Search

New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The drug semaglutide, commonly known by the brand names Ozempic or Wegovy, was <a href="https://theconversation.com/the-rise-of-ozempic-how-surprise-discoveries-and-lizard-venom-led-to-a-new-class-of-weight-loss-drugs-219721">originally developed</a> to help people with type 2 diabetes manage their blood sugar levels. However, researchers have discovered it may help with other health issues, too. Clinical trials show semaglutide can be effective for <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032183">weight loss</a>, and hundreds of thousands of people around the world are using it <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">for this purpose</a>. Evidence has also shown the drug can help manage <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2306963">heart failure</a> and <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403347">chronic kidney disease</a> in people with obesity and type 2 diabetes. Now, a study published in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">New England Journal of Medicine</a> has suggested semaglutide can improve knee pain in people with obesity and osteoarthritis. So what did this study find, and how could semaglutide and osteoarthritis pain be linked? <h2>Osteoarthritis and obesity</h2> Osteoarthritis is a common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. Most people with osteoarthritis <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">have pain</a> and find it difficult to perform common daily activities such as walking. The knee is <a href="https://pubmed.ncbi.nlm.nih.gov/37675071/">the joint most commonly affected</a> by osteoarthritis. Being overweight or obese is a <a href="https://pubmed.ncbi.nlm.nih.gov/25447976/">major risk factor</a> for osteoarthritis in the knee. The link between the two conditions <a href="https://pubmed.ncbi.nlm.nih.gov/26821091/">is complex</a>. It involves a combination of increased load on the knee, <a href="https://www.nature.com/articles/s41413-023-00301-9">metabolic factors</a> such as high cholesterol and high blood sugar, and inflammation. For example, elevated blood sugar levels increase the production of inflammatory molecules in the body, which can damage the cartilage in the knee, and lead to the <a href="https://pubmed.ncbi.nlm.nih.gov/30712918/">development of osteoarthritis</a>. Weight loss is strongly recommended to reduce the pain of knee osteoarthritis in people who are overweight or obese. <a href="https://pubmed.ncbi.nlm.nih.gov/31908149/">International</a> and <a href="https://www.safetyandquality.gov.au/sites/default/files/2024-08/osteoarthritis-knee-clinical-care-standard-2024.pdf">Australian guidelines</a> suggest losing as little as 5% of body weight can help. But losing weight with just diet and exercise can be difficult for many people. <a href="https://pubmed.ncbi.nlm.nih.gov/26180980/">One study</a> from the United Kingdom found the annual probability of people with obesity losing 5% or more of their body weight was less than one in ten. Semaglutide has recently entered the market as a potential alternative route to weight loss. It comes from a class of drugs known as GLP-1 receptor agonists and works by increasing a person’s sense of fullness. <h2>Semaglutide for osteoarthritis?</h2> The rationale for the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">recent study</a> was that while we know weight loss alleviates symptoms of knee osteoarthritis, the effect of GLP-1 receptor agonists was yet to be explored. So the researchers set out to understand what effect semaglutide might have on knee osteoarthritis pain, alongside body weight. They randomly allocated 407 people with obesity and moderate osteoarthritis into one of two groups. One group received semaglutide once a week, while the other group received a placebo. Both groups were treated for 68 weeks and received counselling on diet and physical activity. At the end of the treatment phase, researchers measured changes in knee pain, function, and body weight. As expected, those taking semaglutide lost more weight than those in the placebo group. People on semaglutide lost around 13% of their body weight on average, while those taking the placebo lost around 3% on average. More than 70% of people in the semaglutide group lost at least 10% of their body weight compared to just over 9% of people in the placebo group. The study found semaglutide reduced knee pain significantly more than the placebo. Participants who took semaglutide reported an additional 14-point reduction in pain on a 0–100 scale compared to the placebo group. This is much greater than the pain reduction in another <a href="https://pubmed.ncbi.nlm.nih.gov/36511925/">recent study</a> among people with obesity and knee osteoarthritis. This study investigated the effects of a diet and exercise program compared to an attention control (where participants are provided with information about nutrition and physical activity). The results here saw only a 3-point difference between the intervention group and the control group on the same scale. The amount of pain relief reported in the semaglutide trial is also larger than that reported with commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/35442752/">anti-inflammatories</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">opioids</a> and <a href="https://www.bmj.com/content/372/bmj.m4825">antidepressants</a>. Semaglutide also improved knee function compared to the placebo. For example, people who took semaglutide could walk about 42 meters further than those on the placebo in a six-minute walking test. <h2>How could semaglutide reduce knee pain?</h2> It’s not fully clear how semaglutide helps with knee pain from osteoarthritis. One explanation may be that when a person loses weight, there’s less stress on the joints, which reduces pain. But recent studies have also suggested semaglutide and other GLP-1 receptor agonists might have <a href="https://www.sciencedirect.com/science/article/pii/S1043661822002651">anti-inflammatory</a> properties, and could even protect against <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6731440/">cartilage wear and tear</a>. While the results of this new study are promising, it’s too soon to regard semaglutide as a “miracle drug” for knee osteoarthritis. And as this study was funded by the drug company that makes semaglutide, it will be important to have independent studies in the future, to confirm the findings, or not. The study also had strict criteria, excluding some groups, such as those taking opioids for knee pain. One in seven Australians seeing a GP for their knee osteoarthritis <a href="https://pubmed.ncbi.nlm.nih.gov/34527976/">are prescribed opioids</a>. Most participants in the trial were white (61%) and women (82%). This means the study may not fully represent the average person with knee osteoarthritis and obesity. It’s also important to consider semaglutide can have a range of <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">side effects</a>, including gastrointestinal symptoms and fatigue. There are some concerns that semaglutide could reduce <a href="https://www.sciencealert.com/experts-are-concerned-drugs-like-ozempic-may-cause-muscle-loss">muscle mass</a> and <a href="https://www.healthline.com/health-news/ozempic-muscle-mass-loss">bone density</a>, though we’re still learning more about this. Further, it can be difficult to access. <h2>I have knee osteoarthritis, what should I do?</h2> Osteoarthritis is a disease caused by multiple factors, and it’s important to take <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard/information-consumers-osteoarthritis-knee-clinical-care-standard">a multifaceted approach</a> to managing it. Weight loss is an important component for those who are overweight or obese, but so are other aspects of <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">self-management</a>. This might include physical activity, pacing strategies, and other positive lifestyle changes such as improving sleep, healthy eating, and so on.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/243159/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, Associate Professor, School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstocl This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/new-study-suggests-weight-loss-drugs-like-ozempic-could-help-with-knee-pain-heres-why-there-may-be-a-link-243159">original article</a>. </div>

Body

Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world. When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing. The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>. <h2>Not the first ‘miracle’ weight-loss drug</h2> This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>. Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame. <h2>Ozempic doesn’t work the same for everyone</h2> When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5% What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits. When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon. But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate. <h2>Treatment needs to be ongoing. What will this mean?</h2> When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment. Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods. Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies. <h2>Biology is only part of the story</h2> For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures. But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved. Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants. <h2>A weight-centred approach misses the rest of the story</h2> The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health. Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>. <h2>Obesity isn’t an issue detached from people</h2> Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma. The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum. Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication. <h2>Drugs are tools, not silver bullets</h2> The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is. Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment. Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself. Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.

