A group within the US Department of Health and Human Services called the US Preventive Services Task Force (USPSTF – for those who enjoy acronyms) just published a set of recommendations that strongly endorse the value of treating childhood and adolescent obesity with intensive CBT treatments.  This note provides a description of this group, a summary of key conclusions, an historical perspective on this new set of recommendations relative to two other sets of recommendations, and a bottom line recommendation for you to consider.

Here is the scoop on USPSTF, check out this website for additional details and a list of the current members of this group: http://www.ahrq.gov/clinic/uspstfab.htm <http://www.ahrq.gov/clinic/uspstfab.htm>

About USPSTF: As you’ll see from the information below, this is a very medically oriented group.  At the time this report was finalized it consisted of 16 people– primarily academic primary care physicians and administrators– not primarily researchers, but practitioners and teachers at university medical centers.  Several of them do a fair amount of research, but I do not believe any of them specializes in research on obesity.

The U.S. Preventive Services Task Force (USPSTF), first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the “gold standard” for clinical preventive services. The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care. Background and Mission <http://www.ahrq.gov/clinic/uspstfab.htm#Background#Background>  / Process <http://www.ahrq.gov/clinic/uspstfab.htm#Process#Process>  / Members of the USPSTF <http://www.ahrq.gov/clinic/uspstfab.htm#Members#Members>  / Role of AHRQ Staff <http://www.ahrq.gov/clinic/uspstfab.htm#Role#Role>  / Role of Partners <http://www.ahrq.gov/clinic/uspstfab.htm#Partners#Partners>  / Impact of the USPSTF <http://www.ahrq.gov/clinic/uspstfab.htm#Impact#Impact>  / For More Information <http://www.ahrq.gov/clinic/uspstfab.htm#Information#Information>

Background and Mission: Public Law Section 915 mandates that AHRQ convene the USPSTF to conduct scientific evidence reviews of a broad array of clinical preventive services, develop recommendations for the health care community, and provide ongoing administrative, research, technical, and dissemination support. The Task Force’s pioneering efforts began with the 1989 Guide to Clinical Preventive Services. A second edition of the Guide was published in 1996. The current Guide to Clinical Preventive Services <http://www.ahrq.gov/clinic/pocketgd.htm> is available on the Web. Return to Contents <http://www.ahrq.gov/clinic/uspstfab.htm#contents#contents>

Process: The Task Force makes its recommendations on the basis of explicit criteria. Recommendations issued by the USPSTF are intended for use in the primary care setting. The USPSTF recommendation statements present health care providers with information about the evidence behind each recommendation, allowing clinicians to make informed decisions about implementation.* <http://www.ahrq.gov/clinic/uspstfab.htm#asterisk#asterisk>   The USPSTF is supported by an Evidence-based Practice Center <http://www.ahrq.gov/clinic/epc/>  (EPC). Under contract to AHRQ, the EPC conducts systematic reviews of the evidence on specific topics in clinical prevention that serve as the scientific basis for USPSTF recommendations. The USPSTF reviews the evidence, estimates the magnitude of benefits and harms for each preventive service, reaches consensus about the net benefit for each preventive service, and issues a recommendation. The Task Force grades the strength of the evidence from “A” (strongly recommends), “B” (recommends), “C” (no recommendation for or against), “D” (recommends against), or “I” (insufficient evidence to recommend for or against).

*From: Harris RP, Helfand M, Woolf SH, et al. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20(suppl 3):21-35.

The primary conclusions reached in their 2010 recommendations:

a. Screen children aged 6 yr and older for obesity (using BMI standards).  Offer or refer for intensive counseling and behavioral interventions. They defined “intensive” as moderate or high levels of contact with professionals (moderate = 26-75 hours; high = >75 hours).  “Behavioral interventions” means CBT.  Counseling in this case refers to teaching about nutritional and physical activities.
They gave this recommendation a grade of “B.”  That means that “there is a high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”  In other words, DO IT – IT HELPS A LOT OF PEOPLE MOST OF THE TIME!

b. Lower intensity interventions (e.g., educational counseling alone about diet and activity) did not demonstrate “a significant consistent benefit.” In other words, just working with a dietitian or a trainer for relatively limited periods of time (even as many as 24 sessions) does not work.

c. The risk of harm of these intensive interventions is small. They found “no evidence of adverse effects on growth, eating disorder pathology, or mental health” for these programs. Recall the recent debates in which Wellspring researchers were engaged about this in which we argued against others who stipulated that such treatments do increase risk of harm.

