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Childhood obesity is bad news for heart disease in the future

Carl Heneghan
Last edited 26th September 2012

Apart from stating the obvious, we are in big trouble. Health services costs are rising and we can’t afford it. There are no new drugs to counteract the growing increase in chronic disease which cost us a fortune. Yet, to counteract all this we are getting fatter and fatter, and presenting a future steeped with dire consequences for our children.

Results from 63 studies of 49,220 children aged 5 to 16, published in today’s BMJ by our group, starkly illustrates the effect obesity has upon increasing risk of cardiovascular disease for future generations of children. We know that being overweight in adulthood increase your risk of heart disease and stroke, we now know that for children, these very same risk factors are increased markedly at a very young age.

Obese children have a blood pressure greater by 7.5mmHg than normal weight children. This rises to 11.5 mmHg when the more accurate ambulatory blood pressure readings are used. The increase seems to be greater for girls than boys: but the reason for this additional increase is unknown. Also, other important risk factors for heart disease are raised in obese children: blood lipids (cholesterol and triglycerides) are raised; fasting insulin and insulin resistance are worse and the left ventricular mass of the heart is increased when compared to normal children.

Being overweight as a child corresponds to a Body Mass index (BMI) of 25 to 30 and obesity as a BMI of over 30. BMI is a number calculated from a child's weight and height, and is weight in kg divided by height in metres squared (kg/m2). Although BMI does not measure body fat directly, it correlates with accurate measures of body fat, such as underwater weighing, and can be used as a simple measure for screening children.

Many countries use reference points in children to classify obesity, taking into account age, sex and a reference population. Whilst this data calculates an average for the population, and classifies obesity according to the degree of variation from this mean it may mask worrying trends due to increasing average weight of children over time. In 2007, the US obesity rates have nearly quintupled among 6- to 11-year-olds since the 1970s. Worryingly, in the UK school year, 2010/11, one third of children aged 10 to 11 were overweight or obese.

Like climate change, we know the problem is coming, but because the effects are at some point in the future, we are burying our heads in the sand, hoping the problem might just go away. For what is an easy situation to prevent: we need concerted action now. Jamie Oliver, once said "we're losing the war against obesity," We may have already lost it: 1 in 3 adults and 1 in 6 children are currently obese.

The power of belief to reduce pain and alter arteries

Dr Placebo
Last edited 21st September 2011

In a recent study involving 30 patients having a procedure to evaluate chest pain, researchers found that those who were told they were being given a pain-relieving drug reported a decrease in pain. They also showed a small narrowing of their heart vessels.

Participants were randomized to receive either a verbal suggestion about the potency of an injection or not. Both groups received a saline injection. The verbal suggestion was developed on hypnotherapeutic principles. They were told:

“Mrs./Mr. XYZ, we are now injecting a drug through the catheter which will widen your coronary vessels. This procedure will improve the blood flow in your heart. This drug is very effective and starts its action immediately. It is possible that you might feel some agreeable warmness or formication after only a few seconds.”

Placebos, including verbal suggestions, are often acknowledged to have ‘psychological’ effects that can be measured using ‘subjective’ outcomes such as pain. However, their benefits for ‘objective’ outcomes, including change in the artery diameter, have often been questioned. More generally, the study explodes the myth that there is a strict mind/body division. If placebos can affect the mind, then they affect the body, and vice versa - our minds and bodies are hopelessly intertwined. If our bodies are ill and we are bedridden we are unlikely to feel good. Conversely, our ‘body language’ often reveals our moods. Emotions can affect physical activity, and vice versa. To name just a few examples, reduced serotonin activity can cause depression, dopamine affects motivation (among other things), and noradrenaline affects arousal (in a general sense).

Caregivers might use the results of this and other related studies to boost the effects of the therapies they prescribe.

To be sure, the study was too small to be conclusive. At the same time it was sufficiently well conducted (randomized and double blind) to be very suggestive …

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