A big thank you to Leanne Wagner for providing a summary of the key presentations at the International Congress on Obesity held in Malaysia in March 2014
Should we target specific ages when treating obesity?
Children : Approaches to prevent and/or treat children have proven particularly successful – more than comparable approaches targeting other age groups. Studies have also shown that prevention and treatment strategies for children may also impact parents and other family, household, and community members, leading to greater efficacy and greater benefits to the population as a whole.
Adolescents : the evidence base on which to undertake interventions in this age group is modest. Adolescents are challenging to manage and do not have the cognitive maturity to understand the longer term outcomes of overweight and obesity. A multidisciplinary team is particularly important in dealing with this age group.
Pregnancy : Maternal obesity has consistently been associated with serious pregnancy complications and adverse outcomes in the child, both at birth and later in life. The underlying mechanisms are still poorly understood and meta-analyses have found a small, but robust reduction in gestational weight gain and the risk of gestational diabetes, but fail to identify any effects on other outcomes.
Elderly : Paradoxical finding from many research studies that lower weight in old age is associated with increased risk of death, while heavier weight is associated with lower risk of death. This is especially confusing since heavier persons are at greater risk of disability, diabetes and other conditions.
Metabolic Surgery : Endocrine mechanisms of Diabetes remission
The rapid time course & the disproportional degree of T2DM improvement after RYGB compared with equivalent weight loss from other interventions, and several other bodies of evidence, demonstrate that RYBG activates weight-independent processes to improve glucose homeostasis. Potential mechanisms mediating these direct anti-diabetes effects of RYGB include enhanced secretion of lower intestinal hormones such as GLP-1, altered physiology from excluding ingested nutrients from the upper intestine, compromise of ghrelin secretion, modulations of intestinal nutrient-sensing pathways that regulate insulin sensitivity, alterations in bile acid signalling, modulations of gut microbiota, and other changes yet to be fully characterised.
There were many presentations on the effects and changes in gut microbiota with the concept of the microbiota acting as a separate “organ” in the body.
It has been shown that the composition of the gut microbiota differs in obese versus lean individuals: there is less diversity in microbiota and different species predominating. Also shown that individuals (23% population) with a low gene count have less healthy metabolic and inflammatory traits.
Changes in the gut microbiota composition have been linked to obesity and type 2 diabetes. P. Cani described the concept of metabolic endotoxemia as one of the triggering factors leading to the development of metabolic inflammation and insulin resistance associated with obesity. Gut microbes play a major role in this context by contributing to the development of insulin resistance, alteration of the gut barrier function and thereby metabolic inflammation. They contribute to the regulation of: gut peptides secretion (by targeting the L-cells), mucus layer thickness, antimicrobial peptides and endocannabinoids.
Giving probiotic to UC (double blind study) showed no diff between placebo and patients with UC in all patients however there are some responders ie ones with low gene richness benefitted from administration of probiotic).
**After antibiotics takes approx 1 month after ceasing Ab to return to usual microbiota. However ongoing courses of Abs can permanently change microbiota.
For up-to-date research in this area go to www.gutmicrobiotaforhealth.com/
Intermittent energy restriction improves weight loss efficiency in obese men
Byrne, N; Sainsbury, A; Wood, R; King, N; Hills, A
In Qld, N. Byrne’s research looked at the effects of continuous vs intermittent dieting. After a 2 week maintenance diet men were either assigned to 16 wks of continuous energy restriction vs 16 wks of energy restriction given as blocks of 2 wks restriction alternating with 2 wks maintenance.
Weight loss was significantly greater in the intermittent dieters and there was a significantly > loss of FM (no diff in FFM). While reduction in absolute REE did not differ between the groups, after adjusting for changes in body composition, the reduction in REE was 99 ± 45 kcal/d less in intermittent dieters.
In conclusion, greater weight and fat loss was achieved with INT energy restriction. The findings suggest that interrupting energy restriction with energy balance ‘rest periods’ may reduce compensatory metabolic responses, and in turn, improve weight loss efficiency.