Perspective – other sets of recommendations: In 2005, this group (probably a similar group of academically oriented medical professionals put together by this branch of the Department of Health and Human Services) recommended that BMI screening was valid to assess obesity.  However, they viewed the evidence of the effectiveness of CBT interventions for the treatment of childhood obesity as inadequate.  Considering the number and quality of studies available at that time, I find that conclusion very surprising.  On the other hand, remember that this group included folks who did not specialize in the treatment of obesity.
Now, however, they view the evidence differently.  They apparently commissioned a group of researchers to review the evidence for them (see reference 15).  The current evidence overwhelmingly shows the benefits short term and long term of CBT interventions combined with nutrition and physical activity counseling.
Two other sets of recommendations are attached.  You may recall seeing the 2007 “Expert Panel” recommendations published in Pediatrics (as is the present set of recommendations).  That group was comprised of representatives from 15 healthcare agencies, including the AMA and CDC.  Note that the summary of that group’s recommendations focused on 4 stages of interventions, from educational ones to intensive treatments (including immersion treatment and surgery).  That paper was 33 pages long and included 284 references.  The present USPSTF recommendations is 6 pages long and includes 19 references.  The former set of recommendations provided a much more detailed perspective on some of the relevant literature, but also agreed with the present group in advising that intensive CBT interventions are effective.  Our 7 Steps summary paper (also attached) agreed more with the conclusions of the USPSTF recommendations by asserting that educational counseling alone is simply inadequate.

Bottom Line: All three of the attached sets of recommendations support the work that we do in Wellspring (Wellspring Camps, Wellspring Academies, see www.wellspringweightloss.com). We provide the most intensive and promising versions of counseling + CBT interventions available anywhere – with locations geographically convenient for most families in the USA, as well as for many in Canada and the UK.

This study used complex statistical analyses to examine contributors to change and some could argue with their classifications of techniques and with the inclusion criteria they used for their studies.  Nonetheless, the results support the primacy of self-monitoring and indirectly support the importance of techniques that nurture healthy obsessions.

Self-monitoring – powerful in meta regression Michie HP 2009

ScienceDaily (Dec. 19, 2009) — Time and time again, it has been documented that regular exercise has many health benefits including lowering risks associated with the comorbidities of obesity. With only 30% of Americans trying to lose weight meeting the National Institutes of Health exercise guidelines of 300 minutes/week, a study in the January/February 2010 issue of the Journal of Nutrition Education and Behavior explores the paradox that exists — an antidote for obesity and its comorbidities is exercise, but the majority of obese Americans do not exercise.
Investigators explore and compare the barriers associated with regular exercise in health clubs between overweight and normal weight individuals.
Researchers at The George Washington University Medical Center examined overweight individuals’ intent to exercise at health clubs by administering an online survey instrument based on Ajzen’s Theory of Planned Behavior. This theory is based on
1.     one’s attitude toward the behavior in question,
2.     the perceived social pressure (subjective norm) to perform the behavior, and
3.     the ease or difficulty with which one can actually perform the behavior (perceived control).
Of the 1,552 individuals surveyed, 989 were classified into the overweight category.
The researchers found overweight individuals believed exercise improved appearance and self image more than normal weight individuals. In addition, overweight individuals felt more embarrassed and intimidated about exercising, exercising around young people, exercising around fit people, and about health club salespeople than individuals of normal weight. Overweight and normal weight individuals felt the same about exercising with the opposite sex, complicated exercise equipment, exercise boredom, and intention to exercise. The study interestingly found that the demographics of older age and overweight Caucasians (versus overweight non-Caucasians) had more of an effect on exercise intent than did weight. Most notably, the heavier the subject’s weight, the lower his or her perception of health. In other words, for the overweight, sedentary person, the negative emotions associated with health club exercise may be stronger in controlling regular exercise than the intellectual facts.
Writing in the article, the authors state, “One of the most noteworthy findings of this study was that OW [overweight] and NW [normal weight] subjects did not differ in their overall attitude toward exercising at a health club. This similarity in overall attitude of the OW and NW to club exercise is somewhat surprising, in that it is often assumed that OW people do not exercise as much as NW people because the 2 groups have different attitudes about exercise.
The behavior theories that propose that attitude drives the intent to exercise describe attitude as an evaluation of positive versus negative. If this is the case, then, it is important to minimize the negative and maximize the positive in order to promote the desired behavior. Thus, it would be wise for exercise professionals and commercial health clubs to help OW people feel more comfortable around those who are different from themselves and to minimize the intimidating aspects of the exercise environment, while promoting the benefits of exercise to personal health and wellbeing.
Regardless of which subset of the OW population is the target for increasing health club exercise, the ultimate goal is to increase the number of positive beliefs the individual has concerning exercising in a health club…Accordingly, individual beliefs about health club exercise should be evaluated for each new client. If a plan to increase the positive beliefs and reverse the negative beliefs is constructed and followed, the likelihood of retention of that client will be augmented.”

