Tag Archives: obesity

Dr Hilary’s urgent plea to alter the obesity crisis – ‘it’s crippling the NHS’

“When you look at the huge quantities of sugar, salt, and saturated fat that’s being consumed, it is contributing to the patients that we’re seeing in hospital on a daily basis,” Dr Hilary explained. The death rate from heart disease and stroke is “overwhelming – it’s crippling the NHS”, the doctor stated. A landmark report, commissioned by the Government in 2019 for its post-Brexit food strategy, recommended a “sugar and salt reformation tax”.

Created by food entrepreneur Henry Dimbleby, the money gained by the tax is proposed to expand free school meals and improve the diet of the nation.

The report highlighted that a poor diet contributes to 64,000 deaths every year, costing the economy an estimated £74 billion.

The comprehensive review suggested a £3 per kg on sugar, and a £6 per kg on salt – paid for by the food manufacturers.

Dr Hilary explained that salt draws water into the blood circulation, causing blood pressure to increase and the heart to work harder.

READ MORE: GB News presenter takes knee live on air after Euro 2020 racism

The health risks of obesity

The NHS stated that one in four adults in the UK are considered obese.

Obesity can lead to “potentially life-threatening conditions”, such as:

  • Type 2 diabetes
  • Heart disease
  • Breast cancer
  • Bowel cancer
  • Stroke.

“Obesity can also affect your quality of life and lead to psychological problems, such as depression and low self-esteem,” added the national health body.

What causes obesity?

“Obesity is generally caused by consuming more calories, particularly those in fatty and sugary foods, than you burn off through physical activity,” the NHS explained.

Treatment for obesity

Weight loss can be achieved by eating a healthy, reduced-calorie diet and by exercising regularly.

People hoping to lose weight are encouraged to take up activities such as brisk walking, jogging, swimming or tennis.

In order to shift the pounds, you’ll need to move for around 150 to 300 minutes per week (i.e. two-and-a-half to five hours per week).

“Eat slowly and avoid situations where you know you could be tempted to overeat,” the NHS advised.

If lifestyle changes alone don’t help you lose weight, your doctor might prescribe you medication called orlistat.

The medicine works by reducing the amount of fat you absorb during digestion.

In some cases, weight loss surgery might be suggested by your doctor.

Other health issues caused by obesity include:

  • Breathlessness
  • Increased sweating
  • Snoring
  • Difficulty doing physical activity
  • Often feeling very tired
  • Joint and back pain
  • Low confidence and self-esteem
  • Feeling isolated.

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Novel Colonic Agonist Formulation Promising for Obesity

NEW YORK (Reuters Health) – A colonic release formulation of medium-chain fatty acids (MFCA) curbed appetite and boosted levels of the anorexigenic hormone PYY in a small placebo-controlled crossover trial involving obese adults.

“We have shown that two nutrient-sensing receptors, GPR84 and FFAR4, are expressed on human L-cells;” Dr. Madusha Peiris of Queen Mary University of London, UK told Reuters Health by email. “L-cells are found in high levels in the colon and they store and release the potent appetite-reducing hormones, PYY and GLP-1.”

“We also have shown that stimulating GPR84 and FFAR4 causes a synergistic release of PYY and GLP-1 from human colonic biopsies,” she said. “This was a surprising result.”

The clinical trial, reported in Gut, demonstrated that treating obese volunteers with a combination of nutrients that stimulated GPR84 and FFAR4 reduced calorific intake by increasing the levels of PYY in the blood, she explained. “This hormone travels from the gut to the brain to activate food control centers that tell us we are feeling ‘full.'”

In essence, she said, “We are mimicking gastric bypass surgery but without the risk of surgery.”

In a randomized crossover fashion, Dr. Peiris and colleagues had 20 volunteers come to the clinic on two separate days, separated by at least four weeks, to take combined GPR84 and FFAR4 agonists in colonic-release capsules or placebo before breakfast and lunch. Participants were not diabetic, had a mean age of 49, a mean BMI of 34.2, and had never undergone major gut surgery.

