Obesity Week 2012

SAN ANTONIO – Vigorous aerobic exercise performed for 20 or 40 minutes, 5 days per week, improved fitness and was associated with dose-dependent benefits on insulin resistance and general and visceral adiposity in a randomized controlled trial involving 222 children who were overweight or obese and sedentary.

The intensity of the exercise appeared to be the most important factor for improving aerobic fitness, but volume of exercise was important for reducing adiposity and diabetes risk, Catherine L. Davis, Ph.D., reported at the annual meeting of the Obesity Society.

iStockphoto.com

Fitness, as measured using the adjusted mean difference in peak VO₂, was similar for 73 children randomized to 40 minutes of daily exercise (the high-dose exercise group) and 71 children randomized to 20 minutes of daily exercise (the low-dose group). Fitness was significantly greater for exercise groups compared with 78 controls. The adjusted mean difference in peak VO₂ was 2.4 mL/kg per minute from baseline to 13-weeks’ follow-up for both groups vs. the control group, said Dr. Davis of the Medical College of Georgia, Augusta.

Changes in body fat were measured using dual x-ray absorptiometry, and changes in visceral fat were measured using magnetic resonance imaging. The adjusted mean differences were -1.4% for the high-dose exercise group and -0.8% for the low-dose exercise group compared with controls. For visceral fat, the differences were -3.9% and -2.8%, respectively.

Reductions in the insulin area under the curve were measured using an oral glucose tolerance test. The adjusted mean difference was -3.56 x 10³ microU/mL for the high-dose exercise group and -2.96 x 10³ microU/mL for the low-dose exercise group compared with controls. There were no differences in outcomes based on sex or race.

The presentation of the findings coincided with their publication (JAMA 2012;308:1103-12).

Children in the study were aged 7-11 years (mean of 9.4 years) with an average body mass index of 26. Most (85%) were obese and 28% had prediabetes. The students were recruited from 15 public schools between 2003 and 2006, and were randomized to the high-dose or low-dose exercise groups or to a control group, Dr. Davis said. Six cohorts of 30-40 students participated during the study period.

Both the high- and low-dose groups exercised during an after-school program 5 days each week; exercise was vigorous, but game based, with an emphasis on intensity, fun, and safety rather than competition or skill enhancement. Average daily heart rate was calculated, and students earned bonus points for achieving a rate above 150 beats per minute. These points were used to "purchase" various prizes.

The control group did not participate in an after-school program but met monthly for a "lifestyle class," mainly for the purpose of maintaining contact for follow-up.

One-third of elementary school students in the United States are either overweight or obese, Dr. Davis said. The risk of diabetes in this population has increased as a result – often developing by puberty, with potentially dire consequences for long-term health. Prior to this study, dose-response data with respect to physical activity among children had been lacking.

"Even just 20 minutes of vigorous physical activity on a daily basis makes a big difference after just a few months," she said.

Recent data suggesting a benefit of such activity on cognition and math achievement also could convince schools to make efforts to offer daily exercise for children, she added.

This study was supported by grants from the National Institutes of Health and the Salvador de Madariaga Program of the Spanish Ministry of Education and Science. Dr. Davis and her colleagues reported having no conflicts of interest.

SAN ANTONIO – Vigorous aerobic exercise performed for 20 or 40 minutes, 5 days per week, improved fitness and was associated with dose-dependent benefits on insulin resistance and general and visceral adiposity in a randomized controlled trial involving 222 children who were overweight or obese and sedentary.

The intensity of the exercise appeared to be the most important factor for improving aerobic fitness, but volume of exercise was important for reducing adiposity and diabetes risk, Catherine L. Davis, Ph.D., reported at the annual meeting of the Obesity Society.

iStockphoto.com

Fitness, as measured using the adjusted mean difference in peak VO₂, was similar for 73 children randomized to 40 minutes of daily exercise (the high-dose exercise group) and 71 children randomized to 20 minutes of daily exercise (the low-dose group). Fitness was significantly greater for exercise groups compared with 78 controls. The adjusted mean difference in peak VO₂ was 2.4 mL/kg per minute from baseline to 13-weeks’ follow-up for both groups vs. the control group, said Dr. Davis of the Medical College of Georgia, Augusta.

Changes in body fat were measured using dual x-ray absorptiometry, and changes in visceral fat were measured using magnetic resonance imaging. The adjusted mean differences were -1.4% for the high-dose exercise group and -0.8% for the low-dose exercise group compared with controls. For visceral fat, the differences were -3.9% and -2.8%, respectively.

Reductions in the insulin area under the curve were measured using an oral glucose tolerance test. The adjusted mean difference was -3.56 x 10³ microU/mL for the high-dose exercise group and -2.96 x 10³ microU/mL for the low-dose exercise group compared with controls. There were no differences in outcomes based on sex or race.

The presentation of the findings coincided with their publication (JAMA 2012;308:1103-12).

Children in the study were aged 7-11 years (mean of 9.4 years) with an average body mass index of 26. Most (85%) were obese and 28% had prediabetes. The students were recruited from 15 public schools between 2003 and 2006, and were randomized to the high-dose or low-dose exercise groups or to a control group, Dr. Davis said. Six cohorts of 30-40 students participated during the study period.

Both the high- and low-dose groups exercised during an after-school program 5 days each week; exercise was vigorous, but game based, with an emphasis on intensity, fun, and safety rather than competition or skill enhancement. Average daily heart rate was calculated, and students earned bonus points for achieving a rate above 150 beats per minute. These points were used to "purchase" various prizes.

The control group did not participate in an after-school program but met monthly for a "lifestyle class," mainly for the purpose of maintaining contact for follow-up.

One-third of elementary school students in the United States are either overweight or obese, Dr. Davis said. The risk of diabetes in this population has increased as a result – often developing by puberty, with potentially dire consequences for long-term health. Prior to this study, dose-response data with respect to physical activity among children had been lacking.

"Even just 20 minutes of vigorous physical activity on a daily basis makes a big difference after just a few months," she said.

Recent data suggesting a benefit of such activity on cognition and math achievement also could convince schools to make efforts to offer daily exercise for children, she added.

This study was supported by grants from the National Institutes of Health and the Salvador de Madariaga Program of the Spanish Ministry of Education and Science. Dr. Davis and her colleagues reported having no conflicts of interest.

SAN ANTONIO – Vigorous aerobic exercise performed for 20 or 40 minutes, 5 days per week, improved fitness and was associated with dose-dependent benefits on insulin resistance and general and visceral adiposity in a randomized controlled trial involving 222 children who were overweight or obese and sedentary.

The intensity of the exercise appeared to be the most important factor for improving aerobic fitness, but volume of exercise was important for reducing adiposity and diabetes risk, Catherine L. Davis, Ph.D., reported at the annual meeting of the Obesity Society.

iStockphoto.com

Fitness, as measured using the adjusted mean difference in peak VO₂, was similar for 73 children randomized to 40 minutes of daily exercise (the high-dose exercise group) and 71 children randomized to 20 minutes of daily exercise (the low-dose group). Fitness was significantly greater for exercise groups compared with 78 controls. The adjusted mean difference in peak VO₂ was 2.4 mL/kg per minute from baseline to 13-weeks’ follow-up for both groups vs. the control group, said Dr. Davis of the Medical College of Georgia, Augusta.

Changes in body fat were measured using dual x-ray absorptiometry, and changes in visceral fat were measured using magnetic resonance imaging. The adjusted mean differences were -1.4% for the high-dose exercise group and -0.8% for the low-dose exercise group compared with controls. For visceral fat, the differences were -3.9% and -2.8%, respectively.

Reductions in the insulin area under the curve were measured using an oral glucose tolerance test. The adjusted mean difference was -3.56 x 10³ microU/mL for the high-dose exercise group and -2.96 x 10³ microU/mL for the low-dose exercise group compared with controls. There were no differences in outcomes based on sex or race.

The presentation of the findings coincided with their publication (JAMA 2012;308:1103-12).

Children in the study were aged 7-11 years (mean of 9.4 years) with an average body mass index of 26. Most (85%) were obese and 28% had prediabetes. The students were recruited from 15 public schools between 2003 and 2006, and were randomized to the high-dose or low-dose exercise groups or to a control group, Dr. Davis said. Six cohorts of 30-40 students participated during the study period.

Both the high- and low-dose groups exercised during an after-school program 5 days each week; exercise was vigorous, but game based, with an emphasis on intensity, fun, and safety rather than competition or skill enhancement. Average daily heart rate was calculated, and students earned bonus points for achieving a rate above 150 beats per minute. These points were used to "purchase" various prizes.

The control group did not participate in an after-school program but met monthly for a "lifestyle class," mainly for the purpose of maintaining contact for follow-up.

One-third of elementary school students in the United States are either overweight or obese, Dr. Davis said. The risk of diabetes in this population has increased as a result – often developing by puberty, with potentially dire consequences for long-term health. Prior to this study, dose-response data with respect to physical activity among children had been lacking.

"Even just 20 minutes of vigorous physical activity on a daily basis makes a big difference after just a few months," she said.

Recent data suggesting a benefit of such activity on cognition and math achievement also could convince schools to make efforts to offer daily exercise for children, she added.

This study was supported by grants from the National Institutes of Health and the Salvador de Madariaga Program of the Spanish Ministry of Education and Science. Dr. Davis and her colleagues reported having no conflicts of interest.

SAN ANTONIO – Early childhood presents one of the most promising opportunities for addressing the problem of obesity, according to Dr. Elsie Taveras.

Not only is interaction with the health care system at its highest from the prenatal period through the second year of life, but early childhood also is a time when healthy choices can be made on behalf of children, she explained at the annual meeting of the Obesity Society.

©annedde/iStockphoto.com

"This is a time when children are not making autonomous choices in eating and physical activity. ... This is a time when we can get children and families – but especially children – on a healthy weight trajectory," said Dr. Taveras, a pediatrician who is codirector of the obesity prevention program in the department of population medicine at Harvard Medical School, Boston.

Since monitoring at this stage is fairly continuous, healthy practices can be established and risks can be identified early, she added, noting that prevention is much easier than management.

The importance of prevention is underscored by 2007-2008 National Health and Nutrition Examination Survey (NHANES) data showing that 17% of children aged 2-19 years in the United States are obese, with a disproportionate effect on racial and ethnic minorities. As of 2010, obesity affected 14% of non-Hispanic white children, 24% of black children, and 22% of Hispanic children.

"The other thing that’s starting to gain more attention in the national discourse is that the obesity epidemic has not spared even the youngest of the nation’s children. Almost 10% of infants and toddlers have high weight for length, slightly more than 20% of those aged 2-5 years are overweight or obese, and approximately one to five are carrying extra weight when they enter kindergarten," she said.

Fortunately, quality data exist to help guide efforts to address obesity in these early childhood years, she said.

An Institute of Medicine report released in June 2011 draws on that data to outline important steps that can be taken in early childhood. The "evidence-informed" report specifically addresses the importance of growth monitoring, physical activity, healthy eating, limited screen time (and thus limited exposure to "toxic" food and beverage marketing), and appropriate sleep duration, said Dr. Taveras, who served on the IOM committee on obesity prevention policies for young children, which developed the recommendations in the report.

One thing that stands out based on the data included in the IOM report, as well as from other recent research, is the importance of identifying children at high risk for obesity based on accelerated weight gain during the first 6 months of life, Dr. Taveras said.

Data – including findings from her own recent research – consistently show that accelerated weight-for-length gain in the first 6 months of life is associated with increased obesity risk at age 4 years, she said.

Plot weight and length on a Centers for Disease Control growth chart, and consider it a red flag if the plot crosses two or more growth percentiles very quickly, she advised.

Good evidence also is emerging about the importance of responsiveness to infant satiety and hunger cues, she said, noting that allowing for self-regulation in several areas, including dietary and sleep patterns, appears to have long-term benefits with respect to weight and health in children.

Regarding sleep, CDC data show that insufficient sleep among adults is reported more often in areas where obesity rates are highest, and other data have also suggested a link between sleep deprivation and obesity. Most of the available data are from studies in adults, so additional study to increase understanding of the relationship between obesity and sleep in children is needed, Dr. Taveras said.

The data that are available in children, however, suggest that the worst combination is too little sleep and too much television time. Not only do children who spend a lot of time in front of the television or computer have reduced physical activity levels, but they also have increased exposures to unhealthy food and beverage marketing. Such exposures have been shown to influence food preferences, food requests, and short-term food consumption in children aged 2-12 years, and to be associated with increased body fat percentages in this age group.

Companies are getting very creative when it comes to targeting children, and a particularly disturbing trend, considering the existing disparities in racial and ethnic minorities with respect to obesity, is an increase in marketing to Hispanic youth, Dr. Taveras noted.

Spending on Spanish language television food and beverage advertising has more than doubled, as has exposure in this population.

"There is good reason to be concerned about food marketing," she said.

Taken together, the available data underscore the importance of addressing childhood obesity at a multisector population level.

"For obesity prevention we need to step outside of our comfort zone, out of the clinical setting where we can really reach children where they chiefly spend their time – in the home and community, really thinking about how to develop and implement multisector interventions," she said.

Dr. Taveras said she had no relevant financial disclosures to report.

SAN ANTONIO – Early childhood presents one of the most promising opportunities for addressing the problem of obesity, according to Dr. Elsie Taveras.

Not only is interaction with the health care system at its highest from the prenatal period through the second year of life, but early childhood also is a time when healthy choices can be made on behalf of children, she explained at the annual meeting of the Obesity Society.

©annedde/iStockphoto.com

"This is a time when children are not making autonomous choices in eating and physical activity. ... This is a time when we can get children and families – but especially children – on a healthy weight trajectory," said Dr. Taveras, a pediatrician who is codirector of the obesity prevention program in the department of population medicine at Harvard Medical School, Boston.

