TAG: "Obesity"

Culturally tailored intervention may help reduce obesity in Latino children


Study finds meaningful improvements in child weight and BMI.

By Linda Anderberg, UC Berkeley

A recent collaborative study between UC Berkeley School of Public Health and Contra Costa County researchers evaluated the efficacy of a culturally tailored obesity intervention for Latino children, Familias Activas y Saludables, or Active and Healthy Families (AHF). The study results were published online in Academic Pediatrics.

The randomized controlled trial found that child body mass index (BMI) decreased in the AHF group and increased in the control group over a 10-week period. Children in the AHF group also had reduced triglyceride levels (a type of fat measured in blood), but no significant improvement in blood pressure. This randomized trial is the first to date to show a significant impact on BMI of a culturally tailored primary care program addressing obesity in Latino children.

“Latinos represent the largest minority ethnic group in the United States and suffer disproportionately from childhood obesity and type 2 diabetes,” says Jennifer Falbe, a postdoctoral research fellow at the school and lead author of the study. “Given the unique barriers some Latino communities face regarding diet and physical activity, there is an urgent need for culturally and linguistically tailored programs to address childhood obesity in these communities.”

AHF is a family-based group medical appointment program of Contra Costa County Public Health Clinic Services. It consists of five two-hour sessions that teach healthy eating and exercise habits, as well as parenting skills. AHF sessions were delivered in Spanish by a multidisciplinary team including a registered dietitian, a physician and a promotora — a community health worker who engaged families and facilitated understanding of the content of the sessions. The promotoras called families twice to check on progress, bridge communications gaps and remind families about the next session.

“We found that AHF resulted in meaningful improvements in child weight and BMI,” says Falbe. “AHF was unique in its delivery by a provider triad and its cultural relevance. Furthermore, unlike many interventions, the program is financially sustainable for the publicly funded health centers in which it was delivered.”

The U.S. Preventive Services Task Force has called for studies that address weight management in minority children and investigate efficient, primary care feasible interventions using allied health professionals. This study makes a valuable contribution to that evidence gap.

Co-authors of the study include Kristine Madsen, associate professor at the UC Berkeley School of Public Health; Nicole K. Tantoco, research assistant at the UC Berkeley School of Public Health; Hannah R. Thompson, research scientist at the UC Berkeley School of Public Health; and Annabelle A. Cadiz, Contra Costa Public Health, Contra Costa Health Services.

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Maternal obesity compromises babies’ immune system at birth


Study investigates key innate and adaptive immune cells in umbilical cord blood samples.

Ilhem Messaoudi, UC Riverside

By Iqbal Pittalwala, UC Riverside

Almost 60 percent of women of childbearing age in the United States are overweight or obese. Obesity is a major public health issue, and has been linked to health problems like heart disease, cancer and hypertension. It can complicate pregnancy by increasing the mother’s risk of having gestational diabetes, preeclampsia, preterm birth or a baby with birth defects. Maternal obesity is also linked to several adverse health outcomes for the infant that can persist into adulthood, such as type-2 diabetes, heart disease and mortality.

But when exactly does the immune system of babies born to obese mothers get compromised? Very early in the baby’s life, according to a new study by a research team led by Ilhem Messaoudi of the University of California, Riverside.

The team analyzed umbilical cord blood samples of infants born to lean, overweight and obese mothers, and found that pre-pregnancy maternal weight has a significant impact on the immune system of the neonate, putting such children at risk for potential diseases such as heart disease and asthma.

The pilot study, performed on 39 mothers in Portland, Oregon, is published online in PubMed and will soon appear in the journal Pediatric Allergy and Immunology.

“A number of studies have linked maternal obesity – starting pregnancy with excess weight and gaining a lot of weight during pregnancy – to a higher incidence of cardiovascular disease and asthma in children,” said Messaoudi, an associate professor of biomedical sciences in the School of Medicine at UC Riverside. “Our study offers potential links between changes in the offspring’s immune system and the increased susceptibility and incidence of these diseases later in life.”

The researchers used established body mass index (BMI) categories to sort the mothers participating in the study, BMI being a number calculated from height and weight. A mother was considered overweight if her BMI was 25 to 29.9. A mother was considered obese if her BMI was 30 or higher.

The mothers were all non-smoking, had no diabetes and had an uncomplicated gestation at term. Each mother delivered just one baby. Eleven mothers were lean, 14 were overweight and 14 were obese. Thirty were white, three were Asian American/Pacific Islander, one was an American-Indian/Alaskan native and two were African American. The racial identity of three women was unknown.

“We found that very specific immune cells in circulation – monocytes and dendritic cells –isolated from babies born to moms with high BMI were unable to respond to bacterial antigens compared to babies born to lean moms,” Messaoudi said. “Such babies also showed a reduction in ‘CD4 T-cells.’ Both of these changes could result in compromised responses to infection and vaccination.”

Further, the researchers found that cells (eosinophils) that play a role in allergic response and asthma pathogenesis were significantly reduced in the umbilical cord blood of babies born to obese mothers. One potential explanation for these observations is that these cells have already moved into the lungs, which could explain the increased incidence of asthma observed later in life in children born to obese mothers.

The research is the first to show the link between maternal obesity during pregnancy and neonatal immune outcomes, and shows that changes in immunity are already detectable at birth and could persist for the lifetime of the child into adulthood.

“This could change how we respond to vaccination and how we respond to asthma-inducing environmental antigens,” Messaoudi said. “As we know, in the first two years of life, children typically receive plenty of vaccines. The questions that arise are: Are the responses to vaccines in infants born to obese moms also impaired in the first two years of life?  Should we change how often we vaccinate children born to obese moms? Should we change practices of how much and how often we vaccinate?”