Active capsules contained 500 mg 3′3 diindolyl-methane (250 mg, Olympian Labs); 2100 mg alpha lino-lenic acid contained within perilla oil (500 mg, 90 LiCaps, Fairvital); and 2400 mg lauric acid (Sigma Aldrich).

Those who received the active treatment had reduced overall calorific intake and increased postprandial levels of PYY versus placebo. Specifically, the authors note, “there was no effect of MCFA capsules on subjective hunger ratings but modest yet significant effects on energy intake. This reduction in calorific intake of approximately 12% could result in weight loss of 12 kg over 24 weeks.”

Tissue analyses showed that GPR84 and FFAR4 receptors, among others, were coexpressed on human colonic enteroendocrine cells. Activation of GPR84 alone induced intracellular pERK, whereas FFAR4 selectively activated pCaMKII.

Further, coactivation of GPR84 and FFAR4 induced both phosphoproteins, and a superadditive release of GLP-1 and PYY.

Using a special preparation in a mouse model, the team found that nutrients and hormones convergently activated colonic afferent nerves via GLP-1, Y2 and 5-HT3 receptors.

Dr. Peiris said, “We will begin a 24-week trial in obese volunteers next year, where capsules will be given twice a day. This will allow us to assess weight loss as well as changes to those all-important appetite-reducing hormones, PYY and GLP-1. Upon successful completion of this study, we aim to have a product for clinical use by 2025.”

Dr. Kuldeep Singh, Director of the Maryland Bariatric Center at Mercy, commented in an email to Reuters Health, “This is an excellent study that shows it is possible to simultaneously and in an additive fashion increase the in vivo after-meal production of satiety hormones PYY and GLP-1. It is very promising as just recently GLP-1 agonists (liraglutide and simaglutide) have been approved by FDA (for diabetes) and have shown substantial weight loss, even in patients with no diabetes.”

“The risk profile will dictate the long-term use of these approaches; however, I believe this is very promising and exciting,” he said. “Only serious patients opt for surgery. Once a non-surgical method is introduced, I believe everybody will line up for that.”

SOURCE: https://bit.ly/2UXUvIh Gut, online June 3, 2021.

Author: By Marilynn Larkin
Read more here >>> Medscape Medical News

Semaglutide 2.4 mg 'Ushers in A New Era in Medical Obesity Care'

The recently licensed weight-loss drug semaglutide 2.4 mg/week (Wegovy, Novo Nordisk) “is likely to usher in a new era in the medical treatment of obesity,” stated Lee M. Kaplan, MD, PhD, at the virtual American Diabetes Association (ADA) 81st Scientific Sessions.

Kaplan discussed the clinical implications of caring for patients with obesity now that the glucagon-like peptide-1 (GLP-1) receptor agonist is approved in the United States for weight loss.

Weight loss with semaglutide 2.4 mg was twice that achieved with liraglutide 3 mg (Saxenda, Novo Nordisk) — that is, roughly a 10% to 15% weight loss at 68 weeks, said Kaplan, who was not involved in the pivotal STEP clinical trials of the agent.  

“I think as we start to see more data come in over the next couple of years,” including from the cardiovascular outcome trial SELECT, he continued, “we’ll be able to use the data to create a nuanced [individualized patient treatment] approach, but we’ll also be able to use our clinical experience, which will grow rapidly over the next few years.”

In future, semaglutide is likely to be combined with other drugs to provide even greater weight loss, predicts Kaplan, director of the Obesity, Metabolism, and Nutrition Institute at Massachusetts General Hospital in Boston.

In the meantime, “to be effective, semaglutide needs to be used,” he stressed, while noting that responses to the drug vary by individual, and so this will need to be taken into account.

“Obesity needs to be recognized as a disease in its own right, as well as a risk factor for numerous other diseases, [and] equitable access to obesity treatment needs to be broadened,” he emphasized.

Four Pivotal Phase 3 trials

As previously reported, four pivotal 68-week, phase 3 clinical trials in the Semaglutide Treatment Effect in People With Obesity (STEP) program tested the safety and efficacy of subcutaneous semaglutide 2.4 mg/week in more than 4500 adults with overweight or obesity.