In an attempt to promote better nutrition for children, General Mills has announced they will be reducing the amount of sugar in their cereals for children under twelve years old. The prevalence of overweight children has increased, leading to various health problems. Although this effort does not illustrate a perfect solution, it is a step in the direction of improving children’s lives.

Food maker responds to calls for more nutritious breakfast food

WEDNESDAY, Dec. 9 (HealthDay News) — Good news for health-conscious parents: General Mills plans to further cut the amount of sugar in the cereals it markets to children under 12.

The Minneapolis-based company, the maker of such cereals as Lucky Charms and Cocoa Puffs, announced Wednesday that it will reduce the sugar content in 10 of its products to less than 11 grams, following up on product modifications begun two years ago.
“Our first target was to reduce sugar in cereals advertised to children to 12 grams of sugar or less,” Jeff Harmening, president of General Mills’ Big G cereal division, said in a prepared statement.
“As a result, we have already reduced sugar in many cereals, some by as much as 20 percent, and by spring General Mills cereals advertised to children will all have 11 grams of sugar per serving or less,” he said.
The move is part of an industry-wide response to complaints from consumers, health groups and federal regulators about the nutritional content of foods aimed at U.S. children, who are becoming increasingly overweight and obese, putting them at risk for a variety of health problems, including diabetes. Health experts worry that added sugar contributes to weight gain without providing any nutritional benefit.
“The reduction … doesn’t represent perfection but it represents improvement,” Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, told the Associated Press. “Children deserve to be marketed products that are healthier to them than what is being marketed now,” Brownell added.
According to General Mills, the product changes are not a response to criticism, but rather an attempt to make its products healthier. Other steps include increasing whole grain and nutrients in its cereals. Every Big G cereal now provides 8 grams of whole grain per serving or more, the company said.
Post Foods and Kellogg Co. have also made changes in their cereal lines. Kellogg’s Froot Loops, Apple Jacks and Corn Pops, among others, were updated last year, with sugar reduced by 1 to 3 grams and fiber added to some of the products, the AP said.
Post, which increased the vitamin D in Pebbles and Honeycomb cereals this year, has announced sugar reductions of 20 percent in its Fruity Pebbles and Cocoa Pebbles brands.
Misleading food packaging has come under attack from the U.S. Food and Drug Administration, which is trying to keep companies from touting false health benefits. Already one industry group has discontinued its “Smart Choices” labeling program, because of criticism that sugary cereals qualified for the seal of approval, the AP said.
A recent study published by the Rudd Center, which listed the 10 least healthy cereals, found that General Mills made six of the cereals on the list. It also found that the cereal giant markets to children more than any other cereal maker, the news service reported.
The study also found that children eat twice as much of the highly sweetened cereals as low-sugar cereals.

Is it genetics? Is it neglect or abuse from the parents? Is it the media? Since we know that genetics plays a role, is biology destiny? What exactly is to blame for child obesity? Well, Dr. Sadaf Farooqi and colleagues, James O. Hill, director of the Center for Human Nutrition at the University of Colorado in Denver, Dr. Marc Jacobson, of the American Academy of Pediatrics’ obesity leadership work group, ethicist Erika Blacksher, a research fellow at the Hastings Center, a nonpartisan bioethics research institution in Garrison, N.Y, Melinda Sothern, a clinical exercise physiologist at Louisiana State University New Orleans, and Virginia Williamson, general counsel for the South Carolina Department of Social Services are experts who raise interesting points examining what is to blame for children suffering form obesity.