Since monitoring at this stage is fairly continuous, healthy practices can be established and risks can be identified early, she added, noting that prevention is much easier than management.

The importance of prevention is underscored by 2007-2008 National Health and Nutrition Examination Survey (NHANES) data showing that 17% of children aged 2-19 years in the United States are obese, with a disproportionate effect on racial and ethnic minorities. As of 2010, obesity affected 14% of non-Hispanic white children, 24% of black children, and 22% of Hispanic children.

"The other thing that’s starting to gain more attention in the national discourse is that the obesity epidemic has not spared even the youngest of the nation’s children. Almost 10% of infants and toddlers have high weight for length, slightly more than 20% of those aged 2-5 years are overweight or obese, and approximately one to five are carrying extra weight when they enter kindergarten," she said.

Fortunately, quality data exist to help guide efforts to address obesity in these early childhood years, she said.

An Institute of Medicine report released in June 2011 draws on that data to outline important steps that can be taken in early childhood. The "evidence-informed" report specifically addresses the importance of growth monitoring, physical activity, healthy eating, limited screen time (and thus limited exposure to "toxic" food and beverage marketing), and appropriate sleep duration, said Dr. Taveras, who served on the IOM committee on obesity prevention policies for young children, which developed the recommendations in the report.

One thing that stands out based on the data included in the IOM report, as well as from other recent research, is the importance of identifying children at high risk for obesity based on accelerated weight gain during the first 6 months of life, Dr. Taveras said.

Data – including findings from her own recent research – consistently show that accelerated weight-for-length gain in the first 6 months of life is associated with increased obesity risk at age 4 years, she said.

Plot weight and length on a Centers for Disease Control growth chart, and consider it a red flag if the plot crosses two or more growth percentiles very quickly, she advised.

Good evidence also is emerging about the importance of responsiveness to infant satiety and hunger cues, she said, noting that allowing for self-regulation in several areas, including dietary and sleep patterns, appears to have long-term benefits with respect to weight and health in children.

Regarding sleep, CDC data show that insufficient sleep among adults is reported more often in areas where obesity rates are highest, and other data have also suggested a link between sleep deprivation and obesity. Most of the available data are from studies in adults, so additional study to increase understanding of the relationship between obesity and sleep in children is needed, Dr. Taveras said.

The data that are available in children, however, suggest that the worst combination is too little sleep and too much television time. Not only do children who spend a lot of time in front of the television or computer have reduced physical activity levels, but they also have increased exposures to unhealthy food and beverage marketing. Such exposures have been shown to influence food preferences, food requests, and short-term food consumption in children aged 2-12 years, and to be associated with increased body fat percentages in this age group.

Companies are getting very creative when it comes to targeting children, and a particularly disturbing trend, considering the existing disparities in racial and ethnic minorities with respect to obesity, is an increase in marketing to Hispanic youth, Dr. Taveras noted.

Spending on Spanish language television food and beverage advertising has more than doubled, as has exposure in this population.

"There is good reason to be concerned about food marketing," she said.

Taken together, the available data underscore the importance of addressing childhood obesity at a multisector population level.

"For obesity prevention we need to step outside of our comfort zone, out of the clinical setting where we can really reach children where they chiefly spend their time – in the home and community, really thinking about how to develop and implement multisector interventions," she said.

Dr. Taveras said she had no relevant financial disclosures to report.

SAN ANTONIO – Early childhood presents one of the most promising opportunities for addressing the problem of obesity, according to Dr. Elsie Taveras.

Not only is interaction with the health care system at its highest from the prenatal period through the second year of life, but early childhood also is a time when healthy choices can be made on behalf of children, she explained at the annual meeting of the Obesity Society.

©annedde/iStockphoto.com

"This is a time when children are not making autonomous choices in eating and physical activity. ... This is a time when we can get children and families – but especially children – on a healthy weight trajectory," said Dr. Taveras, a pediatrician who is codirector of the obesity prevention program in the department of population medicine at Harvard Medical School, Boston.

Since monitoring at this stage is fairly continuous, healthy practices can be established and risks can be identified early, she added, noting that prevention is much easier than management.

The importance of prevention is underscored by 2007-2008 National Health and Nutrition Examination Survey (NHANES) data showing that 17% of children aged 2-19 years in the United States are obese, with a disproportionate effect on racial and ethnic minorities. As of 2010, obesity affected 14% of non-Hispanic white children, 24% of black children, and 22% of Hispanic children.

"The other thing that’s starting to gain more attention in the national discourse is that the obesity epidemic has not spared even the youngest of the nation’s children. Almost 10% of infants and toddlers have high weight for length, slightly more than 20% of those aged 2-5 years are overweight or obese, and approximately one to five are carrying extra weight when they enter kindergarten," she said.

Fortunately, quality data exist to help guide efforts to address obesity in these early childhood years, she said.

An Institute of Medicine report released in June 2011 draws on that data to outline important steps that can be taken in early childhood. The "evidence-informed" report specifically addresses the importance of growth monitoring, physical activity, healthy eating, limited screen time (and thus limited exposure to "toxic" food and beverage marketing), and appropriate sleep duration, said Dr. Taveras, who served on the IOM committee on obesity prevention policies for young children, which developed the recommendations in the report.

One thing that stands out based on the data included in the IOM report, as well as from other recent research, is the importance of identifying children at high risk for obesity based on accelerated weight gain during the first 6 months of life, Dr. Taveras said.

Data – including findings from her own recent research – consistently show that accelerated weight-for-length gain in the first 6 months of life is associated with increased obesity risk at age 4 years, she said.

Plot weight and length on a Centers for Disease Control growth chart, and consider it a red flag if the plot crosses two or more growth percentiles very quickly, she advised.

Good evidence also is emerging about the importance of responsiveness to infant satiety and hunger cues, she said, noting that allowing for self-regulation in several areas, including dietary and sleep patterns, appears to have long-term benefits with respect to weight and health in children.

Regarding sleep, CDC data show that insufficient sleep among adults is reported more often in areas where obesity rates are highest, and other data have also suggested a link between sleep deprivation and obesity. Most of the available data are from studies in adults, so additional study to increase understanding of the relationship between obesity and sleep in children is needed, Dr. Taveras said.

The data that are available in children, however, suggest that the worst combination is too little sleep and too much television time. Not only do children who spend a lot of time in front of the television or computer have reduced physical activity levels, but they also have increased exposures to unhealthy food and beverage marketing. Such exposures have been shown to influence food preferences, food requests, and short-term food consumption in children aged 2-12 years, and to be associated with increased body fat percentages in this age group.

Companies are getting very creative when it comes to targeting children, and a particularly disturbing trend, considering the existing disparities in racial and ethnic minorities with respect to obesity, is an increase in marketing to Hispanic youth, Dr. Taveras noted.

Spending on Spanish language television food and beverage advertising has more than doubled, as has exposure in this population.

"There is good reason to be concerned about food marketing," she said.

Taken together, the available data underscore the importance of addressing childhood obesity at a multisector population level.

"For obesity prevention we need to step outside of our comfort zone, out of the clinical setting where we can really reach children where they chiefly spend their time – in the home and community, really thinking about how to develop and implement multisector interventions," she said.

Dr. Taveras said she had no relevant financial disclosures to report.

SAN ANTONIO – School-based interventions for reducing obesity and diabetes risk can have a positive impact, but should be viewed as just one piece of the puzzle, according to Gary Foster, Ph.D.

Findings from the HEALTHY study provide some insight into how and why this is so, Dr. Foster said at the annual meeting of the Obesity Society.

As an investigator on that cluster design, multicomponent, school-based trial, he saw firsthand how school-based interventions can make a difference, but the overall results of that trial, which were published in the New England Journal of Medicine in 2010, underscore the importance of a more comprehensive approach for combating childhood obesity and the development of diabetes, he said.

Thinkstockphotos.com

In more than 4,600 6th grade students from 42 schools that participated in the 3-year randomized, controlled trial, an "incredibly comprehensive and robust intervention" that addressed nutrition, physical activity, behavioral knowledge and skills, and communications and social marketing did not lead to a significant difference between the intervention and control groups with respect to the combined prevalence of overweight and obesity. However, on the obesity measure alone, the difference between the intervention and control groups approached significance, with those in the intervention group having a 19% lower odds of being obese at the end of the study, compared with the students in the control schools (odds ratio, 0.81), the investigators reported (N. Engl. J. Med. 2010;363:443-53).

Also, students in both groups who were overweight or obese at baseline (about 50% of the study population) had about a 16% decrease in the prevalence of overweight and obesity at the end of the study.

The intervention schools also had significantly greater improvements on several secondary outcomes, including body mass index (BMI) z score, insulin, and percentage of students with waist circumference at or above the 90th percentile – "a big deal from a public health point of view," said Dr. Foster, director of the center for obesity research and education at Temple University, Philadelphia.

Why does moving students from the obese to the overweight category make such an impact – perhaps even more of an impact than moving them from the overweight to the healthy category?

"The data are quite compelling," he said, explaining that in this study population, only 2% of students in the healthy range, and only 6% in the overweight range, had elevated insulin levels.

"But a whopping 35% in the obese range had elevated insulin levels ... so if you can modify insulin levels by moving from the obese to the overweight range ... boy, what an impact that would have on diabetes," he said.

Similarly, glucose levels increased with weight range, although the differences were less pronounced. Still, there was a "pretty sharp uptick" in the obese versus the overweight and healthy groups, he noted.

"It’s very troubling that 30% of kids going to school are already obese in 6th grade," Dr. Foster said, but the successes seen in the HEALTHY trial – including the improvement of measures of adiposity that could affect diabetes outcomes, are encouraging, he noted.

Also encouraging was the fact that all schools completed the study, attesting to the value of the cluster design of the trial, and the innovative approach that targeted numerous factors that could contribute to obesity and diabetes risk – from nutritional goals to activity levels to food-based school fundraisers.

Although some resistance was encountered (removing French fries from school lunches didn’t always go over well, Dr. Foster noted), schools, for the most part, were able to effectively enact change.

Programs should take care, however, to avoid targeting only overweight and obese students (and to instead target appropriate outcomes) as it remains important to work to decrease the stigma and discrimination associated with obesity, he said.

School-based programs can indeed be of benefit, although results are mixed, he said, adding that it "really is a comprehensive approach that’s needed."

"Schools are just one piece of this, and there are a lot of pieces to the puzzle," he said.

Dr. Foster disclosed that he is an adviser for Con Agra, United Health Group, Medtronic, and Nutrisystem. The complete list of disclosures for HEALTHY trial investigators is available with the full text of the article at NEJM.org.

SAN ANTONIO – School-based interventions for reducing obesity and diabetes risk can have a positive impact, but should be viewed as just one piece of the puzzle, according to Gary Foster, Ph.D.

Findings from the HEALTHY study provide some insight into how and why this is so, Dr. Foster said at the annual meeting of the Obesity Society.

As an investigator on that cluster design, multicomponent, school-based trial, he saw firsthand how school-based interventions can make a difference, but the overall results of that trial, which were published in the New England Journal of Medicine in 2010, underscore the importance of a more comprehensive approach for combating childhood obesity and the development of diabetes, he said.

Thinkstockphotos.com

In more than 4,600 6th grade students from 42 schools that participated in the 3-year randomized, controlled trial, an "incredibly comprehensive and robust intervention" that addressed nutrition, physical activity, behavioral knowledge and skills, and communications and social marketing did not lead to a significant difference between the intervention and control groups with respect to the combined prevalence of overweight and obesity. However, on the obesity measure alone, the difference between the intervention and control groups approached significance, with those in the intervention group having a 19% lower odds of being obese at the end of the study, compared with the students in the control schools (odds ratio, 0.81), the investigators reported (N. Engl. J. Med. 2010;363:443-53).

Also, students in both groups who were overweight or obese at baseline (about 50% of the study population) had about a 16% decrease in the prevalence of overweight and obesity at the end of the study.

The intervention schools also had significantly greater improvements on several secondary outcomes, including body mass index (BMI) z score, insulin, and percentage of students with waist circumference at or above the 90th percentile – "a big deal from a public health point of view," said Dr. Foster, director of the center for obesity research and education at Temple University, Philadelphia.

Why does moving students from the obese to the overweight category make such an impact – perhaps even more of an impact than moving them from the overweight to the healthy category?

"The data are quite compelling," he said, explaining that in this study population, only 2% of students in the healthy range, and only 6% in the overweight range, had elevated insulin levels.

"But a whopping 35% in the obese range had elevated insulin levels ... so if you can modify insulin levels by moving from the obese to the overweight range ... boy, what an impact that would have on diabetes," he said.

Similarly, glucose levels increased with weight range, although the differences were less pronounced. Still, there was a "pretty sharp uptick" in the obese versus the overweight and healthy groups, he noted.

"It’s very troubling that 30% of kids going to school are already obese in 6th grade," Dr. Foster said, but the successes seen in the HEALTHY trial – including the improvement of measures of adiposity that could affect diabetes outcomes, are encouraging, he noted.

Also encouraging was the fact that all schools completed the study, attesting to the value of the cluster design of the trial, and the innovative approach that targeted numerous factors that could contribute to obesity and diabetes risk – from nutritional goals to activity levels to food-based school fundraisers.

Although some resistance was encountered (removing French fries from school lunches didn’t always go over well, Dr. Foster noted), schools, for the most part, were able to effectively enact change.

Programs should take care, however, to avoid targeting only overweight and obese students (and to instead target appropriate outcomes) as it remains important to work to decrease the stigma and discrimination associated with obesity, he said.

