Britain and France grapple with child obesity problem

To combat the growing problem of child obesity, a French report Tuesday suggested imposing an anti-obesity tax on sweet and fatty foods, while British health officials want to avoid the label "obese" for very overweight children.The French plan would target foods such as pizzas and hamburgers as well as sodas and alcohol.

Drawn up jointly by the French tax and social affairs inspectorates, the report was handed to Budget Minister Eric Woerth and his counterpart for health Roselyne Bachelot late last month, ministry officials said Tuesday.

According to Les Echos newspaper, it calls for the VAT sales tax rate to be lifted from 5.5 percent to 19.6 percent on all food stuffs considered "too rich, too sweet, too salty and which are not strictly necessary."

Meanwhile, health authorities in Britain rejected criticism of plans to use the word "very overweight" instead of "obese" in letters to the parents of schoolchildren.

Officials said research showed the term obese "shuts people down" and was regarded as "highly offensive."

Instead they have recommended that the alternative term be used for children whose body mass index (BMI) exceeds 30.

The National Obesity Forum accused the government of being "prissy" and "namby pamby" by avoiding the word.

The proposals are designed to tackle the growing problem in Britain of overweight children, but the letters will put the onus on parents to contact their doctors or school nurse if they want further information.

Parents will be informed of the child's height and weight and say whether they are underweight, a healthy weight, overweight or very overweight.

Will Cavendish, director of health and wellbeing at the Department of Health, said there was a danger that parents would not react to the information at all if they received a letter containing the word "obese".

"We have not banned (the word obese) but we have chosen not to use it," he said. "There's no point giving them a letter that doesn't have any impact on their behaviour."

Tam Fry, a board member of the National Obesity Forum, however, said experts in the United States had also suggested banning the term obese but had now decided the word was necessary.

"The Americans have gone back to using the term because it's the kind of shock word that makes parents sit up and take notice. It's a nasty word but by God it should sound alarm bells in parents' minds.

"I find this whole approach from the Department of Health a bit prissy and namby pamby."

Two thirds of French men and half of all women aged 35 to 74 are thought to be overweight, according to a study released in June, while one fifth of all adults are obese.

France has taken steps to combat obesity in children with vending machines banned in schools since 2005.

A national programme in Britain now aims to weigh and measure children at age four to five and again aged 10 to 11, but parents can opt out of the process

Overweight problems seen even in infants

New research indicates that problems associated with being overweight occur at a much younger age than previously thought.In a study reported in the journal Pediatrics, overweight infants were at increased risk for developmental delays and possibly breathing problems, such as asthma. Moreover, in most cases, parents were unaware of their child's weight problem.

"Although the consequences of infant and childhood excess body weight may seem to manifest in later years, this perception is inaccurate," Dr. Ron Shaoul, from Bnai Zion Medical Center in Haifa, Israel, and colleagues warn.

"Our findings indicate a need to intervene during these critical years by adopting proper eating habits and active lifestyles," they add.

The findings are based on two studies. The first involved 2139 infants not older than age 2 who were admitted for any reason to the Bnai Zion Medical Center in 2004 and 2005. The second study was community-based and used parental interviews to assess the problems seen in 79 overweight infants and 144 normal-weight infants.

The infants were considered overweight if they had a body mass index (BMI) above the 85th weight-for-height percentile on 2 or more measurements taken at least 3 months part. This means that 85 percent of children their age and gender have a lower BMI, which is a measure of weight in relation to height.

In the first study, the researchers found that infants between the 85th and 94th weight-for-height percentiles actually had fewer hospital admissions and repeat admissions than normal-weight infants. However, higher than expected admission rates were seen in the most overweight infants (95th or higher percentile).

In the second study, overweight infants were more likely than their normal-weight peers to have developmental delays and snoring. There was also evidence that asthma and other breathing problems were more common in overweight infants.

When surveyed, only about 32 percent of mothers with an overweight child believed that their child was overweight.

Parents need to be aware that even infants are at risk for problems related to excess body weight and, therefore, should strive to achieve a normal weight in their young children, Shaoul and colleagues conclude.

SOURCE: Pediatrics, August 2008.

Clinton honors 43 schools for anti-obesity efforts

Former President Clinton is honoring 43 schools for their anti-obesity efforts, including one that banished candy from its building and another that offers a student fitness club.In a ceremony Wednesday at his presidential library in Little Rock, the former president planned to recognize the schools from a dozen states for their participation in the Healthy Schools Program, a joint initiative of the William J. Clinton Foundation and the American Heart Association.

"Despite the rising food prices and constrained budgets impacting programs nationally, these schools are using innovative approaches to curb the country's alarming rates of childhood obesity," Clinton said. "Schools around the country are stepping up and making progress."

The schools being honored include Kenly Elementary School in Tampa, Fla., which banished candy from its building.

A fitness club is offered to students at the Pine Hill Middle School in New Jersey, and the staff does yoga twice a week.

The Healthy Schools Program started in 2006 and now includes nearly 3,000 schools and more than 1.66 million students. It provides in-person support to 1,364 schools and aims to boost that number to 8,000 by 2010.