Social service and legal authorities are grappling with the issue of when to intervene.
Los Angeles Times
December 21, 2009

When Dr. Sadaf Farooqi and colleagues discovered a genetic abnormality that caused severe obesity in a handful of children, she had no cure. Yet the scientist transformed four families’ lives nonetheless.

The British parents had been living in fear of losing their children — the youngsters’ severe obesity had been seen as a possible sign of abuse or neglect, and they had been put on the list of the country’s social services department.

“They were being blamed for their children’s condition, receiving frequent visits from social services, frequent reviews, knowing people could have their children taken away,” Farooqi said.

Farooqi told authorities that this abnormality — a DNA deletion — wiped out a key gene involved in the body’s response to leptin, a hormone that controls appetite. The children were taken off the list.

Farooqi’s study, published Dec. 6 in Nature, affected only five of about 1,200 severely obese youngsters. But as more genes related to obesity are unearthed, and as rates of childhood obesity climb, courts, social services and parents will increasingly have to grapple with difficult social and legal questions:

Can extreme childhood obesity be considered abuse? How much of a child’s weight can be blamed on the parents, and how much is out of their control?

Rising rates

A three-decade rise in childhood obesity rates has meant that related abuse and neglect cases are more often making their way into the courts. According to a 2008 report by the Child Welfare League of America, “California, Indiana, New Mexico, New York, Pennsylvania, and Texas have had to determine whether morbidly obese children whose parents are unable or unwilling to control their children’s weight against medical orders are properly considered abused or neglected.”

In 2007, North Carolina mother Joyce Painter was told she would lose her 255-pound, 7-year-old son if he did not show progress in his weight loss within two months.

And in June, South Carolina mother Jerri Gray lost custody of her son Alexander Draper after being charged with criminal neglect. The 14-year-old weighed 555 pounds. Gray is facing 15 years on two felony counts, the first U.S. felony case involving childhood obesity, said her lawyer, Grant Varner.

Such cases will require authorities to consider not only genetics but the helplessness parents can face in trying to regulate a child’s behavior, especially that of a teen, in today’s calorie-dense environment.

So far, genetic tests have played a very limited role in cases of childhood obesity in which authorities have become involved (Alexander Draper has not been tested, Varner says). The tests are fairly new, expensive and assess only a few of the genes known so far to strongly influence obesity.

In any case, for all but a small number of people, genes tell only part of the obesity story.

“What genetics does is sort of set the range of weights for you,” said James O. Hill, director of the Center for Human Nutrition at the University of Colorado in Denver. “If you’re somebody who is genetically predisposed . . . you may never be lean, but there’s still a wide range of weights in there.”

But today’s environment is likely to push many kids to the higher end of their range, said Dr. Marc Jacobson, who sits on the American Academy of Pediatrics’ obesity leadership work group. In 1955, he said, McDonald’s fries were 210 calories but the large portions more often consumed today are 500. A Coke was 6.5 ounces, versus 20 ounces in today’s plastic bottles. No wonder, he said, that today U.S. kids have an obesity rate of 15%, and that another 15% are overweight.

Food is everywhere

“Food is available 24/7. Domino’s delivers. We’re not programmed for that kind of environment,” Jacobson said. “We’re programmed for an environment where food is scarce.”

Some of the factors are hard for parents to control, especially if they live in disadvantaged communities, said ethicist Erika Blacksher, a research fellow at the Hastings Center, a nonpartisan bioethics research institution in Garrison, N.Y.

“It’s unfair to hold parents accountable for factors such as whether their neighborhoods have safe places for their children to play . . . or when their neighborhoods don’t have grocery stores that sell healthy foods,” she said. “We don’t want quick, easy, negative, punitive responses and tools.”

Melinda Sothern, a clinical exercise physiologist at Louisiana State University New Orleans who works with obese children, says physicians and social workers can be quick to rush to judgment and assume a parent is neglectful in such cases.

She cites an 8-year-old she treated who, at 6, had a body mass index of 48. The boy was so obese that he had to have knee surgery and use a machine to counteract his sleep apnea.

