obesity | MY SPECIAL DOCTOR

Body weight: the dangers of fluctuations

22 February 20246 January 2024 by rosanna.feroldi

That repeated drastic diets are bad for your health, and not just your physical health, is a well-known concept and widely reiterated by doctors and nutritionists, although not always given due consideration by message recipients. That is, by people with a few or many extra pounds who would like to improve their fitness and appearance.

The reason is quickly stated: if the overweight is detrimental because it increases the cardiovascular risk, the general inflammatory state, and the risk of developing hormonal disorders and some cancers (such as colorectal and breast cancer in women), slimming down too quickly imposes considerable metabolic stress on the body, which does not make things much better.

If, then, after the weight loss initial failure to maintain the result (as is the case in most cases, if you are not followed by a nutritionist/dietologist), the effect is even worse because you will be back in the initial risk category on the clinical level and you will accumulate more adipose tissue than muscle mass (partly lost along with the fat mass during slimming).

Past studies had already warned that the yo-yo effect is detrimental to overweight or obese people with cardiovascular disease, who can benefit greatly from a weight loss of at least 5-10% of their initial weight, but only if maintained over the long term.

New data from a Korean study involving 3,678 men and women who underwent body weight monitoring and medical evaluations every 2 years for a period of 16 years now report that, even in those without specific diseases, repeated weight fluctuations are to be avoided because they are associated with a significant increase in mortality (as much as more than 50 percent compared with those who maintain a fairly stable weight).

The only category of people who manage to derive some benefit from this metabolically incorrect form of slimming is obese individuals who are free of cardiovascular disease. Indeed, in this subgroup, weight losses, although transient, appear to result in a lower overall risk of developing diabetes with age (reduced by 24 percent on average). On the other hand, it should be pointed out that the benefit would be significantly greater if the weight was lost once and for all and no longer regained.

But beware: the protective effect of weight yo-yoing toward diabetes applies only to those who are obese to begin with. For people who are initially normal weight or with only a few extra pounds, each somewhat pronounced fluctuation in the scale increases the likelihood of losing blood glucose control in later years, rather than decreasing it.

By contrast, in no case does slimming-fat-reduced-fat-reduction, etc., more or less often seem to have, in itself, a significant impact on the risk of going on to acute cardiovascular events such as heart attack and stroke, unless one already suffers from predisposing diseases in this regard.

In view of the hearty meals of the Christmas season, it is best to keep these figures in mind and try not to accumulate too many kilograms, which would then be hard to lose at the beginning of the New Year.

Source

Tae Jung Oh et al. Body-weight fluctuation and incident diabetes mellitus, cardiovascular disease, and mortality: a 16-year prospective cohort study. The Journal of Clinical Endocrinology & Metabolism, 2018; doi1:0.1210/jc.2018-01239

By 2022, obese children will outnumber underweight children

25 February 20246 January 2024 by clemente.ferrara

We all know how important it is for the well-being of the body to keep a proper diet. This is especially crucial when it comes to children. Eating problems are unfortunately widespread among younger people, although we are seeing a substantial shift from the past. Until now, in fact, the problem of malnutrition mainly affected children who are in the underweight condition, especially in the poorest parts of the planet. The numbers are changing, however, and a new scenario, in some ways opposite to the past, seems about to occur.

The study

According to research published in Lancet, the most important (in terms of numbers) on the study of obesity carried out in the past 40 years, five years from now the number of obese children will exceed the number of underweight children. Weight and height of about 129 million subjects in an age range of 5 to 19 years were analyzed. The first worrisome finding from this study is that over the past 40 years the number of overweight children has become 10 times larger, rising from 11 million in 1975 to 124 million in the past year (moreover, there were about 213 million children just below the obesity threshold in 2013).

Blame it on a lifestyle that is certainly more sedentary than in the past but not only that. One of the main causes, according to experts, would also be the increase in poverty. In fact, the economic crisis has taken away the opportunity for more and more people to buy healthy foods with high nutritional values, forcing them to fall back on junk food, most often cheaper than others.