School-based programs can indeed be of benefit, although results are mixed, he said, adding that it "really is a comprehensive approach that’s needed."

"Schools are just one piece of this, and there are a lot of pieces to the puzzle," he said.

Dr. Foster disclosed that he is an adviser for Con Agra, United Health Group, Medtronic, and Nutrisystem. The complete list of disclosures for HEALTHY trial investigators is available with the full text of the article at NEJM.org.

SAN ANTONIO – School-based interventions for reducing obesity and diabetes risk can have a positive impact, but should be viewed as just one piece of the puzzle, according to Gary Foster, Ph.D.

Findings from the HEALTHY study provide some insight into how and why this is so, Dr. Foster said at the annual meeting of the Obesity Society.

As an investigator on that cluster design, multicomponent, school-based trial, he saw firsthand how school-based interventions can make a difference, but the overall results of that trial, which were published in the New England Journal of Medicine in 2010, underscore the importance of a more comprehensive approach for combating childhood obesity and the development of diabetes, he said.

Thinkstockphotos.com

In more than 4,600 6th grade students from 42 schools that participated in the 3-year randomized, controlled trial, an "incredibly comprehensive and robust intervention" that addressed nutrition, physical activity, behavioral knowledge and skills, and communications and social marketing did not lead to a significant difference between the intervention and control groups with respect to the combined prevalence of overweight and obesity. However, on the obesity measure alone, the difference between the intervention and control groups approached significance, with those in the intervention group having a 19% lower odds of being obese at the end of the study, compared with the students in the control schools (odds ratio, 0.81), the investigators reported (N. Engl. J. Med. 2010;363:443-53).

Also, students in both groups who were overweight or obese at baseline (about 50% of the study population) had about a 16% decrease in the prevalence of overweight and obesity at the end of the study.

The intervention schools also had significantly greater improvements on several secondary outcomes, including body mass index (BMI) z score, insulin, and percentage of students with waist circumference at or above the 90th percentile – "a big deal from a public health point of view," said Dr. Foster, director of the center for obesity research and education at Temple University, Philadelphia.

Why does moving students from the obese to the overweight category make such an impact – perhaps even more of an impact than moving them from the overweight to the healthy category?

"The data are quite compelling," he said, explaining that in this study population, only 2% of students in the healthy range, and only 6% in the overweight range, had elevated insulin levels.

"But a whopping 35% in the obese range had elevated insulin levels ... so if you can modify insulin levels by moving from the obese to the overweight range ... boy, what an impact that would have on diabetes," he said.

Similarly, glucose levels increased with weight range, although the differences were less pronounced. Still, there was a "pretty sharp uptick" in the obese versus the overweight and healthy groups, he noted.

"It’s very troubling that 30% of kids going to school are already obese in 6th grade," Dr. Foster said, but the successes seen in the HEALTHY trial – including the improvement of measures of adiposity that could affect diabetes outcomes, are encouraging, he noted.

Also encouraging was the fact that all schools completed the study, attesting to the value of the cluster design of the trial, and the innovative approach that targeted numerous factors that could contribute to obesity and diabetes risk – from nutritional goals to activity levels to food-based school fundraisers.

Although some resistance was encountered (removing French fries from school lunches didn’t always go over well, Dr. Foster noted), schools, for the most part, were able to effectively enact change.

Programs should take care, however, to avoid targeting only overweight and obese students (and to instead target appropriate outcomes) as it remains important to work to decrease the stigma and discrimination associated with obesity, he said.

School-based programs can indeed be of benefit, although results are mixed, he said, adding that it "really is a comprehensive approach that’s needed."

"Schools are just one piece of this, and there are a lot of pieces to the puzzle," he said.

Dr. Foster disclosed that he is an adviser for Con Agra, United Health Group, Medtronic, and Nutrisystem. The complete list of disclosures for HEALTHY trial investigators is available with the full text of the article at NEJM.org.

SAN ANTONIO – Earlier may be better when it comes to bariatric surgery for obesity.

Data increasingly suggest that surgery for extreme obesity during adolescence is associated with prevention or reversal of obesity-related health problems, including diabetes, frequently seen in those who remain obese into adulthood, Dr. Thomas Inge said at the annual meeting of the Obesity Society.

Currently, an estimated 4%-7% of adolescents are extremely obese, and a number of researchers have noted significant detrimental effects decades down the road and even early in adulthood for those affected by obesity and diabetes, he said.

These effects include years of life lost and "typical adult life complications of diabetes," such as amputation and renal disease, said Dr. Inge, a surgeon and director of the Center for Bariatric Research and Innovation at Cincinnati Children’s Hospital Medical Center.

Particularly disturbing is the fact that as many as 50% of children in some racial subgroups – including very young children – may develop diabetes in their lifetime, he added, noting that managing diabetes and obesity in this age group is quite challenging and that outcomes are often suboptimal.

Further, school-based studies suggest that morbidly obese children and teens tend to continue to gain weight over time, adding about 1 point of body mass index and 1 inch of waist circumference each year.

In a retrospective study designed to assess the association between adolescent weight status and adult health status, Dr. Inge found that obesity at age 18 based on participant recall increased the risk of diabetes and related comorbidities in adulthood by 37%, and increased the risk of renal disease fivefold.

The study, which involved nearly 1,500 adults who were part of the Longitudinal Assessment of Bariatric Surgery (LABS) 2 study, was reported in a poster at the meeting.

"By having been severely obese as an adolescent, they really did face quite significant problems later in life," he said.

The dilemma when it comes to treating obese adolescents is that medical treatment often fails. In one study, adolescents were found to have a greater risk of failure on metformin monotherapy at every time point compared with adults. Similar, but less striking, findings have been reported with rosiglitazone.

"One might propose, then, that adolescent diabetes is a more virulent condition, and if that’s the case, shouldn’t we really be thinking about more aggressive treatment – particularly today, in light of the fact that we do have surgical therapies with very high-powered evidence of demonstrated effectiveness?" he said.

Not only have studies in adults shown that gastric bypass surgery, for example, is highly effective for reducing fat mass and improving insulin resistance and beta-cell function, but adolescent data also show a benefit.

In a small retrospective study of 11 adolescent teens with type 2 diabetes and a preoperative BMI of about 50 kg/m², Dr. Inge found that BMI and weight decreased by 34% at 1 year follow-up.

Additionally, all participants were using medication at baseline, including one who was on insulin, and all but that one patient were off their medications at follow-up, he said, noting that the patient on insulin had successfully reduced medication dosages by 50% at follow-up. Mean glucose levels in the participants fell from 140 to 84 mmol/L, mean insulin values normalized, and insulin sensitivity measures improved dramatically. Glycosylated hemoglobin normalized, on average, and cardiovascular measures also improved.

"So this leads to the question: What could be responsible for the reduced efficacy of medical treatment in adolescents?" Dr. Inge said.

Because compliance has been good in the studies looking at this, it is possible that biological factors are involved that affect insulin resistance, and this suggests there may be an even greater role for surgery in adolescents. In both adults and adolescents, surgery has been found to dramatically improve insulin resistance.

In fact, in one study gastric bypass seemed to restore a more normal relationship between insulin sensitivity and the first-phase response – even though participants still had "impressive obesity," with a BMI of nearly 40 on average after surgery, he said.

This suggests that in adolescents something more happens as a result of bariatric surgery than just weight loss or "a change in the plumbing."

"It’s changing, perhaps, something more fundamentally important. I think it’s true that these operations are doing something fundamentally metabolic to improve the patient’s response to whatever this pathologic obesity milieu is," Dr. Inge said, noting that additional study via the Teen-LABS multisite consortium and registry is underway.

Teen-LABS, which aims to facilitate coordinated clinical, epidemiological, and behavioral research in the field of adolescent bariatric surgery, recently finished recruitment.

"We’re really testing the hypothesis that bariatric surgery earlier in life may be better than waiting until many more decades have eroded the important metabolic systems in the body," Dr. Inge said, concluding that the future health of obese and severely obese children is of great concern, and that aggressive intervention will be increasingly needed and warranted.

"We need to build upon the evidence base for this, and really describe in detail the risks and benefits to be expected. After gastric bypass, I’m becoming more and more convinced that metabolic defects can dramatically improve. We don’t know exactly why ... but for now, it is fairly clear that this is metabolic surgery," he said, adding that he expects surgical models will provide important clues to mechanisms which can be exploited to expand the armamentarium for fighting pediatric obesity.

Dr. Inge’s research is supported by the National Institutes of Health. He had no other disclosures to report.

SAN ANTONIO – Earlier may be better when it comes to bariatric surgery for obesity.

Data increasingly suggest that surgery for extreme obesity during adolescence is associated with prevention or reversal of obesity-related health problems, including diabetes, frequently seen in those who remain obese into adulthood, Dr. Thomas Inge said at the annual meeting of the Obesity Society.

Currently, an estimated 4%-7% of adolescents are extremely obese, and a number of researchers have noted significant detrimental effects decades down the road and even early in adulthood for those affected by obesity and diabetes, he said.

These effects include years of life lost and "typical adult life complications of diabetes," such as amputation and renal disease, said Dr. Inge, a surgeon and director of the Center for Bariatric Research and Innovation at Cincinnati Children’s Hospital Medical Center.

Particularly disturbing is the fact that as many as 50% of children in some racial subgroups – including very young children – may develop diabetes in their lifetime, he added, noting that managing diabetes and obesity in this age group is quite challenging and that outcomes are often suboptimal.

Further, school-based studies suggest that morbidly obese children and teens tend to continue to gain weight over time, adding about 1 point of body mass index and 1 inch of waist circumference each year.

In a retrospective study designed to assess the association between adolescent weight status and adult health status, Dr. Inge found that obesity at age 18 based on participant recall increased the risk of diabetes and related comorbidities in adulthood by 37%, and increased the risk of renal disease fivefold.

The study, which involved nearly 1,500 adults who were part of the Longitudinal Assessment of Bariatric Surgery (LABS) 2 study, was reported in a poster at the meeting.

"By having been severely obese as an adolescent, they really did face quite significant problems later in life," he said.

The dilemma when it comes to treating obese adolescents is that medical treatment often fails. In one study, adolescents were found to have a greater risk of failure on metformin monotherapy at every time point compared with adults. Similar, but less striking, findings have been reported with rosiglitazone.

"One might propose, then, that adolescent diabetes is a more virulent condition, and if that’s the case, shouldn’t we really be thinking about more aggressive treatment – particularly today, in light of the fact that we do have surgical therapies with very high-powered evidence of demonstrated effectiveness?" he said.

Not only have studies in adults shown that gastric bypass surgery, for example, is highly effective for reducing fat mass and improving insulin resistance and beta-cell function, but adolescent data also show a benefit.

In a small retrospective study of 11 adolescent teens with type 2 diabetes and a preoperative BMI of about 50 kg/m², Dr. Inge found that BMI and weight decreased by 34% at 1 year follow-up.

Additionally, all participants were using medication at baseline, including one who was on insulin, and all but that one patient were off their medications at follow-up, he said, noting that the patient on insulin had successfully reduced medication dosages by 50% at follow-up. Mean glucose levels in the participants fell from 140 to 84 mmol/L, mean insulin values normalized, and insulin sensitivity measures improved dramatically. Glycosylated hemoglobin normalized, on average, and cardiovascular measures also improved.

"So this leads to the question: What could be responsible for the reduced efficacy of medical treatment in adolescents?" Dr. Inge said.

Because compliance has been good in the studies looking at this, it is possible that biological factors are involved that affect insulin resistance, and this suggests there may be an even greater role for surgery in adolescents. In both adults and adolescents, surgery has been found to dramatically improve insulin resistance.

In fact, in one study gastric bypass seemed to restore a more normal relationship between insulin sensitivity and the first-phase response – even though participants still had "impressive obesity," with a BMI of nearly 40 on average after surgery, he said.

This suggests that in adolescents something more happens as a result of bariatric surgery than just weight loss or "a change in the plumbing."

"It’s changing, perhaps, something more fundamentally important. I think it’s true that these operations are doing something fundamentally metabolic to improve the patient’s response to whatever this pathologic obesity milieu is," Dr. Inge said, noting that additional study via the Teen-LABS multisite consortium and registry is underway.

Teen-LABS, which aims to facilitate coordinated clinical, epidemiological, and behavioral research in the field of adolescent bariatric surgery, recently finished recruitment.

"We’re really testing the hypothesis that bariatric surgery earlier in life may be better than waiting until many more decades have eroded the important metabolic systems in the body," Dr. Inge said, concluding that the future health of obese and severely obese children is of great concern, and that aggressive intervention will be increasingly needed and warranted.

"We need to build upon the evidence base for this, and really describe in detail the risks and benefits to be expected. After gastric bypass, I’m becoming more and more convinced that metabolic defects can dramatically improve. We don’t know exactly why ... but for now, it is fairly clear that this is metabolic surgery," he said, adding that he expects surgical models will provide important clues to mechanisms which can be exploited to expand the armamentarium for fighting pediatric obesity.

Dr. Inge’s research is supported by the National Institutes of Health. He had no other disclosures to report.

SAN ANTONIO – Earlier may be better when it comes to bariatric surgery for obesity.

Data increasingly suggest that surgery for extreme obesity during adolescence is associated with prevention or reversal of obesity-related health problems, including diabetes, frequently seen in those who remain obese into adulthood, Dr. Thomas Inge said at the annual meeting of the Obesity Society.

Currently, an estimated 4%-7% of adolescents are extremely obese, and a number of researchers have noted significant detrimental effects decades down the road and even early in adulthood for those affected by obesity and diabetes, he said.