The trials have been published in high profile journals — the New England Journal of Medicine (STEP 1), The Lancet (STEP 2), and JAMA (STEP 3, STEP 4) — said Robert F. Kushner, MD.

“I would encourage all of you to download and read each of these trials on your own,” said Kushner, professor of medicine and medicine education at Northwestern University Feinberg School of Medicine, in Chicago, Illinois, and coauthor of STEP 1, before presenting a top-level review of key results.

STEP 1 examined weight management, STEP 3 added a background of intensive behavioral therapy, STEP 4 investigated sustained weight management, and STEP 2 (unlike the others) investigated weight management in patients with type 2 diabetes, he summarized.

In STEP 1, patients who received semaglutide had an average 15% weight loss, and those who stayed on the drug had a 17% weight loss, compared with the 2.4% weight loss in the placebo group.

“One third of individuals in the trial achieved at least a 20% weight loss or more,” Kushner said, which is “really phenomenal.”

The results of STEP 3 “suggest that semaglutide with monthly brief lifestyle counseling alone is sufficient to produce a mean weight loss of 15%,” he noted, as adding a low-calorie diet and intensive behavior therapy sped up the initial weight loss but did not increase the final weight loss.

A post-hoc analysis of STEP 2 showed “it’s clear that improvement in A1c” is greater with at least a 10% weight loss versus a smaller weight loss, Kushner said. A1c dropped by 2.2% versus 1.3%, with these two weight losses respectively.

In STEP 4, after dose escalation to 2.4 mg at 20 weeks, patients had lost 10.6% of their initial weight. At 68 weeks, those who were switched to placebo at 20 weeks had lost 5.4% of their initial weight, whereas those who remained on semaglutide had lost 17.7% of their initial weight.

This shows that “if you remove the drug, the disease starts to come back,” Kushner pointed out.

Nausea, the most common side effect, occurred in 20% of patients, but was mostly mild or moderate, and gastrointestinal effects including constipation, vomiting, and diarrhea were transient and occurred early in the dose escalation phase.

Large Individual Variability, Combination Therapies on Horizon

Kaplan pointed out, however, that “like [with] other anti-obesity therapies…there’s a large patient-to-patient variability.”

A third of patients exhibit more than 20% weight loss, and 10% exhibit more than 30% weight loss — approaching the efficacy of bariatric surgery.

However, nearly 10% of patients without diabetes and upwards of 30% of patients with diabetes will experience less than 5% weight loss, he said.

Therefore, “success or failure in one patient doesn’t predict response in another, and we should always remember that as we treat different patients with these medications,” Kaplan advised clinicians.

A recent phase 1b study suggests that combination therapy with semaglutide and the amylin agonist cagrilintide ups weight loss, as previously reported.

In this short trial with no lifestyle modification, it took 16 weeks for patients to reach full dosing, and at 20 weeks, patients on semaglutide had lost 8% of their initial weight, whereas those on combination therapy had lost 17% of their initial weight.

“There’s hope that, in combination with cagrilintide and probably with several other agents that are still in early development, we’ll be seeing average weight loss that is in the range of that seen with bariatric surgery,” Kushner said.

Doctors Discuss Two Hypothetical Cases

Session moderator Julio Rosenstock, MD, of the University of Texas Southwestern Medical Center, Dallas, a co-investigator in several of the STEP trials, invited Kaplan and two other panelists to explain how they would manage two hypothetical patients.

Case 1

You have a patient with type 2 diabetes, a body mass index (BMI) of 32, 33 kg/m2, and an A1c of 7.5% or 8% on metformin. Would you use semaglutide 1 mg (Ozempic, Novo Nordisk) that is indicated for type 2 diabetes, or would you use semaglutide 2.4 mg that is indicated for obesity and risk factors?

“We have the answer to that from STEP 2,” said Melanie J. Davies, MB ChB, MD, professor of diabetes medicine at the University of Leicester, UK, who led the STEP 2 trial.

“For some patients, the 1-mg dose, which we use routinely in the clinic, may be reasonable to get good glycemic control for cardiovascular protection and will obviously achieve some weight loss. But if you really want to go for the weight-related comorbidities, then the 2.4-mg dose is what you need,” she said.