Statistics

According to the survey by Imperial College London, the number of obese children has risen from 1 percent recorded in 1975 to 6 percent for girls and even 8 percent in boys in 2016. An entire generation, therefore, is growing up affected by malnutrition. This time, however, unlike in the past, the trend is reversing in favor of overweight children, who are in ever-increasing numbers.

Despite this, even on the side of underweight children, the situation does not seem to be improving at all. In fact, in 2016 the average or severely underweight individuals were about 75 million for girls, and well 117 million for boys, who are concentrated more in the world’s poorest areas (two-thirds of them live in the south of Asia where high population growth is failing to come to terms with policies put in place by the government against malnutrition).

HEALTH: Beware of obesity when expecting a baby

24 February 20246 January 2024 by MinnieLuongo

Obesity is always dangerous, but it becomes even more so for mothers expecting a baby. This is emphasized by the World Health Organization (WHO), specifying that maternal obesity is not only a global health problem but is also associated with adverse outcomes, both for pregnant women and newborns.

The alarming data on obesity

Obesity is now officially identified as a global epidemic, that is, as one of the biggest health problems of the 21st century. Recent data from the WHO are alarming: since 1975, obesity worldwide has almost tripled to 13 percent, with an absolute 650 million obese individuals over the age of 18; 41 million children under the age of 5 who are overweight or obese; and more than 340 million children and adolescents between the ages of 5 and 19 living with obesity.

Maternal obesity

Obesity can impact the individual from the moment of conception: in fact, very frequent cases of pregnant women who are obese due to previous obesity or excessive weight gain during gestation. “Maternal obesity,” says Dr. Daniela Galliano, director of the IVI Center in Rome – constitutes a serious problem that is associated with both maternal and perinatal adverse outcomes: in fact, it increases abortion rates and obstetric and neonatal complications, resulting in lower birth rates of healthy babies.

In addition to the negative consequences of moods for the mother,”Obesity is a major risk factor for the onset of chronic diseases during their children’s lifetimes, especially in adolescence and adulthood, such as cardiovascular disease, metabolic syndrome, type 2 diabetes, osteoporosis, cancer, and neurodevelopmental delay. Finally, obesity-induced fetal programming of metabolic function may have an intergenerational effect and could, therefore, pass on obesity into the next generation.”

Conclusions on obesity

Therefore, it is essential to seek medical advice and, at the same time, change one’s eating behavior and lifestyle. How? With diets suggested by specialists (no to “do-it-yourself” diets, but early pregnancy diets followed by the doctor) and increased exercise, with the aim of reducing weight in women before conception of a child, and thus to break the vicious cycle of intergenerational obesity.

Obesity, disease or choice?

22 February 20246 January 2024 by Renato Torlaschi

In 2013, theAmerican Medical Association (AMA) declared obesity a disease, requiring a range of interventions to promote its prevention and treatment.

Five years later, U.S. health care professionals are still not fully aware of this, the surprising results of a survey conducted for Medscape, the well-known medical portal, reveal.

When asked whether obesity should be considered a disease, only 57 percent of respondents answered in the affirmative, and more than one-third of health professionals do not consider it a disease state, a percentage that is even higher among primary care physicians.

According to experts, the persistence of this belief is an obstacle in finally addressing a situation that is reaching pandemic proportions. “It’s time for us to recognize obesity as a disease, ” says endocrinologist Akshay Jain. Until we medical professionals take obesity seriously, we will be ineffective in treating its biopsychosocial and economic consequences. Defining obesity as a disease is the first step toward objectively assessing the factors that cause it and its prevention and treatment.”. There are several reasons why obesity is to be considered a disease: first, it is associated with impaired body function; second, it results from the dysfunction of a complex system of physiological regulation, fostered by multiple factors particularly present in today’s societies.

Finally, it should not be forgotten that obesity causes, worsens, or accelerates more than 160 comorbid conditions that arise as metabolic, structural, inflammatory, degenerative, neoplastic, or psychological complications of obesity itself, significantly affect the quality of life and also its duration.

