospital admission costs in 2013 could be attributed to overweight or obesity in women of this age group. 


https://discover.dc.nihr.ac.uk/content/signal-00575/hospital-admission-rates-and-costs-increase-in-line-with-bmi


From the NIHR Dissemination Centre

Study IDs Psychosocial Barriers to Treating Childhood Obesity

A new study shows that obese children whose families have elevated psychological and social risks, including child behavior problems, parent mental health issues, and family financial difficulties, are more likely to drop out of weight management treatment and less likely to lose weight.  Click here to read further.

NIHR Signal Being overweight or having diabetes are both linked to cancer

For western high-income countries such as the UK, an estimated 15% to 16% of cancers could be avoided by preventing diabetes, obesity or excess weight (defined as a Body Mass Index [BMI] greater than 25). A high BMI was responsible for almost twice as many cancers as diabetes
.
Around 5.6% of cancers globally in 2012 were attributable to diabetes or high BMI. Because obesity is increasing globally, this number may rise by 25% by 2035.


From the NIHR Dissemination Centre

UHCW publication: Differential expression of Lp-PLA2 in obesity and type 2 diabetes and the influence of lipids

Differential expression of Lp-PLA2 in obesity and type 2 diabetes and the influence of lipids.
Jackisch L, Kumsaiyai W, Moore JD, Al-Daghri N, Kyrou I, Barber TM, Randeva H, Kumar S, Tripathi G, McTernan PG.
Diabetologia 2018 Feb 9. doi: 10.1007/s00125-018-4558-6. [Epub ahead of print]


Abstract
AIMS/HYPOTHESIS: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a circulatory macrophage-derived factor that increases with obesity and leads to a higher risk of cardiovascular disease (CVD). Despite this, its role in adipose tissue and the adipocyte is unknown. Therefore, the aims of this study were to clarify the expression of Lp-PLA2 in relation to different adipose tissue depots and type 2 diabetes, and ascertain whether markers of obesity and type 2 diabetes correlate with circulating Lp-PLA2. A final aim was to evaluate the effect of cholesterol on cellular Lp-PLA2 in an in vitro adipocyte model.METHODS: Analysis of anthropometric and biochemical variables from a cohort of lean (age 44.4 ± 6.2 years; BMI 22.15 ± 1.8 kg/m2, n = 23), overweight (age 45.4 ± 12.3 years; BMI 26.99 ± 1.5 kg/m2, n = 24), obese (age 49.0 ± 9.1 years; BMI 33.74 ± 3.3 kg/m2, n = 32) and type 2 diabetic women (age 53.0 ± 6.13 years; BMI 35.08 ± 8.6 kg/m2, n = 35), as part of an ethically approved study. Gene and protein expression of PLA2 and its isoforms were assessed in adipose tissue samples, with serum analysis undertaken to assess circulating Lp-PLA2 and its association with cardiometabolic risk markers. A human adipocyte cell model, Chub-S7, was used to address the intracellular change in Lp-PLA2 in adipocytes. RESULTS: Lp-PLA2 and calcium-independent PLA2 (iPLA2) isoforms were altered by adiposity, as shown by microarray analysis (p < 0.05). Type 2 diabetes status was also observed to significantly alter gene and protein levels of Lp-PLA2 in abdominal subcutaneous (AbdSc) (p < 0.01), but not omental, adipose tissue. Furthermore, multivariate stepwise regression analysis of circulating Lp-PLA2 and metabolic markers revealed that the greatest predictor of Lp-PLA2 in non-diabetic individuals was LDL-cholesterol (p = 0.004). Additionally, in people with type 2 diabetes, oxidised LDL (oxLDL), triacylglycerols and HDL-cholesterol appeared important predictors, accounting for 59.7% of the variance (p < 0.001). Subsequent in vitro studies determined human adipocytes to be a source of Lp-PLA2, as confirmed by mRNA expression, protein levels and immunochemistry. Further in vitro experiments revealed that treatment with LDL-cholesterol or oxLDL resulted in significant upregulation of Lp-PLA2, while inhibition of Lp-PLA2 reduced oxLDL production by 19.8% (p < 0.05).CONCLUSIONS/INTERPRETATION: Our study suggests adipose tissue and adipocytes are active sources of Lp-PLA2, with differential regulation by fat depot and metabolic state. Moreover, levels of circulating Lp-PLA2 appear to be influenced by unfavourable lipid profiles in type 2 diabetes, which may occur in part through regulation of LDL-cholesterol and oxLDL metabolism in adipocytes.