Messaoudi sees the research paper as a launching point for further studies and a call to action.

“If you are thinking of becoming or are already pregnant, talk to your ob-gyn about weight management, weight gain and the ideal targets for weight gain,” she said. “When moms come in for prenatal visits, doctors tell them about smoking, recreational drug use and alcohol. But they should be talking also about weight and weight management. Obesity has serious repercussions for maternal health. It is associated with low fertility and success with pregnancy.  Rates of gestational diabetes, preeclampsia, placental abruption – all of these risks increase dramatically with weight gain and obesity. So it is important to talk to your doctor about ideal weight entering into pregnancy and throughout pregnancy.”

Messaoudi was joined in the study by Randall M. Wilson and Daniel R. Jeske at UCR; and Nicole E. Marshall, Jonathan Q. Purnell and Kent Thornburg at the Oregon Health & Science University, Portland, Oregon.

The research was supported by grants from the National Institutes of Health.

More information about obesity and pregnancy can be found here.

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Why do obese men get bariatric surgery far less than women?


Demographic, socioeconomic, cultural factors all add to sizable gender gap.

UC San Diego School of Medicine researchers report men undergo bariatric surgeries in far lower numbers than women.

By Bonnie Ward, UC San Diego

A new study by researchers at the UC San Diego School of Medicine has identified demographic, socioeconomic and cultural factors that contribute to a major gender disparity among U.S. men and women undergoing weight loss surgeries. Men undergo the surgeries in far lower numbers than women.

The study is published in the March issue of the Journal of Laparoendoscopic & Advanced Surgical Techniques.

Eighty percent of patients who undergo bariatric surgery, which involve procedures that either limit the amount of food that can be consumed or reduce food absorption, are female, despite equal rates of obesity among American men and women.

“The results of this study should raise awareness in men about the complications that obesity brings to their health,” said senior author Santiago Horgan, M.D., chief of the Division of Minimally Invasive Surgery at UC San Diego Health System. “Even though we have a 50-50 percent split in obesity rates among U.S. men and women, women get 80 percent of the bariatric surgeries and men only 20 percent. That’s a very uneven distribution.”

Horgan said the study explored non-biological factors that may be causing fewer men to seek weight reduction surgery. Among the factors identified that may influence gender distribution:  surgery eligibility, insurance coverage, health awareness and perception of body image. Age was also a factor.

The researchers examined data from 190,705 U.S. patients who underwent bariatric surgery (93 percent gastric bypass, 7 percent sleeve gastrectomy) from 1998-2010.

“We think some of it is cultural,” said Horgan. “Women seem to be more aware of the problems obesity brings to health. They are much more willing to look at surgical weight loss earlier in life, whereas men tend to wait until they have more co-morbidities (adverse health conditions).”

He pointed to a 2014 study from Kansas State University showing differences in health satisfaction between obese men and women. That study found that 72.8–94 percent of overweight and obese men were satisfied with their health as compared to 56.7–85 percent of overweight and obese women.

“This skewed male body perception hinders the likelihood of seeking health care advice,” said Horgan. “This is something we hope to change by educating men about the need to treat obesity earlier, so they don’t develop complications in the future.”

“Bariatric surgery contributes to improving medical conditions associated with obesity, such as diabetes, high blood pressure, high cholesterol, sleep apnea, and arthritis. Men need to wake up to the need to control their obesity.”

Age also plays a pivotal role in the gender differences, said co-author Cristina Harnsberger, M.D., of the UC San Diego Department of Surgery’s Division of Minimally Invasive Surgery, noting more men seek bariatric surgery as they age. “There are still more women than men, but when people get into their 70s, the split narrows to about 70 percent women to 30 percent men,” she said. “Once they get sicker and older, men begin to seek bariatric surgery in greater numbers.”

Another possible explanation for the higher rate of females undergoing bariatric surgery is greater eligibility, said the researchers. A recent analysis of racial trends in U.S. bariatric surgery by Medical University of South Carolina researchers found an overall larger proportion of females were eligible for the surgery from 1999–2010. According to the National Hospital Discharge Survey and National Health and Nutrition Examination Survey databases, the proportion held true across ethnic groups.

The scientists did note that race and income appeared to affect male to female surgery ratios within certain populations. “A significantly higher female percentage was observed in counties with lower median income as well as in some ethnic groups,” said Hans Fuchs, M.D., co-first author with Ryan Broderick, M.D., both of the UC San Diego Division of Minimally Invasive Surgery. “This suggests that cultural differences and racial differences may accentuate the gender disparity,” added Broderick.

Co-authors include Bryan J. Sandler, Garth R. Jacobsen and David C. Chang, all at UCSD.

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Improving school nutrition with 21st century strategies


UC researchers to use nearly $2M grant for childhood obesity prevention in SF schools.

Students who use the SmartMeal app to pre-order nutritious meals will be able to pick up food at an express location.

By Craig Noble, ANR

Researchers at the UC Division of Agriculture and Natural Resources’ Nutrition Policy Institute and UC Berkeley School of Public Health will use a nearly $2 million childhood obesity prevention grant from the U.S.  Department of Agriculture to evaluate a two-year school meal technology and design innovation project developed by the San Francisco Unified School District (SFUSD). The project will measure the impact of 21st century student-centered strategies based on behavioral economics to increase student participation in the school lunch program, reduce plate waste, improve dietary intake and reduce obesity among low-income youth.