Body

Obese woman sparks debate for not giving up extra seat for toddler

An obese woman has sparked debate online after refusing to give up the second seat she paid for to a fussy toddler. The 34-year-old booked the two seats for her cross-country flight to visit her family for Christmas because she was previously unable to comfortably fit in one seat. All was well until the young woman next to her demanded that she "squeeze into one seat" so her son could sit on the other. "I am obese," she admitted on the Reddit thread. "I'm actively working toward losing weight and I've made progress - but I booked an extra seat because I'm fat." She added that she insisted on keeping her seat because she paid for it, but the mum "made a big fuss over it, and she told the flight attendant I was stealing the seat from her son." "Then I showed her my boarding passes, proving that I paid for the extra seat. The flight attendant asked me if I could try to squeeze in, but I said no, that I wanted the extra seat I paid for." The woman claimed that the toddler was only 18 months old, so he didn't need his own seat and could've sat on his mum's lap for the duration of the flight. "I got dirty looks and passive-aggressive remarks from her for the entire flight and I do feel a little bad because the boy looked hard to control - but am I in the wrong?" she asked other social media users. Many shared their overwhelming support for the woman and slammed the mum and flight attendant for their "horrific" behaviour. "The mum is an a**hole for not buying a seat for her son and assuming someone else would give up a seat they paid for. Odds are she was hoping there'd be extra seats on the flight so she didn't have to pay and used the lap thing as a loophole," one commented. "What's even the point of the extra seat if the flight attendants are going to let entitled people bully others into giving it up?" another added. "People buy entire seats for high-end musical equipment. Not even people. Their lack of planning does not constitute an emergency on your part," a third wrote. However, there were a few others that said the woman was in the wrong for causing an inconvenience. "If you are so fat that you have to have more than one seat on an airplane then you are selfish," one said. "Flights overbook all the time especially during the holidays - how can you justify having two seats to yourself?" "How much room does a kid take up, seriously? Yeah the mum should've bought a seat but that doesn't mean you have to be selfish and cause two people discomfort," another commented. Image: Getty

Travel Trouble

Renaming obesity won’t fix weight stigma overnight. Here’s what we really need to do

<a href="https://theconversation.com/profiles/ravisha-jayawickrama-1457644">Ravisha Jayawickrama</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/blake-lawrence-1452739">Blake Lawrence</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>, and <a href="https://theconversation.com/profiles/briony-hill-1041619">Briony Hill</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> The stigma that surrounds people living in larger bodies is pervasive and deeply affects the people it’s directed at. It’s been described as one of the last acceptable <a href="https://theconversation.com/how-australias-discrimination-laws-and-public-health-campaigns-perpetuate-fat-stigma-80471">forms of</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592337">discrimination</a>. Some researchers think the term “obesity” itself is part of the problem, and are calling for a <a href="https://pubmed.ncbi.nlm.nih.gov/27967229/">name change</a> to reduce stigma. They’re <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">proposing</a> “adipose-based chronic disease” instead. We study the stigma that surrounds obesity – around the time of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/obr.13147">pregnancy</a>, among <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/oby.23266">health professionals</a> and health <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00071-8/fulltext">students</a>, and in <a href="https://www.phrp.com.au/issues/october-2022-volume-32-issue-3/weight-stigma-in-australia/">public health</a> more widely. Here’s what’s really needed to reduce weight stigma. <h2>Weight stigma is common</h2> Up to <a href="https://pubmed.ncbi.nlm.nih.gov/26596238/">42% of adults</a> living in larger bodies experience weight stigma. This is when others have negative beliefs, attitudes, assumptions and judgements towards them, unfairly viewing them as lazy, and lacking in willpower or self-discipline. People in larger bodies experience <a href="https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2008.636">discrimination</a> in many areas, including in the workplace, intimate and family relationships, education, health care and the media. Weight stigma is associated with <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5">harms</a> including increased cortisol levels (the main stress hormone in the body), negative body image, increased weight gain, and poor mental health. It leads to decreased uptake of, and quality of, health care. Weight stigma may even pose a <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5">greater threat</a> to someone’s health than increasing body size. <h2>Should we rename obesity?</h2> Calls to remove or rename health conditions or identifications to reduce stigma are not new. For example, in the 1950s homosexuality was classed as a “<a href="https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2022.180103">sociopathic personality disturbance</a>”. Following many years of protests and activism, the term and condition <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/">were removed</a> from the globally recognised classification of mental health disorders. In recent weeks, European researchers have renamed non-alcoholic fatty liver disease “metabolic dysfunction-associated steatotic liver disease”. This occurred after <a href="https://www.bmj.com/content/382/bmj.p1587">up to 66%</a> of health-care professionals surveyed felt the terms “non-alcoholic” and “fatty” to be stigmatising. Perhaps it is finally time to follow suit and rename obesity. But is “adiposity-based chronic disease” the answer? <h2>A new name needs to go beyond BMI</h2> There are two common ways people view obesity. First, most people use the term for people with a body-mass index (BMI) of 30kg/m² or above. Most, if not all, public health organisations also use BMI to categorise obesity and <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00138-9/fulltext">make assumptions</a> about health. However, BMI alone is not enough to accurately summarise someone’s health. It does not account for muscle mass and <a href="https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf">does not provide</a> information about the distribution of body weight or adipose tissue (body fat). A high BMI can occur <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">without</a> biological indicators of poor health. Second, obesity is sometimes used to describe the condition of excess weight when mainly <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">accompanied by</a> metabolic abnormalities. To simplify, this reflects how the body has adapted to the environment in a way that makes it more susceptible to health risks, with excess weight a by-product of this. Renaming obesity “adiposity-based chronic disease” acknowledges the chronic metabolic dysfunction associated with what we currently term obesity. It also avoids labelling people purely on body size. <h2>Is obesity a disease anyway?</h2> “Adiposity-based chronic disease” is an acknowledgement of a disease state. Yet there is still no universal consensus on whether obesity is a disease. Nor is there clear agreement on the definition of “disease”. People who take a biological-dysfunction approach to disease <a href="https://pubmed.ncbi.nlm.nih.gov/25336733/">argue</a> dysfunction occurs when physiological or psychological systems don’t do what they’re supposed to. By this definition, obesity may <a href="https://pubmed.ncbi.nlm.nih.gov/37279872/">not be classified as a disease</a> until after harm from the additional weight occurs. That’s because the excess weight itself may not initially be harmful. Even if we do categorise obesity as a disease, there may still be value in renaming it. Renaming obesity may improve public understanding that while obesity is often associated with an increase in BMI, the increased BMI itself is not the disease. This change could move the focus from obesity and body size, to a more nuanced understanding and discussion of the biological, environmental, and lifestyle factors <a href="https://onlinelibrary.wiley.com/doi/10.1111/obr.13590">associated</a> with it. <h2>Workshopping alternatives</h2> Before deciding to rename obesity, we need discussions between obesity and stigma experts, health-care professionals, members of the public, and crucially, <a href="https://www.phrp.com.au/issues/october-2022-volume-32-issue-3/weight-stigma-in-australia/">people living with obesity</a>. Such discussions can ensure robust evidence informs any future decisions, and proposed new terms are not also stigmatising. <h2>What else can we do?</h2> Even then, renaming obesity may not be enough to reduce the stigma. Our constant exposure to the socially-defined and acceptable idealisation of smaller bodies (the “thin ideal”) and the pervasiveness of weight stigma means this stigma is deeply ingrained at a societal level. Perhaps true reductions in obesity stigma may only come from a societal shift – away from the focus of the “thin ideal” to one that acknowledges health and wellbeing can occur at a range of body sizes.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209224/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ravisha-jayawickrama-1457644">Ravisha Jayawickrama</a>, PhD candidate, School of Population Health, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/blake-lawrence-1452739">Blake Lawrence</a>, Lecturer, Curtin School of Population Health, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>, and <a href="https://theconversation.com/profiles/briony-hill-1041619">Briony Hill</a>, Deputy Head, Health and Social Care Unit and Senior Research Fellow, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/renaming-obesity-wont-fix-weight-stigma-overnight-heres-what-we-really-need-to-do-209224">original article</a>.