View details on PubMed at https://www.ncbi.nlm.nih.gov/pubmed/29427237

UHCW publication: Metabolic phenotype of male obesity-related secondary hypogonadism pre-replacement and post-replacement therapy with intra-muscular testosterone undecanoate therapy

Metabolic phenotype of male obesity-related secondary hypogonadism pre-replacement and post-replacement therapy with intra-muscular testosterone undecanoate therapy.

Georgios K. Dimitriadis, Harpal S. Randeva, Saboor Aftab, Asad Ali, John G. Hattersley, Sarojini Pandey, Dimitris K. Grammatopoulos, Georgios Valsamakis

Georgios Mastorakos, T. Hugh Jones, Thomas M. Barber.

Endocrine. 2018 Feb 2. doi: 10.1007/s12020-017-1516-x
Abstract
AIM:
To explore the metabolic phenotype of obesity-related secondary hypogonadism (SH) in men pre-replacement and post-replacement therapy with long-acting intramuscular (IM) testosterone undecanoate (TU).
METHODS:
A prospective observational pilot study on metabolic effects of TU IM in male obesity-related SH (hypogonadal [HG] group, n = 13), including baseline comparisons with controls (eugonadal [EG] group, n = 15). Half the subjects (n = 7 in each group) had type 2 diabetes mellitus (T2D). Baseline metabolic assessment on Human Metabolism Research Unit: fasting blood samples; BodPod (body composition), and; whole-body indirect calorimetry. The HG group was treated with TU IM therapy for 6-29 months (mean 14.8-months [SD 8.7]), and assessment at the Human Metabolism Research Unit repeated. T-test comparisons were performed between baseline and follow-up data (HG group), and between baseline data (HG and EG groups). Data reported as mean (SD).
RESULTS:
Overall, TU IM therapy resulted in a statistically significant improvement in HbA1C (9 mmol/mol, P = 0.03), with 52% improvement in HOMA%B. Improvement in glycaemic control was driven by the HG subgroup with T2D, with 18 mmol/mol [P = 0.02] improvement in HbA1C. Following TU IM therapy, there was a statistically significant reduction in fat mass (3.5 Kg, P = 0.03) and increase in lean body mass (2.9 kg, P = 0.03). Lipid profiles and energy expenditure were unchanged following TU IM therapy. Comparisons between baseline data for HG and EG groups were equivalent apart from differences in testosterone, SHBG and basal metabolic rate (BMR).
CONCLUSION:
In men with obesity-related SH (including a subgroup with T2D), TU IM therapy improved glycaemic control, beta cell function, and body composition.

Open access full text available at: https://link.springer.com/article/10.1007/s12020-017-1516-x

Naltrexone–bupropion for managing overweight and obesity [TA494]

New:  Technology appraisal guidance

Naltrexone–bupropion is not recommended within its marketing authorisation for managing overweight and obesity in adults alongside a reduced-calorie diet and increased physical activity.

This recommendation is not intended to affect treatment with naltrexone–bupropion that was started in the NHS before this guidance was published. Adults having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

CBT Can Help Binge Eaters Lose Weight

According to new findings from the University of Pennsylvania published in the journal Obesity, binge eating is a significant obstacle to losing weight. Those who continue to binge eat while trying to lose weight drop about half as much as those who don’t or those who do and then subsequently stop. Click here for link to PsychCentral article

Plasma irisin is elevated in type 2 diabetes and is associated with increased E-selectin levels

Cardiovasc Diabetol. 2017 Nov 9;16(1):147. doi: 10.1186/s12933-017-0627-2.