The “Technology and Design Innovation to Support 21st Century School Nutrition” project will assess the impact of using a “SmartMeal” technology platform, distributed points of sale and staff promotion of school meals at 12 SFUSD middle and high schools. Sixty percent of the district’s students are eligible for free and reduced-price meals, as part of the National School Lunch Program, the country’s largest child nutrition program. The researchers say that improving dietary intake among low-income youth is essential to reducing obesity, and schools are arguably the most important venue for change.

“Improving school meals is critical for addressing social inequities to healthful food access, said Lorrene Ritchie, Ph.D., R.D., UC ANR Nutrition Policy Institute director, Cooperative Extension specialist and co-primary investigator. “Poor nutrition is a primary cause of the obesity epidemic that threatens the health of American children, especially in low-income communities. We are targeting schools for interventions because most school-age children spend half of their waking hours and consume up to half of their daily calories in school.”

The project will use cutting-edge strategies reflecting scientific knowledge about behavior change among teens to increase school meal participation and reduce plate waste. For example, research has shown that convenience is a primary determinant of student behavior, and long meal lines and hectic cafeterias are a barrier to student participation. The project seeks to circumvent these hassles by giving students access to healthy foods in mobile food carts and vending machines outside the cafeteria. It also will feature a SmartMeal e-application that delivers nutrition education and school meal promotion to students on their smart phones and tablet computers provided by the district. Students who use the app to pre-order nutritious meals will be able to bypass long lines by going to an express food pick-up location.

“This project will test whether we can change behavior by addressing the reality of today’s adolescent lifestyles,” said Kristine Madsen, M.D., associate professor in the UC Berkeley School of Public Health and co-primary investigator.

“Mobile phones are ubiquitous among teens from diverse economic backgrounds, which makes this technology an ideal tool for promoting healthful food choices and nutrition education.”

The Nutrition Policy Institute was created in 2014 by UC Agriculture and Natural Resources, the division of the University of California charged with sharing research-based information with the public about healthy communities, nutrition, agricultural production and environmental stewardship. NPI seeks to improve nutrition and health in low-income communities in California and the nation by engaging in research and communications that inform, build and strengthen policy. SFUSD’s Future Dining Experience is funded by USDA and the Sara & Evan Williams Foundation.

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Researchers ID ‘beige’ fat-burning cells in humans


Energy-burning cells hold potential for new anti-obesity drugs.

Shingo Kajimura, UC San Francisco

By Steve Tokar

For the first time, a research team, led by a UC San Francisco biologist, has isolated energy-burning “beige” fat from adult humans, which is known to be able to convert unhealthy white fat into healthy brown fat. The scientists also found new genetic markers of this beige fat.

The discovery is an important advance in the search for new medications to fight obesity, said senior investigator Shingo Kajimura, Ph.D., UCSF assistant professor of cell and tissue biology, with a joint appointment in the UCSF Diabetes Center and the Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research at UCSF.

The finding was published online March 16 in Nature Medicine.

All mammals, including humans, have two types of fat with completely opposite functions: white, which stores energy and is linked with diabetes and obesity, and brown, which produces heat by burning energy and is associated with leanness. Human babies are born with brown fat as a natural defense against cold, and hibernating animals such as bears build up large stores of brown fat for the same reason.

Since 2009, explained Kajimura, it’s been known that adult humans also have significant amounts of brown fat. But until now, it had not been known whether this fat is the so-called classical brown fat of the type that babies are born with, or beige fat, which is found within white fat and has the ability to convert, or recruit, white fat into brown fat in response to cold or other stresses.

To answer that question, Kajimura and his team isolated and cloned single brown fat cells from two adult individuals. After sophisticated genetic and protein analyses of the cloned cells, they concluded that they had successfully isolated recruitable brown fat.

“This finding brings us another step closer to the goal of our laboratory, which is engineering fat cells to fight obesity,” said Kajimura. “We are trying to learn how to convert white fat into brown fat, and until now, it had not been demonstrated that this recruitable form of brown fat is actually present in humans.”

Now that they have a reliable human beige fat cell culture system, Kajimura said, his team will be able to use the system as a screening platform to identify and test small molecules that activate the development, differentiation, and thermogenic (heat-producing) activity of human brown fat.

The ultimate aim, he said, is the creation of drugs to turn white fat into brown fat through brown fat recruitment.

“If you think about obesity, it’s generally caused by an imbalance between energy intake and energy expenditure,” Kajimura said. “So far, all of the approved anti-obesity medications reduce energy intake by decreasing appetite. They work in the short term, but they often have side effects such as depression. If we have a compound that increases energy expenditure by recruiting new brown fat and activating brown fat thermogenesis, then it might work synergistically with conventional anti-obesity medications. This would be a novel approach to modulating whole-body energy balance.”

Co-authors of the study are Kosaku Shinoda, Ph.D., Ineke H. N. Luijten, Yutaka Hasegawa, M.D., Ph.D., Haemin Hong, Si B. Sonne, Ph.D., and Miae Kim, Ph.D., of UCSF; Ruidan Xue Ph.D., of Joslin Diabetes Center (JBS) and Harvard Medical School (HMS); Maria Chondronikola of Shriners Hospital for Children (SHC) and University of Texas (UT); Aaron M Cypess, M.D., Ph.D., and Yu-Hua Tseng, Ph.D., of JBS and HMS; Jan Nedergaard, Ph.D., of Stockholm University, Sweden; and Labros S. Sidossis, Ph.D., of SHC and UT.

The study was supported by funds from the National Institutes of Health, Pew Charitable Trust, Japan Science and Technology Agency, Japan Society for the Promotion of Science, and Manpei Suzuki Diabetes Foundation.