Genetic tests for two known obesity genes came up negative. The endocrinologist and social worker then suggested he be taken out of the home.

But, Sothern said, her patient’s mother was a single working mom in post-Katrina Louisiana who was not quite poor enough to qualify for Medicaid. She was making her doctors’ visits and enrolling her son in karate class.

Similarly, Varner said, Jerri Gray could not be held entirely responsible for what her son ate and did outside the home.

“She’s a single mom. She’s at work, busting her butt to make sure there’s a roof over their heads, and this kid’s at school six, seven hours a day,” Varner said. “Trying to control a teenager — that’s trying to knock down a solid brick wall with your bare hands.”

Virginia Williamson, general counsel for the South Carolina Department of Social Services, would not comment on the particulars of Gray’s case.

But, she said, “I think everybody wanted to see the mom supported and able to take care of her child. Our intervention only comes when we get information that there’s been a breakdown, in the form of a parent who isn’t following up with what the child’s doctors or treatment team would be recommending. That failure to follow up is placing the child at risk of harm.”

In the December issue of Archives of Pediatrics & Adolescent Medicine, Andrea Danese, M.D., M.Sc., of King’s College London, England, and colleagues studied the effects of adverse conditions in one’s childhood.  It seems that experiences with psychological and social adversities in childhood increases the risk of developing obesity, high blood pressure and other diseases in adulthood. With obesity and other chronic diseases reaching epidemic proportions in the world, becoming aware and active in prevention is fundamental from a health and financial perspective.

ScienceDaily (Dec. 8, 2009)

Individuals who experience psychological or social adversity in childhood may have lasting emotional, immune and metabolic abnormalities that help explain why they develop more age-related diseases in adulthood, according to a report in the December issue ofArchives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
As the population ages, age-related conditions such as heart disease, type 2 diabetes and dementia are becoming more prevalent, according to background information in the article. New ways of preventing these diseases and enhancing the quality of longer lives are needed. “Interventions targeting modifiable risk factors (e.g., smoking, inactivity and poor diet) in adult life have only limited efficacy in preventing age-related disease,” the authors write. “Because of the increasing recognition that preventable risk exposures in early life may contribute to pathophysiological processes leading to age-related disease, the science of aging has turned to a life-course perspective.”
Andrea Danese, M.D., M.Sc., of King’s College London, England, and colleagues studied 1,037 members of the Dunedin Multidisciplinary Health and Development Study, a long-term investigation of individuals born in New Zealand between April 1972 and March 1973. During the first 10 years of life, participants were assessed for exposure to three adverse experiences: socioeconomic disadvantage, maltreatment and social isolation. At age 32, they were evaluated for the presence of three risks for age-related diseases: depression, high inflammation levels (measured by the blood marker C-reactive protein) and the clustering of metabolic risk factors, including high blood pressure, abnormal cholesterol levels and being overweight.
Individuals who had experienced adverse events as children were at higher risk of developing depression, high inflammation levels and the clustering of metabolic risk factors at age 32. The researchers estimate that 31.6 percent of the cases of depression, 13 percent of the cases of elevated inflammation and 32.2 percent of cases with clustered metabolic risk factors could be attributed to adverse childhood experiences.
“The effects of adverse childhood experiences on age-related disease risks in adulthood were non-redundant, cumulative and independent of the influence of established developmental and concurrent risk factors,” such as family history, low birth weight or high childhood body mass index, the authors write.
“In conclusion, it has long been known that pathophysiological processes leading to age-related diseases may already be under way in childhood,” they continue. “The promotion of healthy psychosocial experiences for children is a necessary and potentially cost-effective target for the prevention of age-related disease.”

Wednesday, December 02, 2009

REUTERS
Children who are relatively tall may be more likely than their shorter peers to become overweight young adults, a study published Tuesday suggests.

The study, which followed 2,800 U.S. children, found that those who were both tall and overweight at age 8 were at greatest risk of being overweight or obese around the age of 18.

But even among children who were within the normal weight range, those who were relatively tall were more likely to be overweight by young adulthood.

It’s well known that overweight children often become overweight adults. However, the new findings, published in the American Journal of Preventive Medicine, suggest that extra height also puts some kids at risk for extra pounds in the long term.

