Bradley Waggoner, MD

GSU Professor Finds Link Between Obesity and Federal School Nutrition Programs

With obesity becoming an epidemic among school-aged children in this country, a Georgia State University professor has found a link between overweight children and federal school nutrition programs.

Research reveals that children who eat lunch as part of the National School Lunch Program (NSLP) have an increased likelihood of becoming overweight, according to research co-authored by Rusty Tchernis, associate professor with Georgia State University’s Andrew Young School of Policy Studies¹. The findings also show that the School Breakfast Program (SBP) is a “valuable tool in the current battle against childhood obesity,” according to the research.

“Overweight children are more likely to become obese adults,” Tchernis said. “So the only way to reduce obesity is to prevent it from happening in children.”

The study, "School Nutrition Programs and the Incidence of Childhood Obesity,” will be published in the summer edition of The Journal of Human Resources.

The research – co-authored also by Muna Husain and Daniel Millimet, both of Southern Methodist University – was funded with a $200,000 grant from the U.S. Department of Agriculture through 2011.

For the study, Tchernis and his co-authors analyzed the relationship between the SBP and the NSLP and obesity using data on over 13,500 primary school students. Students were interviewed in kindergarten, first and third grades, and then again in later grades.

Other findings show that those who participate in both federal programs end up less heavy than those who don’t participate in either, or those who only eat lunch as part of NSLP.

The NSLP provides lunch to more than 30 million children every day in approximately 101,000 schools, with 17.5 million students receiving reduced price or free meals, according to the program’s website.

In recent years, some schools have banned soda as well as vending machines containing unhealthy snacks. Many school districts also are considering measures that could impact the government’s program, using “Farm to School” programs.

“Some children don’t know how to peel oranges,” Tchernis said. “It’s surprising how little children know about food.”

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¹Reprinted from materials provided by Georgia State University , via Andrew Young School of Policy Studies.

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New Eating Device Retrains Dietary Habits and Helps Children Lose Weight

A new computerized device that tracks portion size and how fast people eat is more successful in helping obese children and adolescents lose weight than standard treatments, according to research published on bmj.com¹.

The Mandometer device, a portable computerized weighing scale, was developed at the Karolinska Institutet in Stockholm. It helps to retrain individuals to eat less and more slowly by providing real-time feedback during meal times. The device plots a graph showing the rate at which food actually disappears from the plate, compared to the ideal graph programmed in by a food therapist.

Childhood obesity is an increasing global problem and there is little evidence to support one specific treatment program. While it is unknown whether specific eating patterns are common in all obese people, in this study the patients ate large portions very quickly.

Researchers at Bristol Royal Hospital for Children and the University of Bristol, led by Professor Julian Hamilton-Shield, carried out a randomized controlled trial of 106 obese patients aged between 9-17 years.

One group of participants received Mandometer therapy to lose weight and the other were provided with standard care. Both groups were encouraged to increase their levels of physical activity to 60 minutes of exercise a day and to eat a balanced diet based on the Food Standards Agency "eatwell plate."

Participants were assessed after 12 months and followed up at 18 months. During the research period they were also regularly monitored and offered telephone support and encouragement.

After 12 months, the Mandometer group not only had a significantly lower average body mass index and body fat score than the standard care group, but their portion size was smaller and their speed of eating was reduced by 11% compared with a gain of 4% in the other group. Levels of 'good cholesterol' were also significantly higher in the Mandometer group.

The improvement in body mass index was maintained six months after the end of treatment, suggesting an element of longer term behavioral change, add the authors.

"Mandometer therapy, focusing on eating speed and meal size, seems to be a useful addition to the rather sparse options available for treating adolescent obesity effectively without recourse to pharmacotherapy," say the authors.

They acknowledge that the Mandometer requires further evaluation in other settings and with different groups of patients, but conclude that "Retraining eating behavior and reinforcing feelings of satiety, however, does seem to improve weight loss in obese adolescents."

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¹ http://www.bmj.com. Full text of this study can be found at the BMJ Journal's website.

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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Weight Loss Surgery Can Break a Family’s Cycle of Obesity

Adolescent and young children of obese mothers who underwent weight-loss surgery prior to pregnancy have been found to have a lower prevalence of obesity and significantly improved cardio-metabolic markers when compared to siblings born before the same obese mothers had weight-loss surgery. This new study has been accepted for publication in The Endocrine Society’s¹ Journal of Clinical Endocrinology & Metabolism (JCEM).

Obesity can lead to insulin resistance, cardiovascular disease and pregnancy complications and is a major contributor to causes of death in industrialized nations. Previous studies of obese pregnant women have shown that obesity and its co-morbidities can be transmitted to their children, which indicates that the intrauterine environment may determine whether a child at birth is already destined to become obese.

“Our study confirms previous research showing that the intrauterine environment may be more important than genes and the post-natal environment when it comes to the association between maternal obesity and childhood obesity,” said John Kral, MD, PhD, of SUNY Downstate Medical Center in Brooklyn, N.Y. and co-author of the study. “Any medical or surgical treatment to reduce obesity and existing metabolic disorders before pregnancy can be an investment in the life of future offspring.”

Weight-loss surgery limits the amount of food a person can consume. Some of these operations also restrict the amount of food that can be digested. This particular study focused on women who had undergone biliopancreatic diversion (BPD) prior to becoming pregnant. BPD changes the normal process of digestion by making the stomach smaller and directing food to bypass part of the small intestine resulting in fewer calorie absorption.

Specifically, researchers studied 49 mothers who had undergone BPD surgery and their
111 children (between the ages of 2.5 and 25 years). All mothers in this study had children born before and then after their weight-loss surgery. The research found that children who were born after their mother underwent weight-loss surgery had reduced birth weight and waist circumference and were three times less likely to become severely obese. Furthermore, children born after their mother’s weight-loss surgery had improved cardiovascular markers including reduced insulin resistance and lower cholesterol.

“To our knowledge, our paper is the first to demonstrate that dramatic maternal weight loss causes metabolic improvements in their children,” said Kral. “Our findings show that obese women should be encouraged to lose weight before becoming pregnant, and then, once pregnant, should limit their weight gain. For those women interested in both surgical treatment and having children, we believe surgery should come first. Preventing obesity and treating it effectively in young women could prevent further transmission to future generations.”

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¹The Endocrine Society. September 1, 2009. http://www.endo-society.org/media/press/2008/AugustNewsBrief.cfm.

Other researchers working on the study include J. Smith, K. Cianflone, S. Simard and Picard Marceau of the Centre de Recherche Institut Universitaire de Cardiologie et Pneumologie de Quebec in Canada; S. Biron, S. Lebel, S. Marceau, O. Lescelleur and L. Biertho of Laval University in Quebec, Canada; and J.G. Kral of SUNY Downstate Medical Center in Brooklyn, N.Y.
 

The article, “Effects of maternal surgical weight loss on intergenerational transmission of obesity,” will appear in the November 2009 issue of JCEM.

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