So that the misconception that obesity is simply a choice can be overcome, the American Association of Clinical Endocrinologists has proposed to change its name and rename it as “chronic adipose disease,” so that it is readily recognized as a real health threat and not just a cosmetic problem.

Childhood obesity: two “household” risks

17 February 20246 January 2024 by rosanna.feroldi

Sitting for too long in front of a computer screen, TV, smartphone or tablet or playing playstation, especially with a high-calorie snack in hand, puts children and adolescents’ fitness and health at risk.

A conclusion that certainly is not surprising and could have been easily predicted even without doing an ad hoc study that comes from theEndocrine Society‘s congress, ENDO 2019, held in New Orleans, USA, March 23-26. But you know, science has to measure phenomena before it can state anything.

Thus, we now know “for sure” that the guys who maintain these habits, in spite of the invitations from parents to unplug and engage in more dynamic pastimes, they are exposed to a risk not inconsiderable to accumulate extra pounds and early development of metabolic syndrome, a condition given by the simultaneous presence of overweight (especially concentrated at the abdominal level), hypertension, hypercholesterolemia, and hyperglycemia/diabetes type 2 (the typical adult one, mostly resulting from an incorrect lifestyle).

In the research, which analyzed the usage habits of technological devices and lifestyle of nearly 34,000 Brazilian adolescents (average age 14.6 years), spending more than 6 hours a day sitting in front of a screen resulted in a 71 percent increased risk of metabolic syndrome compared to those who sat less.

Since metabolic syndrome is associated with a significantly increased risk of developing cardiovascular disease, and that problems on this front increase over time, it is crucial that parents who recognize excessively sedentary behaviors of their children, especially when associated with disordered and unhealthy eating, intervene immediately with appropriate measures to modify the lifestyle. Agreed: it is not easy, but it is important. And setting a good example helps.

A second, decidedly less obvious piece of news coming out of ENDO 2019 concerns the potential weight-shape implications for children, adolescents, and adults of exposure to chemical compounds that accumulate in indoor dust.

Based on analysis of dust collected by researchers at Duke University’s School of the Environment in Durham, U.S., in 194 North Carolina homes, about 70 percent of the 100 chemical compounds in the household dust would appear to be able to promote the development of adipocytes, which are the cells in which subcutaneous fat is deposited in the human body.

In essence, this means that the substances that accumulate in our homes may make us gain weight more easily. The finding, at present, has been obtained in cellular systems and should, therefore, be considered as basic biological information to be further investigated in complex organisms. However, this is a very interesting indication because it may suggest a non-food and external mechanism outside the body that can promote the development of overweight and obesity.

Source

Annual meeting of the Endocrine Society – ENDO 2019, March 23-26 New Orleans (USA):

https://www.endodaily.org/study-shows-increased-risk-of-obesity-tied-to-unhealthy-snacking-coupled-with-extensive-screen-time-in-teens/
https://www.endodaily.org/researchers-link-chemicals-in-household-dust-to-fat-cell-development/

Obesity: the OECD quantifies its costs, which are also very heavy for Italy

14 February 20246 January 2024 by Redazione My Special Doctor

Obesity-related diseases will cause more than 90 million victims in OECD countries over the next three decades, with life expectancy reduced by nearly three years; economically, too, the consequences will be significant, with a 3.3 percent reduction in GDP and an average of about $360 per year burdening the budgets of each citizen. The figures were provided by the OECD itself, in a report that outlines a very worrying landscape for Italy as well.

Although the prevalence of obesity in our country is lower than in most of the Organization for Economic Cooperation and Development’s member countries, its impact is considerable. Italians live an average of 2.7 years less due to being overweight, which is responsible for 9.0% of health care spending, above the average of other countries. If we could change our dietary regimen, with a 20 percent reduction in our intake of sugar, salt, calories and saturated fat, we could prevent 688,000 noncommunicable diseases by 2050, save 278 million annually in health care costs and increase employment and productivity by an amount corresponding to the equivalent of 18 thousand full-time workers.