These effects include years of life lost and "typical adult life complications of diabetes," such as amputation and renal disease, said Dr. Inge, a surgeon and director of the Center for Bariatric Research and Innovation at Cincinnati Children’s Hospital Medical Center.

Particularly disturbing is the fact that as many as 50% of children in some racial subgroups – including very young children – may develop diabetes in their lifetime, he added, noting that managing diabetes and obesity in this age group is quite challenging and that outcomes are often suboptimal.

Further, school-based studies suggest that morbidly obese children and teens tend to continue to gain weight over time, adding about 1 point of body mass index and 1 inch of waist circumference each year.

In a retrospective study designed to assess the association between adolescent weight status and adult health status, Dr. Inge found that obesity at age 18 based on participant recall increased the risk of diabetes and related comorbidities in adulthood by 37%, and increased the risk of renal disease fivefold.

The study, which involved nearly 1,500 adults who were part of the Longitudinal Assessment of Bariatric Surgery (LABS) 2 study, was reported in a poster at the meeting.

"By having been severely obese as an adolescent, they really did face quite significant problems later in life," he said.

The dilemma when it comes to treating obese adolescents is that medical treatment often fails. In one study, adolescents were found to have a greater risk of failure on metformin monotherapy at every time point compared with adults. Similar, but less striking, findings have been reported with rosiglitazone.

"One might propose, then, that adolescent diabetes is a more virulent condition, and if that’s the case, shouldn’t we really be thinking about more aggressive treatment – particularly today, in light of the fact that we do have surgical therapies with very high-powered evidence of demonstrated effectiveness?" he said.

Not only have studies in adults shown that gastric bypass surgery, for example, is highly effective for reducing fat mass and improving insulin resistance and beta-cell function, but adolescent data also show a benefit.

In a small retrospective study of 11 adolescent teens with type 2 diabetes and a preoperative BMI of about 50 kg/m², Dr. Inge found that BMI and weight decreased by 34% at 1 year follow-up.

Additionally, all participants were using medication at baseline, including one who was on insulin, and all but that one patient were off their medications at follow-up, he said, noting that the patient on insulin had successfully reduced medication dosages by 50% at follow-up. Mean glucose levels in the participants fell from 140 to 84 mmol/L, mean insulin values normalized, and insulin sensitivity measures improved dramatically. Glycosylated hemoglobin normalized, on average, and cardiovascular measures also improved.

"So this leads to the question: What could be responsible for the reduced efficacy of medical treatment in adolescents?" Dr. Inge said.

Because compliance has been good in the studies looking at this, it is possible that biological factors are involved that affect insulin resistance, and this suggests there may be an even greater role for surgery in adolescents. In both adults and adolescents, surgery has been found to dramatically improve insulin resistance.

In fact, in one study gastric bypass seemed to restore a more normal relationship between insulin sensitivity and the first-phase response – even though participants still had "impressive obesity," with a BMI of nearly 40 on average after surgery, he said.

This suggests that in adolescents something more happens as a result of bariatric surgery than just weight loss or "a change in the plumbing."

"It’s changing, perhaps, something more fundamentally important. I think it’s true that these operations are doing something fundamentally metabolic to improve the patient’s response to whatever this pathologic obesity milieu is," Dr. Inge said, noting that additional study via the Teen-LABS multisite consortium and registry is underway.

Teen-LABS, which aims to facilitate coordinated clinical, epidemiological, and behavioral research in the field of adolescent bariatric surgery, recently finished recruitment.

"We’re really testing the hypothesis that bariatric surgery earlier in life may be better than waiting until many more decades have eroded the important metabolic systems in the body," Dr. Inge said, concluding that the future health of obese and severely obese children is of great concern, and that aggressive intervention will be increasingly needed and warranted.

"We need to build upon the evidence base for this, and really describe in detail the risks and benefits to be expected. After gastric bypass, I’m becoming more and more convinced that metabolic defects can dramatically improve. We don’t know exactly why ... but for now, it is fairly clear that this is metabolic surgery," he said, adding that he expects surgical models will provide important clues to mechanisms which can be exploited to expand the armamentarium for fighting pediatric obesity.

Dr. Inge’s research is supported by the National Institutes of Health. He had no other disclosures to report.

SAN ANTONIO – Parents tend to fall short when it comes to accurately reporting the height and weight of their overweight or obese children, findings from a recent survey suggest.

The findings are of concern because failure to recognize when a child is overweight may prevent parents from seeking appropriate treatment or taking steps to address the problem, Craig A. Johnston, Ph.D., reported in a poster at the annual meeting of the Obesity Society.

The mean parent-reported weight for 118 children aged 5-12 years who were included in the study was 39.97 kg, which was slightly but not significantly greater than the actual mean weight of 39.62 kg. Reported mean height, however, was significantly greater than actual mean height (142.2 cm vs. 140.79 cm), resulting in a discrepancy in actual vs. reported body mass index, BMI as translated into a standardized z score, and body mass index percentile.

For example, zBMI based on parental report vs. actual measurement was 0.55 vs. 0.76, and BMI percentile was 65.12 vs. 70.55, respectively, said Dr. Johnston of the Children’s Nutrition Research Center at Baylor College of Medicine in Houston.

In addition to underreporting their child’s BMI percentile by about 5 percentile points, only about 70% of parents correctly identified the presence or absence of a weight problem in their child, and of those who misclassified their child, 71% underreported BMI, Dr. Johnston said in an interview.

A closer look at the numbers shows that, while all parents of normal and underweight children correctly classified their children as not having a weight problem, the same was not true for parents of overweight and obese children. Parents of overweight children denied that their child had a weight problem in 94% of cases; parents of obese children denied that their child had a weight problem in 48% of cases, he said.

The findings suggest that some parents recognize when their child is overweight or obese but don’t see it as the problem that it is, Dr. Johnston said.

Survey respondents were mostly women (77%). Their children, 55% of whom were girls, had a mean age of 9.4 years.

The findings, which are concerning given that about a third of children in the United States are either overweight or obese, underscore the need for physicians to discuss weight issues with parents. Research has demonstrated that patients are more likely to engage in healthier behaviors when physicians address weight than when physicians do not address weight, he noted.

The findings also highlight a need for better education of parents about recognizing weight problems, as well as about the implications of their child’s overweight or obese status, he said, adding that physicians, schools, and community organizations can all play a role in providing that education.

The study was supported by a grant from the U.S. Department of Agriculture and the American Heart Association. Dr. Johnston said he had no relevant financial conflicts to report.

SAN ANTONIO – Parents tend to fall short when it comes to accurately reporting the height and weight of their overweight or obese children, findings from a recent survey suggest.

The findings are of concern because failure to recognize when a child is overweight may prevent parents from seeking appropriate treatment or taking steps to address the problem, Craig A. Johnston, Ph.D., reported in a poster at the annual meeting of the Obesity Society.

The mean parent-reported weight for 118 children aged 5-12 years who were included in the study was 39.97 kg, which was slightly but not significantly greater than the actual mean weight of 39.62 kg. Reported mean height, however, was significantly greater than actual mean height (142.2 cm vs. 140.79 cm), resulting in a discrepancy in actual vs. reported body mass index, BMI as translated into a standardized z score, and body mass index percentile.

For example, zBMI based on parental report vs. actual measurement was 0.55 vs. 0.76, and BMI percentile was 65.12 vs. 70.55, respectively, said Dr. Johnston of the Children’s Nutrition Research Center at Baylor College of Medicine in Houston.

In addition to underreporting their child’s BMI percentile by about 5 percentile points, only about 70% of parents correctly identified the presence or absence of a weight problem in their child, and of those who misclassified their child, 71% underreported BMI, Dr. Johnston said in an interview.

A closer look at the numbers shows that, while all parents of normal and underweight children correctly classified their children as not having a weight problem, the same was not true for parents of overweight and obese children. Parents of overweight children denied that their child had a weight problem in 94% of cases; parents of obese children denied that their child had a weight problem in 48% of cases, he said.

The findings suggest that some parents recognize when their child is overweight or obese but don’t see it as the problem that it is, Dr. Johnston said.

Survey respondents were mostly women (77%). Their children, 55% of whom were girls, had a mean age of 9.4 years.

The findings, which are concerning given that about a third of children in the United States are either overweight or obese, underscore the need for physicians to discuss weight issues with parents. Research has demonstrated that patients are more likely to engage in healthier behaviors when physicians address weight than when physicians do not address weight, he noted.

The findings also highlight a need for better education of parents about recognizing weight problems, as well as about the implications of their child’s overweight or obese status, he said, adding that physicians, schools, and community organizations can all play a role in providing that education.

The study was supported by a grant from the U.S. Department of Agriculture and the American Heart Association. Dr. Johnston said he had no relevant financial conflicts to report.

SAN ANTONIO – Parents tend to fall short when it comes to accurately reporting the height and weight of their overweight or obese children, findings from a recent survey suggest.

The findings are of concern because failure to recognize when a child is overweight may prevent parents from seeking appropriate treatment or taking steps to address the problem, Craig A. Johnston, Ph.D., reported in a poster at the annual meeting of the Obesity Society.

The mean parent-reported weight for 118 children aged 5-12 years who were included in the study was 39.97 kg, which was slightly but not significantly greater than the actual mean weight of 39.62 kg. Reported mean height, however, was significantly greater than actual mean height (142.2 cm vs. 140.79 cm), resulting in a discrepancy in actual vs. reported body mass index, BMI as translated into a standardized z score, and body mass index percentile.

For example, zBMI based on parental report vs. actual measurement was 0.55 vs. 0.76, and BMI percentile was 65.12 vs. 70.55, respectively, said Dr. Johnston of the Children’s Nutrition Research Center at Baylor College of Medicine in Houston.

In addition to underreporting their child’s BMI percentile by about 5 percentile points, only about 70% of parents correctly identified the presence or absence of a weight problem in their child, and of those who misclassified their child, 71% underreported BMI, Dr. Johnston said in an interview.

A closer look at the numbers shows that, while all parents of normal and underweight children correctly classified their children as not having a weight problem, the same was not true for parents of overweight and obese children. Parents of overweight children denied that their child had a weight problem in 94% of cases; parents of obese children denied that their child had a weight problem in 48% of cases, he said.

The findings suggest that some parents recognize when their child is overweight or obese but don’t see it as the problem that it is, Dr. Johnston said.

Survey respondents were mostly women (77%). Their children, 55% of whom were girls, had a mean age of 9.4 years.

The findings, which are concerning given that about a third of children in the United States are either overweight or obese, underscore the need for physicians to discuss weight issues with parents. Research has demonstrated that patients are more likely to engage in healthier behaviors when physicians address weight than when physicians do not address weight, he noted.

The findings also highlight a need for better education of parents about recognizing weight problems, as well as about the implications of their child’s overweight or obese status, he said, adding that physicians, schools, and community organizations can all play a role in providing that education.

The study was supported by a grant from the U.S. Department of Agriculture and the American Heart Association. Dr. Johnston said he had no relevant financial conflicts to report.

SAN ANTONIO – Earlier may be better when it comes to bariatric surgery for obesity.

Data increasingly suggest that surgery for extreme obesity during adolescence is associated with prevention or reversal of obesity-related health problems, including diabetes, frequently seen in those who remain obese into adulthood, Dr. Thomas Inge said at the annual meeting of the Obesity Society.

Currently, an estimated 4%-7% of adolescents are extremely obese, and a number of researchers have noted significant detrimental effects decades down the road and even early in adulthood for those affected by obesity and diabetes, he said.

"Bariatric surgery earlier in life may be better than waiting until many more decades have eroded the important metabolic systems in the body."

These effects include years of life lost and "typical adult life complications of diabetes," such as amputation and renal disease, said Dr. Inge, a surgeon and director of the Center for Bariatric Research and Innovation at Cincinnati Children’s Hospital Medical Center.

Particularly disturbing is the fact that as many as 50% of children in some racial subgroups – including very young children – may develop diabetes in their lifetime, he added, noting that managing diabetes and obesity in this age group is quite challenging and that outcomes are often suboptimal.

Further, school-based studies suggest that morbidly obese children and teens tend to continue to gain weight over time, adding about 1 point of body mass index and 1 inch of waist circumference each year.

In a retrospective study designed to assess the association between adolescent weight status and adult health status, Dr. Inge found that obesity at age 18 based on participant recall increased the risk of diabetes and related comorbidities in adulthood by 37%, and increased the risk of renal disease fivefold.

The study, which involved nearly 1,500 adults who were part of the Longitudinal Assessment of Bariatric Surgery (LABS) 2 study, was reported in a poster at the meeting.

"By having been severely obese as an adolescent, they really did face quite significant problems later in life," he said.

The dilemma when it comes to treating obese adolescents is that medical treatment often fails. In one study, adolescents were found to have a greater risk of failure on metformin monotherapy at every time point compared with adults. Similar, but less striking, findings have been reported with rosiglitazone.

"One might propose, then, that adolescent diabetes is a more virulent condition, and if that’s the case, shouldn’t we really be thinking about more aggressive treatment – particularly today, in light of the fact that we do have surgical therapies with very high-powered evidence of demonstrated effectiveness?" he said.

Not only have studies in adults shown that gastric bypass surgery, for example, is highly effective for reducing fat mass and improving insulin resistance and beta-cell function, but adolescent data also show a benefit.

In a small retrospective study of 11 adolescent teens with type 2 diabetes and a preoperative BMI of about 50 kg/m², Dr. Inge found that BMI and weight decreased by 34% at 1 year follow-up.

Additionally, all participants were using medication at baseline, including one who was on insulin, and all but that one patient were off their medications at follow-up, he said, noting that the patient on insulin had successfully reduced medication dosages by 50% at follow-up. Mean glucose levels in the participants fell from 140 to 84 mmol/L, mean insulin values normalized, and insulin sensitivity measures improved dramatically. Glycosylated hemoglobin normalized, on average, and cardiovascular measures also improved.