All U.S. adults could be overweight in 40 years

If the trends of the past three decades continue, it's possible that every American adult could be overweight 40 years from now, a government-funded study projects.The figure might sound alarming, or impossible, but researchers say that even if the actual rate never reaches the 100-percent mark, any upward movement is worrying; two-thirds of the population is already overweight.

"Genetically and physiologically, it should be impossible" for all U.S. adults to become overweight, said Dr. Lan Liang of the federal government's Agency for Healthcare Research and Quality, one of the researchers on the study.

However, she told Reuters Health, the data suggest that if the trends of the past 30 years persist, "that is the direction we're going."

Already, she and her colleagues point out, some groups of U.S. adults have extremely high rates of overweight and obesity; among African- American women, for instance, 78 percent are currently overweight or obese.

The new projections, published in the journal Obesity, are based on government survey data collected between the 1970s and 2004.

If the trends of those years continue, the researchers estimate that 86 percent of American adults will be overweight by 2030, with an obesity rate of 51 percent. By 2048, all U.S. adults could be at least mildly overweight.

Weight problems will be most acute among African-Americans and Mexican- Americans, the study projects. All black women could be overweight by 2034, according to the researchers, as could more than 90 percent of Mexican-American men.

All of this rests on the "big assumption" that the trends of recent decades will march on unabated, Liang acknowledged.

"This is really intended as a wake-up call to show what could happen if nothing changes," she said.

Waistlines aren't the only thing poised to balloon in the future, according to Liang and her colleagues. They estimate that the healthcare costs directly related to excess pounds will double each decade, reaching $957 billion in 2030 -- accounting for one of every six healthcare dollars spent in the

U.S.

Those financial projections are based on Census data and published estimates of the current healthcare costs attributed to excess weight -- and they are probably a "huge underestimate" of what the actual costs will be, Liang said.

The findings highlight a need for widespread efforts to improve Americans' lifestyles and keep their weight in check, according to the researchers. Simply telling people to eat less and exercise more is not enough, Liang noted.

Broader social changes are needed as well, she said -- such as making communities more pedestrian-friendly so that people can walk regularly, or getting the food industry to offer healthier, calorie-conscious choices.

"It really needs to be more than an individual effort," Liang said. "It needs to be a societal effort."

SOURCE: Obesity, online July 24, 2008.

Prostate cancer prognosis worse in obese men

Prostate cancer diagnosis tends to be delayed and surgical treatment more difficult in obese men than in lean men, according to two studies published Friday.The primary reason for the later diagnosis, and consequently poorer prognosis, seems to be that the PSA test used to screen for prostate cancer is "biased" against obese men, according to researchers.

The problem, they explain, may stem from obese men's larger blood volume, which dilutes their PSA levels. High blood levels of PSA -- or prostate specific antigen - can signal the presence of a prostate tumor.

"We know that obese men tend to have lower PSA values than their normal-weight counterparts, possibly caused by larger blood volumes which dilute their readings," Dr. Stephen J. Freedland, who led the studies, said in a written statement.

"Now we know some of the real implications of this -- that these men are at a disadvantage in terms of prognosis compared to normal-weight men."

Freedland, of Duke University Medical Center in Durham, North Carolina, and his colleagues report their findings online in the journal BJU International.

In one study, the researchers looked at the outcomes of nearly 3,400 prostate cancer patients who had undergone surgical removal of the prostate between 1988 and 2007. Some had had their cancer detected by PSA, while the rest had had it discovered during a digital rectal exam.

Overall, Freedland's team found, obese men were more likely to have more-aggressive tumors and to suffer a cancer recurrence after surgery.

However, the link between weight and disease progression was limited to men treated since 2000, when PSA screening had become the norm.

By contrast, obesity had no effect on the risk of progression for cancers detected by digital rectal exam. The findings support the notion that PSA testing, in particular, confers a bias against obese men, according to Freedland.

In the second study, the researchers found that obese prostate cancer patients tend to have a higher rate of "positive surgical margins" after prostate removal -- which means the odds are higher that some tumor cells were left behind.

"The aggressiveness of obese men's tumors, coupled with the fact that they may be more difficult to remove, is like a double whammy for being obese," Dr. Jayakrishnan Jayachandran, another researcher on the studies, said in a statement.

The findings of both studies, according to Freedland, build up the case for developing alternative prostate cancer screening methods for obese men -- or for lowering the PSA threshold for these patients.

"The least we can do is find a way to level the playing field when it comes to diagnostic tools," Freedland said.

SOURCE: BJU International, online August 8, 2008.

Obese Men Face Twin Threat From Prostate Cancer

The standard screening test for prostate cancer may not be accurate for obese men, leaving them more vulnerable to the disease, and surgery is less likely to be effective for them, a new pair of studies found."Obese men are more likely to be diagnosed with an aggressive form of the disease," said Dr. Stephen Freedland, an associate professor of urology and pathology at the Duke University Prostate Center, and an author of one of the studies.