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Sense of smell may reveal weight bias


Prejudice against overweight people is likely more pervasive than previously thought.

By Rebecca Kendall, UCLA

Could our reaction to an image of an overweight or obese person affect how we perceive odor? A trio of researchers, including two from UCLA, says yes.

The researchers discovered that visual cues associated with overweight or obese people can influence one’s sense of smell, and that the perceiver’s body mass index matters, too. Participants with higher BMI tended to be more critical of heavier people, with higher-BMI participants giving scents a lower rating when scent samples were matched with an obese or overweight individual.

The findings, published online in the International Journal of Obesity and scheduled to be presented today (March 18) at the annual conference of the American Psychosomatic Society, suggest that the extent of negative bias toward overweight and obese people may be greater than previously believed.

“You wouldn’t think that not liking someone’s weight could then be seen in a totally different sensory modality, which makes us think, ‘How else is weight stigma affecting our lives that we don’t even know about?’” said A. Janet Tomiyama, a UCLA assistant professor of psychology. Tomiyama conducted the research with Angela Incollingo Rodriguez, a UCLA doctoral student in psychology, and Andrew Ward, a professor of psychology at Swarthmore College.

“This is the first step in proving that the consequences of weight stigma could be very widespread in ways that we don’t even know,” Tomiyama said.

Incollingo Rodriguez, the report’s lead author, said while some people are overtly biased, others are more subtle about it and may not even be aware that they harbor negative feelings toward heavy people.

“There are no checks and balances on weight stigma in the way you would see with racism, sexism or homophobia,” Tomiyama said.

In two related studies, the researchers showed subjects one of two sets of images. Both sets contained photographs of different people — half who were visibly overweight or obese, and half who were normal weight or thin — along with a series of “distractor” objects.

With each image they viewed, participants were asked to smell a container of lotion tinted with a different food coloring. Although all of the “scent samples” were actually fragrance free, the researchers wanted to test whether participants would perceive them to have different smells — and whether their reactions could be associated with the images they were viewing at the same time.

As each image appeared, the experimenter placed the scent sample under the participant’s nose. Participants were instructed to rate each scent of 1 to 11.  The more positive the rating, the more positive the reported smell.

The researchers found that when overweight or obese people were on the screen, participants gave worse ratings to the scent samples. Images of average-sized or thin people tended to trigger higher ratings.

The correlation between visual stimuli and sense of smell is well-established: Previous research has connected the perception of foul odors to feelings of disgust.

“Right now, we only have a couple of ways to measure implicit attitudes, such as an implicit-association test measure,” Incollingo Rodriguez said. “We wanted to see if looking at something you find unappealing or unpleasant could influence how you evaluate a smell that has nothing to do with weight. This shows that something is happening implicitly, and we may have tapped into a new methodology for assessing people.”

She said weight bias can affect people’s everyday lives in many different ways, including how they are treated in social situations, the quality of medical care they receive, and hiring and promotion decisions.

“It also undermines people’s motivation to diet and exercise,” Incollingo Rodriguez said. “If anything, stigma is a barrier to these lifestyle changes that people commonly use to lose weight.”

Weight bias can also affect people’s health, including by increasing their cortisol levels and by causing them to eat more. In 2014, a study by Tomiyama in the journal JAMA Pediatrics showed that simply being called “fat” at age 10 increased a girl’s chances of becoming overweight by the time she turned 19.

“By being aware of our deep-seated attitudes regarding weight, we can begin to change our behavior,” Incollingo Rodriguez said.

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Necklace and smartphone app can help people track food intake


UCLA-developed app could help battle obesity, heart disease and diabetes.

WearSens rests loosely above the sternum and uses highly sensitive sensors to capture vibrations from the action of swallowing.

By Bill Kisliuk, UCLA

A sophisticated necklace developed by researchers at the UCLA Henry Samueli School of Engineering and Applied Science can monitor food and drink intake, which could help wearers track and improve their dietary habits.

The inventors of the WearSens device say it could help battle obesity, heart disease, diabetes and other problems related to nutrition.

Majid Sarrafzadeh, a distinguished professor of computer science and co-director of UCLA’s Wireless Health Institute, led a team that created the device and an algorithm that translates data from the necklace, and tested it on 30 people who ate a variety of foods.

The researchers found that WearSens can differentiate between solids and liquids with 87 percent accuracy, between hot drinks and room-temperature drinks with 90 percent accuracy, and between food items with different textures with 80 percent accuracy. Researchers say those figures will improve as users calibrate the device based on their eating habits.

The research was published online by the IEEE Sensors Journal.

“Today, many people try to track their food intake with journals, but this is often not effective or convenient,” Sarrafzadeh said. “This technology allows individuals and health care professionals to monitor intake with greater accuracy and more immediacy.”

WearSens rests loosely above the sternum and uses highly sensitive piezoelectric sensors to capture vibrations from the action of swallowing. Piezoelectric sensors produce voltage based on the mechanical stress — or movement or pressure — that is applied to them.

When the wearer eats or drinks, skin and muscle motion from the lower trachea trigger the sensors, and the necklace transmits the signals to a smartphone, where the UCLA-developed algorithm converts the data into information about the food or beverage. The phone displays data about the volume of food or liquid consumed and can offer advice or analysis; for example, that the wearer is eating more than in previous days or that the person should drink more water.

With the WearSens device, the sensor information is translated using a spectrogram, which offers a visual representation of vibrations picked up by the sensors. Spectrograms are often used in speech therapy and seismology, among other applications.