"So this leads to the question: What could be responsible for the reduced efficacy of medical treatment in adolescents?" Dr. Inge said.

Because compliance has been good in the studies looking at this, it is possible that biological factors are involved that affect insulin resistance, and this suggests there may be an even greater role for surgery in adolescents. In both adults and adolescents, surgery has been found to dramatically improve insulin resistance.

In fact, in one study gastric bypass seemed to restore a more normal relationship between insulin sensitivity and the first-phase response – even though participants still had "impressive obesity," with a BMI of nearly 40 on average after surgery, he said.

This suggests that in adolescents something more happens as a result of bariatric surgery than just weight loss or "a change in the plumbing."

"It’s changing, perhaps, something more fundamentally important. I think it’s true that these operations are doing something fundamentally metabolic to improve the patient’s response to whatever this pathologic obesity milieu is," Dr. Inge said, noting that additional study via the Teen-LABS multisite consortium and registry is underway.

Teen-LABS, which aims to facilitate coordinated clinical, epidemiological, and behavioral research in the field of adolescent bariatric surgery, recently finished recruitment.

"We’re really testing the hypothesis that bariatric surgery earlier in life may be better than waiting until many more decades have eroded the important metabolic systems in the body," Dr. Inge said, concluding that the future health of obese and severely obese children is of great concern, and that aggressive intervention will be increasingly needed and warranted.

"We need to build upon the evidence base for this, and really describe in detail the risks and benefits to be expected. After gastric bypass, I’m becoming more and more convinced that metabolic defects can dramatically improve. We don’t know exactly why ... but for now, it is fairly clear that this is metabolic surgery," he said, adding that he expects surgical models will provide important clues to mechanisms which can be exploited to expand the armamentarium for fighting pediatric obesity.

Dr. Inge’s research is supported by the National Institutes of Health. He had no other disclosures to report.

SAN ANTONIO – Earlier may be better when it comes to bariatric surgery for obesity.

Data increasingly suggest that surgery for extreme obesity during adolescence is associated with prevention or reversal of obesity-related health problems, including diabetes, frequently seen in those who remain obese into adulthood, Dr. Thomas Inge said at the annual meeting of the Obesity Society.

Currently, an estimated 4%-7% of adolescents are extremely obese, and a number of researchers have noted significant detrimental effects decades down the road and even early in adulthood for those affected by obesity and diabetes, he said.

"Bariatric surgery earlier in life may be better than waiting until many more decades have eroded the important metabolic systems in the body."

These effects include years of life lost and "typical adult life complications of diabetes," such as amputation and renal disease, said Dr. Inge, a surgeon and director of the Center for Bariatric Research and Innovation at Cincinnati Children’s Hospital Medical Center.

Particularly disturbing is the fact that as many as 50% of children in some racial subgroups – including very young children – may develop diabetes in their lifetime, he added, noting that managing diabetes and obesity in this age group is quite challenging and that outcomes are often suboptimal.

Further, school-based studies suggest that morbidly obese children and teens tend to continue to gain weight over time, adding about 1 point of body mass index and 1 inch of waist circumference each year.

In a retrospective study designed to assess the association between adolescent weight status and adult health status, Dr. Inge found that obesity at age 18 based on participant recall increased the risk of diabetes and related comorbidities in adulthood by 37%, and increased the risk of renal disease fivefold.

The study, which involved nearly 1,500 adults who were part of the Longitudinal Assessment of Bariatric Surgery (LABS) 2 study, was reported in a poster at the meeting.

"By having been severely obese as an adolescent, they really did face quite significant problems later in life," he said.

The dilemma when it comes to treating obese adolescents is that medical treatment often fails. In one study, adolescents were found to have a greater risk of failure on metformin monotherapy at every time point compared with adults. Similar, but less striking, findings have been reported with rosiglitazone.

"One might propose, then, that adolescent diabetes is a more virulent condition, and if that’s the case, shouldn’t we really be thinking about more aggressive treatment – particularly today, in light of the fact that we do have surgical therapies with very high-powered evidence of demonstrated effectiveness?" he said.

Not only have studies in adults shown that gastric bypass surgery, for example, is highly effective for reducing fat mass and improving insulin resistance and beta-cell function, but adolescent data also show a benefit.

In a small retrospective study of 11 adolescent teens with type 2 diabetes and a preoperative BMI of about 50 kg/m², Dr. Inge found that BMI and weight decreased by 34% at 1 year follow-up.

Additionally, all participants were using medication at baseline, including one who was on insulin, and all but that one patient were off their medications at follow-up, he said, noting that the patient on insulin had successfully reduced medication dosages by 50% at follow-up. Mean glucose levels in the participants fell from 140 to 84 mmol/L, mean insulin values normalized, and insulin sensitivity measures improved dramatically. Glycosylated hemoglobin normalized, on average, and cardiovascular measures also improved.

"So this leads to the question: What could be responsible for the reduced efficacy of medical treatment in adolescents?" Dr. Inge said.

Because compliance has been good in the studies looking at this, it is possible that biological factors are involved that affect insulin resistance, and this suggests there may be an even greater role for surgery in adolescents. In both adults and adolescents, surgery has been found to dramatically improve insulin resistance.

In fact, in one study gastric bypass seemed to restore a more normal relationship between insulin sensitivity and the first-phase response – even though participants still had "impressive obesity," with a BMI of nearly 40 on average after surgery, he said.

This suggests that in adolescents something more happens as a result of bariatric surgery than just weight loss or "a change in the plumbing."

"It’s changing, perhaps, something more fundamentally important. I think it’s true that these operations are doing something fundamentally metabolic to improve the patient’s response to whatever this pathologic obesity milieu is," Dr. Inge said, noting that additional study via the Teen-LABS multisite consortium and registry is underway.

Teen-LABS, which aims to facilitate coordinated clinical, epidemiological, and behavioral research in the field of adolescent bariatric surgery, recently finished recruitment.

"We’re really testing the hypothesis that bariatric surgery earlier in life may be better than waiting until many more decades have eroded the important metabolic systems in the body," Dr. Inge said, concluding that the future health of obese and severely obese children is of great concern, and that aggressive intervention will be increasingly needed and warranted.

"We need to build upon the evidence base for this, and really describe in detail the risks and benefits to be expected. After gastric bypass, I’m becoming more and more convinced that metabolic defects can dramatically improve. We don’t know exactly why ... but for now, it is fairly clear that this is metabolic surgery," he said, adding that he expects surgical models will provide important clues to mechanisms which can be exploited to expand the armamentarium for fighting pediatric obesity.

Dr. Inge’s research is supported by the National Institutes of Health. He had no other disclosures to report.

SAN ANTONIO – Earlier may be better when it comes to bariatric surgery for obesity.

Data increasingly suggest that surgery for extreme obesity during adolescence is associated with prevention or reversal of obesity-related health problems, including diabetes, frequently seen in those who remain obese into adulthood, Dr. Thomas Inge said at the annual meeting of the Obesity Society.

Currently, an estimated 4%-7% of adolescents are extremely obese, and a number of researchers have noted significant detrimental effects decades down the road and even early in adulthood for those affected by obesity and diabetes, he said.

"Bariatric surgery earlier in life may be better than waiting until many more decades have eroded the important metabolic systems in the body."

These effects include years of life lost and "typical adult life complications of diabetes," such as amputation and renal disease, said Dr. Inge, a surgeon and director of the Center for Bariatric Research and Innovation at Cincinnati Children’s Hospital Medical Center.

Particularly disturbing is the fact that as many as 50% of children in some racial subgroups – including very young children – may develop diabetes in their lifetime, he added, noting that managing diabetes and obesity in this age group is quite challenging and that outcomes are often suboptimal.

Further, school-based studies suggest that morbidly obese children and teens tend to continue to gain weight over time, adding about 1 point of body mass index and 1 inch of waist circumference each year.

In a retrospective study designed to assess the association between adolescent weight status and adult health status, Dr. Inge found that obesity at age 18 based on participant recall increased the risk of diabetes and related comorbidities in adulthood by 37%, and increased the risk of renal disease fivefold.

The study, which involved nearly 1,500 adults who were part of the Longitudinal Assessment of Bariatric Surgery (LABS) 2 study, was reported in a poster at the meeting.

"By having been severely obese as an adolescent, they really did face quite significant problems later in life," he said.

The dilemma when it comes to treating obese adolescents is that medical treatment often fails. In one study, adolescents were found to have a greater risk of failure on metformin monotherapy at every time point compared with adults. Similar, but less striking, findings have been reported with rosiglitazone.

"One might propose, then, that adolescent diabetes is a more virulent condition, and if that’s the case, shouldn’t we really be thinking about more aggressive treatment – particularly today, in light of the fact that we do have surgical therapies with very high-powered evidence of demonstrated effectiveness?" he said.

Not only have studies in adults shown that gastric bypass surgery, for example, is highly effective for reducing fat mass and improving insulin resistance and beta-cell function, but adolescent data also show a benefit.

In a small retrospective study of 11 adolescent teens with type 2 diabetes and a preoperative BMI of about 50 kg/m², Dr. Inge found that BMI and weight decreased by 34% at 1 year follow-up.

Additionally, all participants were using medication at baseline, including one who was on insulin, and all but that one patient were off their medications at follow-up, he said, noting that the patient on insulin had successfully reduced medication dosages by 50% at follow-up. Mean glucose levels in the participants fell from 140 to 84 mmol/L, mean insulin values normalized, and insulin sensitivity measures improved dramatically. Glycosylated hemoglobin normalized, on average, and cardiovascular measures also improved.

"So this leads to the question: What could be responsible for the reduced efficacy of medical treatment in adolescents?" Dr. Inge said.

Because compliance has been good in the studies looking at this, it is possible that biological factors are involved that affect insulin resistance, and this suggests there may be an even greater role for surgery in adolescents. In both adults and adolescents, surgery has been found to dramatically improve insulin resistance.

In fact, in one study gastric bypass seemed to restore a more normal relationship between insulin sensitivity and the first-phase response – even though participants still had "impressive obesity," with a BMI of nearly 40 on average after surgery, he said.

This suggests that in adolescents something more happens as a result of bariatric surgery than just weight loss or "a change in the plumbing."

"It’s changing, perhaps, something more fundamentally important. I think it’s true that these operations are doing something fundamentally metabolic to improve the patient’s response to whatever this pathologic obesity milieu is," Dr. Inge said, noting that additional study via the Teen-LABS multisite consortium and registry is underway.

Teen-LABS, which aims to facilitate coordinated clinical, epidemiological, and behavioral research in the field of adolescent bariatric surgery, recently finished recruitment.

"We’re really testing the hypothesis that bariatric surgery earlier in life may be better than waiting until many more decades have eroded the important metabolic systems in the body," Dr. Inge said, concluding that the future health of obese and severely obese children is of great concern, and that aggressive intervention will be increasingly needed and warranted.

"We need to build upon the evidence base for this, and really describe in detail the risks and benefits to be expected. After gastric bypass, I’m becoming more and more convinced that metabolic defects can dramatically improve. We don’t know exactly why ... but for now, it is fairly clear that this is metabolic surgery," he said, adding that he expects surgical models will provide important clues to mechanisms which can be exploited to expand the armamentarium for fighting pediatric obesity.

Dr. Inge’s research is supported by the National Institutes of Health. He had no other disclosures to report.

SAN ANTONIO – Excess visceral fat at baseline, subsequent weight gain, and markers of insulin resistance were among factors independently associated with incident prediabetes and type 2 diabetes in obese adults in the Dallas Heart Study.

General adiposity was not found to be associated with increased prediabetes and type 2 diabetes risk, Dr. James A. de Lemos reported at the annual meeting of the Obesity Society.

© okeyphotos/iStockphoto.com

The findings provide insight as to why some obese individuals develop diabetes while others do not, said Dr. de Lemos of the University of Texas Southwestern Medical Center, Dallas.

The epidemic of obesity has led to a secondary epidemic in diabetes that has offset any improvements that would have occurred to the cardiovascular event rate due to lower rates of smoking, lower levels of low-density lipoprotein cholesterol, and less hypertension in the population, Dr. de Lemos explained. Diabetes manifestations are heterogeneous among obese individuals, and body mass index doesn’t help discriminate individuals who are at risk for diabetes versus those who aren’t, he added.

"Our hypothesis was that markers of adipose tissue dysfunction may better predict diabetes and prediabetes onset than general adiposity markers in a specifically obese population," he said.

Of 732 participants in the multiethnic population-based cohort study who were obese at baseline, 84 (11.5%) developed diabetes.

Independent predictors of diabetes on multivariate analysis included higher baseline visceral fat mass (odds ratio per 1 standard deviation 1.4 kg, 2.4), fructosamine level (1.1 micromol/L, 2.0), fasting glucose level (1.1 micromol/L, 1.9), family history of diabetes (OR 2.3), systolic blood pressure (OR per 10 mm Hg, 1.3), and weight gain over follow-up (OR per 1 kg, 1.06). No associations were noted for body mass index, total body fat, or abdominal subcutaneous fat, Dr. de Lemos and his colleagues found (JAMA. 2012; 308: 1150-9).

Conversely, lower body fat mass and adiponectin level showed significant graded, inverse associations with incident prediabetes and diabetes.

Among 512 study participants with normal baseline glucose values, 39% experienced a composite outcome of prediabetes or diabetes. Factors significantly associated with this outcome included baseline measurements of visceral fat mass, fasting glucose level, insulin, and fructosamine, as well as older age, nonwhite race, family history of diabetes, and weight gain over follow-up, Dr. de Lemos said, noting that this composite outcome also was not associated with measures of general adiposity.