This may be out of sync with what a lot of parents and doctors hope – namely, that taller children who are a bit heavy will keep getting taller while weight gain will slow — basically allowing them to “outgrow” their extra pounds.

Based on the current findings, extra height can instead be a liability. But it is not clear why that is, said lead researcher Dr. Steven Stovitz, an associate professor of family medicine and community health at the University of Minnesota in Minneapolis.

It’s likely, though unproven, he told Reuters Health, that in some children, taller height is a sign of “advanced skeletal maturity,” rather than a genetic predisposition toward being tall.

Advanced skeletal maturity essentially means that a child is moving toward his or her ultimate adult height more quickly compared with shorter kids. At a certain point, weight gain continues, but the rate of vertical growth slows down.

That results in an increase in the child’s body mass index (BMI) — a measure of weight in relation to height — and a higher risk of excess pounds and obesity.

The findings are based on 2,802 students whose weight and height were measured in 3rd grade and again in 12th grade. One-quarter were overweight or obese in 3rd grade, as were nearly 36 percent as high school seniors.

Overall, the study found, the odds of becoming an overweight young adult were greatest among overweight 3rd graders who were in the top 25th percentile for height — meaning they were taller than three-quarters of their same-sex peers.

These children had an 85 percent chance of still being overweight as high school seniors. Those odds were 67 percent among overweight children who were in the bottom 25th percentile for height.

Similarly, among normal-weight 3rd grade students, the tallest kids had a 25 percent probability of becoming overweight by 12th grade. That figure was 17 percent among the shortest children.

According to Stovitz, the findings may be most relevant to parents who are not tall but have a child who is — as that height may be a sign of advanced skeletal maturity. He noted that while all parents should try to ensure their children are eating healthfully and getting regular exercise, it may be particularly important in these cases.

When a child has two tall parents, Stovitz said, the extra vertical inches are probably just a sign that he or she will be a tall adult.

Reuters

NEW YORK (Reuters Health) – Children are generally pretty good at estimating their true body size but heavier kids, and particularly girls, seem more prone to underestimating their body size, research from the UK suggests.

Three investigators at University College, London asked 205 boys and 194 girls, 7 to 14 years old, to match their body size to one of seven numbered images of similarly aged boys and girls. The images ranged in body size from very thin to very heavy. They also asked the youngsters privately to describe their body size, giving them choices of too thin, just right, or too fat.

Actual measurements showed that 16 percent of the kids were underweight, just over 13 percent were overweight, 5 percent were obese, and the rest were at a healthy weight.

The investigators report that both boys and girls seemed to generally perceive their actual body size, but with consistent biases.

For example, underweight kids tended to identify a figure heavier than their own, while heavier children “showed a striking tendency toward underestimation of size,” Jane Wardle and colleagues report in the journal Archives of Disease in Childhood.

Among overweight and obese boys and girls, the vast majority matched themselves to a figure smaller than their own.

And a little more than half of the overweight and obese kids verbally described themselves as “just right” in body size.

As overweight and obesity rates rise, how youngsters perceive their body size has garnered more attention, the investigators note. Misperceptions of body size could influence whether overweight and obese individuals recognize the personal relevance of weight management recommendations, they warn.

SOURCE: Archives of Disease in Childhood, December 2009

Obesity places stress on the entire body and multiple organ systems. According to Dr. Burns, the strain of the excess weight causes back pain which is linked to higher morbidity rates among adults, as well as decreased quality and productivity of life.

PR Newswire
CHICAGO, Dec. 1 /PRNewswire/ — Being overweight as a child could lead to early degeneration in the spine, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

“This is the first study to show an association between increased body mass index (BMI) and disc abnormalities in children,” said the study’s lead author, Judah G. Burns, M.D., fellow in diagnostic neuroradiology at The Children’s Hospital at Montefiore in New York City.

In this retrospective study, Dr. Burns and colleagues reviewed MR images of the spines of 188 adolescents between the ages of 12 and 20 who complained of back pain and were imaged at the hospital over a four-year period. Trauma and other conditions that would predispose children to back pain were eliminated from the study.

The images revealed that 98 (52.1 percent) of the patients had some abnormality in the lower, or lumbar, spine. Most of those abnormalities occurred within the discs, which are sponge-like cushions in between the bones of the spine. Disc disease occurs when a bulging or ruptured disc presses on nerves, causing pain or weakness.