“The breakthroughs are in the design of the necklace, which is simple and does not interfere with daily activity, and in identifying statistical measures that distinguish food intake based on spectrogram images generated from piezoelectric sensor signals,” said Nabil Alshurafa, a graduate student researcher at UCLA who is a co-inventor of the device and the first author of the research.

The study’s other authors are co-inventor Haik Kalantarian, a graduate student researcher; Shruti Sarin and Behnam Shahbazi, also graduate student researchers; Jason Liu, who was a UCLA graduate student at the time he worked on the research; and postdoctoral researcher Mohammad Pourhomayoun.

The team is continuing to refine the algorithms and the necklace’s design. The researchers hope WearSens will be available to the public later this year.

The technology is available for licensing via the UCLA Office of Intellectual Property and Industry-Sponsored Research, which facilitates the conversion of UCLA research to benefit the public.

The research was supported by the National Science Foundation.

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Partnership to broaden fitness opportunities for Los Angeles adolescents


UCLA Health System partners with Sound Body Sound Mind Foundation.

Students at East Valley High School workout on new equipment that was provided as part of a new program called UCLA Health Sound Body Sound Mind. (Photo by WorldWise Productions)

By Roxanne Moster, UCLA

UCLA Health System and the Sound Body Sound Mind Foundation have formed a partnership to provide practical ways to combat childhood obesity and promote healthy lifestyles in Los Angeles. The new entity, UCLA Health Sound Body Sound Mind, funded by a $3 million pledge from Sound Body Sound Mind, will replicate the foundation’s existing program model.

The announcement was made today at North Hollywood’s East Valley High School during the unveiling of a new, state-of-the art fitness center provided by UCLA Health Sound Body Sound Mind.

“We are proud to establish UCLA Health Sound Body Sound Mind as a means of strengthening preventive health solutions for middle school and high school students,” said Dr. David Feinberg, president of the UCLA Health System. “By encouraging students to embrace fitness in their adolescent years, we intend to address bad habits and inactivity before they become an integral part of their lives.”

“Our ultimate goal is to ensure that every student has the opportunity, knowledge and tools to pursue a healthy lifestyle through physical fitness,” said Bill Simon, co-founder of Sound Body Sound Mind. “Our collaboration with UCLA Health System will allow us access to their world-renowned resources and personnel. Ultimately, we believe this partnership will allow us to reach our goals faster and more effectively as we bring to bear the experience of both our organizations on this challenge.”

UCLA Health Sound Body Sound Mind will provide under-resourced schools with commercial-grade fitness equipment and an innovative curriculum designed to build students’ competence and confidence in a range of physical activities. The $3 million gift will enable UCLA Health System to expand its preventive care solutions among the city’s most vulnerable adolescent populations. The project exemplifies UCLA Health System’s commitment to community engagement.

Anastasia Loukaitou-Sideris, a UCLA professor of urban planning and associate dean of the Luskin School of Public Affairs, also has collaborated with the Robert F. Kennedy Community Schools to evaluate the effectiveness of the Sound Body Sound Mind curriculum and find ways to improve community health through additional research and publications.

According to the Los Angeles County Department of Public Health, 42 percent of children in L.A. County are overweight or obese and therefore have a higher risk for serious chronic health problems. More than one-third of children and adolescents were overweight or obese, according to a 2012 study by the Children’s Defense Fund.

UCLA Health Sound Body Sound Mind will give students the tools they need to take charge of their health by ensuring that they have access to fitness resources.

“Our population-based approach identifies and focuses on low-socioeconomic schools and formulates the best physical fitness resources for each school,” said Nathan Nambiar, executive director of the Sound Body Sound Mind Foundation. “This program will help to improve the health of thousands of young Angelenos, and over the long term it may drive down health care costs and help boost economic productivity.”

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Obesity poses serious health risks for moms and their babies


‘Eating for two’ no longer holds weight.

By Shari Roan, U Magazine

Veronica Romero was 21 years old and worried. Pregnant with her first child, she was putting on a lot of weight. Her obstetrician leveled with her: “You’re gaining too much.” But as she approached 50 pounds of weight gain near the end of her pregnancy, Romero felt helpless.

“I tried to watch what I was eating, but it was so hard. Pregnant women get cravings, and my cravings were sugary,” she recalled.

“I tried to eat carrots and small appetizers, but it didn’t work. I was disappointed. I didn’t want to get bigger.” The pregnancy set into motion a health crisis on two fronts: for Romero, now 38, and her son, Anthony, now 17. Romero eventually grew to nearly 300 pounds, and Anthony became a big baby, then a chubby toddler and now an obese adolescent.

This mother-child pair is not unique. The obesity tsunami that has washed across the United States over the past four decades has swept up pregnant women and their offspring too. In fact, pregnant women today are considered by some medical authorities to be at the nexus of the obesity crisis. Abundant research has revealed that pregnancy is a key period of increased risk for developing obesity in women and that obesity in pregnancy may genetically “program” offspring to become overweight or obese later in life.

The concept, commonly known as fetal programming, is rapidly altering the fields of obstetrics and pediatrics, said Dr. Sherin Devaskar, Mattel Executive Endowed Chair of the Department of Pediatrics, physician-in-chief of Mattel Children’s Hospital UCLA and assistant vice chancellor of children’s health. “There have been many studies to prove beyond a doubt that fetal programming is real. If a mother is obese, her babies are at very high risk for obesity and chronic disease.”