The OECD urges authorities to take public health actions to promote healthier lifestyles, which have a positive impact on the population and are a good investment: on average, for every euro invested, up to six euros are returned in economic benefits. And, for Italy, it is especially important to turn our eyes to the future and think in terms of prevention, given that we are now the fourth-largest country in the world in terms of childhood obesity, clear evidence of the progressive spread of unhealthy habits and lifestyles.

” Children – OECD experts declare – They pay a high price for obesity: they do less well in school and, when they grow up, are less likely to complete higher education; they also show less satisfaction with life and are three times more likely to be bullied, which in turn may contribute to lower school performance.”

Frequently, moreover, children’s obesity or overweight status will be maintained into adulthood, with an increased risk of chronic diseases, such as diabetes, and reduced life expectancy. In the European Union, women and men with the lowest incomes are 90% and 50% more likely to be obese, respectively, than those with the highest incomes, reinforcing inequalities. In access to employment, individuals with at least one chronic disease associated with overweight are at a disadvantage and, when they do have a job, they are more often absent and are less productive.

Source:

OECD. The Heavy Burden of Obesity. The Economics of Prevention. Published on October 10, 2019

Overweight and obesity: if you know them (maybe) avoid them

14 February 20246 January 2024 by rosanna.feroldi

In a world where everyone wants to be thin, one is increasingly overweight, even from childhood. With all that it entails in terms of physical and psychological discomfort and health repercussions, especially after a certain age. What to do? Here are some tips.

When it comes to nutrition and body weight, it opens up a universe of contradictions. You want to stay in shape or lose weight, but also eating what they like without paying too much attention to quantity. Hundreds are spent of euros for the gym, but then you almost never go. A thousand diets, but none are maintained. You buy jumpsuits and sneakers, but you don’t can do without an elevator and a car. The most ironclad healthy living resolutions, but the tomorrow to implement them never comes.

The result is always the same: month after month, the needle of the balance goes in the opposite direction from what is desired or, at best assumptions, remains inexorably fixed on a somewhat round figure. Despair does not help, because it often leads to drowning one’s own frustrations. Resign even less, because it makes people get used to standards of weight and fitness that tend to get progressively worse, almost without realizing it account. So what? As always, the solution lies in the middle, viz. In identifying a healthy balance between actual metabolic needs of the body and pleasures for the palate and spirit.

The origin of the extra pounds

No use cheating or looking for alibis in slow metabolism or the unfavorable constitution: except for a very small proportion of cases in which indeed there may be a significant genetic component or specific pathologies that work against it, if you gain weight or don’t lose weight, the reason goes sought in lifestyle errors, that is, essentially in the combination of a diet that is high in calories relative to individual needs and/or unbalanced and insufficient movement. This rule applies at any age, but in childhood/adolescence can have a metabolic impact particularly negative, which also has unfavorable repercussions on body weight and health In adulthood.

Numerous studies have now indicated that a child in strong overweight or obese will remain so as an adult (or who will slim down with effort), resulting in exposure to an increased risk of cardiovascular disease, diabetes, hormonal disorders and different types of neoplasms (e.g., breast cancer in women and colorectal cancer in both sexes.

For women, then, obesity (as well as being overweight) can impair fertility or cause serious problems during pregnancy and at the time of delivery, not the least of which is to also predispose the child to develop overweight/obesity and diabetes. Not to mention the psychological implications and Relational of the many extra pounds in adolescence and early adulthood adult, when physical appearance plays an important role in the perception of self and in interactions with others.

For women, even those who were initially thin or normal weight, A critical moment on the body weight front is the pregnancy. If you gain too much weight at this stage (i.e., more than the 10-12 kg. physiological, which gynecologists recommend not to exceed), lose weight after childbirth can be difficult, especially if you are over 35-40 years old, if you have a demanding family to care for and/or a job sedentary, leaving little time for physical activity. Residual extra pounds neglected for a long time, in fact, tend to “settle” by constituting the starting point for further increases in subsequent years.

