Does Adenovirus 36 Infection Cause Childhood Obesity?

Findings from new a study of Southern California children support the idea that a viral infection may play a role in causing or contributing to obesity. 

Reported in the Sept. 20, 2010 online edition of Pediatrics, researchers led by Dr. Jeffrey B. Schwimmer, associate professor of clinical pediatrics at University of California, San Diego, studied 124 children aged 8-18 years in primary clinics in San Diego for the presence of antibodies specific to adenovirus 36 (AD36), which is the only human adenovirus currently linked to human obesity. 

Of the 124 children 67 (54%) were defined as obese based on a body mass index in the 95^th percentile or greater (Pediatrics Sept. 20, 1010 [Epub doi:10.1542/peds.2009-3362]). Of these 124 children 19 (15%) had neutralizing antibodies specific to AD36. A whopping 78% of these AD36-positive children were obese. 

On average, children who were AD36-positive weighed almost 50 pounds more than their peers who were AD36-negative. In addition, obese children who were AD36-positive infection weighed an average of 35 pounds more than obese children who were AD36-negative. 

“Many people believe that obesity is one’s own fault or the fault of one’s parents or family,” Dr. Schwimmer commented in a prepared statement about the study (a downloadable video of Dr. Schwimmer highlighting the findings is also available). “This work helps point out that body weight is more complicated than it’s made out to be. And it is time that we move away from assigning blame in favor of developing a level of understanding that will better support efforts at both prevention and treatment.” 

— Doug Brunk (on Twitter@dougbrunk)

Getting Kids HEALTHY

Thank God – or school administrators, or Dr. Gary Foster, or kids who just want to have fun – thank anyone you want… but there’s finally some good news about childhood obesity. It came on June 27, at the annual meeting of the American Diabetes Association. 

The Move It Kids demonstrate fun fitness. By Flickr user nutrition educator.

 The results of the three-year HEALTHY Study are in, and while they might not be exactly what researchers hoped for, they’re plenty good. A three-pronged middle school program that improved food in schools, jacked up gym classes, and made it “cool” to be healthy, helped husky 6th-graders slim down by the time they were headed off to high school.  

Technically, the study didn’t succeed – that is, it did not meet the primary endpoint of decreasing the prevalence of a combination of overweight and obesity at target schools more than control schools. But by the end of the intervention, HEALTHY schools did have fewer kids with extremely high waist circumference, and fewer with a body mass index above the 95th percentile.  

The program seemed to work best in the kids who were already overweight or obese as 6th-graders. They were 21% less likely to be overweight or obese in 8th grade than students at the control schools. And they had a trend – though not a significant difference toward a greater reduction in the BMI z-score  by grade eight.  

Perhaps the best news in the study was its “failed” primary endpoint: By the end of the study both intervention and control schools saw significant decreases of 4% in the prevalence of kids who were overweight or obese. It’s not entirely clear why, but at a press briefing, Dr. Foster, a Temple University endocrinologist, suggested a few possibilities.  

The control schools had the same enrollment procedure as the intervention schools: All the 6th-graders had a health screening that included weight, blood pressure, a lipid panel, and insulin and fasting glucose levels. All the parents got a “health report card” describing their child’s status and suggesting a doctor visit if indicated. That might have been enough to stimulate some family changes that helped children shed pounds.  

Just as likely, he suggested, are societal trends. Maybe word of the looming avalanche of obesity-related diabetes, cancers, and cardiovascular disasters has finally penetrated the cacophony of advertisements suggesting that kids can live off the “Children’s Menu” diet – chicken fingers, french fries, and a soda.  

Whatever the reason, I’m thrilled: Last year, my son wanted to celebrate  his 13th birthday by taking some buddies to a theme park . Two of them — one “husky” and one frankly huge —  couldn’t take the strain of walking around a slightly hilly park on a warm late-April day. The bigger one ended up in the nurse’s station for 4 hours with a splitting headache and an upset stomach.  

It was a lesson learned for my son, though. He has moderated his own diet noticeably since then, referring several times to how sad it was that his lifelong, overweight friend couldn’t keep up, even in the race to have fun. 

— Michele G. Sullivan (on Twitter @MGsullivan)

   

Fightin’ Words

The battle against adolescent obesity has been elevated to the status of war. “The incidence of adolescent obesity is rising meteorically and represents the largest healthcare crisis in young adults since Vietnam,” Dr. Robert Cywes said at the annual meeting of the American Society for Metabolic & Bariatric Surgery. 

Via Flickr Creative Commons user enviziondotnet

 

That being the case, he wondered, where is the outrage? Why — in the face of mounting evidence that procedures such as adjustable gastric banding are not only safe and effective, but may represent the most realistic option for achieving significant weight loss and improving multiple metabolic risk factors in adolescents — has the FDA not yet approved these procedures for use in adolescents? 

Dr. Cywes of Jacksonville Surgical Associates in Florida — who does have a financial relationship with gastric band maker Allergan — presented data from a retrospective study looking at the outcomes of 402 obese adolescents (mean BMI 43) who underwent “off-label” adjustable gastric banding from 2005-2009 following extensive pre-operative psychological, nutritional, and lifestyle assessment and counseling, and showed that patients’ mean BMI declined to 35.7 and 31.9, respectively, at six months and one year. Additionally, of the 38 patients who had complete follow-up data at 4 years, the mean BMI was 27.8. 

In a separate study looking at the outcomes of 17 morbidly obese adolescents who underwent gastric banding surgery as part of an FDA investigational device exemption study, Dr. Kirk Reichard of Nemours, A. I. Dupont Hospital for Children in Wilmington, Del., and his colleagues observed significant improvements in weight, waist circumference, systolic blood pressure, and HDL cholesterol—all “clinically significant changes given the difficulty of achieving these results in an otherwise treatment-resistant population,” he said. 

While the sustainability of these observed changes  still need to be evaluated over time, the findings suggest that the “the FDA should accelerate the lifting of barriers to banding in this population,” said Dr. Cywes. “The question is no longer whether laparoscopic adjustable gastric banding is safe or effective [in adolescents]. The question is whether it is negligent not to offer it as an option for the treatment of severely obese children.” 

— Diana Mahoney 

Have a Coke and a Tax

Image via Flickr user gcardinal by Creative Commons License

Before long, Californians may have to pay extra cash for consuming sugary beverages.

On May 12, 2010, the state’s Senate Committee on Revenue and Taxation will consider Senate Bill 1210, which would place a state excise tax of one penny per teaspoon of added sugar on beverages sweetened with sugar, including soft drinks, energy drinks, sweet teas, and sports drinks. The estimated $1.5 billion raised by the tax would be used to fund childhood obesity programs in the state, including physical education classes and healthful school meals. 

Introduced by Senate Majority Leader Dean Florez (D-Shafter), SB 1210 is sponsored by the California Center for Public Health Advocacy (CCPHA), which, in a prepared document about the bill, notes that nearly 16 million Californians are obese or overweight. 

“There are 10 teaspoons of sugar in every 12 oz can of soda and a child’s risk of obesity increases an average of 60% with each additional daily serving of soda,” the CCPHA document reads. “Yet, a study released last year by the CCPHA and the UCLA Center for Health Policy Research found that 41% of children ages 2-11 and 62% of adolescents ages 12-17 consume at least one soda or other sugar-sweetened beverage every day.” 

What are your thoughts? Do you think this is bill is a good idea?

— Doug Brunk (on Twitter at dougbrunk)