People struggled to manage their weight during COVID-19 lockdown
26 July 2022
Just in case you were wondering, you are not alone in having been negatively affected by lockdowns with respect to your eating habits and, as a result, your weight. It is no surprise to me that it is such a big proportion of people (65%) for whom lockdowns caused weight gain. Lockdowns were such a unique situation and it brought about changes in our lifestyle that we were definitely unprepared for. Interestingly, there was a proportion of people who were experiencing positive impacts, and these were people who were receiving support from a 'slimming club'. I take from that that building up a support network that will help with your weight loss journey would seem to be extremely important. This also applies to people who choose to go down the bariatric surgery pathway as well! Look forward to meeting you soon.
More than half of adults have found it difficult to manage their weight during the COVID-19 lockdown, according to the results of an online survey involving over 800 UK adults, presented at The European and International Congress on Obesity. Most of the respondents said their difficulties stemmed from increased snacking, not exercising as much as usual, increased anxiety or stress and not being able get hold of healthier food. However, those questioned who had received weight-management support from a slimming club continued to lose weight during this time, exercised more and reporting higher overall wellbeing compared to respondents from the general population.
The findings come at a time when the UK Government has unveiled a new obesity strategy with its 'Better Health' campaign to encourage millions of adults to kick start their health and reduce their risk of serious illness, including COVID-19. An estimated two-thirds (63%) of UK adults are above a healthy weight, with 36% having overweight and 28% having obesity.
The research was organised by Slimming World as part of their Health and Wellbeing Study, which is surveying new members regularly over the course of one year about aspects of their health and lifestyle. The survey at the six-month point coincided with lockdown, so questions were added to learn more about how lockdown measures had impacted the nation's health, wellbeing, and lifestyle behaviours.
Between April and May 2020, 222 Slimming World members (94% female, average age 52 years) and a representative sample of 637 adults in the general population completed an online survey asking their opinions about their general health, mood, diet, alcohol intake, physical activity and weight management.
Similar proportions of the general population (65%; 414/637) and Slimming World members (59%; 131/222) admitted to finding managing their weight since lockdown "very" or "somewhat difficult". The four key reasons given by both groups included difficulty getting to the shops and obtaining the usual healthy foods; boredom and being at home leading to increased snacking; higher levels of stress and anxiety leading to comfort eating; and more sedentary time and exercising less. However, some respondents in both groups reported some benefits of lockdown including more time to plan meals, cooking from scratch and sticking to a routine.
Two in five (42%) Slimming World members and one in three (34%) of the general population admitted eating more sugary foods during lockdown, while one in four (27%) members and one in five (18%) of the general population reported reaching for fatty foods. When looking at key parts of the diet, data indicated that members had a healthier overall diet than non-members (healthy eating score 13 vs 10; with a higher value indicating better overall diet quality).
This could help explain why Slimming World members reported continuing to lose weight during this time, with an average weight loss of 2kg (4.4 lbs) at the early stages of lockdown compared to three months earlier.
The research also highlighted differences in the impact of lockdown on overall health and wellbeing - fewer members said that their general health had been negatively affected compared to the general population (14% vs 22%). In addition, members said they had exercised more (25% vs 17%) and reported higher overall wellbeing (wellbeing score 28 vs 24; with a higher score indicating more positive wellbeing).
More than a quarter (28%) of members and 16% of the general population said they were drinking more alcohol during lockdown. Their reported alcohol intake was within government guidelines, with Slimming World members consuming around 13 units per week and respondents from the general population 14 units per week.
"Lockdown inevitably had an effect on our choices around food, drink and activity. Given that excess weight is associated with a higher risk of severe illness from COVID-19 and with lots of people coming out of lockdown feeling concerned about their weight and health, the findings of the study show behaviour change support is more important now than ever,” said study lead, Dr Sarah-Elizabeth Bennett, Slimming World's Senior Research Associate.
The authors of the study point to several limitations, including the reduced sample size of those who had completed all surveys to the point of lockdown and the inclusion of self-reported data which could be prone to reporting biases. The study included a representative sample of the general population at each timepoint, rather than following the same people, therefore it was difficult to make certain comparisons over time. The authors also noted that there could be variations in behaviour and wellbeing depending upon when respondents completed the survey, given the rapidly changing news and guidance during lockdown. Finally, they did not account for potentially confounding factors such as comorbidities, which may have influenced lifestyle behaviour changes.