In both sexes, then, the coming of age 40-45 involves. an initial, inevitable metabolic slowdown, which will worsen later: especially after age 50-55 for women, corresponding to the onset of the menopause; and shortly thereafter for men, also due to the reduction of hormones male and muscle mass (which is the one that burns the most calories). If, During and after this transition, you do not revise your habits food (reducing the calories introduced each day and increasing the consumption of vitamins and antioxidants that support metabolism), fattening by a few pounds is practically inevitable.

As mentioned, in a minority of cases, overweight and obesity can arise and persist due to diseases, mainly of endrocrine-metabolic type, or as a side effect of drugs needed to treat a variety of ailments. Among the former include. hypothyroidism, adrenal gland dysfunction, and the ovary polycystic, just to give a few examples.

Among the latter are insulin used for the treatment of more severe forms of diabetes, cortisone, some antidepressants, the antiepileptics, mood stabilizers, antipsychotics, some hormone therapies used for women’s issues and anti-androgenic drugs Against prostate disorders and cancers in men. In all these cases, the Body weight management must go hand in hand with disease treatment basis and be defined and monitored by the physician.

Healthy diet: better start with children

First, recall that the concepts of normal weight, overweight and obesity are based on the calculation of body mass index or BMI (Body Mass Index), a value that is obtained by dividing the weight expressed in kilograms by the square of the height expressed in meters. So, for example, a person who is 1.70 m tall and weighs 70 kg will have a BMI = 70 kg / (1.70 x 1.70)^{m2 =} 24.22 kg/^m2. This person will be “normal weight,” a category that includes all those with a BMI between 18.50 and 24.99 ^kg/m2. It will be, instead, “overweight” Those with a BMI between 25.00 and 29.99 ^kg/m2 and “obese mild” (class I) those who have a BMI between 29.99 and 34.99 ^kg/m2; with BMI between 35.00 and 39.99 ^kg/m2 you fall into medium obesity (class II), while from 40 ^kg/m2 upwards we speak of severe obesity (class III).

Assuming that overweight and obesity in childhood/adolescence. influence the characteristics of metabolism and health in adulthood, it is crucial that the habit of keeping fit through a healthy diet and exercise regular be promoted to children. This also creates a kind of “imprinting behavioral” that makes it more spontaneous and natural to follow a style of Healthy living and continue to keep body weight under control over the decades Next.

If the child/adolescent is already overweight by several pounds, the advice is to consult the pediatrician and agree with him or her on a regimen age-appropriate diet and exercise, after ruling out any disorders organic not yet diagnosed. If there are many pounds to lose, it is almost imperative to also consult a dietician/nutritionist, whereas if approach to food appears to be influenced by psychological aspects is useful Also consult a psychologist/psychiatrist experienced in eating disorders.

The most important thing, however, is not to trivialize nor dramatize the problem and not nag the child about his or her weight, to what he eats or why he doesn’t move enough. Much better results will achieve by creating a serene and cheerful family environment (where meals become a pleasant time of sharing), filling the pantry and refrigerator with healthy foods (fresh fruits and vegetables first and foremost), cooking light and, above all, setting a good example, both at the dinner table and on the activity front physics.

Many teenagers and young adults are often is tempted from promises of rapid weight loss through diets as curious as they are ineffective, if not downright dangerous to health. Avoid them and recommended to avoid them in any case. If the pounds to be lost are few (3-5 kg), in most cases it is sufficient to make an honest analysis of the their own eating habits (perhaps by compiling a food diary for some days) and correct trivial mistakes (such as regularly taking drinks sugary drinks and alcohol, nibbling while cooking or at aperitifs, exceeding With bread and buns at the table, add too much oil or cheese to salads etc.).