BACKGROUND: Irisin is a hormone released mainly from skeletal muscle after exercise which increases adipose tissue energy expenditure. Adipocytes can also release irisin after exercise, acting as a local adipokine to induce white adipose tissue to take on a brown adipose tissue-like phenotype, suggesting that irisin and its receptor may represent a novel molecular target for the treatment of obesity and obesity-related diabetes. Previous reports provide conflicting evidence regarding circulating irisin levels in patients with type 2 diabetes (T2DM).

CONCLUSION:These data suggest that elevated plasma irisin in T2DM is associated with indices of adiposity, and that irisin may be involved in pro-atherogenic endothelial disturbances that accompany obesity and T2DM. Accordingly, irisin may constitute a potentially novel therapeutic opportunity in the field of obesity and cardiovascular diabetology.

UHCW Research: Kyrou I and Randeva HS

NIHR Signal Being overweight or obese is linked with heart disease even without other metabolic risk factors

People with certain metabolic risk factors who are obese are two and a half times as likely to develop heart disease as healthy people of normal weight. But those who are obese without these other risk factors still have a 28% increased risk of heart disease compared with healthy people of normal weight.

This suggests excess weight should be seen as an independent risk factor, challenging the idea that people can be “fat but fit”.

From the NIHR Dissemination Centre

Setmelanotide for pro-opiomelanocortin deficiency obesity

Body fat and food intake are regulated by signals from the brain to the gut. One of the important hormones that is responsible for this is pro-opiomelanocortin (POMC). In a very small group of people there is a lack of this hormone (due to a genetic mutation), referred to as POMC deficiency. This causes severe overeating which leads to obesity and high blood sugar in children. Very few adults have been observed with this condition, which may be due to high death rates in adolescence. Pale skin that does not tan and red hair are common signs of POMC deficiency obesity.
Currently there are no licensed treatment options for POMC deficiency obesity, however weight loss medicines orlistat and methylcellulose are the only treatment options offered. Setmelanotide is being developed to treat pro-opiomelanocortin (POMC) deficiency obesity. If marketed setmelanotide could be the first effective treatment option aimed specifically at this patient group as it replaces one of the key hormones that is lacking in POMC deficiency patients (melanocytestimulating hormone). It has been shown to reduce hunger and has resulted in substantial weight loss in previous patients.


From NIHR Innovation Observatory

NHS targets super-sized chocolate bars in battle against obesity, diabetes and tooth-decay

Hospitals have been ordered to take super-size chocolate bars and “grab bags” of sugary snacks off the shelves in the latest step of the NHS plan to fight obesity, diabetes and tooth-decay.

NHS England chief executive Simon Stevens has announced a 250 calorie limit on confectionery sold in hospital canteens, stores, vending machines and other outlets.

Hospital chiefs will have to ensure that four out of five items purchased on their premises do not bust the limit, which is an eighth of a woman’s and a tenth of a man’s recommended daily intake, or lose out on funding ring-fenced for improving the health of staff, patients and their visitors.

Unhealthy sandwiches and drinks are also being targeted as the NHS, Europe’s largest employer, takes a lead in tackling the availability of unhealthy food and drinks that are fuelling an obesity crisis.

Child weight management services: systematic review

This report, published by Public Health England, addresses the critical features of successful Tier 2 weight management programmes for children aged 0 to 11 years.

NIHR Signal 52-week programme leads to more weight loss than 12-week

Obese people referred to a 52-week group weight management programme lost about 2kg more weight on average by one and two years compared to those referred for the standard 12 weeks. These modest health gains were also more likely to be sustained over time in the long programme. A brief intervention led to 3kg weight loss at 12 months, but the 12- and 52-week more intensive programmes led to 23% and 46% more weight loss respectively.