“In children, back pain is usually attributed to muscle spasm or sprain,” Dr. Burns said. “It is assumed that disc disease does not occur in children, but my experience says otherwise.”

According to the Centers for Disease Control and Prevention, 15 percent of U.S. children (age 6 – 11) and 18 percent of U.S. adolescents (age 12 -19) are overweight. BMI, a mathematical ratio of body weight and height, is a widely used measurement for obesity. Lower BMI is associated with being underweight or a healthy body size; higher BMI scores are associated with being overweight or obese. Children above the 85th percentile are generally classified as overweight or at risk of being overweight.

The researchers were able to determine an age-adjusted BMI for 106 of the total 188 patients. Fifty-four had BMI greater than the 75th percentile for age. Thirty-seven (68.5 percent) of these children showed abnormal findings on their spine MRI. Fifty-two patients fell into the lowest three quartiles. Only 18 (34.6 percent) of the children at or below a healthy weight had an abnormal MRI of the spine.

“We observed a trend toward increased spine abnormality with higher BMI,” Dr. Burns said. “These results demonstrate a strong relationship between increased BMI in the pediatric population and the incidence of lumbar disc disease.”

According to Dr. Burns, data revealed in the study could signal a significant public health problem given the health costs of back pain in the U.S.

“Back pain causes significant morbidity in adults, affecting quality of life and the ability to be productive,” he said.

Co-authors are Amichai J. Erdfarb, M.D., Jordana Schneider, David Ginsburg, B.A., Benjamin Taragin, M.D., and Michael L. Lipton, M.D., Ph.D.

Note: Copies of RSNA 2009 news releases and electronic images will be available online at RSNA.org/press09 beginning Monday, Nov. 30.

RSNA is an association of more than 44,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (RSNA.org)

Many researchers and experts such as, James Levine, M.D., Ph.D., of the Mayo Clinic in Rochester, MN, Marc Hamilton, Ph.D., associate professor of biomedical sciences at the University of Missouri, Douglas Lentz, a certified strength and conditioning specialist and the director of fitness and wellness for Summit Health in Chambersburg, PA, Genevieve Healy, Ph.D., a research fellow at the Cancer Prevention Research Centre of the University of Queensland, Australia, and Neville Owen, Ph.D., of the University of Queensland agree that way to nip this problem in the bud is to get up off of our butts – and to start moving every day.

Women’s Health

12/9/09

You might not want to take the following stat sitting down: According to a poll of nearly 6,300 people by the Institute for Medicine and Public Health, it’s likely that you spend a stunning 56 hours a week planted like a geranium — staring at your computer screen, working the steering wheel, or collapsed in a heap in front of your high-def TV. And it turns out women may be more sedentary than men, since they tend to play fewer sports and hold less active jobs.
Even if you think you have an energetic lifestyle, sitting is how most of us spend a good part of our day. And it’s killing us — literally — by way of obesity, heart disease, and diabetes. All this downtime is so unhealthy that it’s given birth to a new area of medical study called inactivity physiology, which explores the effects of our increasingly butt-bound, tech-driven lives, as well as a deadly new epidemic researchers have dubbed “sitting disease.”

The modern-day desk sentence
“Our bodies have evolved over millions of years to do one thing: move,” says James Levine, M.D., Ph.D., of the Mayo Clinic in Rochester, Minn., and author of “Move a Little, Lose a Lot.” “As human beings, we evolved to stand upright. For thousands of generations, our environment demanded nearly constant physical activity.”
But thanks to technological advances, the Internet, and an increasingly longer work week, that environment has disappeared. “Electronic living has all but sapped every flicker of activity from our daily lives,” Levine says. You can shop, pay bills, make a living, and with Twitter and Facebook, even catch up with friends without so much as standing up. And the consequences of all that easy living are profound.

When you sit for an extended period of time, your body starts to shut down at the metabolic level, says Marc Hamilton, Ph.D., associate professor of biomedical sciences at the University of Missouri. When muscles — especially the big ones meant for movement, like those in your legs — are immobile, your circulation slows and you burn fewer calories. Key flab-burning enzymes responsible for breaking down triglycerides (a type of fat) simply start switching off. Sit for a full day and those fat burners plummet by 50 percent, Levine says.