T2DM patients should have bariatric surgery earlier
13 July 2021
The Scandinavian Obesity Surgery Registry has to be joined by every patient who has Bariatric Surgery in Scandinavian countries. Because of the wide inclusion of patients it makes it a very powerful tool for analysing outcomes. Any analysis relies on including as close to 100% of eligible patients as possible - and the SOSR achieves that. This analysis demonstrates the danger of type 2 diabetes - even for people considered pre-diabetic only. What follows is that the more successful a treatment is at preventing diabetes altogether, the more powerful it is. Weight loss surgery is the only treatment known that prevents people from becoming diabetic. And that is why it is becoming so popular for both patients, their medical specialists and their GPs.
Happy researching and I look forward to meeting you soon.
The latest findings from the annual Scandinavian Obesity Surgery Registry (SOReg) report could challenge existing recommendations and clinical practice for bariatric surgery and type 2 diabetes (T2DM) patients, according to the authors of a summary paper of the report, ‘Bariatric Surgery: There Is a Room for Improvement to Reduce Mortality in Patients with Type 2 Diabetes’, published in Obesity Surgery.
"SOReg provides a large high-quality database which gives the opportunity to better explore the associations between diabetes, weight loss after surgery, remission of diabetes and mortality," explained co-author of the paper, Professor Carel le Roux from the Diabetes Complications Research Center, University College Dublin, Dublin, Ireland. "Novel data which can only be obtained from these large datasets now challenge current guidelines and practice, because it appears as if we can improve significantly on our current best practice."
The 2020 SOReg report, published in May, examined 65,345 patients with up to ten-year follow-up after primary bariatric surgery and looked at the outcomes of patients with and without T2DM prior to surgery and those patients who achieved T2DM remission within one year after surgery. Crucially, the report found that the impact of T2DM duration on glycaemic remission suggest that patients with T2DM should have bariatric surgery earlier. Nevertheless, the SOReg report also shows that there was no change in the percentage of people with diabetes having bariatric surgery before 2012 (19.9%) or after 2012 (17.5%), “despite overwhelming evidence that bariatric surgery is superior to nonsurgical treatment”, the authors of the paper note.
Of the 65,345 patients included in the report, 11,990 (18.1%) patients had T2DM prior to bariatric surgery (gastric bypass or sleeve gastrectomy) and 19,281 (29.5%) had prediabetes. At 6.3 years after surgery, the report found that the mortality rate was 4.1% (487/11,990) in patients with T2DM prior to surgery, compared with 0.15% (798/53,355) in patients without T2DM prior to surgery (p<0.001).
“Thus, bariatric surgery reduces mortality compared with non-surgical medical care, but preoperative T2DM increases mortality 27-fold even after bariatric surgery. Therefore, more is needed to make bariatric surgery even better,” they write.
Moreover, in those patients with T2DM prior to surgery demonstrated improved survival if they achieved glycaemic remission one year after surgery. Some 2.9% (204/7,130) of patients died within 6.3 years despite achieving remission compared with 174 out of 3,379 patients (5.1%) who did not achieve glycaemic remission (p<0.001), meaning suboptimal glycaemic control one year after surgery was associated with a 1.7-fold increase in mortality.
They also noted that standard medications for T2DM with proven mortality benefits such as metformin, GLP-1 agonists etc are stopped after surgery - because the reduction in medication after surgery is a driver of the health economic benefit of bariatric surgery - without considering the impact on mortality. Therefore, the authors call for a “move away from the idea of surgery against medicine, but rather consider surgery with medicine.”
"We are getting better insight in what matters for the chance for remission and risk for relapse, but we could optimise this by improving collaboration between surgery and medicine," le Roux added. "Even if it seems possible to stop all drugs after surgery should we really do this? The question now is if we are keeping medications then which drug, which dose, and what metabolic targets should we aim for in the short and longer term? More work is needed, but we are on the right track."