In the United States, more than half of all pregnant women are overweight or obese, according to the American College of Obstetricians and Gynecologists. An estimated 9 percent of babies are born macrosomic — weighing too much for their gestational age. Fetal macrosomia is typically defined as a birth weight of more than 9 pounds, 15 ounces, regardless of gestational age.

However, obesity in pregnancy can also result in babies who are born prematurely or underweight. These infants also seem to be predisposed to obesity and related diseases, such as diabetes and heart disease, later in life, Devaskar explained.

More than three decades ago, Dr. David Barker, a British physician and epidemiologist, linked birth weight, either excessively high or low, to a heightened risk of heart disease, type 2 diabetes and obesity in offspring. He posited that these diseases had their roots, at least in part, in under- or over-nutrition during pregnancy. If a pregnant woman is under-nourished, her infant is prone to low birth weight with a rapid “catch-up” gain in body fat later when exposed to plentiful food. If a pregnant woman is over-nourished, her infant is prone to high birth weight and a booming growth trajectory that increases the risk of obesity later in life.

The amount of nutrients provided to a developing fetus, as well as the type of nutrients, appears to chemically modify genes that predispose a child to obesity and obesity-related diseases, said  Devaskar, whose own research on the subject resulted in her election to the prestigious Institute of Medicine in 2012. Her current research focuses on whether or not it’s possible to further modify those genes to reverse the propensity to gain weight. “In the fetus, the organs are still developing,” she explained. “It’s a critical window of development, and it’s very plastic at that time. Any insult — whether it’s from diet, drugs or toxins — creates a permanent mark that lasts for one’s lifetime. The hypothalamus — the part of the brain governing metabolism and hunger — is already programmed. The infant is used to seeing so much nutrition coming from the mother. These children are ever-hungry; they are born hypersensitive to high-calorie foods. Their insulin sensitivity is low, so they are at high risk for developing diabetes, obesity and heart disease.”

In 2009, the Institute of Medicine issued revolutionary new guidelines to begin to address obesity in pregnancy. The group put tighter limits on weight gain in pregnancy, warning doctors to help their patients stay within a healthy range and even strictly limit weight gain in obese pregnant women to 11 to 20 pounds.

“It’s a major change,” said Dr. Aisling Murphy, assistant professor in the Division of Maternal-Fetal Medicine. “More recent data have suggested that obese women really don’t need to be gaining as much weight as women who enter pregnancy at a normal weight.”

Moreover, doctors are encouraging pregnant women to exercise — something many women had been fearful of doing. “Sometimes, women are under the impression that they shouldn’t be walking or going to the gym when they are pregnant. That is not the case,” Murphy said. “They really should be active.”

In addition to the risk of fetal programming, obesity during pregnancy is linked to several other potential complications. The chances of developing both hypertension and gestational diabetes are higher in pregnant women who are obese. About 7 percent of pregnant women in the United States develop gestational diabetes. Studies show that these women have an increased likelihood of developing type 2 diabetes later in life. In essence, gestational diabetes often isn’t a “temporary” condition that goes away after childbirth.

Obesity during pregnancy also raises the risk of some types of birth defects and other complications, such as an increased risk of Cesarean section or complications during childbirth, Murphy noted.

While two decades ago, few pregnant women were given extra resources and support they needed to manage weight gain, overweight or obese women who are planning to have children are now encouraged to seek pre-conception counseling, where they are given advice and resources to help them lose weight before becoming pregnant. And pregnant women who are obese are typically referred to a registered dietician for assistance with a healthy diet. Breastfeeding for at least six months is highly recommended to help the mother lose weight.

“If we can take care of young women before pregnancy and during pregnancy, we will end up with a healthier society, and it will bring down health care costs dramatically,” Dr. Devaskar said.

Read the complete story in the latest issue of U Magazine.

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UCSF researchers redefine role of brain’s ‘hunger circuit’


Unexpected findings have implications for anti-obesity therapies.

By Pete Farley, UC San Francisco

Using techniques developed only over the past few years, UC San Francisco researchers have completed experiments that overturn the scientific consensus on how the brain’s “hunger circuit” governs eating.

Because of this circuit’s potential role in obesity, it has been extensively studied by neuroscientists and has attracted intense interest among pharmaceutical companies. According to the UCSF scientists, their unexpected new findings could reshape basic research on feeding behavior as well as strategies for the development of new anti-obesity drugs.

Scientists have generally believed that the hunger circuit, made up of two groups of cells known as AgRP and POMC neurons, senses long-term changes in the body’s hormone and nutrient levels, and that the activation of AgRP neurons directly drives eating. But the new work shows that the AgRP-POMC circuit responds within seconds to the mere presence of food, and that AgRP neurons motivate animals to seek and obtain food, rather than directly prompting them to consume it.

“No one would have predicted this. It’s one of the most surprising results in the field in a long time,” said Zachary Knight, Ph.D., assistant professor of physiology at UCSF. “These findings really change our view of what this region of the brain is doing.”

It has been known for 75 years that a region at the base of the brain called the hypothalamus exerts profound control over eating behavior. As neuroscientists refined this observation over the ensuing decades, they zeroed in first on a small area of the hypothalamus known as the arcuate nucleus, and more recently on AgRP and POMC neurons, two small populations of cells within that nucleus.

These two groups of cells, which collectively occupy an area smaller than a millimeter in the mouse brain, are functionally organized in a seesaw-like fashion: when AgRP neurons are active, POMC neurons are not, and vice versa.