A few suggestions for adults

In addition to the classic advice to reduce intake of the carbohydrates in general and to a minimum that of simple sugars (added or contained in sweet foods), favor proteins from legumes and fish, and Increase fiber consumption (i.e., low-sugar vegetables and fruits), a trick useful for cutting calories without revolutionizing your habits too much food is to gradually reduce portions. It may sound trivial, but by 10-20 g less pasta on your plate you hardly notice (especially if you have shrewdness to start using smaller plates), but week after week week can make a difference on the scale.

On the contrary, it is important to drink more water or other beverages unsweetened (teas, herbal teas, infusions, natural flavored waters, etc.): both because liquids have an immediate satiating effect and help to dampen attacks of starvation; both because it has been observed that many people fail to distinguish well between the stimuli of hunger and thirst and end up with the eat when they should actually drink (the kidneys will also benefit).

When the pounds to be lost are more than 5-10, it is good to consult first their own physician and then a dietitian/nutritionist to set up an eating plan compatible with the needs and characteristics Individuals (age, gender, presence of other conditions and any therapies hired, specific needs, etc.) and establish a “calendar” of the weight loss that has the dual purpose of stimulating adherence to the program dietary and physical activity (which should always be provided in combination) and of allow strategies and goals to be recalibrated, depending on the results via via reached.

As already reported for children/adolescents, also for the adults psychological/psychiatric support can be very helpful, if we realizes that he attributes to food valences that have little to do with hunger (e.g., compensation for frustrations and nervousness). In cases of severe obesity or Very severe, the doctor may prescribe certain appetite-reducing drugs or support weight loss, or consideration may be given to the bariatric surgery, weighing its pros and cons well.

Absolutely to be avoided, however, is any kind of Supplement or “miracle” remedy touted online or by centers aesthetics, gyms, clinics of dubious reputation: experience has shown that they do not serve no purpose and can damage health, at great cost.

Slimming down after the “hip”

Given that metabolism physiologically slows down starting from age 40 and increasingly in later years, slimming down will require more commitment and time after this age. But one should not be discouraged or give up because it is precisely after “age” that eliminating (or reducing) pounds of Too much becomes more important to prevent cardiovascular disease and diabetes Type 2 or help keep them under control.

Numerous studies have shown that a weight loss of equal to at least 10% of the initial one significantly reduces the risk global cardiovascular and may even reverse type 2 diabetes in early stage. In addition, at any age, losing weight helps to snore less, to alleviate (or resolve) gastroesophageal reflux disease, to avoid many sore back, not to put too much stress on the hip and knee joints, and to maintain satisfying sexuality for longer.

Of course, to achieve this and get these benefits, you need a some good will and be convinced that it is a good right thing. The suggestion is to start trying hard, without wait until you are too old, but remembering that losing the excess weight is possible and useful at any age.

Sources:

National Heart, Lung and Blood Institute – NIH (https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity)
National Institute of Diabetes and Digestive and Kidney Diseases – NIDDK (https://www.niddk.nih.gov/health-information/weight-management/helping-your-child-who-is-overweight)
World Health Organization – WHO (https://www.who.int/nutrition/topics/5keys_healthydiet/en/; https://www.who.int/en/news-room/fact-sheets/detail/healthy-diet)
Arnold M et al. Duration of Adulthood Overweight, Obesity, and Cancer Risk in the Women’s Health Initiative: A Longitudinal Study from the United States. PLoS Med 2016;13(8):e1002081 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987008)
Johnson RJ et al. Perspective: A Historical and Scientific Perspective of Sugar and Its Relation with Obesity and Diabetes. Adv Nutr 2017;8:412-422
Gardener H et al. Diet Soda and Sugar-Sweetened Soda Consumption in Relation to Incident Diabetes in the Northern Manhattan Study. Curr Dev Nutr 2018;2:nzy008

Vegan diet reduces body weight and improves insulin sensitivity

14 February 20246 January 2024 by Redazione My Special Doctor

A low-fat vegan diet induces changes in the gut microbiota and improves insulin sensitivity, according to the results of a randomized controlled trial conducted in overweight or obese adults.