That’s not all. The less you move, the less blood sugar your body uses; research shows that for every two hours spent on your backside per day, your chance of contracting diabetes goes up by 7 percent. Your risk for heart disease goes up, too, because enzymes that keep blood fats in check are inactive. You’re also more prone to depression: With less blood flow, fewer feel-good hormones are circulating to your brain.
Spending the day on your rear is also hell on your posture and spine health, says Douglas Lentz, a certified strength and conditioning specialist and the director of fitness and wellness for Summit Health in Chambersburg, Pa. “When you sit all day, your hip flexors and hamstrings shorten and tighten, while the muscles that support your spine become weak and stiff,” he says. It’s no wonder that the incidence of chronic lower-back pain among women has increased threefold since the early 1990s.

And even if you exercise, you’re not immune. Consider this: We’ve become so sedentary that 30 minutes a day at the gym may not do enough to counteract the detrimental effects of eight, nine, or 10 hours of sitting, says Genevieve Healy, Ph.D., a research fellow at the Cancer Prevention Research Centre of the University of Queensland in Australia. That’s one big reason so many women still struggle with weight, blood sugar, and cholesterol woes despite keeping consistent workout routines.

In a recent study, Healy and her colleagues found that regardless of how much moderate to vigorous exercise participants did, those who took more breaks from sitting throughout the day had slimmer waists, lower BMIs (body mass indexes), and healthier blood fat and blood sugar levels than those who sat the most. In an extensive study of 17,000 people, Canadian researchers drew an even more succinct conclusion: The longer you spend sitting each day, the more likely you are to die an early death — no matter how fit you are.
The non-exercise answer
So if exercise alone isn’t the solution, what is? Fortunately, it’s easier than you think to ward off the perils of prolonged parking. Just ramp up your daily non-exercise activity thermogenesis — or NEAT. That’s the energy (i.e., calories) you burn doing everything but exercise. It’s having sex, folding laundry, tapping your toes, and simply standing up. And it can be the difference between wearing a sarong or flaunting your bikini on your next beach vacation.

In his groundbreaking study on NEAT, the Mayo Clinic’s Levine used motion-sensing underwear to track every single step and fidget of 20 people who weren’t regular exercisers (half of them were obese; half were not). After 10 days, he found that the lean participants moved an average of 150 minutes more per day than the overweight people did — enough to burn 350 calories, or about one cheeseburger.

Fidgeting, standing, and puttering may even keep you off medications and out of the doctor’s office. Think of your body as a computer: As long as you’re moving the mouse and tapping the keys, all systems are go. But let it idle for a few minutes, and the machine goes into power-conservation mode. Your body is meant to be active, so when you sit and do nothing for too long, it shuts down and burns less energy. Getting consistent activity throughout the day keeps your metabolism humming along in high gear.

When you get out of your chair and start moving around, you turn on fat burners. Simply standing up fries three times as many calories as sitting on your butt, according to Levine. And, he adds, “NEAT activity can improve blood flow and increase the amount of serotonin available to the brain, so that your thinking becomes sharper and you’ll be less likely to feel depressed.”
Get your move on
Shake things up throughout the day by interrupting your sedentary stints as often as possible. “Stand up every half hour,” says Neville Owen, Ph.D., of the University of Queensland. “If you have to sit for longer than that, take more extended and active breaks and move around for a few minutes before sitting back down.”

When you’re reading e-mail and taking phone calls, do it standing. Walk with colleagues to brainstorm ideas. And consider trading your chair for a large stability ball. “It forces you to engage your muscles, and you’re likely to stand up more because you’re not melting into a chair,” Lentz says.

At home, it’s simple: Limit TV time to two hours a day or less. Better yet, watch it from a treadmill or exercise bike. Among women, the risk for metabolic syndrome — a constellation of health woes including high blood pressure, high cholesterol, and high blood sugar — shoots up 26 percent for every hour per day they spend watching the tube.

Not sure how much of a difference these mini moves will make? Check out the chart below. Swapping a more active approach for just a few of your daily activities can help stave off the one-to two-pound weight gain most women accumulate every year — and it can keep your metabolism buzzing the way nature intended it to.