Hundreds of experiments in which scientists added hormones or nutrients to brain slices while recording the activity of AgRP and POMC neurons have laid the foundation of the dominant model of how the hunger circuit works. As we grow hungry, this view holds, gradual changes in hormone levels send signals that begin to trigger AgRP neurons, the activity of which eventually drives us to eat. As we become sated, circulating nutrients such as glucose activate POMC neurons, which suppresses the desire to eat more food.

Yiming Chen, a graduate student in Knight’s lab, was expecting to build on the prevailing model of the hunger circuit when he began experiments using newly developed fiber optic devices that allowed him to record AgRP-POMC activity in real time as mice were given food after a period of fasting. “No one had actually recorded the activity of these neurons in a behaving mouse, because the cells in this region are incredibly heterogeneous and located deep within the brain,” said Chen. “The technology to do this experiment has only existed for a few years.”

But as reported in the Feb. 19 online issue of Cell, just seconds after food was given to the mice, and before they had begun to eat, Chen saw AgRP activity begin to plummet, and POMC activity correspondingly begin to rise.

“Our prediction was that if we gave a hungry mouse some food, then slowly, over many minutes, it would become satiated and we would see these neurons slowly change their activity,” Knight said. “What we found instead was very surprising. If you simply give food to the mouse, almost immediately the neurons reversed their activation state. This happens when the mouse first sees and smells the food, before they even take a bite.”

The researchers found that the AgRP-POMC circuit could be quickly “reset,” with POMC cell activity dampened and AgRP neurons again beginning to fire, if the food were taken away. The magnitude of the transition from AgRP to POMC activity was also directly correlated with the palatability of the food offered: peanut butter and chocolate, both of which are much preferred by mice over standard lab chow, caused a stronger and more rapid reversal of AgRP-POMC activity. The AgRP-POMC responses also depended on the accessibility of the food. A slower and weaker transition was seen if the mice were able to detect the presence of peanut butter through smell, but couldn’t see the food.

These results show that, while slow, hunger-induced changes in hormones and nutrients activate AgRP neurons over the long term, these neurons are rapidly inactivated by the sight and smell of food alone. A major implication of this discovery, Knight and Chen said, is that the function of AgRP neurons is to motivate hungry animals to seek and find food, not to directly control eating behavior itself.

The fact that more accessible and more palatable, energy-rich foods engage POMC neurons and shut down AgRP activity more strongly suggests that the circuit also has “anticipatory” aspects, by which these neurons predict the nutritional value of a forthcoming meal and adjust their activity accordingly.

Both of these roles of the AgRP-POMC circuit make sense, said the researchers: if an animal has successfully obtained food, the most adaptive brain mechanism would suppress the motivation to continue searching; likewise, since energy-dense foods alleviate hunger for longer periods, discovery of these foods should more strongly tamp down the hunger circuit and the desire to seek additional nutrition.

“Evolution has made these neurons a key control point in the hunger circuit, but it’s primarily to control the discovery of food,” said Knight. “It’s controlling the motivation to go out and find food, not the intake of food itself.”

So far, clinical trials of drugs that target AgRP-related pathways have been disappointing, Knight said, and he believes the new research may provide a new perspective on these efforts. “What probably drives obesity is the rewarding aspect of food. When you want dessert after you’ve finished dinner, it’s because it tastes good, and that doesn’t require hunger at all,” Knight said. “Finding that this circuitry primarily controls food discovery rather than eating changes our view of what we might be manipulating with drugs targeting AgRP pathways. We might be manipulating the decision to go to the grocery store, not necessarily the decision to take the next bite of food.”

Other members of the Knight laboratory participating in the research were Yen-Chu Lin, research specialist, and graduate student Tzu-Wei Kuo. The research was supported by the New York Stem Cell Foundation, the Rita Allen Foundation, the McKnight Foundation, the Alfred P. Sloan Foundation, a NARSAD Young Investigator Grant from the Brain and Behavior Research Foundation, the Esther A. and Joseph Klingenstein Foundation, the Program for Breakthrough Biomedical Research, the UCSF Diabetes Center Obesity Pilot Program, and the National Institutes of Health.

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Molecular link between obesity, type 2 diabetes reveals potential therapy


UC San Diego researchers find that inflammatory molecule LTB4 promotes insulin resistance.

By Heather Buschman, UC San Diego

Obesity causes inflammation, which can in turn lead to type 2 diabetes. What isn’t well established is how inflammation causes diabetes — or what we can do to stop it. Researchers at the UC San Diego School of Medicine have discovered that the inflammatory molecule LTB4 promotes insulin resistance, a first step in developing type 2 diabetes. What’s more, the team found that genetically removing the cell receptor that responds to LTB4, or blocking it with a drug, improves insulin sensitivity in obese mice. The study is published today (Feb. 23) by Nature Medicine.

“This study is important because it reveals a root cause of type 2 diabetes,” said Jerrold M. Olefsky, M.D., professor of medicine, associate dean for scientific affairs and senior author of the study. “And now that we understand that LTB4 is the inflammatory factor causing insulin resistance, we can inhibit it to break the link between obesity and diabetes.”

Here’s what’s happening in obesity, according to Olefsky’s study. Extra fat, particularly in the liver, activates resident macrophages, the immune cells living there. These macrophages then do what they’re supposed to do when activated — release LTB4 and other immune signaling molecules to call up an influx of new macrophages. Then, in a positive feedback loop, the newly arriving macrophages also get activated and release even more LTB4 in the liver.

This inflammatory response would be a good thing if the body was fighting off an infection. But when inflammation is chronic, as is the case in obesity, all of this extra LTB4 starts activating other cells, too. Like macrophages, nearby liver, fat and muscle cells also have LTB4 receptors on their cell surfaces and are activated when LTB4 binds them. Now, in obesity, those cells become inflamed as well, rendering them resistant to insulin.