Body

5 ways alcohol can sabotage your weight loss goals, according to an obesity doctor

Alcohol and weight loss “Hey Siri, can I still lose weight if I drink alcohol?” Goodness, we only wish the answer was that simple. Research is mixed (no pun intended) on whether alcohol can lead to weight gain. That’s because weight is complex – and some people notice a shift on the scale when they consume alcohol, while others don’t. As a doctor who specialises in the science of weight, I can say what we do know is that many of these alcoholic drinks are energy-dense (meaning high in kilojoules) and provide little to no nutrition, which may put a damper on your weight loss efforts. Here are five major reasons alcohol can impede you weight loss efforts. Your body views alcohol as a toxin Your body metabolises and eliminates alcohol from the body with the help of two enzymes: Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). When you imbibe, these two work together to break apart the alcohol molecules, producing a toxic substance, acetaldehyde, then acetate, so that your body can get rid of it – and fast. Here’s why that matters when you’re trying to lose weight. Since your body prioritises alcohol digestion, it puts digestion of other nutrients (like fat, carbs, and protein) on the back burner. In other words, your body might put off metabolising fat and carbs when it’s busy breaking down alcohol. Over time and repeated patterns, this could lead to increased fat storage and weight gain. Alcohol can cause inflammation Alcohol can impair the functions of the gut, liver, and other organs – interfering with the immune system and causing systemic inflammation. Alcohol consumption stimulates a cascade of inflammatory responses, one of which is the release of cortisol, the stress hormone. And research has shown that persistently high levels of cortisol are associated with obesity. That’s why it’s best for people with obesity, who are already at an increased risk of inflammation, to limit or avoid alcohol. Alcohol affects sleep - and sleep impacts weight It may seem like that nightcap helps you fall asleep, but alcohol can actually disrupt how well you snooze. One study, which looked at participants’ heart rates and ability to relax during sleep, showed that even small amounts (0.25 grams per kilogram or less) of alcohol decreased those markers of quality of sleep by 9.3%. And the more you drink, the worse you sleep – the same study linked moderate drinking to a 24% decrease in sleep quality, and heavy drinking to a 39.2% decrease in sleep quality. You may think a few nights of low-quality shut-eye is harmless, but research has shown that just one to three nights of poor sleep can lead to insulin resistance. Over time, that could put you at risk of obesity. Alcohol is often full of sneaky of sneaky kilojoules and sugar Many mixed drinks, tasty as they might be, contain added kilojoules and sugar on top of the naturally occurring sugars and kilojoules in alcohol. Even a so-called “lower-kilojoule” option, like a vodka tonic, can have as many kilojoules and grams of sugar as a serving of ice cream. Before you know it, your 30ml serving of vodka just jumped from 280 kilojoules to 700 kilojoules when you add 200ml of tonic. Have a few of those, and you’re looking at upwards of 2000 or more kilojoules on liquid alone – kilojoules that don’t provide your body with the best nutrition. Let’s compare these 2000 kilojoules in a few vodka tonics to a 2000-kilojoule meal of salmon, brown rice, and steamed veggies. The drinks are empty kilojoules, whereas the meal has fat, fibre and protein to keep you fuller and satisfied for longer – a win-win while trying to lose weight – while also providing high-quality nourishment. Drinking impacts food choices Have you ever noticed after drinking alcohol, you get a sudden hankering for a fast food run or pizza delivery? That’s because alcohol can impair decision-making and lead to impulse decisions when it comes to food – and research suggests it may even stimulate the appetite. Those who drink alcohol with a meal also tend to eat more – 30% more, according to one study. While alcohol won’t impact everyone’s weight the same way, it’s best to be mindful of how much you drink when trying to lose weight. Consider skipping it altogether or aim for moderation. Just know that even if you follow the limit for moderate drinking as recommended in the Australian Alcohol Guidelines by the National Health and Medical Research Council (NHMRC) —no more than 10 standard drinks a week and no more than 4 standard drinks on any one day – it still adds up over time. Several studies have shown that the risk of obesity is roughly two times higher in adults who consume alcohol than in those who don’t. Considering mocktails (non-alcoholic beverages) are popping up on more and more bar menus these days, rest assured your after-work social hour will still be filled with cheers. Just be sure to opt for a lower-kilojoule option, such as soda water with a squeeze of fresh lime or a craft mocktail with half the amount of simple syrup. Image credits: Getty Images This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/diet/5-ways-alcohol-can-sabotage-your-weight-loss-goals-according-to-an-obesity-doctor" target="_blank" rel="noopener">Reader's Digest</a>.

Body

Loneliness can be twice as unhealthy as obesity in older people

A study has found that loneliness is twice as unhealthy as obesity in older people. Over six years, the study looked at the impact variables had on death rates. After tracking more than 2,000 people aged 50 and over, scientists found that people who were identified as the loneliest were nearly twice as likely to die during the study than those who were the least lonely. Compared with the average person within the study, those who were lonely had a 14 per cent higher risk of dying, which was around twice the impact obesity had on early death rates. Poverty ranked higher than loneliness with a 19 per cent increase. A separate study in 2012 found that around a fifth of older people feel lonely all the time, and a quarter of them become steadily lonelier as time went on. People reported that loneliness was the worst at weekends, and three quarters felt the effects strongly at night. In the past, loneliness has been linked to health problems like high blood pressure, and increased risk of stroke, heart attack and depression. <a href="../finance/insurance/2015/01/benefits-of-being-a-volunteer/" target="_blank" rel="noopener">Related link: The benefits of becoming a volunteer</a> John Cacioppo, a psychologist at the University of Chicago recommends thinking twice before uprooting yourself during retirement. Moving away to “greener pastures” may have certain appeals, but it can often take you away from your support network of friends and family. In the light of these studies, it follows that people need to feel involved and valued by those around them. The results also reflected that company alone was perhaps not enough. If you know someone you think might be lonely, maybe you can invite them to take part in some activities with you and your friends. Phone calls are a great way to stay in touch with people who are further away, especially if you involve someone in your life by asking them for their advice on various subjects. Pets have also been shown to be great in alleviating loneliness. And if you’re looking to interact with some new friends, you can always <a href="../forums/" target="_blank" rel="noopener">visit our forums</a>, or <a href="https://www.facebook.com/oversixtys" target="_blank" rel="noopener">Facebook page</a>. Related links: <a href="../health/wellbeing/2015/02/reasons-to-be-happy-with-you/" target="_blank" rel="noopener">5 reasons to celebrate you</a> <a href="../health/wellbeing/2015/02/why-appreciate-the-little-things/" target="_blank" rel="noopener">Why you should celebrate all the little moments</a> <a href="../health/wellbeing/2015/01/make-this-your-best-year/" target="_blank" rel="noopener">How to make this your happiest year yet</a> Image credit: Shutterstock