The reason: The blood test that looks for elevated levels of the protein prostate-specific antigen (PSA), indicating a heightened cancer risk, doesn't seem as reliable for obese men, Freedland said.

"Our assumption is that these men have more blood volume, so PSA gets diluted, he said. "By the time obese men get to elevated levels, the cancer is more advanced."

The study, published online Friday in the journal BJU International included nearly 3,400 men who had PSA tests. The researchers found that the risk of an aggressive cancer was doubled in obese men diagnosed because of high PSA levels. No such association was found for obese men diagnosed by a digital rectal examination, in which the physician feels for an abnormally large prostate gland.

Prostate cancer is suspected when the PSA reading is 4 or higher. The current recommendation is for men aged 50 and older to be offered an annual PSA test, with explanations of its possible risks and benefits. A federal preventive medicine committee this week said that PSA screening should not be done for men aged 75 and older because the risks outweigh the benefits.

"I'm not sure that we should check obese men more often," Freedland said. "But we should have a higher [PSA] index of suspicion of what is not normal -- 3.4 rather than 4; for really obese men, 3.2."

The Duke study measured obesity using body-mass index, which is a ratio of weight to height. Obesity is defined as a BMI of 30 or more.

A second report from Duke in the same issue of the journal found that excess weight influenced the outcome of surgery for prostate cancer. Men with a BMI of 35 or higher were nearly 60 percent more likely to have a recurrence of the cancer than thinner men, the study of 1,434 men found.

One reason is "the difficulty of operating on obese men in general," said study author Dr. Jayakrishnan Jayachandran, a urology oncology fellow at the Duke Prostate Cancer Center. "The prostate is a narrow thing to operate on, and when there is a big wad of fat in your way, if the abdominal wall is thick, it becomes a technical issue."

The result is that not all the cancer may be removed, which means a recurrence after time, Jayachandran said. "The only thing we can think of is that when you operate on obese people, you have to be more careful," he said.

The studies results apply to men who might not regard themselves as obese, Freedland said. "We can't forget that when we use the term, we are not just talking about very large men," he said. "A man who is 5 foot 9 and weighs 203 pounds would be considered obese."

Jayachandran added, "We are not screening these obese men effectively and are not doing as good a job surgically as could be done."

Fit and fat: Study shows it's possible

It may be possible to be both fat and healthy, researchers reported on Monday, for at least half of overweight adults, and close to a third of obese men and women, have normal blood pressure, cholesterol and other measures of heart health.And being lean does not necessarily protect people, either. Close to a quarter of normal-weight U.S. adults in one study had risk factors for heart disease or diabetes.

"We really don't know as much about obesity as we think we do," Judith Wylie-Rosett of the Albert Einstein College of Medicine in New York, who oversaw the study, said in a telephone interview.

"A considerable proportion of overweight and obese U.S. adults are metabolically healthy, whereas a considerable proportion of normal-weight adults express a clustering of cardiometabolic abnormalities," Wylie-Rosett and Rachel Wildman and colleagues wrote in their report, published in the journal Archives of Internal Medicine.

Wylie-Rosett's team looked at data on 5,440 men and women who were examined and filled out questionnaires for the National Health and Nutritional Examination Surveys between 1999 and 2004. Most did not exercise very much.

They found just over 51 percent of those who were overweight, and 31.7 percent of those who were obese, had healthy levels of cholesterol, blood sugar, blood pressure and other measures linked to heart disease.

These measures have been shown in many other studies to predict heart attacks, strokes, diabetes and other heart disease, although this particular study did not look at whether people suffered any of these problems.

OBESE YET HEALTHY

More than 23 percent of those who were at a healthy weight, as measured by body mass index, had two or more unhealthy readings, the researchers found.

"Our study shows you can still be healthy even if you are obese," Wylie-Rosett said.

Her team did not look at people's diets, but she believes the location of body fat is as important as how much there is. Many studies have shown that having visceral fat, in and among the internal organs, may be more dangerous than having fat thighs or buttocks.

But when Wylie-Rosett's team measured waist circumference, a common way to estimate visceral fat, more than 36 percent of the obese people with what should have been dangerously large waists had healthy blood test results.

A second study suggested that the liver may be the key.

Dr. Norbert Stefan and colleagues at the University of Tubingen in Germany closely examined 314 people, using magnetic resonance imaging to look at precisely how much body fat they had and where it was.

They also found that obese men and women could have healthy hearts and arteries and suggested that having fat on the liver may be what makes the difference.

"Altogether, 10 percent of the study population and 25 percent of the obese subjects had a high insulin sensitivity phenotype or 'metabolically benign obesity,"' they wrote in their Archives report.

"Our data suggest that ectopic fat accumulation in the liver may be more important than visceral fat in the determination of such a beneficial phenotype in obesity," they wrote.

"That's an area that we are very intrigued with as well," Wylie-Rosett said," adding: "If you start stuffing people with calories, it is very much like making pate from goose liver."

Geese are often force-fed to make their livers fatty and thus more suitable for pate-making.