The intervention lasted for 16 weeks, during which time body weight was reduced significantly more in subjects on the vegan diet than in those who continued the previous diet. With the vegan diet plan, there was an average weight loss of 5.8 kg, largely due to a decrease in fat mass, despite no calorie restriction being imposed.

The work was coordinated by Hana Kahleova, director of the Physicians Committee for Responsible Medicine in Washington, D.C., who has previously shown how people can lose twice as much weight on a vegan diet as on a non-vegan diet of the same caloric intake. “The new study,” Kahleova said in an interview with Medscape Medical News, “was created with the goal of finding out why.

For the trial, 148 adults who were overweight but had never suffered from diabetes were recruited; they were divided into two groups to follow either a low-fat vegan diet or no dietary modification. The mean age in the vegan and control groups was 53 and 57 years, respectively, and women were 60% and 67%; body mass index was about 33 kg/m3 in both groups.

The results suggest that the beneficial effects are mediated by induced changes in the community of microorganisms that are present in the gut. ” A plant-based diet with good fiber intake improves the composition of the gut microbiota, promoting bacterial strains that play a positive role in health, particularly the Faecalibacterium prausnitzii, which produces many metabolic benefits, including weight loss, increased insulin sensitivity, and reduced fat mass, including visceral fat mass.”

Source:

Hana Kahleova presented the results of her study at the annual meeting of the European Association for the Study of Diabetes (EASD), which was held in Barcelona from September 17-20, 2019

Artificial sweeteners: the position of US pediatricians

12 February 20246 January 2024 by rosanna.feroldi

As Italy prepares to introduce the “Sugar tax,” not only to balance the state budget but also with a view to discouraging the intake of beverages (and foods) containing excess sugar and calories, U.S. pediatricians are wondering about the possible health effects of the growing number of artificial sweeteners used as substitutes by the food industry and consumed in increasing quantities by children. Consumption of which, often, parents are not fully aware, since sweeteners are listed by law only in the list of ingredients (which not everyone reads and in any case written in microscopic characters), while the “reduced sugar content” that everyone likes is always made explicit in clear letters on the packaging and in advertising claims, leading to an interpretation, if not fallacious, at least partial and somewhat distorted of the characteristics of the product being purchased.

But is there really anything to fear when it comes to artificial sweeteners approved for food use by the Regulatory Agencies (i.e. the Food and Drug Administration – FDA in the United States and theEuropean Food Security Agency – EFSA in Europe) responsible for ensuring the safety and wholesomeness of substances used to produce food of any kind? In principle, no, because only compounds for which no indications of possible harm to the human body have emerged are allowed for food use. But it is precisely on this point that theAmerican Academy of Pediatrics – AAP does not agree much and would like a little more caution from everyone, institutions, manufacturers and parents. According to the Position statement published on this matter in the scientific journal Pediatrics, in fact, while for some sweeteners that have been in use for a longer time (saccharin, aspartame, acesulfame, sucralose) health criticalities from moderate consumption can be reasonably ruled out, for others of more recent introduction (such as stevia) the evidence supporting their total harmlessness is considered insufficient, especially with regard to the effects from prolonged use and especially in children.

Not only that. One aspect that the JPA believes should be investigated further concerns quantities because, as is known, any substance can result in extremely different effects in the human body depending on how much is taken in a single day and repeatedly on successive days for varying periods of time. This is also true of common sugar, which is a harmless and valuable source of ready-to-use energy for the muscles and brain when taken in low doses, but becomes an enemy of metabolic and cardiovascular health when consumed in excessive amounts, promoting-as is well known-conditions of overweight/obesity, insulin resistance and diabetes. Unfortunately, unlike other nutrients in foods, artificial sweeteners are not required to be labeled with quantities (absolute or percentage) per 100 grams or per serving of product, which prevents (the consumer and those who have to assess individual/population exposure levels) from knowing how much they are taking in through their usual diet.