The ‘healthy obesity’ myth
22 June 2021
This is an interesting piece of basic science that disproves the notion of being morbidly obese but 'healthy'. I do hear that a lot. "I'm actually really healthy." It's nice to 'feel' healthy but in reality the damage caused by obesity is still being done at a microscopic level. This does mean that the inevitability of developing medical problems associated with being overweight is a certainty unless a drastic intervention kicks in. The final statement about following these people who had the fat biopsy prior to Bariatric surgery to re-take a sample after weight loss following Bariatric surgery will be an exciting observation. This will show microscopic changes back to a healthy appearance with significant weight loss, would be my guess... Watch this space!
Fire away with any questions if you have any.
Look forward to meeting soon.
The term "healthy obesity" has gained traction over the past 15 years, but scientists have recently questioned its very existence. A study published in the journal Cell Reports provides further evidence against the notion of a healthy obese state, revealing that white fat tissue samples from obese individuals classified as either metabolically healthy or unhealthy actually show nearly identical, abnormal changes in gene expression in response to insulin stimulation.
"The findings suggest that vigorous health interventions may be necessary for all obese individuals, even those previously considered to be metabolically healthy," said first author, Dr Mikael Rydén of the Karolinska Institutet, Solna, Sweden. "Since obesity is the major driver altering gene expression in fat tissue, we should continue to focus on preventing obesity."
Obesity has reached epidemic proportions globally, affecting approximately 600 million people worldwide and significantly increasing the risk of heart disease, stroke, cancer, and type 2 diabetes. Since the 1940s, evidence supporting the link between obesity and metabolic and cardiovascular diseases has been steadily growing. But in the 1970s and 80s, experts began to question the extent to which obesity increases the risk for these disorders. Subsequent studies in the late 90s and early 2000s showed that some obese individuals display a relatively healthy metabolic and cardiovascular profile.
Recent estimates suggest that up to 30% of obese individuals are metabolically healthy and therefore may need less vigorous interventions to prevent obesity-related complications. A hallmark of metabolically healthy obesity is high sensitivity to the hormone insulin, which promotes the uptake of blood glucose into cells to be used for energy. However, there are currently no accepted criteria for identifying metabolically healthy obesity, and whether or not such a thing exists is now up for debate.
To address this controversy, in their study ‘The Adipose Transcriptional Response to Insulin Is Determined by Obesity, Not Insulin Sensitivity’,Rydén, Carsten Daub, and Peter Arner of the Karolinska Institutet assessed responses to insulin in 15 healthy, never-obese participants and 50 obese subjects enrolled in a clinical study of gastric bypass surgery. The researchers took biopsies of abdominal white fat tissue before and at the end of a two-hour period of intravenous infusion of insulin and glucose. Based on the glucose uptake rate, the researchers classified 21 obese subjects as insulin sensitive and 29 as insulin resistant.
Surprisingly, mRNA sequencing of white fat tissue samples revealed a clear distinction between never-obese participants and both groups of obese individuals. White fat tissue from insulin-sensitive and insulin-resistant obese individuals showed nearly identical patterns of gene expression in response to insulin stimulation. These abnormal gene expression patterns were not influenced by cardiovascular or metabolic risk factors such as waist-to-hip ratio, heart rate, or blood pressure. The findings show that obesity rather than other common risk factors is likely the primary factor determining metabolic health.
"Our study suggests that the notion of metabolically healthy obesity may be more complicated than previously thought, at least in subcutaneous adipose tissue," added Rydén. "There doesn't appear to be a clear transcriptomic fingerprint that differentiates obese subjects with high or low insulin sensitivity, indicating that obesity per se is the major driver explaining the changes in gene expression."
One limitation of the study is that it examined gene expression profiles only in subcutaneous white fat tissue, not other types of fat tissue or other organs. Moreover, all of the obese subjects were scheduled to undergo bariatric surgery, so the findings may only apply to individuals with severe obesity.
In future research, Rydén and his collaborators will track the study participants after bariatric surgery to determine whether weight loss normalises gene expression responses to insulin. They will also look for specific genes linked to improved metabolic health in these individuals.
In the meantime, the study has an important take-home message: "Insulin-sensitive obese individuals may not be as metabolically healthy as previously believed," he said. "Therefore, more vigorous interventions may be necessary in these individuals to prevent cardiovascular and metabolic complications."
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