Mind

Obese yet malnourished toddler mummy sheds light on life in 17th century aristocratic Austria

In a creepy discovery published, a collaboration of German scientists have performed a ‘virtual autopsy’ on a mummified toddler’s body, found in a 17th century Austrian crypt. Buried in a wooden coffin that was slightly too small and deformed the skull, the young child’s body appeared to be both obese and malnourished. Researchers say the findings might provide a rare insight into historical Austrian aristocratic society. By using CT scanning, scientists were able to perform a ‘virtual autopsy’ on the mummy which was naturally mummified in the conditions of the crypt. Well-preserved soft tissue showed the child was a boy, overweight for his age, and radiocarbon dating suggests a date of death between 1550 and 1635 CE. By examining the formation and length of the body’s bones, plus evidence of tooth eruption, the researchers were able to estimate that the child was about one year old when he died. The bones also showed that despite being well-fed, the boy was malnourished, with his malformed ribs displaying signs of rachitic rosary. This condition presents in a pattern of prominent bony knobs at points where the rib joins cartilage and results from diseases associated with specific vitamin deficiencies such as rickets (vitamin D) and scurvy (vitamin C). Vitamin D is found in foods like salmon, tuna, mackerel and beef liver and egg yolks, but we typically only get around 10% of our required Vitamin D from our diets – the rest is made by our bodies when exposed to ultraviolet B (UVB) from the sun. “The combination of obesity along with a severe vitamin-deficiency can only be explained by a generally ‘good’ nutritional status along with an almost complete lack of sunlight exposure,” said Dr Andreas Nerlich of the Academic Clinic Munich-Bogenhausen and lead researcher. The child appears to have died from pneumonia, judging by the evidence of inflammation in the lungs. Rickets is known to make children more vulnerable to pneumonia, suggesting that, sadly, not only was the child malnourished, but that this condition may have also led to his untimely demise. “We have to reconsider the living conditions of high aristocratic infants of previous populations,” said Nerlich. Relatively little is known about aristocratic childhood in the late Renaissance period, so these mummified remains give key insights into life in Europe of a period generally known for its fervent creativity and intellectual development. “This is only one case,” said Nerlich, “but as we know that the early infant death rates generally were very high at that time, our observations may have considerable impact in the over-all life reconstruction of infants even in higher social classes.” To understand more about this period, researchers scoured historical records of the crypt and the family to whom the crypt belonged. Curiously, the child was buried in a simple, unmarked, wooden coffin, although he was dressed in an expensive silk hooded coat. The unmarked coffin appeared to have been slightly too small for the body such that the skull became deformed and was the only infant buried amongst the identifiable adult metal coffins in the crypt. Historical records of renovations on the crypt confirmed the radiocarbon dating, indicating the child was likely buried sometime after 1600 CE. The crypt belonged to the Counts of Starhemberg and traditionally was kept exclusively for the burial of heirs to their titles, and their wives, making the body likely to be that of the first-born (and only) son, Reichard Wilhelm, of Count Starhemberg. “We have no data on the fate of other infants of the family,” Nerlich said, regarding the unique burial. “According to our data, the infant was most probably [the count’s] first-born son after erection of the family crypt, so special care may have been applied.” This article originally appeared on <a href="https://cosmosmagazine.com/history/toddler-mummy-17thcentury-austria/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Clare Kenyon. Image: Andreas et al. (2022)

Travel Trouble

Fans share concern over Sam Armytage's dog: "Her dog is obese"

Fans have taken to social media to express concern for Samantha Armytage’s Labrador dog, Banjo. Online commentary has kicked off after recent photos of the only five-year-old dog were shared, with many suggesting Banjo is at a worrying weight. <img style="width: 500px; height: 281.25px;" src="https://oversixtydev.blob.core.windows.net/media/7841979/banjo-armytage.jpg" alt="" data-udi="umb://media/b9e86791167a4dd2882f98301401bc03" /> “Please put Banjo on a diet - he shouldn't be that big, it's not fair on him,” one concerned observer said. Another wrote: “Her dog is obese, she should take the dog for a walk and get off the couch.” Others felt sad for Banjo’s physical appearance. One fan jokingly offered to digitally reduce the dog's waistline, writing, “Hey Sam, I will photo shop your dog for $20. It will look real. Just saying....” Some fans were simply happy for Sam and Banjo who have a lot more time to spend together now since resigning from her role on Sunrise. <img style="width: 500px; height: 281.25px;" src="https://oversixtydev.blob.core.windows.net/media/7841977/banjo-armytage-1.jpg" alt="" data-udi="umb://media/364146f6a4794cef84db14874949b1be" /> Samantha made the decision to step down from Channel 7's breakfast program earlier this year, and I’d now fronting her own podcast called Something To Talk About for Stellar magazine. Rumours raged for months that Sam may be looking to quit after the couple announced their engagement in June last year. She tied the knot with the millionaire businessman on New Year's Eve, in a beautiful and intimate ceremony at his Southern Highlands home.

Family & Pets

Aussie researchers' new pill to fight obesity

A new pill could be the next weapon in the fight against obesity, after researchers from the Garvan Institute discovered a way to turn ‘energy-storing’ fat into ‘energy-burning’ fat. The Australian scientists found that blocking the Y1 receptor, which normally helps us regulate our body heat, could increase the amount of fat we metabolise and prevent weight gain. “The Y1 receptor acts as a ‘brake’ for heat generation in the body,” said Dr Yan-Chuan Shi, Leader of the Neuroendocrinology Group at Garvan and a senior author of the paper published in <a href="https://doi.org/10.1038/s41467-021-22925-3">Nature Communications</a>. “In our study, we found that blocking this receptor in fat tissues transformed ‘energy-storing’ fat into ‘energy-burning’ fat, which switched on heat production and reduced weight gain.” Dr Shi continued, “Most of the current medications used to treat obesity target the brain to suppress appetite and can have severe side effects that limit their use. “Our study reveals an alternative approach that targets the fat tissues directly, which may potentially be a safer way to prevent and treat obesity.” Y1 receptor linked to obesity In a seven-week trial, scientists tested their theory with mice divided into two groups and fed a high-fat diet. One of the groups was also fed BIBO3304, the experimental treatment, which blocked the Y1 receptor. This group of mice gained about 40 percent less body weight than the mice who were only given the high fat diet, caused by “an increase in body heat generation and reduction in fat mass,” Dr Shi said. When the treatment was applied to human fat cells taken from obese individuals, the researhers found that the same genes that produced heat in mice also turned on, meaning that targeting the Y1 receptor pathway could increase fat metabolism and reduce weight gain in people too. Targeting the brain versus human tissue Researchers also emphasised that the experimental treatment does not cross the blood-brain barrier, meaning that the anti-obesity effects occur in peripheral tissues rather than the brain. Most current weight-loss treatments reduce how much we eat by targeting our central nervous system, but this can result in significant psychiatric or cardiovascular side effects and “over 80 percent of these medications being withdrawn from the market,” said Dr Shi. By targeting the Y1 receptor, Professor Herzog said the treatment “is effective at preventing obesity by increasing energy expenditure”. “It reveals a new therapeutic approach that is potentially safer than current medications that target appetite,” said Professor Herzog. With obesity affecting an estimated two thirds of Australian adults, the team of researchers hope human clinical trials can begin within three years.