Add to this that, contrary to what was initially assumed and touted, studies to date have indicated that consumption of artificial sweeteners in place of common sugar is not necessarily associated with weight loss unless their use is part of an overall healthy, balanced diet aimed at weight loss. Thus, opting for “low-sugar” or “zero-sugar” beverages or foods, per se, does not help counter the growing prevalence of overweight and obesity, either among adults or children.

Given these considerations, while not wishing to generate unreasonable alarmism, U.S. pediatricians believe that more in-depth studies need to be conducted to assess the long-term effects of different artificial sweeteners, including on children’s intake levels, and which parents should be better informed about the properties and, more importantly, the amounts of artificial sweeteners in commercially available industrial food products to support informed choices and avoid excessive intakes.

Source:

CM Baker-Smith et al. The Use of Nonnutritive sweeteners in Children – American Academy of Pediatrics (AAP) Policy Statement. Pediatrics 2019;114(5):e20192765; doi:10.1542/peds.2019-2765(www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Looks-at-Use-of-Nonnutritive-Sweeteners-by-Children.aspx; pediatrics.aappublications.org/content/early/2019/10/25/peds.2019-2765)

Obesity: dietary therapy

7 February 20246 January 2024 by Alessia Giannino

Obesity is defined as “malnutrition by excess, with marked increase in fat mass, of greater magnitude than overweight.” Based on excess body fat and using BMI as a reference, obesity is considered grade 1 for values between 30 and 34.9 kg/m², grade 2 if between 35 and 39.9, and grade 3 if values exceed 40 kg/m².

Excess body fat is influenced by certain factors such as familiarity for other chronic diseases, fat distribution, age, and the presence of complications and/or morbid associations.

Dietary advice

Dietary therapy for obesity is based on a balanced diet, which should ensure adequate intake of macronutrients and micronutrients, taking into account the individual’s excess body fat, energy expenditure, and body composition. Typically, low-calorie diets range from 1200 to 1500 kcal daily. Carbohydrates should be taken mainly as complex carbohydrates and account for 55 percent of Total Energy. Fats, on the other hand, should consist of monounsaturated fatty acids and account for 25-30% of Total Energy.

In addition, the diet should contain 5 servings of fresh fruits, vegetables and greens per day. It is necessary to limit consumption of energy-dense foods, such as those high in simple fats and sugars and alcoholic beverages.

Diet should always be combined with regular muscle exercise, mainly aerobic exercise.

Source: Handbook of Dietetics and Clinical Nutrition by Franco Contaldo et al.

Restrictive, mixed, malabsorptive bariatric surgery

7 February 20246 January 2024 by Alessia Giannino

The goal of obesity therapy is to enable reasonable weight loss. The obese may sometimes fail to halt the path to severe forms of obesity. This leads to a condition where body weight is no longer included in acceptable values and health risks become increasingly pressing.

In this case, bariatric surgery can be used, so after a series of investigations and after evaluation by the specialist team, those who are overweight can reduce their weight through surgery.

In the field of surgery bariatric there are many types of intervention with different effectiveness therapeutics and each characterized by specific clinical effects and complications. The technique to be adopted is the one that comes closest to the goal Of an ideal intervention.

The minimum criteria for the indication To bariatric surgery are:

BMI > 40 kg/m²
Age between 18 and 60 years
Obesity of duration greater than 5 years
Failure of attempts weight loss
Absence of cause endocrine
Absence of Pathology unrelated to obesity that increases operative risk
Absence of Unrelated diseases that reduce life expectancy
Absence of problems psychiatric
Full availability of the long-term postoperative follow-up

In general, the criteria of choice should be based on:

BMI
Behavior food
Psychological evaluation
Age
Sex
Work activity

In order to make a careful assessment, it is necessary to carry out an “integrated” diagnostic evaluation of the obese person. An integrated treatment protocol has been established that also provides patients with psychological support. In addition, two types of interventions are distinguished: those aimed at reducing food intake and those aimed at reducing intestinal absorption.

Source: Handbook of Dietetics and Medical Nutrition by Franco Contaldo et al.