“A lot of [clinicians] might say: ‘I’ll see how [the patient goes] with the 1-mg dose, and then maybe if they’re not losing the weight and not getting to glycemic target, then maybe I’ll switch to 2.4 mg,'” said John Wilding, MD, who leads clinical research into obesity, diabetes, and endocrinology at the University of Liverpool, in the UK, and led the STEP 1 trial.

“But the STEP 2 data show very clearly that you get almost the same A1c,” Rosenstock interjected. “I would go for 2.4 mg. The patient has a BMI of 32, 33 kg/m2. I would hit hard the BMI. We need to change that paradigm.”

“For other diseases we don’t always go to the maximum dose that’s available. We go to the dose that’s necessary to achieve the clinical endpoint that we want,” Kaplan noted. “I think one of the challenges is going to be to learn how to clinically nuance our therapy the way we do for other diseases.”

“That is the usual thinking,” Rosenstock agreed. But “with the 2.4-mg dose, one third get a 20% reduction of BMI, and 10% get almost a 30% reduction — and you [aren’t] going to see that with semaglutide 1 mg!”

“That’s true,” Kaplan conceded. However, a patient with a relatively low BMI of 32, 33 kg/m2 may not need the higher dose, unlike a patient who has a BMI of 45 kg/m2 and diabetes. But we’re going to find that out over the next couple of years, he expects.

Case 2

You have a patient with a BMI of 31 kg/m2 who is newly diagnosed with type 2 diabetes. Why should you start them with metformin? Why won’t you start them with something that will directly tackle obesity and get the patient to lose 20 pounds and for sure the blood sugar is going to be better?

“I think if I have someone who is really keen to put their diabetes into remission,” Wilding said, “this would be a fantastic approach because they would have a really high chance of doing that.”

The prediabetes data from STEP showed that “we can put a lot of people from prediabetes back to normal glucose tolerance,” Wilding noted. “Maybe we can put people with early diabetes back to normal as well. I think that’s a trial that really does need to be done,” he said.

“We’re going to have to figure out the best pathway forward,” Kaplan observed, noting that multiple stakeholders, including payors, patients, and providers, play a role in the uptake of new obesity drugs.

“Do you think we will see less bariatric surgery with these drugs?” Rosenstock asked Kaplan.

“I think you have to remember that of the millions and millions of people with obesity, a very small portion are currently treated with anti-obesity medication, and an even smaller portion are getting bariatric surgery,” Kaplan replied.

“In the United States, 90% of people who get bariatric surgery are self-referred,” he said, so, “I think initially we are not going to see much of a change” in rates of bariatric surgery.

Rosenstock has reported being an advisory board member for Applied Therapeutics, Boehringer Ingelheim, Eli Lilly, Intarcia Therapeutics, Novo Nordisk, Oramed, and Sanofi, and a consultant for Applied Therapeutics, Boehringer Ingelheim, Eli Lilly, Intarcia Therapeutics, Novo Nordisk, Oramed, and Sanofi. He has reported receiving research support from Applied Therapeutics, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Genentech, Intarcia Therapeutics, Lexicon Pharmaceuticals, Novartis, Novo Nordisk, Oramed, Pfizer, REMD Biotherapeutics, and Sanofi.

Kaplan has reported being an advisory panel member for Eli Lilly, Gelesis, GI Dynamics, Novo Nordisk, and Pfizer; a consultant for Eli Lilly, Gelesis, Intellihealth, Johnson & Johnson, Novo Nordisk, Pfizer, and Rhythm Pharmaceuticals; and a stock/shareholder of Gelesis.

Wilding has reported being a consultant for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Mundipharma International, Napp Pharmaceuticals, Novo Nordisk, Rhythm Pharmaceuticals, Saniona, and Sanofi; receiving research support from AstraZeneca and Novo Nordisk; and being on speakers bureaus for AstraZeneca, Boehringer Ingelheim, Eli Lilly, and Napp Pharmaceuticals.