Notably, weight gain in this subgroup was the most powerful predictor of prediabetes and diabetes risk over the follow-up period, Dr. de Lemos said.

Also, an evaluation of measures of subclinical cardiovascular disease showed that those who went on to develop prediabetes or diabetes had a greater prevalence of coronary calcium and left ventricular hypertrophy well before onset of these conditions.

"This suggests that some of the factors that contribute to the development of prediabetes and diabetes may be contributing to the development of subclinical cardiovascular disease even before prediabetes and diabetes are manifest," he said.

The Dallas Heart Study enrolled more than 6,100 patients, with oversampling of African Americans, who made up half of the study population. The subset of participants included in the current analysis were adults aged 30-65 years with a BMI of 30 or higher who were enrolled between 2000 and 2002 and followed for a median of 7 years. Body composition was measured using dual energy x-ray absorptiometry scanning and magnetic resonance imaging; subclinical atherosclerosis and cardiac structure and function were measured by computed tomography and MRI. Circulating adipokines and biomarkers of insulin resistance, dyslipidemia, and inflammation also were measured.

The findings indicate that a dysfunctional adiposity phenotype, characterized by excess visceral fat mass and insulin resistance, is associated with both incident prediabetes and diabetes in a specifically obese population, Dr. de Lemos said. This, along with the absence of an association between markers of general adiposity and incident prediabetes and diabetes, suggests that obesity is a "heterogeneous disorder with a distinct adiposity set of phenotypes.

"Important is the fact that many of our obese participants over this 8-year period did not develop diabetes or prediabetes, and it remains likely that some favorable metabolic phenotypes exist within the obese population," he added.

Although caution must be taken in drawing direct clinical implications with respect to therapy from an observational study such as this, it is reasonable to consider the possibility that incorporating measures of visceral fat mass and biomarkers of insulin resistance may help to characterize the risk of diabetes among obese individuals, and might be used to identify individuals who would most benefit from intensive lifestyle therapy, he said.

More importantly, they could be used to target those in whom drug therapy or bariatric surgery would be of the most benefit. The observation that continued weight gain among the already obese is a powerful predictor of diabetes onset also holds implications for patient management.

Even if [obese patients] can’t lose weight, "if we can prevent additional weight gain we can modulate their subsequent risk for prediabetes and diabetes," he said.

The Dallas Heart Study received grant support from the Donald W. Reynolds Foundation, the U.S. Public Health Service General Clinical Research Center, and the National Institutes of Health. Dr de Lemos reported receiving grant support from Roche Diagnostics, Abbott Diagnostics, and Alere. He also received consulting income from Tethys Bioscience, AstraZeneca, and Daiichi Sankyo; and lecture honoraria from Bristol-Myers Squibb/Sanofi-Aventis.

SAN ANTONIO – Excess visceral fat at baseline, subsequent weight gain, and markers of insulin resistance were among factors independently associated with incident prediabetes and type 2 diabetes in obese adults in the Dallas Heart Study.

General adiposity was not found to be associated with increased prediabetes and type 2 diabetes risk, Dr. James A. de Lemos reported at the annual meeting of the Obesity Society.

© okeyphotos/iStockphoto.com

The findings provide insight as to why some obese individuals develop diabetes while others do not, said Dr. de Lemos of the University of Texas Southwestern Medical Center, Dallas.

The epidemic of obesity has led to a secondary epidemic in diabetes that has offset any improvements that would have occurred to the cardiovascular event rate due to lower rates of smoking, lower levels of low-density lipoprotein cholesterol, and less hypertension in the population, Dr. de Lemos explained. Diabetes manifestations are heterogeneous among obese individuals, and body mass index doesn’t help discriminate individuals who are at risk for diabetes versus those who aren’t, he added.

"Our hypothesis was that markers of adipose tissue dysfunction may better predict diabetes and prediabetes onset than general adiposity markers in a specifically obese population," he said.

Of 732 participants in the multiethnic population-based cohort study who were obese at baseline, 84 (11.5%) developed diabetes.

Independent predictors of diabetes on multivariate analysis included higher baseline visceral fat mass (odds ratio per 1 standard deviation 1.4 kg, 2.4), fructosamine level (1.1 micromol/L, 2.0), fasting glucose level (1.1 micromol/L, 1.9), family history of diabetes (OR 2.3), systolic blood pressure (OR per 10 mm Hg, 1.3), and weight gain over follow-up (OR per 1 kg, 1.06). No associations were noted for body mass index, total body fat, or abdominal subcutaneous fat, Dr. de Lemos and his colleagues found (JAMA. 2012; 308: 1150-9).

Conversely, lower body fat mass and adiponectin level showed significant graded, inverse associations with incident prediabetes and diabetes.

Among 512 study participants with normal baseline glucose values, 39% experienced a composite outcome of prediabetes or diabetes. Factors significantly associated with this outcome included baseline measurements of visceral fat mass, fasting glucose level, insulin, and fructosamine, as well as older age, nonwhite race, family history of diabetes, and weight gain over follow-up, Dr. de Lemos said, noting that this composite outcome also was not associated with measures of general adiposity.

Notably, weight gain in this subgroup was the most powerful predictor of prediabetes and diabetes risk over the follow-up period, Dr. de Lemos said.

Also, an evaluation of measures of subclinical cardiovascular disease showed that those who went on to develop prediabetes or diabetes had a greater prevalence of coronary calcium and left ventricular hypertrophy well before onset of these conditions.

"This suggests that some of the factors that contribute to the development of prediabetes and diabetes may be contributing to the development of subclinical cardiovascular disease even before prediabetes and diabetes are manifest," he said.

The Dallas Heart Study enrolled more than 6,100 patients, with oversampling of African Americans, who made up half of the study population. The subset of participants included in the current analysis were adults aged 30-65 years with a BMI of 30 or higher who were enrolled between 2000 and 2002 and followed for a median of 7 years. Body composition was measured using dual energy x-ray absorptiometry scanning and magnetic resonance imaging; subclinical atherosclerosis and cardiac structure and function were measured by computed tomography and MRI. Circulating adipokines and biomarkers of insulin resistance, dyslipidemia, and inflammation also were measured.

The findings indicate that a dysfunctional adiposity phenotype, characterized by excess visceral fat mass and insulin resistance, is associated with both incident prediabetes and diabetes in a specifically obese population, Dr. de Lemos said. This, along with the absence of an association between markers of general adiposity and incident prediabetes and diabetes, suggests that obesity is a "heterogeneous disorder with a distinct adiposity set of phenotypes.

"Important is the fact that many of our obese participants over this 8-year period did not develop diabetes or prediabetes, and it remains likely that some favorable metabolic phenotypes exist within the obese population," he added.

Although caution must be taken in drawing direct clinical implications with respect to therapy from an observational study such as this, it is reasonable to consider the possibility that incorporating measures of visceral fat mass and biomarkers of insulin resistance may help to characterize the risk of diabetes among obese individuals, and might be used to identify individuals who would most benefit from intensive lifestyle therapy, he said.

More importantly, they could be used to target those in whom drug therapy or bariatric surgery would be of the most benefit. The observation that continued weight gain among the already obese is a powerful predictor of diabetes onset also holds implications for patient management.

Even if [obese patients] can’t lose weight, "if we can prevent additional weight gain we can modulate their subsequent risk for prediabetes and diabetes," he said.

The Dallas Heart Study received grant support from the Donald W. Reynolds Foundation, the U.S. Public Health Service General Clinical Research Center, and the National Institutes of Health. Dr de Lemos reported receiving grant support from Roche Diagnostics, Abbott Diagnostics, and Alere. He also received consulting income from Tethys Bioscience, AstraZeneca, and Daiichi Sankyo; and lecture honoraria from Bristol-Myers Squibb/Sanofi-Aventis.

SAN ANTONIO – Excess visceral fat at baseline, subsequent weight gain, and markers of insulin resistance were among factors independently associated with incident prediabetes and type 2 diabetes in obese adults in the Dallas Heart Study.

General adiposity was not found to be associated with increased prediabetes and type 2 diabetes risk, Dr. James A. de Lemos reported at the annual meeting of the Obesity Society.

© okeyphotos/iStockphoto.com

The findings provide insight as to why some obese individuals develop diabetes while others do not, said Dr. de Lemos of the University of Texas Southwestern Medical Center, Dallas.

The epidemic of obesity has led to a secondary epidemic in diabetes that has offset any improvements that would have occurred to the cardiovascular event rate due to lower rates of smoking, lower levels of low-density lipoprotein cholesterol, and less hypertension in the population, Dr. de Lemos explained. Diabetes manifestations are heterogeneous among obese individuals, and body mass index doesn’t help discriminate individuals who are at risk for diabetes versus those who aren’t, he added.

"Our hypothesis was that markers of adipose tissue dysfunction may better predict diabetes and prediabetes onset than general adiposity markers in a specifically obese population," he said.

Of 732 participants in the multiethnic population-based cohort study who were obese at baseline, 84 (11.5%) developed diabetes.

Independent predictors of diabetes on multivariate analysis included higher baseline visceral fat mass (odds ratio per 1 standard deviation 1.4 kg, 2.4), fructosamine level (1.1 micromol/L, 2.0), fasting glucose level (1.1 micromol/L, 1.9), family history of diabetes (OR 2.3), systolic blood pressure (OR per 10 mm Hg, 1.3), and weight gain over follow-up (OR per 1 kg, 1.06). No associations were noted for body mass index, total body fat, or abdominal subcutaneous fat, Dr. de Lemos and his colleagues found (JAMA. 2012; 308: 1150-9).

Conversely, lower body fat mass and adiponectin level showed significant graded, inverse associations with incident prediabetes and diabetes.

Among 512 study participants with normal baseline glucose values, 39% experienced a composite outcome of prediabetes or diabetes. Factors significantly associated with this outcome included baseline measurements of visceral fat mass, fasting glucose level, insulin, and fructosamine, as well as older age, nonwhite race, family history of diabetes, and weight gain over follow-up, Dr. de Lemos said, noting that this composite outcome also was not associated with measures of general adiposity.

Notably, weight gain in this subgroup was the most powerful predictor of prediabetes and diabetes risk over the follow-up period, Dr. de Lemos said.

Also, an evaluation of measures of subclinical cardiovascular disease showed that those who went on to develop prediabetes or diabetes had a greater prevalence of coronary calcium and left ventricular hypertrophy well before onset of these conditions.

"This suggests that some of the factors that contribute to the development of prediabetes and diabetes may be contributing to the development of subclinical cardiovascular disease even before prediabetes and diabetes are manifest," he said.

The Dallas Heart Study enrolled more than 6,100 patients, with oversampling of African Americans, who made up half of the study population. The subset of participants included in the current analysis were adults aged 30-65 years with a BMI of 30 or higher who were enrolled between 2000 and 2002 and followed for a median of 7 years. Body composition was measured using dual energy x-ray absorptiometry scanning and magnetic resonance imaging; subclinical atherosclerosis and cardiac structure and function were measured by computed tomography and MRI. Circulating adipokines and biomarkers of insulin resistance, dyslipidemia, and inflammation also were measured.

The findings indicate that a dysfunctional adiposity phenotype, characterized by excess visceral fat mass and insulin resistance, is associated with both incident prediabetes and diabetes in a specifically obese population, Dr. de Lemos said. This, along with the absence of an association between markers of general adiposity and incident prediabetes and diabetes, suggests that obesity is a "heterogeneous disorder with a distinct adiposity set of phenotypes.

"Important is the fact that many of our obese participants over this 8-year period did not develop diabetes or prediabetes, and it remains likely that some favorable metabolic phenotypes exist within the obese population," he added.

Although caution must be taken in drawing direct clinical implications with respect to therapy from an observational study such as this, it is reasonable to consider the possibility that incorporating measures of visceral fat mass and biomarkers of insulin resistance may help to characterize the risk of diabetes among obese individuals, and might be used to identify individuals who would most benefit from intensive lifestyle therapy, he said.

More importantly, they could be used to target those in whom drug therapy or bariatric surgery would be of the most benefit. The observation that continued weight gain among the already obese is a powerful predictor of diabetes onset also holds implications for patient management.

Even if [obese patients] can’t lose weight, "if we can prevent additional weight gain we can modulate their subsequent risk for prediabetes and diabetes," he said.

The Dallas Heart Study received grant support from the Donald W. Reynolds Foundation, the U.S. Public Health Service General Clinical Research Center, and the National Institutes of Health. Dr de Lemos reported receiving grant support from Roche Diagnostics, Abbott Diagnostics, and Alere. He also received consulting income from Tethys Bioscience, AstraZeneca, and Daiichi Sankyo; and lecture honoraria from Bristol-Myers Squibb/Sanofi-Aventis.

SAN ANTONIO – Education about appropriate weight gain, healthy eating, and exercise during pregnancy improves dietary restraint and self-weighing, and prevents postpartum weight retention, according to 12-month findings from the randomized, controlled Fit for Delivery study.

Benefits accrued even after the "pretty practical, low-intensity intervention" ended, suggesting that "pregnancy may be a teachable moment for promoting continued behavioral changes," Suzanne Phelan, Ph.D., of California Polytechnic State University, San Luis Obispo, reported at the annual meeting of the Obesity Society.

©Stephanie Horrocks/iStockphoto.com

Among 201 normal-weight study participants, 40% of those randomized to receive standard care plus a lifestyle modification intervention exceeded 1990 Institute of Medicine recommendations for weight gain during pregnancy, compared with 52% of those randomized to receive standard care as part of a control group.