Body

Body fat deep below the surface is a toxic risk especially for your heart

Amid the COVID-19 pandemic, it’s easy to forget one of the largest health challenges we face remains the global obesity epidemic. <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">World Health Organisation data</a> shows obesity has nearly tripled in less than 50 years, with about <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">40% of adults worldwide</a> now overweight or obese. High body fat increases the risk of chronic diseases, including heart problems, diabetes and cancer. However, it’s not simply the total amount of body fat that can increase the risk of disease. The type and location of fat is also important. We’ve known for some time that subcutaneous fat — the fat just below the skin — <a href="https://www.sciencedirect.com/science/article/pii/S0171933513000459">increases inflammation</a> in the body. But in recent years, researchers have realised an even more serious risk is the unseen deep body fat that accumulates around vital organs. Fat around organs can be ‘toxic’ Fat is not all bad — in fact, some fat does a lot of good. It helps protect vulnerable organs and tissues, and provides a convenient energy supply. If you’re out in the cold, it’s essential fuel for body warming through shivering. But excess fat can increase blood pressure and potentially lead to complications such as heart disease and stroke. Many clinicians use <a href="https://theconversation.com/body-mass-and-evolution-why-the-body-mass-index-is-a-limited-measure-of-public-health-79671">body mass index (BMI)</a> to measure a healthy weight range. It’s calculated as body weight divided by the square of height, and it factors in a healthy amount of fat. But BMI can’t provide information about the shape and size of potentially dangerous internal fat deposits, known as “visceral fat”. Over recent years it’s become apparent visceral fat can lead to disease, and good fat can turn into toxic fat when there is too much. Various organs seem to accumulate visceral fat. This can be a problem because it can create and release damaging molecules and hormones into the blood. These are transported in the bloodstream, potentially causing health complications in distant parts of the body. For example, toxic fat can release proteins that blunt the body’s sensitivity to insulin. Blood glucose levels then rise, potentially <a href="https://www.diabetes.co.uk/body/visceral-fat.html">causing diabetes in the long term</a>. Visceral fat can also stimulate uncontrolled cell growth and replication, <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet">potentially triggering some forms of cancer</a>. A fatty liver is associated with metabolic diseases, and excess kidney fat interferes with the body’s fluid balance. The heart is especially vulnerable Visceral fat can also directly affect the organ around which it’s wrapped. Our <a href="https://www.onlinejacc.org/content/76/10/1197?download=true">new research</a>, published in September in the Journal of the American College of Cardiology, found visceral fat around the heart produces biochemical molecules that can make the heart beat erratically. These molecules potentially cause a serious heart condition called <a href="https://www.heartfoundation.org.au/conditions/atrial-fibrillation">atrial fibrillation</a>, by disrupting the heart’s electrical activity. Atrial fibrillation is one of the most common types of heart rhythm disturbance, and <a href="https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa612/5899003">one in three people</a> over 55 will develop the condition. It occurs when the regular signal to drive each heartbeat originating in the top portion of the heart, the atria, is disrupted. It can cause an irregular and chaotic heartbeat, disrupting the heart’s coordinated pumping action. This can mean not enough fresh blood is circulated to allow regular daily activity. For some people, living with episodes of atrial fibrillation is a daily challenge – coping with bouts of dizziness, the distressing awareness of a “racing heart”, and chest palpitations. Other people may be unaware they have the condition and the first sign could be tragic, such as a stroke due to a blood clot travelling to the brain. This can lead to <a href="https://www.heartfoundation.org.au/conditions/heart-failure">heart failure</a>. An advertisement from the Western Australian health department warning viewers about toxic fat. Only in recent years have researchers discovered the dangers of hidden fat around organs. We worked with clinical cardiologists at the Royal Melbourne Hospital and found fat around the heart secretes molecules which change how nearby cells “talk” to each other, slowing cell-to-cell communication. Because the transfer of electrical signals in the heart muscle are delayed, the heartbeat is potentially destabilised. Although a high BMI increases the risk of atrial fibrillation, it’s the fat burden on the heart, and not BMI itself, that’s most important in electrical and structural disruption. This suggests toxic substances released from the surrounding fat can directly harm the nearby organ, without travelling via the blood. For heart patients, these findings mean the surgical removal of cardiac fat could be an effective treatment to consider. Also, it potentially paves the way for the future development of drugs that can suppress the release of damaging molecules from hidden fat. Nevertheless, these findings underscore the danger of an “obese heart”, particularly amid the COVID-19 pandemic. Research is emerging that obesity is a major risk factor for <a href="https://www.cdc.gov/obesity/data/obesity-and-covid-19.html">serious complications while infected with the virus</a>, and the fat load on the heart may be implicated. Written by <a href="https://theconversation.com/profiles/lea-m-d-delbridge-1155735">Lea M D Delbridge</a>, University of Melbourne and <a href="https://theconversation.com/profiles/james-bell-1156890">James Bell</a>, La Trobe University. Republished with permission of <a href="https://theconversation.com/body-fat-deep-below-the-surface-is-a-toxic-risk-especially-for-your-heart-146307">The Conversation</a>.