Davies has reported being an advisory panel member for Boehringer Ingelheim, Eli Lilly, Lexicon Pharmaceuticals, Novo Nordisk, and Sanofi, and on speakers bureaus for AstraZeneca, Boehringer Ingelheim, Eli Lilly, Napp Pharmaceuticals, Novo Nordisk, and Sanofi. She has reported other relationships with AstraZeneca, NIHR Leicester Biomedical Research Centre, and Novo Nordisk.

ADA 2021 Scientific Sessions. Presented on June 26, 2021.

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This post originally appeared on Medscape Medical News Headlines

Obesity Increases Risk for Long-COVID, Study Finds

June 8, 2021 — Obesity — an established major risk factor in the development of severe infection or death from COVID-19 infection — also appears to significantly increase the risk of developing long-term complications from the disease, a syndrome often referred to as long-haul COVID-19, according to a new study.

“To our knowledge, this current study for the first time suggests that patients with moderate to severe obesity are at a greater risk of developing long-term complications of COVID-19 beyond the acute phase,” the study’s lead author, Ali Aminian, MD, director of Cleveland Clinic’s Bariatric & Metabolic Institute, said in a press statement.

The study included 2,839 patients who tested positive for COVID-19 in the Cleveland Clinic Health System between March and July 2020 who did not require admission to the ICU and survived the initial phase of COVID-19.

The doctors looked for three indicators of possible long-term complications of COVID-19 — hospital admission, death, and need for diagnostic medical tests — that occurred 30 days or more after the first positive viral test for COVID-19.

In the 10 months after their initial COVID-19 infection, 44% of the patients required hospital admission and 1% had died.

The need for diagnostic tests after infection was 25% higher among those with moderate obesity (BMI of 35-39.9) and 39% higher in those with severe obesity (BMI of >40), compared with those of with a BMI of 18.5-24.9.

Specifically, those with obesity were more likely to require diagnostic tests for the heart, lung, and kidney; for gastrointestinal or hormonal symptoms; or blood disorders; and for mental health problems following COVID-19 infection.

Obesity was not associated with a higher risk of death during the follow-up period, however.

The findings suggest that obesity’s effects extend beyond worsening infection and influence the long-term symptoms.

“The observations of this study can possibly be explained by the underlying mechanisms at work in patients who have obesity, such as hyperinflammation, immune dysfunction, and comorbidities,” senior author Bartolome Burguera, MD, PhD, said in the Cleveland Clinic press statement.

While a wide array of milder long-term effects after COVID-19 infection including psychological symptoms, fatigue, brain fog, muscle weakness, and sleep difficulties have been reported, the current study did not include information on those symptoms.

However, even the finding that up to 44% of the patients required hospital admission after COVID-19 — regardless of weight status — is of concern, the authors noted.

“These findings suggest a profound magnitude of the public health impact of [long-haul COVID-19] in the setting worldwide infection,” they wrote.

The study is published in the journal Diabetes, Obesity and Metabolism.

SOURCES:

Ali Aminian, MD, director of Cleveland Clinic’s Bariatric & Metabolic Institute.

Bartolome Burguera, MD, PhD, Cleveland Clinic.

Diabetes, Obesity and Metabolism: “Association of Obesity with Post-Acute Sequelae of COVID-19 (PASC).”

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Author:
This post originally appeared on Medscape Medical News Headlines

Obesity Paradox Challenged: Weight Gain Does Not Protect Cognition

In contrast to previous research, a new study suggests that weight gain in older adults does not preserve cognition — and may actually be detrimental.

The findings challenge the “obesity paradox” in cognition, which suggests that overweight or obesity in older adults protects cognitive function.

Judith M. Kronschnabl

In the current study, weight loss associated with cognitive decline was largely reflective of progressive physical deterioration, whereas weight gain linked to small positive effects was found in underweight people or after illness-related weight loss, signalling recovery, said study investigator Judith M. Kronschnabl, MA, Munich Center for the Economics of Aging at Max Planck Institute for Social Law and Social Policy, Germany.

However, “persistent weight gain or weight gain at already high levels of [body mass index (BMI)] eventually becomes detrimental,” Kronschnabl told Medscape Medical News.

“It has been suggested that higher weight or weight gain in older age may become beneficial for keeping up cognitive performance [but] we find no evidence for this,” she added.