No such difference was seen among 200 overweight or obese participants in the intervention and control groups (67% and 61%). Regardless of weight status at study entry, 31% of 201 women in the intervention group returned to their prepregnancy weight by 6 months post partum, compared with 19% of 200 women in the control group.

The 6-month results of the Fit for Delivery study were published last year in the American Journal of Clinical Nutrition (2011;93:772-9). Dr. Phelan’s presentation included findings at 12 months’ follow-up.

At 12 months post partum, 45% of normal-weight and overweight/obese participants in the intervention group and 35% in the control group reached their prepregnancy weight. The women in the intervention group may have been more successful because they exhibited significantly greater dietary restraint and were significantly more likely to monitor their weight throughout the study period. For example, the intervention group reduced calories consumed from soft drinks during pregnancy and until 6 months’ follow-up.

More sophisticated analyses to explore the complex relationships between potential mediators of treatment effects are underway, she added.

Fit for Delivery study participants were pregnant women recruited from six obstetrics practices between 2006 and 2008. At study entry, their mean age was 29 years and mean gestation was 13.5 weeks. Two-thirds were non-Hispanic white women and 77% were primiparous. Half were normal weight and half were overweight or obese.

Those in the intervention group had one 30-minute face-to-face visit, three phone calls throughout pregnancy (with more for those gaining more or less than the recommended amount of weight), and mail delivery of "challenge cards" highlighting key behavioral targets such as healthy eating and physical activity. The intervention group also received a scale, pedometer, and nutritional resources such as calorie-counting booklets.

A motivational approach to the intervention, which ended at delivery, aimed to teach participants to consider the impact of their behavior on the health of their growing baby, Dr. Phelan noted.

Participants in the control group had one face-to-face visit with a dietitian, and received general educational brochures and newsletters about pregnancy-related topics.

The final analysis excluded 6 women who experienced a miscarriage, 32 who developed gestational diabetes, 5 who became pregnant within 6 months of delivery, and an additional 36 who became pregnant within 12 months of delivery.

Excessive gestational weight gain is a major determinant of high postpartum weight retention as well as long-term obesity and several adverse maternal and offspring outcomes, Dr. Phelan said. About half of normal-weight women and 65% of overweight or obese women gain more weight than recommended during pregnancy.

This type of program could be useful in the clinical setting, she added, noting that additional research to evaluate the effects of higher-intensity programs is needed.

The Fit for Delivery study was supported by the National Institutes of Health. Dr. Phelan and her colleagues reported having no relevant financial disclosures.

SAN ANTONIO – Education about appropriate weight gain, healthy eating, and exercise during pregnancy improves dietary restraint and self-weighing, and prevents postpartum weight retention, according to 12-month findings from the randomized, controlled Fit for Delivery study.

Benefits accrued even after the "pretty practical, low-intensity intervention" ended, suggesting that "pregnancy may be a teachable moment for promoting continued behavioral changes," Suzanne Phelan, Ph.D., of California Polytechnic State University, San Luis Obispo, reported at the annual meeting of the Obesity Society.

©Stephanie Horrocks/iStockphoto.com

Among 201 normal-weight study participants, 40% of those randomized to receive standard care plus a lifestyle modification intervention exceeded 1990 Institute of Medicine recommendations for weight gain during pregnancy, compared with 52% of those randomized to receive standard care as part of a control group.

No such difference was seen among 200 overweight or obese participants in the intervention and control groups (67% and 61%). Regardless of weight status at study entry, 31% of 201 women in the intervention group returned to their prepregnancy weight by 6 months post partum, compared with 19% of 200 women in the control group.

The 6-month results of the Fit for Delivery study were published last year in the American Journal of Clinical Nutrition (2011;93:772-9). Dr. Phelan’s presentation included findings at 12 months’ follow-up.

At 12 months post partum, 45% of normal-weight and overweight/obese participants in the intervention group and 35% in the control group reached their prepregnancy weight. The women in the intervention group may have been more successful because they exhibited significantly greater dietary restraint and were significantly more likely to monitor their weight throughout the study period. For example, the intervention group reduced calories consumed from soft drinks during pregnancy and until 6 months’ follow-up.

More sophisticated analyses to explore the complex relationships between potential mediators of treatment effects are underway, she added.

Fit for Delivery study participants were pregnant women recruited from six obstetrics practices between 2006 and 2008. At study entry, their mean age was 29 years and mean gestation was 13.5 weeks. Two-thirds were non-Hispanic white women and 77% were primiparous. Half were normal weight and half were overweight or obese.

Those in the intervention group had one 30-minute face-to-face visit, three phone calls throughout pregnancy (with more for those gaining more or less than the recommended amount of weight), and mail delivery of "challenge cards" highlighting key behavioral targets such as healthy eating and physical activity. The intervention group also received a scale, pedometer, and nutritional resources such as calorie-counting booklets.

A motivational approach to the intervention, which ended at delivery, aimed to teach participants to consider the impact of their behavior on the health of their growing baby, Dr. Phelan noted.

Participants in the control group had one face-to-face visit with a dietitian, and received general educational brochures and newsletters about pregnancy-related topics.

The final analysis excluded 6 women who experienced a miscarriage, 32 who developed gestational diabetes, 5 who became pregnant within 6 months of delivery, and an additional 36 who became pregnant within 12 months of delivery.

Excessive gestational weight gain is a major determinant of high postpartum weight retention as well as long-term obesity and several adverse maternal and offspring outcomes, Dr. Phelan said. About half of normal-weight women and 65% of overweight or obese women gain more weight than recommended during pregnancy.

This type of program could be useful in the clinical setting, she added, noting that additional research to evaluate the effects of higher-intensity programs is needed.

The Fit for Delivery study was supported by the National Institutes of Health. Dr. Phelan and her colleagues reported having no relevant financial disclosures.

SAN ANTONIO – Education about appropriate weight gain, healthy eating, and exercise during pregnancy improves dietary restraint and self-weighing, and prevents postpartum weight retention, according to 12-month findings from the randomized, controlled Fit for Delivery study.

Benefits accrued even after the "pretty practical, low-intensity intervention" ended, suggesting that "pregnancy may be a teachable moment for promoting continued behavioral changes," Suzanne Phelan, Ph.D., of California Polytechnic State University, San Luis Obispo, reported at the annual meeting of the Obesity Society.

©Stephanie Horrocks/iStockphoto.com

Among 201 normal-weight study participants, 40% of those randomized to receive standard care plus a lifestyle modification intervention exceeded 1990 Institute of Medicine recommendations for weight gain during pregnancy, compared with 52% of those randomized to receive standard care as part of a control group.

No such difference was seen among 200 overweight or obese participants in the intervention and control groups (67% and 61%). Regardless of weight status at study entry, 31% of 201 women in the intervention group returned to their prepregnancy weight by 6 months post partum, compared with 19% of 200 women in the control group.

The 6-month results of the Fit for Delivery study were published last year in the American Journal of Clinical Nutrition (2011;93:772-9). Dr. Phelan’s presentation included findings at 12 months’ follow-up.

At 12 months post partum, 45% of normal-weight and overweight/obese participants in the intervention group and 35% in the control group reached their prepregnancy weight. The women in the intervention group may have been more successful because they exhibited significantly greater dietary restraint and were significantly more likely to monitor their weight throughout the study period. For example, the intervention group reduced calories consumed from soft drinks during pregnancy and until 6 months’ follow-up.

More sophisticated analyses to explore the complex relationships between potential mediators of treatment effects are underway, she added.

Fit for Delivery study participants were pregnant women recruited from six obstetrics practices between 2006 and 2008. At study entry, their mean age was 29 years and mean gestation was 13.5 weeks. Two-thirds were non-Hispanic white women and 77% were primiparous. Half were normal weight and half were overweight or obese.

Those in the intervention group had one 30-minute face-to-face visit, three phone calls throughout pregnancy (with more for those gaining more or less than the recommended amount of weight), and mail delivery of "challenge cards" highlighting key behavioral targets such as healthy eating and physical activity. The intervention group also received a scale, pedometer, and nutritional resources such as calorie-counting booklets.

A motivational approach to the intervention, which ended at delivery, aimed to teach participants to consider the impact of their behavior on the health of their growing baby, Dr. Phelan noted.

Participants in the control group had one face-to-face visit with a dietitian, and received general educational brochures and newsletters about pregnancy-related topics.

The final analysis excluded 6 women who experienced a miscarriage, 32 who developed gestational diabetes, 5 who became pregnant within 6 months of delivery, and an additional 36 who became pregnant within 12 months of delivery.

Excessive gestational weight gain is a major determinant of high postpartum weight retention as well as long-term obesity and several adverse maternal and offspring outcomes, Dr. Phelan said. About half of normal-weight women and 65% of overweight or obese women gain more weight than recommended during pregnancy.

This type of program could be useful in the clinical setting, she added, noting that additional research to evaluate the effects of higher-intensity programs is needed.

The Fit for Delivery study was supported by the National Institutes of Health. Dr. Phelan and her colleagues reported having no relevant financial disclosures.

SAN ANTONIO – Pediatric cardiovascular risk reduction guidelines are underutilized, according to data from an ongoing study.

Data from a 2-year trial conducted in 32 practices show that most are recording body mass index and blood pressure in children as recommended by 2011 guidelines from the National Heart, Lung, and Blood Institute (NHLBI). However, more work is needed with respect to interpreting blood pressure results, initiating management of increased BMI and blood pressure, and addressing tobacco and second-hand smoke exposures, Lauren M. Whetstone, Ph.D., reported in a poster at the annual meeting of the Obesity Society.

©Sean Locke/iStockphoto.com

The findings were derived from a chart review of 963 well-child checks at 32 primary care practices. Specifically, 88% of the charts included a record of BMI, 83% included interpretation of the BMI findings, and 98% included a record of blood pressure. But only 30% of the charts included recommendations for managing children with an elevated BMI percentile, and none of the charts included an interpretation of the blood pressure findings or recommendations for management, Dr. Whetstone, of East Carolina University in Greenville, N.C., said in an interview.

Furthermore, 14% of charts documented counseling about a smoke-free environment to parents of 3- to 4-year-olds, and 2% documented assessment for a smoke-free environment and child smoking in 5- to 11-year-olds. Counseling about the importance of a smoke-free environment and about the importance of avoiding smoking was documented in 4% of the charts, she noted.

"The findings identify a real need for making it easier to interpret blood pressure for children. That appears to be a place where physicians can use help," she said, noting that assessment for, and counseling about tobacco exposure is another area where resources are needed.

The project focuses specifically on improving primary provider care for the BMI, blood pressure, and tobacco components of the NHLBI guidelines, Dr. Whetstone noted. The 32 practices from North Carolina and Illinois that are participating in the trial were randomly assigned to a control group or to participate in an academic detailing session that reviewed the NHLBI guidelines and offered a toolkit that included a copy of the guidelines, a clinical decision support tool for mobile devices and computers, and a patient and family engagement workbook. The intervention practices also participate in monthly webinars and collaborative calls for sharing best practices and building quality improvement skills.

The 16 practices in the intervention group and the 16 that make up the control group all underwent a baseline chart abstraction detailed by Dr. Whetstone in her poster, and received data feedback. The 12-month intervention is currently ongoing, and a follow-up chart review will be conducted in November and December.

The baseline chart review for the study included 30 randomly selected charts per participating practice for patients aged 3-11 years who were seen for a well visit. At follow-up, 40 charts per practice will be reviewed, and the efficacy of the tools and training used in the intervention will be reviewed. Based on this review and feedback from participating practices, the decision support tools will be refined and modified for anticipated release by the NHLBI to the public upon project completion, Dr. Whetstone said.

All practices participating in the study receive credit for the Quality Improvement component of Maintenance of Board Certification, a component that may have facilitated recruitment, Dr. Whetstone noted.

The trial is funded by the NHLBI. Dr. Whetstone had no disclosures to report.

SAN ANTONIO – Pediatric cardiovascular risk reduction guidelines are underutilized, according to data from an ongoing study.

Data from a 2-year trial conducted in 32 practices show that most are recording body mass index and blood pressure in children as recommended by 2011 guidelines from the National Heart, Lung, and Blood Institute (NHLBI). However, more work is needed with respect to interpreting blood pressure results, initiating management of increased BMI and blood pressure, and addressing tobacco and second-hand smoke exposures, Lauren M. Whetstone, Ph.D., reported in a poster at the annual meeting of the Obesity Society.

©Sean Locke/iStockphoto.com

The findings were derived from a chart review of 963 well-child checks at 32 primary care practices. Specifically, 88% of the charts included a record of BMI, 83% included interpretation of the BMI findings, and 98% included a record of blood pressure. But only 30% of the charts included recommendations for managing children with an elevated BMI percentile, and none of the charts included an interpretation of the blood pressure findings or recommendations for management, Dr. Whetstone, of East Carolina University in Greenville, N.C., said in an interview.

Furthermore, 14% of charts documented counseling about a smoke-free environment to parents of 3- to 4-year-olds, and 2% documented assessment for a smoke-free environment and child smoking in 5- to 11-year-olds. Counseling about the importance of a smoke-free environment and about the importance of avoiding smoking was documented in 4% of the charts, she noted.

"The findings identify a real need for making it easier to interpret blood pressure for children. That appears to be a place where physicians can use help," she said, noting that assessment for, and counseling about tobacco exposure is another area where resources are needed.

The project focuses specifically on improving primary provider care for the BMI, blood pressure, and tobacco components of the NHLBI guidelines, Dr. Whetstone noted. The 32 practices from North Carolina and Illinois that are participating in the trial were randomly assigned to a control group or to participate in an academic detailing session that reviewed the NHLBI guidelines and offered a toolkit that included a copy of the guidelines, a clinical decision support tool for mobile devices and computers, and a patient and family engagement workbook. The intervention practices also participate in monthly webinars and collaborative calls for sharing best practices and building quality improvement skills.