Retirement Life

Why obesity is more common than you think

The World Health Organization has <a href="https://www.who.int/nutrition/topics/obesity/en/">described</a> obesity as a global epidemic and one of today’s “most blatantly visible yet neglected public health problems”. In the last few years <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1614362">reports</a> on the rise of this life-threatening condition among children and adults across the globe have been <a href="https://www.ncbi.nlm.nih.gov/pubmed/29029897">alarming</a>. A total of 107.7 million children and 603.7 million adults were considered to be obese in 2015. But now our <a href="https://www.who.int/bulletin/volumes/96/11/17-205948/en/">research</a> shows that obesity is even more common than these reports suggest, and that in many countries most people are now living with obesity. Obesity is a disease in which the amount of body fat is too high – high enough to harm health. It can increase the risk of diabetes, high blood pressure, heart problems, stroke and some cancers. But measuring body fatness accurately is difficult – and so most scientific studies and national surveys do not measure it, but use instead the weight-to-height <a href="https://www.nhs.uk/common-health-questions/lifestyle/what-is-the-body-mass-index-bmi/">body mass index</a> (BMI) as a simple proxy for body fatness. But the issue here is that the BMI can be a misleading proxy for high body fatness in both children and adults – and even more so in particular ethnic groups. This means that many people with apparently healthy BMI will actually be living with high body fatness without being aware of it, and so be at risk of the serious health consequences without realising it. Our research aimed to assess how problematic BMI is when used as a proxy for high body fatness in African children. The problem with body-mass index A high BMI or BMI-for-age – in children and adolescents BMI has to be adjusted for age because it increases with growth and maturation – is usually taken to represent high body fatness. The problem is that while almost all <a href="https://www.ncbi.nlm.nih.gov/pubmed/20125098">adults</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/24961794">children</a> who have a high BMI will have a high level of body fat, many people with an apparently healthy BMI will also have a high level of body fat. <iframe width="440" height="260" src="https://www.youtube.com/embed/mjR6KRMPQGw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe> It is well known that BMI misclassifies the body fatness of athletes, bodybuilders and sportsmen and women, because a high muscle mass produces a high BMI. Only a small proportion of the population are athletic though, and the far more common problem with BMI is that it misclassifies body fatness of this much larger, non-athletic portion of the population – but in the opposite direction, meaning it downplays its extent. The extent of the misclassifying of body fatness by BMI matters. Most studies which have measured both body fatness and BMI have taken place in Europe and North America – and in these studies the prevalence of high body fatness has been as much as two to three times greater than the prevalence of high BMI. In <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0033308">one example</a> 26% of US adults were obese according to their BMI, while 64% of the same adults were obese according to a more accurate measure which images the amount of fat in the body directly using X-rays. Obesity and ethnicity The problem of underestimating obesity is even worse in some population groups. The extent to which the BMI misclassifies the body fatness of people <a href="https://www.ncbi.nlm.nih.gov/pubmed/27383689">depends on their ethnicity</a>. It is well established, but not well known, that BMI misclassifies children and adults in south and east Asia even more than Europeans. There is emerging evidence that this problem extends to using BMI in other population groups too. In our <a href="https://www.who.int/bulletin/volumes/96/11/17-205948/en/">recent study</a> of children living in eight cities across Africa from Windhoek in the south to Tunis in the north, we found that 9% were obese according to their BMI-for-age, but 29% had high body fat according to a <a href="https://humanhealth.iaea.org/HHW/Nutrition/BodyComposition/RefsBodyComp/TBW_2015.pdf">stable isotope technique</a> designed for measuring body fatness. By underestimating the prevalence of obesity because of reliance on BMI in clinics, research studies and national health surveys, we also underestimate the need for action to prevent and treat obesity. To use our African study as an example, the case for action at a 29% prevalence of obesity is much stronger than at a prevalence of 9%. Obesity is far more common than it seems, and it requires much greater effort and more urgent attention than it is currently receiving. As we enter a new decade it is time for national resolutions that are more ambitious. The main drivers of the global obesity epidemic are well known: excessive fat and sugar intake, lack of sleep, too much screen time, insufficient physical activity. We need global measures across all age groups to address these elements and we need them now.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/131341/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/john-j-reilly-679057">John J Reilly</a>, Professor of Physical Activity and Public Health Science, <a href="https://theconversation.com/institutions/university-of-strathclyde-1287">University of Strathclyde </a> This article is republished from <a href="http://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/obesity-is-more-common-than-you-think-heres-why-131341">original article</a>.

Body

Aussie pet owners urged to tackle obesity epidemic amongst pets

According to PetSure, Australia’s largest pet insurance underwriter, claims for obesity related conditions in pets, such as diabetes, heat intolerance and glucose intolerance have soared by 100 per cent over the last five years. Pet owners are being urged to tackle the obesity epidemic that is facing almost half of Aussie pets. Senior Veterinarian Dr Oliver Conradi commented on this growing issue, saying that the reason for the increase was due to the “humanisation of pets”. “Along with all these related conditions such as diabetes and associated conditions like joint disorders, there is a body of evidence to suggest that fit and lean dogs have a significant increase in their median lifespan and a significant delay in the onset of chronic disease,” he explained. “One of the reasons claims are increasing is the humanisation of pets. This means pet owners are increasingly treating their fur babies like little humans, which reflects the wonderful bond they have, but this treatment can extend to their pet’s diet and the quantity of food they eat. “To manage obesity in dogs and cats, owners must avoid giving pets treats, particularly human food such as biscuits, chips or cheese. Even a small amount adds a lot of calories to their pet’s daily intake.” Cats have a slightly higher incidence of diabetes than dogs, which is a significant indicator of obesity. The two cat breeds most at risk of diabetes are the Australian Mist and the Abysssinian. The six dog breeds most at risk of diabetes are: <ul> <li style="font-weight: 400;">Australian Terriers</li> <li style="font-weight: 400;">Siberian Husky</li> <li style="font-weight: 400;">Bichon Frise</li> <li style="font-weight: 400;">Schnoodles</li> <li style="font-weight: 400;">Maltese</li> <li style="font-weight: 400;">Rottweilers</li> </ul> However, there are things you can do to help your furry friends lose some weight. “Following the feeding guide on the packaging of pet food is an easy reference but for those pets already overweight, owners should speak to their vet about changing to a low calorie or weight loss diet,” Dr Conradi explained. “Vets will give owners advice such as avoiding bones and other fatty foods or replacing bones with carrots as a crunchy treat.” Dr Conradi also recommended keeping a close eye on your pets in case they are still gaining weight despite a healthier diet. “Although the vast majority of pets are obese because of their lifestyle, there are also some diseases that can cause obesity in dogs and cats. If people are concerned that their pet is gaining weight in spite of a healthy diet, they should chat to their vet.”