“Accordingly, such a wrong belief should not contribute to physicians’ reluctance in advising” patients with obesity or overweight to reduce excess bodyweight, Kronschnabl said.

The findings were published online April 21 in PLOS ONE.

Worldwide Prevalence

World Health Organization data show the prevalence of overweight status and obesity among older people has increased worldwide. Another major concern is the aging population and the associated increase in rates of cognitive decline, including dementia.

Although past research has shown that overweight and obesity are associated with poorer cognition in children and younger adults, studies on this association among older adults have provided conflicting results.

Some studies have shown improved reasoning, visuospatial processing speed, and cognitive flexibility among older people who are overweight or obese compared with those of normal weight. However, other studies have shown a negative association between body weight and cognition, much like the relationship observed among children and young adults.

In the current research, investigators examined the relationship between weight change and cognition in older adults using an international population. They also attempted to minimize the methodological problems found in previous studies, which included their cross-sectional design and vulnerability to survivor bias.

The researchers examined data from the Survey of Health, Ageing and Retirement in Europe, which includes participants aged 50 years or older. Data are collected every 2 years in this study, and the current researchers examined four waves of data.

Participants who were eligible for the current analysis had been observed at least three times and included 32,467 women and 25,922 men from 15 countries.

Cognition was assessed with a modified version of the Rey Auditory Verbal Learning Test, which evaluates immediate and delayed word recall. These measures were chosen because fluid cognitive skills are affected first and are most noticeable in cognitive aging.

BMI was used to measure height-adjusted body weight, and participants’ reported reasons for weight loss were recorded.

Because BMI does not provide information about body composition, the researchers supplemented the data with handgrip strength, which correlates with lean body mass. Adding this information helped to distinguish between weight loss resulting from a reduction in fat mass and weight loss resulting from a reduction in muscle mass.

In addition, the investigators examined participants’ self-reported physical activity, identified comorbidities that could result in weight changes such as Parkinson’s disease or stroke, and recorded demographics.

Small BMI Effects

Results showed that BMI explained little of the variation in cognitive performance — either between participants or within participants over time. The effect sizes of BMI on cognition were small. A one-unit increase in BMI changed predicted cognition by 0.007 standard deviations or about 0.03 additional words in the combined immediate and delayed recall task.

No significant positive effect of weight gain on cognition was found in men or women. Weight loss was associated with a significant negative effect on cognition in women (-0.0106; standard error, 0.0026; P < .001) but had no significant effect in men.

When the researchers added grip strength, reported diseases, and physical activity to the analysis, the effect of weight loss on cognition was reduced significantly in both the women (-0.0086; standard error, 0.0026; P < .001) and men (-0.0092; standard error, 0.0034; P < .01).

The researchers then divided the study population into two groups according to age, with 65 years as the cut point. The mean age was 60 years in the younger group and 76 years in the older group.

Among women, weight gain without prior weight loss did not affect cognitive performance. However, weight gain had a beneficial effect on cognition when it followed high levels of weight loss.

For example, following a seven-unit decrease in BMI, a one-unit increase in BMI was associated with an increase in cognitive performance by approximately 0.04.

The previously observed positive effect of weight gain on cognition in women likely resulted from a recovery effect, the researchers note.

Methodological Pitfalls

In the current study, there was no significant interaction in men between weight gain and cognition, with or without previous weight loss.

When investigators examined weight gain effect on cognition, stratified by BMI, they found that weight gain might have cognitive benefits at low BMI. However, the beneficial effect decreased and became harmful as BMI increased.

Among men, weight loss had particularly harmful effects on cognition in those who were underweight. For example, BMI decrease among men with a BMI of 15 was associated with a decrease in cognition of approximately 0.09; but weight loss had no effect on those who were overweight.

“With our study, we were able to empirically address the possible methodological pitfalls that have been known and discussed in the literature before using a large longitudinal data set, where we observe respondents multiple times up to 10 years,” Kronschnabl said.

Restricting the cognitive testing in the study to immediate and delayed word recall prevents the researchers from drawing conclusions about the effects of body weight change on cognitive performance in other cognitive domains, she added.