The 16 practices in the intervention group and the 16 that make up the control group all underwent a baseline chart abstraction detailed by Dr. Whetstone in her poster, and received data feedback. The 12-month intervention is currently ongoing, and a follow-up chart review will be conducted in November and December.

The baseline chart review for the study included 30 randomly selected charts per participating practice for patients aged 3-11 years who were seen for a well visit. At follow-up, 40 charts per practice will be reviewed, and the efficacy of the tools and training used in the intervention will be reviewed. Based on this review and feedback from participating practices, the decision support tools will be refined and modified for anticipated release by the NHLBI to the public upon project completion, Dr. Whetstone said.

All practices participating in the study receive credit for the Quality Improvement component of Maintenance of Board Certification, a component that may have facilitated recruitment, Dr. Whetstone noted.

The trial is funded by the NHLBI. Dr. Whetstone had no disclosures to report.

SAN ANTONIO – Pediatric cardiovascular risk reduction guidelines are underutilized, according to data from an ongoing study.

Data from a 2-year trial conducted in 32 practices show that most are recording body mass index and blood pressure in children as recommended by 2011 guidelines from the National Heart, Lung, and Blood Institute (NHLBI). However, more work is needed with respect to interpreting blood pressure results, initiating management of increased BMI and blood pressure, and addressing tobacco and second-hand smoke exposures, Lauren M. Whetstone, Ph.D., reported in a poster at the annual meeting of the Obesity Society.

©Sean Locke/iStockphoto.com

The findings were derived from a chart review of 963 well-child checks at 32 primary care practices. Specifically, 88% of the charts included a record of BMI, 83% included interpretation of the BMI findings, and 98% included a record of blood pressure. But only 30% of the charts included recommendations for managing children with an elevated BMI percentile, and none of the charts included an interpretation of the blood pressure findings or recommendations for management, Dr. Whetstone, of East Carolina University in Greenville, N.C., said in an interview.

Furthermore, 14% of charts documented counseling about a smoke-free environment to parents of 3- to 4-year-olds, and 2% documented assessment for a smoke-free environment and child smoking in 5- to 11-year-olds. Counseling about the importance of a smoke-free environment and about the importance of avoiding smoking was documented in 4% of the charts, she noted.

"The findings identify a real need for making it easier to interpret blood pressure for children. That appears to be a place where physicians can use help," she said, noting that assessment for, and counseling about tobacco exposure is another area where resources are needed.

The project focuses specifically on improving primary provider care for the BMI, blood pressure, and tobacco components of the NHLBI guidelines, Dr. Whetstone noted. The 32 practices from North Carolina and Illinois that are participating in the trial were randomly assigned to a control group or to participate in an academic detailing session that reviewed the NHLBI guidelines and offered a toolkit that included a copy of the guidelines, a clinical decision support tool for mobile devices and computers, and a patient and family engagement workbook. The intervention practices also participate in monthly webinars and collaborative calls for sharing best practices and building quality improvement skills.

The 16 practices in the intervention group and the 16 that make up the control group all underwent a baseline chart abstraction detailed by Dr. Whetstone in her poster, and received data feedback. The 12-month intervention is currently ongoing, and a follow-up chart review will be conducted in November and December.

The baseline chart review for the study included 30 randomly selected charts per participating practice for patients aged 3-11 years who were seen for a well visit. At follow-up, 40 charts per practice will be reviewed, and the efficacy of the tools and training used in the intervention will be reviewed. Based on this review and feedback from participating practices, the decision support tools will be refined and modified for anticipated release by the NHLBI to the public upon project completion, Dr. Whetstone said.

All practices participating in the study receive credit for the Quality Improvement component of Maintenance of Board Certification, a component that may have facilitated recruitment, Dr. Whetstone noted.

The trial is funded by the NHLBI. Dr. Whetstone had no disclosures to report.

SAN ANTONIO – Sugar-sweetened beverages may take a bigger toll on those genetically predisposed to obesity, according to an analysis of data from the Nurses’ Health Study and the Health Professionals Follow-up Study.

In a combined cohort of 6,934 women and 4,423 men from those prospective longitudinal studies, intake of sugar-sweetened beverages had an impact on a genetic-predisposition score for adiposity. The score was calculated based on single nucleotide polymorphisms representing 32 loci that have an established association with body mass index.

© travis manley/Fotolia.com

The increases in BMI per increment of 10 risk alleles were 1.00 for those who drank less than one serving of sugar-sweetened beverages per month, 1.20 for those who drank 1-4 servings, and 1.37 for those who drank 4-6 servings. For those who drank one or more servings each day, the risk was 1.85, Dr. Lu Qi reported at the annual meeting of the Obesity Society.

The relative risks of incident obesity per increment of 10 risk alleles were 1.19, 1.67, 1.58, and 5.06 for those same intake categories, respectively, said Dr. Qi of the Harvard School of Public Health, Boston.

Similar findings were seen in a replication cohort of 21,740 women in the Women’s Genome Health Study, another prospective longitudinal cohort study of initially healthy women. The increases in BMI per increment of 10 risk alleles in this cohort were 1.39, 1.64, 1.90, and 2.53 for the four categories of intake, respectively, and the relative risks for incident obesity were 1.40, 1.50, 1.16, 1.54, and 3.16, respectively.

"In all three cohorts, the combined genetic effects on BMI and obesity risk among persons consuming one or more servings of sugar-sweetened beverages per day were approximately twice as large as those among persons consuming less than one serving per month. These data suggest that persons with greater consumption of sugar-sweetened beverages may be more susceptible to genetic effects on adiposity. Viewed differently, persons with a greater genetic predisposition to obesity appeared to be more susceptible to the deleterious effects of sugar-sweetened beverages on BMI," according to Dr. Qi and his colleagues.

The presentation of the findings coincided with their publication online (N. Engl. J. Med. 2012 Sept. 21 [doi: 10.1056/NEJMoa1203039]).

The consumption of sugar-sweetened beverages has increased dramatically over the past three decades, as has the prevalence of obesity.

One strength of this study is the use of the genetic-predisposition score comprised of multiple genetic variants.

Dr. Qi said that sugar-sweetened beverages have high calorie content but are associated with low satiety and incomplete compensation for the liquid-calorie increases in total energy intake. Also, the large amount of rapidly absorbable carbohydrates in these beverages may increase risk of insulin resistance, beta-cell dysfunction, inflammation, visceral adiposity, and other metabolic disorders.

Future studies are needed to clarify the underlying mechanisms of the interaction between the intake of sugar-sweetened beverages and a genetic predisposition to elevated adiposity or obesity, as the biologic functions of most established BMI-associated loci remain largely unknown.

The findings nonetheless underscore the need to test interventions that may reduce the intake of sugar-sweetened beverages as a means for reducing obesity risk and for preventing related diseases, Dr. Qi said.

This study was supported by the National Institutes of Health, Merck Research Laboratories, the American Heart Association Scientist, and the Harvard Glaucoma Center of Excellence. Dr. Qi reported receiving lecture fees from Kellogg. Complete author disclosures are available with the full text of the article at www.NEJM.org.

SAN ANTONIO – Sugar-sweetened beverages may take a bigger toll on those genetically predisposed to obesity, according to an analysis of data from the Nurses’ Health Study and the Health Professionals Follow-up Study.

In a combined cohort of 6,934 women and 4,423 men from those prospective longitudinal studies, intake of sugar-sweetened beverages had an impact on a genetic-predisposition score for adiposity. The score was calculated based on single nucleotide polymorphisms representing 32 loci that have an established association with body mass index.

© travis manley/Fotolia.com

The increases in BMI per increment of 10 risk alleles were 1.00 for those who drank less than one serving of sugar-sweetened beverages per month, 1.20 for those who drank 1-4 servings, and 1.37 for those who drank 4-6 servings. For those who drank one or more servings each day, the risk was 1.85, Dr. Lu Qi reported at the annual meeting of the Obesity Society.

The relative risks of incident obesity per increment of 10 risk alleles were 1.19, 1.67, 1.58, and 5.06 for those same intake categories, respectively, said Dr. Qi of the Harvard School of Public Health, Boston.

Similar findings were seen in a replication cohort of 21,740 women in the Women’s Genome Health Study, another prospective longitudinal cohort study of initially healthy women. The increases in BMI per increment of 10 risk alleles in this cohort were 1.39, 1.64, 1.90, and 2.53 for the four categories of intake, respectively, and the relative risks for incident obesity were 1.40, 1.50, 1.16, 1.54, and 3.16, respectively.

"In all three cohorts, the combined genetic effects on BMI and obesity risk among persons consuming one or more servings of sugar-sweetened beverages per day were approximately twice as large as those among persons consuming less than one serving per month. These data suggest that persons with greater consumption of sugar-sweetened beverages may be more susceptible to genetic effects on adiposity. Viewed differently, persons with a greater genetic predisposition to obesity appeared to be more susceptible to the deleterious effects of sugar-sweetened beverages on BMI," according to Dr. Qi and his colleagues.

The presentation of the findings coincided with their publication online (N. Engl. J. Med. 2012 Sept. 21 [doi: 10.1056/NEJMoa1203039]).

The consumption of sugar-sweetened beverages has increased dramatically over the past three decades, as has the prevalence of obesity.

One strength of this study is the use of the genetic-predisposition score comprised of multiple genetic variants.

Dr. Qi said that sugar-sweetened beverages have high calorie content but are associated with low satiety and incomplete compensation for the liquid-calorie increases in total energy intake. Also, the large amount of rapidly absorbable carbohydrates in these beverages may increase risk of insulin resistance, beta-cell dysfunction, inflammation, visceral adiposity, and other metabolic disorders.

Future studies are needed to clarify the underlying mechanisms of the interaction between the intake of sugar-sweetened beverages and a genetic predisposition to elevated adiposity or obesity, as the biologic functions of most established BMI-associated loci remain largely unknown.

The findings nonetheless underscore the need to test interventions that may reduce the intake of sugar-sweetened beverages as a means for reducing obesity risk and for preventing related diseases, Dr. Qi said.

This study was supported by the National Institutes of Health, Merck Research Laboratories, the American Heart Association Scientist, and the Harvard Glaucoma Center of Excellence. Dr. Qi reported receiving lecture fees from Kellogg. Complete author disclosures are available with the full text of the article at www.NEJM.org.

SAN ANTONIO – Sugar-sweetened beverages may take a bigger toll on those genetically predisposed to obesity, according to an analysis of data from the Nurses’ Health Study and the Health Professionals Follow-up Study.

In a combined cohort of 6,934 women and 4,423 men from those prospective longitudinal studies, intake of sugar-sweetened beverages had an impact on a genetic-predisposition score for adiposity. The score was calculated based on single nucleotide polymorphisms representing 32 loci that have an established association with body mass index.

© travis manley/Fotolia.com

The increases in BMI per increment of 10 risk alleles were 1.00 for those who drank less than one serving of sugar-sweetened beverages per month, 1.20 for those who drank 1-4 servings, and 1.37 for those who drank 4-6 servings. For those who drank one or more servings each day, the risk was 1.85, Dr. Lu Qi reported at the annual meeting of the Obesity Society.

The relative risks of incident obesity per increment of 10 risk alleles were 1.19, 1.67, 1.58, and 5.06 for those same intake categories, respectively, said Dr. Qi of the Harvard School of Public Health, Boston.

Similar findings were seen in a replication cohort of 21,740 women in the Women’s Genome Health Study, another prospective longitudinal cohort study of initially healthy women. The increases in BMI per increment of 10 risk alleles in this cohort were 1.39, 1.64, 1.90, and 2.53 for the four categories of intake, respectively, and the relative risks for incident obesity were 1.40, 1.50, 1.16, 1.54, and 3.16, respectively.

"In all three cohorts, the combined genetic effects on BMI and obesity risk among persons consuming one or more servings of sugar-sweetened beverages per day were approximately twice as large as those among persons consuming less than one serving per month. These data suggest that persons with greater consumption of sugar-sweetened beverages may be more susceptible to genetic effects on adiposity. Viewed differently, persons with a greater genetic predisposition to obesity appeared to be more susceptible to the deleterious effects of sugar-sweetened beverages on BMI," according to Dr. Qi and his colleagues.

The presentation of the findings coincided with their publication online (N. Engl. J. Med. 2012 Sept. 21 [doi: 10.1056/NEJMoa1203039]).

The consumption of sugar-sweetened beverages has increased dramatically over the past three decades, as has the prevalence of obesity.

One strength of this study is the use of the genetic-predisposition score comprised of multiple genetic variants.

Dr. Qi said that sugar-sweetened beverages have high calorie content but are associated with low satiety and incomplete compensation for the liquid-calorie increases in total energy intake. Also, the large amount of rapidly absorbable carbohydrates in these beverages may increase risk of insulin resistance, beta-cell dysfunction, inflammation, visceral adiposity, and other metabolic disorders.

Future studies are needed to clarify the underlying mechanisms of the interaction between the intake of sugar-sweetened beverages and a genetic predisposition to elevated adiposity or obesity, as the biologic functions of most established BMI-associated loci remain largely unknown.

The findings nonetheless underscore the need to test interventions that may reduce the intake of sugar-sweetened beverages as a means for reducing obesity risk and for preventing related diseases, Dr. Qi said.

This study was supported by the National Institutes of Health, Merck Research Laboratories, the American Heart Association Scientist, and the Harvard Glaucoma Center of Excellence. Dr. Qi reported receiving lecture fees from Kellogg. Complete author disclosures are available with the full text of the article at www.NEJM.org.