Family & Pets

Obesity has become the new normal but it’s still a health risk

Nike’s London store recently introduced a plus-sized mannequin to display its active clothing range which goes up to a size 32. The mannequin triggered a cascade of responses ranging from outrage to celebration. <a href="https://www.telegraph.co.uk/women/life/obese-mannequins-selling-women-dangerous-lie/">One side argues</a> that the mannequin normalises obesity and leads obese people to feel that they are healthy when in fact they are not. The <a href="https://www.abc.net.au/news/2019-06-19/plus-size-mannequin-criticism-wrong-experts-say/11219126">other side argues</a> the representations are inclusive, combat fat stigma and encourage fat women to exercise. Both arguments have some merit. The representations of bodies we see around us — including shop mannequins – affect the way we calibrate our sense of what is normal and acceptable. And obesity is indeed associated with a <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">greater risk of</a> heart disease, stroke, type 2 diabetes and early death. It is possible to be metabolically healthy and fat. But even metabolically healthy obese people may still have a <a href="https://www.ncbi.nlm.nih.gov/pubmed/24400816">shorter life expectancy</a> than their lean peers. On the other hand, exercise is almost <a href="https://theconversation.com/au/topics/benefits-of-exercise-33888">universally beneficial</a>, and people of all shapes and sizes should be encouraged to participate. Overweight and obesity have become the new normal Based on body mass index (BMI), about two-thirds of Australian adults and one-quarter of kids are overweight or obese. While this proportion has <a href="https://s3.amazonaws.com/academia.edu.documents/39224048/00b7d52f5a6147c3ec000000.pdf?response-content-disposition=inline%3B%20filename%3DTrends_in_the_prevalence_of_childhood_ov.pdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAIWOWYYGZ2Y53UL3A%2F20190621%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20190621T001743Z&X-Amz-Expires=3600&X-Amz-SignedHeaders=host&X-Amz-Signature=b7341d0be1637fba4b5c361e1470d642f3a106626fa996b58acd50cb2d225993">flattened out for children</a> in the last 20 years, it continues to rise for adults. There is strong evidence parents consistently misjudge the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/obr.12570">weight status of their children</a> because they see more and more fat kids. The same is true for adults: <a href="https://bmcobes.biomedcentral.com/articles/10.1186/s40608-016-0102-8">a recent study from the United Kingdom</a> found 55% of overweight men and 31% of overweight women considered their weight to be in the healthy range. I would guess the Nike mannequin is close to 100 kg, with a BMI maybe in the low 30s, well into the obese category. But given the average female shop mannequin has a <a href="https://theconversation.com/your-ideal-body-and-why-you-want-it-53433">BMI of about 17</a>, there are probably at least ten times as many Australian women like the plus-size mannequins than like the usual minus-size variety. Obesity is not a lifestyle choice like smoking Obesity is necessarily the <a href="https://theconversation.com/genes-joules-or-gut-bugs-which-one-is-most-to-blame-when-it-comes-to-weight-gain-102266">result of behaviours</a> — eating too much, exercising too little — albeit heavily constrained by genetic predispositions, and social and economic pressures. But unlike, say, smoking, being fat is also part of what a person is: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800694/">most people who are fat have usually been fat for a long time</a>. It’s not something a person has complete control over. Divergent paths into fat and lean <a href="https://s3.amazonaws.com/academia.edu.documents/42450392/Tracking_of_childhood_overweight_into_ad20160208-26579-18ghusq.pdf?response-content-disposition=inline%3B%20filename%3DTracking_of_childhood_overweight_into_ad.pdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAIWOWYYGZ2Y53UL3A%2F20190621%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20190621T001954Z&X-Amz-Expires=3600&X-Amz-SignedHeaders=host&X-Amz-Signature=1aebec6c98d1eb24cfbadc0cb91a8b36843423144f03031258ffbde238fc3e61">start very young</a>, and once you’re on the obesity train it’s hard to get off. While it is possible to “give up obesity”, for many it can be a very hard road, involving a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855339/">lifelong struggle</a> with hunger and recidivism. Empowering vs shaming Anti-obesity campaigns that are built on disgust, fear or shame – such as <a href="https://www.iccp-portal.org/measure-campaign">Measure Up</a> – have been criticised as being <a href="https://www.tandfonline.com/doi/abs/10.1080/09581596.2014.885115">stigmatising, ethically problematic and ineffective</a>. There has, to my knowledge, been no high-quality research comparing the actual effectiveness of shaming versus empowering anti-obesity, or pro-physical activity, campaigns. However a number of studies show, unsurprisingly, that obese and inactive people <a href="https://www.obesityaction.org/community/article-library/shame-campaigns-do-they-work/">prefer empowering campaigns</a>, find them more motivating and less stigmatising. Health risks of obesity It has been argued one can be “fit and healthy at any size”: that an obese person can be as fit and healthy as a lean person. Depending on definitions, about 25-50% of obese people have “<a href="https://www.ncbi.nlm.nih.gov/pubmed/18695075?dopt=Abstract">metabolically healthy obesity</a>” – normal levels of inflammation, blood sugar, insulin, blood fats, and blood pressure. Other than being obese, these people appear healthy. But obese people — fit or unfit, active or not — remain on average at <a href="https://www.ncbi.nlm.nih.gov/pubmed/24400816">greater risk</a> of heart disease, diabetes and early death than lean people with similar behaviours. Similarly, the claim that people can be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885314/">both fit and fat</a>, and that fit, fat people are at less risk than unfit, lean people depends on how we define fitness and fatness. One study, for example, might compare overweight people in the top 20% of fitness with lean people in the bottom 20%. Because there are modest differences in fatness and big differences in fitness, fat people are much more likely to have a similar risk to lean people. But if another study compares obese people in the top 50% of fitness to lean people in the bottom 50%, the fatter people will be much less healthy. What is certain is that whoever you are, exercise will almost certainly improve your health. The Nike mannequin controversy is a morality tale of how we navigate between the devil of normalising obesity and the deep blue sea of excluding obese people from the world of exercise. Obesity has been called both a disability and a disease, and just another way of being in the world. The reality is that for most people, it’s something in between. Written by Tim Olds. Republished with permission of <a href="https://theconversation.com/obesity-has-become-the-new-normal-but-its-still-a-health-risk-118829">The Conversation</a>.

Body

This airline has just instructed "obese" employees to lose weight

Pakistan’s national flag carrier has reportedly told “obese” flight attendants to lose weight or risk being grounded. The Pakistan International Airlines (PIA) issued a memo to its 1,800 staff that cabin crew with “excess weight” will have six months to slim down or they will not be given clearance to fly. Aamir Bashir, the airline’s general manager, said any crew found to be above 30 pounds from the “desired weight” after January 31 will be grounded and referred for medical evaluation and treatment until “weight is reduced up to desired standard/BMI”. The excess weight limit will then be cut down by 5 pounds per month. <blockquote class="twitter-tweet" data-lang="en-gb"> Lose weight, or lose your job: Pakistan International Airlines 'tells overweight cabin crew they need to shed up to 30lbs by July or face being grounded' <a href="https://t.co/iGf0sUgKVM">pic.twitter.com/iGf0sUgKVM</a> — ABC (@farhanjamil1975) <a href="https://twitter.com/farhanjamil1975/status/1082252961747734528?ref_src=twsrc%5Etfw">7 January 2019</a></blockquote> PIA also issued a suggested weight chart according to the crew’s height. For example, the guide for a woman of 5 feet 7 inches height (1.7m) is 133 to 147 pounds (60 to 67 kilograms). Around 100 of the crew will need to lose all the excess weight by July 1 to avoid being grounded, according to PIA spokesman Mashhood Tajwar. He told CNN that the policy was to ensure that the cabin crew remain “slim, smart and fit”, following apparent complaints about “obese” flight attendants. “No one would like to have shabby crew in the aircraft,” said Tajwar. This is not the first time an airline has applied weight standards for its aircraft employees. Air India grounded its flight attendants in 2006 and 2015 for being overweight. In November, India’s aviation regulator set a Body Mass Index (BMI) norm of 18 to 25 for pilots and crews.

Travel Trouble

"Chunky" Jamie Oliver hires personal trainer after criticism from fans

Jamie Oliver has hired a personal trainer to lose weight after criticism from fans during his campaign for new methods to tackle childhood obesity rates. <a href="https://honey.nine.com.au/" target="_blank">Nine Honey reports</a> the celebrity chef has decided to shift the focus on himself and has reportedly made tremendous strides with the help of celebrity trainer, Jamie Sawyer. “I will get rid of it in the next couple of months. I was always active as a kid and in pretty good nick until maybe the beginning of my 30's. And then I started to get a little bit too chunky,” he said. Last week, Oliver sent a 13-point plan to UK Prime Minister Theresa May, outlining some ideas he had to help reduce the amount of childhood obesity in the country. Interestingly though, his efforts have been faced with a backlash from some fans on Twitter, who labelled him the “fun police” and saw his views somewhat patronising. <blockquote class="twitter-tweet"> Boring old Jamie Oliver banging on again about childhood obesity.. You took away our turkey twizzlers at school now you want to take away adverts on tv 😂🖕🏻 he’s defo the fun police <a href="https://twitter.com/hashtag/ThisMorning?src=hash&ref_src=twsrc%5Etfw">#ThisMorning</a> — Bryony mackenzie (@Bryonymackenzie) <a href="https://twitter.com/Bryonymackenzie/status/989082718230237185?ref_src=twsrc%5Etfw">April 25, 2018</a></blockquote> <blockquote class="twitter-tweet"> Sorry Jamie Oliver, life is too short to be constantly healthy eating. I'm all for everything in moderation but trying to shield children from junk food is near enough impossible, they are entitled to a treat every now and then too. <a href="https://twitter.com/hashtag/ThisMorning?src=hash&ref_src=twsrc%5Etfw">#ThisMorning</a> — Ry ✌️ (@ryan_mcdonagh) <a href="https://twitter.com/ryan_mcdonagh/status/989082460599324672?ref_src=twsrc%5Etfw">April 25, 2018</a></blockquote> <blockquote class="twitter-tweet"> Jamie Oliver is a rich elitist set on making poorer families pay more for their weekly shop. No respect for this man. <a href="https://twitter.com/hashtag/ScrapTheSugarTax?src=hash&ref_src=twsrc%5Etfw">#ScrapTheSugarTax</a> <a href="https://t.co/wkfoXOrNTP">https://t.co/wkfoXOrNTP</a> — chloe westley (@LowTaxChloe) <a href="https://twitter.com/LowTaxChloe/status/985926342482055168?ref_src=twsrc%5Etfw">April 16, 2018</a></blockquote> But as other users noted, it’s a complicated issue. “I think it goes back to when the British industrial revolution happened- in comparison to the rest of Europe,” Oliver argued. <blockquote class="twitter-tweet"> <a href="https://twitter.com/hashtag/ThisMorning?src=hash&ref_src=twsrc%5Etfw">#ThisMorning</a> I’m currently writing my dissertation on childhood obesity and I think there’s still a massive way to go before there’s progression. It’s not a simple issue, culture, environment and society all need to be considered too. <a href="https://twitter.com/thismorning?ref_src=twsrc%5Etfw">@thismorning</a> <a href="https://twitter.com/jamieoliver?ref_src=twsrc%5Etfw">@jamieoliver</a> — emily lovell (@itsonly_emily) <a href="https://twitter.com/itsonly_emily/status/989082436414865408?ref_src=twsrc%5Etfw">April 25, 2018</a></blockquote> “At the heart of that is really an observation of, in my opinion, how women have been let down over the last 40 years, as women have gone to work, as the pot of tax has got bigger, because they’re working. It’s really important, that love and care, especially for children, and how to modern-day, busy, contemporary parents… how do we make their lives easier?” What are your thoughts?

