The Academy of Royal Medical Colleges called for action this week to tackle the obesity epidemic in the UK, which remains a very serious problem despite various awareness campaigns and proposed interventions. A quarter of adults and a third of primary school children are now overweight, and this figure is expected to double by 2050 if urgent measures are not taken. An enquiry by the academy found that public health interventions to curb obesity are “piecemeal and disappointingly ineffective” in adults and children, and UK doctors recommend that new approaches should be taken to resolve the crisis.
In an opinion article published this week in BMC Medicine, Stephen R Zubrick and colleagues from the Telethon Institute for Child Health Research explored the basic science behind weight-loss interventions, and described how current approaches based on simple models of energy balance fail to achieve long-term results. The authors recommend that multiple factors affecting energy regulation should be considered in order to design effective strategies to tackle obesity.
Being overweight increases the risk of developing many chronic conditions, including type 2 diabetes, cardiovascular disease and cancer. Research published in BMC Medicine this week has addressed some of these problems; Simonetta Bellone and colleagues from the University of Eastern Piedmont explored the hormones linked to cardiovascular risk factors in obese children, and showed that high levels of adrenocorticotropic hormone and cortisol are associated with distinct risk factors. The authors concluded that complex mechanisms underlie interactions between hormones and metabolic impairments in obesity, which could be targeted to reduce cardiovascular risk in obese children.
Type 2 diabetes can develop rapidly in those who are overweight, and can cause many complications if left untreated. In a research article, Bernardo Costa and colleagues from the PREDICE project for the prevention of type 2 diabetes showed that the Finnish Diabetes Risk Score (FINDRISC) can predict diabetes effectively when using glucose-based diagnostic criteria, but the predictive ability is reduced when the new hemoglobin A1c-based criteria proposed by the American Diabetes Association are applied. These results indicate that it is important to have reliable scores to predict the development of diabetes in at-risk populations in order to identify the most appropriate individuals for targeted prevention strategies.
Given the growing numbers of people suffering from type 2 diabetes, it is increasingly important to identify new combination therapies to treat these patients. In early February, NICE issued draft guidance to announce that it did not recommend dapagliflozin in combination with other diabetes treatments due to insufficient long-term data, and highlighted that more good quality trials are required. In a randomized controlled trial carried out over 102 weeks by Clifford J Bailey and colleagues from Aston University, addition of dapagliflozin to metformin therapy was shown to be effective for glycemic control in patients with type 2 diabetes who are inadequately responsive to metformin alone. These results add strong evidence for the long-term efficacy of dapagliflozin combination therapy and should be incorporated into the final NICE guidance, which is expected to be released in June 2013.
Research in BMC Medicine this week has also explored other lifestyle choices and the impact they can have on health and disease. Fernando Rodríguez-Artalejo and colleagues from the Autonomous University of Madrid found that adherence to generally accepted healthy behaviors, including not smoking, being active and eating a healthy diet, as well as other behaviors such as interacting with friends and not sitting for too long, could substantially reduce the risk of mortality in older adults.
A study led by the Norwegian Institute of Public Health investigated the impact of a mother’s lifestyle choices on her baby, showing that maternal caffeine intake is associated with increased risk of the baby being small for gestational age and having decreased birth weight. Verena Sengpiel and colleagues argue that these results could have implications for the recommended consumption of caffeine during pregnancy, and suggest that pregnant women should consider giving up caffeine altogether.
The importance of living a healthy lifestyle in order to prevent the development of disease is well known, but these studies show that new interventions are still urgently required to prevent the obesity crisis and the subsequent onset of co-morbid diseases.