“However, we know from previous studies that not all cognitive domains are affected the same through aging,” she said. “Particularly episodic memory, as measured by recall, is affected first and more pronounced, while crystallized skills like verbal skills have been shown to remain relatively stable over the life course.”

In addition, impairments in episodic memory are good predictors of dementia and Alzheimer’s disease. Such impairments correlate with blood-based markers of neural plasticity such as brain-derived neurotrophic factor, Kronschnabl said.  

“Excellent Analysis”

Commenting on the findings for Medscape Medical News David Knopman, MD, professor of neurology at Mayo Clinic, Rochester, Minnesota, said that, from the perspective of an analytic epidemiologist, “this is an excellent and thoughtful analysis.”

Dr David Knopman

The apparent protective effect of being overweight on late-life cognition, which previous studies have noted, was a consequence of the way in which relative risks were calculated, Knopman noted.

Comparison groups of participants with normal weight also included those with low weight resulting from chronic disease, who are more likely to develop cognitive impairment because of those chronic diseases, he added.

“The contribution of this article is to show with longitudinal BMI data that it is indeed weight loss that is indexing those chronic diseases. As the authors clearly point out, weight gain and weight loss are not symmetric,” Knopman said.

A similar “paradox” is found in hypertension. This comorbidity appears to be neutral or to provide slight benefits for cognition in older age because the comparator group of individuals without high blood pressure often includes those with hypotension resulting from systemic or neurological disease, Knopman noted.

Clinicians should bear in mind that obesity is a risk factor for cardiovascular disease, hypertension, diabetes, hyperlipidemia, lower back problems, gait difficulty, and obstructive sleep apnea, he added.

“This study removes the false expectation that obesity somehow protects against dementia. It does not. All of these statements can be made regardless of adult age,” Knopman concluded.  

PLOS ONE. Published online April 21, 2021. Full text

Kronschnabl and Knopman have reported no relevant financial relationships.

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Alarming figures lay bare the toll obesity is taking on nation's health

Women accounted for two thirds of cases, while admissions were twice as likely in the most deprived areas. Health experts said yesterday’s shocking figures laid bare the immense toll obesity is taking on the nation’s health. Tam Fry of the National Obesity Forum said: “Obesity is a risk factor for a plethora of medical conditions – diabetes, heart, kidney, lung disease, to name but a few.
“It is only with statistics such as these that the widespread damage caused by fat becomes really apparent.”

In 2019-20, 1.02 million admissions listed obesity as a primary or secondary diagnosis, up from 876,000 the previous year.

NHS Digital has said some of the increase may be due to better recording of data in hospitals.

There was a three percent fall to 10,780 in cases where obesity was the main cause of admission.

But Mr Fry said although those figures fell, “we should be truly alarmed at the huge increase in the other admissions that excess fat triggers”.

Admissions included 6,740 for weight loss surgery, down four percent on the previous year. Eighty per cent of bariatric op patients were women.

About two thirds of England’s adults are overweight or obese. Twenty-seven percent of men and 29 percent of women are obese. Children in the most deprived places are more than twice as likely to be obese than those in the least deprived areas.

Christina Marriott of the Royal Society for Public Health warned the figures “paint a familiar picture that we have a serious obesity problem”.

She said: “Behind the numbers are people living with the negative mental and physical ill health effects, which is a particular concern given the increased risk people with obesity have from becoming seriously ill with Covid-19.

“We need to take a holistic approach to reducing obesity and prioritise prevention by tackling the environment that influences us to eat food of poor nutritional quality and to lead sedentary lifestyles.

“If we are to reverse the obesity trend, we need to support people to understand how to make healthier choices, along with making those healthier choices readily available and remove barriers such as availability and cost of nutritional food, poor mental health and deprivation levels.”

John Maingay of the British Heart Foundation said: “These striking figures underline the immense toll that obesity is taking on the nation’s health.

“It is particularly disturbing to see the disproportionate impact it is having on people in our most deprived communities. Such startling inequality demands urgent action.”

NHS England medical director Professor Stephen Powis said: “Today’s shocking figures are a growing sign of the nation’s obesity crisis.” 

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