Body

Study finds sugar is as addictive as drugs

Ever wondered why shortly after a sugary snack you suddenly crave more? New research from the Queensland University of Technology has found that sugar has the same addictive properties as certain drugs, like cocaine. Masoor Shariff, one of the scientists behind the study, found that the effects of sugar on the brain are similar to that of drug abuse – they both change the layout of brain cells in the same manner. “Basically brain cells communicate with each other and other parts of the body and if there’s a change in the structure and layout it’s going to change that communication, impacting behaviour,” he told <a href="http://www.news.com.au/lifestyle/health/health-problems/new-research-finds-sugar-addiction-is-like-drug-abuse/news-story/e67611eed4bba66a94e7d945669c22b2" target="_blank">News.com.au</a>. These behavioural impacts include binge-eating, lack of motivation and low mood. Like certain drugs, when we consume sugar our brain releases the "happy hormone" dopamine. Since our dopamine levels drop after having sugar, our brains send out signals that make us want more, so that we can get those good feelings back. This is how we get addicted to drugs, and, as this study shows, to sugar as well. On the other side, this also means we experience withdrawals from sugar in the same way as recovering drug addicts when they go cold turkey. The research shows promise for the obesity epidemic in Australia, as it is thought that medication used to lower tobacco cravings could also be used to help sugar addicts. As for switching sugar for artificial sweeteners? Don’t even think about it. Because they taste just like sugar, they produce the same effects in the brain as sugar. So, while they may be better for your waistline, they’re just as bad for your brain. Related links: <a href="/health/body/2016/04/full-fat-milk-reduces-diabetes-risk/">Full-fat milk said to reduce risk of diabetes</a> <a href="/health/body/2016/04/shocking-effect-of-fast-foods-on-body/">Shocking effect of fast foods on the body</a> <a href="/health/body/2016/04/images-on-food-packaging-causing-you-to-overeat/">The sneaky thing that causes you to overeat</a>

News

Shocking effect of fast foods on the body

An intriguing <a href="http://www.nature.com/ncomms/2015/150428/ncomms7342/full/ncomms7342.html#affil-auth" target="_blank">new study</a> shows the effect of a fast food-filled diet. The effect, it seems, is much faster than you might think. Researchers from the University of Pittsburgh asked 20 Americans to do a diet switch with 20 Africans for two weeks. The Americans were given a high-fibre, low-fat African-style diet with plenty of pulses and beans, while the rural Africans were fed a high-fat, low-fibre Western-style diet, liberal in burgers and fries. It is not hard to guess which diet is better for us, but the surprise was in the speed our bodies respond to diet. In comparison with their usual diets, the food changes resulted in "remarkable" changes in biomarkers of bowel cancer risk. "In just two weeks, a change in diet from a Westernised composition to a traditional African high-fibre, low-fat diet reduced these biomarkers of cancer risk, indicating that it is likely never too late to modify the risk of colon cancer," lead researcher Dr Stephen O'Keefe said. Researchers estimate that up to <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/bowel_cancer" target="_blank">one third of bowel cancer</a> cases could be avoided by improving your diet. Fibre is fabulous for more than just our bowels. One new study found that eating more of it is one simple way to lose weight and improve your overall health. "By changing one thing, people in the fibre group were able to improve their diet and lose weight and improve their overall markers for metabolic syndrome," said the study's lead author. That said, the study is small and the results need to be put into context. A similar new study found that just five days of eating a high-fat diet can change the way your body's muscle processes food. "It is important to realise that any change in diet will bring about changes in the way your body metabolises foods," Associate Professor Amanda Salis, of Sydney University's Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders said. "In the short term those changes are generally adaptive, in that they help your body to maintain a healthy status quo, and the responses subside when the previous diet is resumed." Still, they show the powerful effect diet can have on our health and that it's never too late to improve our nutrition. "I found it very encouraging that just two weeks of dietary changes for the better can bring about changes in health markers that indicate improvements," Salis says of the new study, published in the journal Nature Communication. "As for the negative effects, it is always a case that those dietary changes need to be sustained long-term for the changes in health to translate to long-term benefits." Written by Sarah Berry. First appeared on <a href="http://Stuff.co.nz" target="_blank">Stuff.co.nz</a>. Related links: <a href="/health/body/2016/03/digestive-tips/">5 “digestible” tips to reboot your health and wellbeing</a> <a href="/health/body/2016/03/diets-over-detoxes/">Detox versus diet: which one is best?</a> <a href="/health/body/2016/03/low-carb-diet-for-irritable-bowel/">The low carb diet for irritable bowel</a>

Body

Our Partners

Over 60

News

Shop

Catalogues

Contests

Entertainment

Travel

Health

Lifestyle

Finance

Property

Games

Information

Keep up to date

Search

New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link

Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

Obese woman sparks debate for not giving up extra seat for toddler

Renaming obesity won’t fix weight stigma overnight. Here’s what we really need to do

5 ways alcohol can sabotage your weight loss goals, according to an obesity doctor

Loneliness can be twice as unhealthy as obesity in older people

Obese yet malnourished toddler mummy sheds light on life in 17th century aristocratic Austria

Fans share concern over Sam Armytage's dog: "Her dog is obese"

Aussie researchers' new pill to fight obesity

Body fat deep below the surface is a toxic risk especially for your heart

Why obesity is more common than you think

Aussie pet owners urged to tackle obesity epidemic amongst pets

Obesity has become the new normal but it’s still a health risk

This airline has just instructed "obese" employees to lose weight

"Chunky" Jamie Oliver hires personal trainer after criticism from fans

Study finds sugar is as addictive as drugs

Shocking effect of fast foods on the body

Our Partners