Once Olefsky and his team had established this mechanism in their obese mouse models, they looked for ways to inhibit it. First, they genetically engineered mice that lack the LBT4 receptor. When that approach dramatically improved the metabolic health of obese mice, they also tried blocking the receptor with a small molecule inhibitor. This particular compound was at one time being tested in clinical trials, but was dropped when it didn’t prove all that effective in treating its intended ailment. Olefsky’s team fed the prototype drug to their mice and found that it worked just as well as genetic deletion at preventing — and reversing — insulin resistance.

“When we disrupted the LTB4-induced inflammation cycle either through genetics or a drug, it had a beautiful effect — we saw improved metabolism and insulin sensitivity in our mice,” Olefsky said. “Even though they were still obese, they were in much better shape.”

Co-authors of this study include Pingping Li, Da Young Oh, Gautam Bandyopadhyay, William S. Lagakos, Saswata Talukdar, Olivia Osborn, Andrew Johnson, Heekyung Chung, Rafael Mayoral, Michael Maris, Jachelle M Ofrecio, Sayaka Taguchi, Min Lu, all at UC San Diego.

This research was funded, in part, by the National Institute of Diabetes and Digestive and Kidney Diseases (DK033651, DK074868, DK063491, DK09062), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Merck Inc.

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Study taps into healthy drink choices


Low-quality water in rural immigrant communities could be prompting kids to drink sugary beverages.

The water study is part of a five-year project investigating whether community-based intervention can help prevent childhood obesity.

By Jeannette Warnert, ANR

Having established a link between obesity and sugary beverages, doctors and nutritionists recommend that children instead drink plain tap water. In virtually all of the United States and California, tap water is the best drink available for good health.

However, a team of UC Cooperative Extension and UC Davis scientists have found that low-quality tap water in some rural immigrant communities could be an obstacle to making this healthy dietary change.

The study was conducted in conjunction with a five-year research and outreach project underway in Firebaugh and San Joaquin, small communities in the San Joaquin Valley with high Mexican-American populations. The researchers are investigating whether a community-based intervention – involving nutrition education, a monthly voucher of $25 to purchase fruit and vegetables, and a physical activity program – can help prevent childhood obesity in Californians of Mexican descent living in low-income rural communities. UC Agriculture and Natural Resources and UC Davis were recipients of a $4.8 million National Institute for Food and Agriculture grant to carry out this research.

Twenty-seven mothers in the study shared with the researchers whether they use tap water and gave their perceptions of tap water quality. In addition, the researchers assessed local water quality by the frequency of violations reported by Cal EPA and contaminant-level data from the California Department of Public Health.

Contamination concerns

All 27 mothers said they avoid drinking tap water due to unpleasant taste, dirty or yellow appearance, excessive iron or general “contamination.” Most of the women rely instead on bottled, and to a lesser extent, home filtered water for drinking and cooking.

“This cost is an extra burden for these families, many of whom have limited incomes,” said Lucia Kaiser, UC Cooperative Extension specialist in the Department of Nutrition at UC Davis.

The mothers shared in interviews that at least 38 percent of their children aged 3 to 8 years old drank sugar-sweetened beverages – such as soda, energy drinks, powered drink mixes or fruit punch – more than two or three times per week.

“The children may be drinking sugar-sweetened beverages so frequently because of real or perceived low quality of water coming from their taps,” Kaiser said. “I’m not surprised. One time I was in our Firebaugh office and turned on the tap and the water came out brown. “

Two state-regulated water systems serve the majority of people in Firebaugh and San Joaquin. The rest rely on at least 11 small public or private systems. All of the 13 systems have had monitoring violations in the last 12 years. Two have had reporting violations, indicating that they either did not test for contaminants or did not report their findings.

Seeking solutions

The mothers’ perception that tap water was unappealing or contaminated was confirmed when the researchers took a close look at regulatory analyses reports from previous years. There were low-levels of arsenic detected, which fell above the benchmark for safe drinking water in the U.S. The analyses also detected high levels of manganese and iron, which are considered secondary contaminants and do not have enforceable limits set by the EPA. However, the World Health Organization has set health benchmarks for manganese, which were exceeded in some samples.

“The neurotoxic effects of manganese and chronic exposure to low levels of arsenic warrant further study,” Kaiser said. “Even if it’s not dangerous, the high level of manganese and iron can give the water an off taste.”

Regardless, removing the contaminants may not matter if perceptions and drinkability are not improved. A possible solution is better communication.

“A simple step could be sending easy-to-understand water quality reports to all residents,” Kaiser said. “Sending reports to renters in addition to property owners and in Spanish as well as English will help raise awareness about the safety of local tap water.”

The study was funded in part by the UC Davis Center for Poverty Research, which developed a two-page policy brief outlining the research findings. UC Davis doctoral student Caitlin French was the main author. Other contributors, in addition to Kaiser, were postdoctoral researcher Rosa Gomez-Camacho, UC Cooperative Extension nutrition, family and consumer sciences advisor Cathi Lamp and UC Davis nutrition professor Adela de la Torre.

In the policy brief, the authors included some additional suggestions to address the issue:

  • Increase state funds to agencies working to identify who is at risk in order to bring more water systems into compliance
  • Provide subsidies for home water filters
  • Provide subsidies to private well owners in exchange for testing reports
  • Step up outreach to owners of targeted private water systems in known problem areas
  • Provide funding for additional research to inform outreach messages about substituting tap water for sugar-sweetened beverages

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