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School & Program Updates

School & Program Updates

Obesity Initiatives at Temple

New study suggests risks of snacking habits among overweight children.

Consumers receive an array of options and information about snacking: what to eat, how often, and whether to snack at all. But for young children, the advice is clear: Snacking is important. The American Academy of Pediatrics and the U.S. Department of Agriculture recommend two snacks per day for preschool-aged children. Yet until now, surprisingly few studies have considered how snacking contributes to dietary intake among preschoolers.

A recent study by researchers at Temple’s College of Public Health, Baylor University and the University of Michigan published in Pediatric Obesity found that early weight problems may come not only from the quality and quantity of snacks children eat but from having a stronger appetite – a trait that may be inherent.

“While children consume a significant amount of energy from snacks and the snacks eaten tend to be of poor nutritional quality, the extent to which snacking contributes to excessive dietary intakes was unclear until now,” says Professor Jennifer Fisher, associate director of Temple’s Center for Obesity Research and Education (CORE) and one of the paper’s authors.

The study of 181 Hispanic 4- and 5-year-olds in Houston found that they got 28 percent of their daily calories from snacks and that those snacks are typically high in added sugar and fat. More than 40 percent of these children’s daily intake of added sugars came from snacks.

The study also went further, looking not only at what preschoolers were eating but how much they enjoyed eating – making this analysis the first to evaluate the role of the child’s appetite and weight in snacking.

Unsurprisingly, overweight children who reported enjoying food more also snacked more. They snacked more frequently and got more of their calories from sugars than other children. But the surprising, and perhaps telling, piece of the study is that normal weight children who snacked less than the overweight and obese children also reported lower levels of enjoyment of food.

“These findings may reflect a more general predisposition of overweight/obese children toward reward sensitivity,” the paper explains. Food enjoyment is a trait-like dimension of eating behavior that has a heritable component.

Fisher says the findings may help researchers, clinicians, and caregivers to recognize those children who may be most at risk to the pitfalls of snacking, such as eating high-calorie, low-nutrition foods. “Heavier children and those with greater motivation to eat may be susceptible to excessive intake from snacks,” she says.

New obesity research says maybe pre-op weight loss might not have the post-op benefits we expect.

Bariatric surgery is no quick fix. Both before and after the procedure, patients receive support, counseling, and testing from an array of healthcare providers: dietitians, nurses, mental health professionals, physicians, and others. The team’s goal: maximize successful weight loss and minimize risk.

Often an important piece of this care is preoperative medical weight management (MWM). Theoretically, losing some weight before surgery could reduce the risk of surgical complications and help with weight loss after surgery. It is a guideline that many insurance companies require; the thing is, there is very little research to substantiate, much less standardize, its use.

That was the starting point for Ms. Colleen Tewksbury, a registered dietician and PhD student in the Temple College of Public Health’s Department of Social and Behavioral Sciences, who is specializing in nutrition. As lead author on a paper published in the October 2016 issue of Obesity Surgery, Tewksbury examines what we’ve learned so far about the effects of MWM — and in the process, points the compass for new obesity research.

“As a clinician, I’m called upon to adhere to insurance requirements, yet I’m also responsible for providing effective care for my patients,” she says. “And as a researcher, I want to find out what will point us toward the best outcomes. Right now there isn’t much research to substantiate the need for what insurance companies are requiring. So there was some disconnect.”

Ms. Tewksbury developed the paper with Dr. David Sarwer, associate dean for research for the College of Public Health and director of Temple’s Center for Obesity Research and Education (CORE), as well as with researchers at the University of Pennsylvania’s Metabolic and Bariatric Surgery Program, where Tewksbury works. Culling through the current literature, she found that the benefits of MWM are undetermined, and that researchers have yet to land on a consistent methodology to test its effectiveness.

“MWM in its current form does not appear to be strong enough to produce effective weight loss or meaningful outcomes,” the paper concludes.

However, the authors continue, “whether this is a true failure of treatment or methodological error is unclear.” Studies so far have been inconsistent in their methodology and duration, in part because the MWM requirements of insurance mandates are also inconsistent.

“While insurance companies require that patients make efforts to lose weight prior to bariatric surgery, it’s unclear if losing weight before surgery increases the amount of weight lost after surgery,” says Sarwer, who is Tewksbury’s dissertation advisor and co-author on paper. “It may be that the real value of preoperative MWM is providing patients an opportunity to practice new eating behaviors that will serve them well after surgery.” Sarwer is also an associate editor of Obesity Surgery.

Varying MWM requirements among insurance providers can really complicate matters in the real world. Different companies want patients to lose different amounts of weight; some don’t require it at all. The repercussions at the patient level can be significant. “When patients talk to one another and start learning that their MWM requirements differ, it can really impact motivation,” says Tewksbury, who sees patients and supervises clinicians in her role as bariatric program manager for the Hospital of the University of Pennsylvania.

Tewksbury hopes to continue to do research that helps improve obesity treatment and heals the disconnect between clinical practice and daily management—a point of critical need, considering that 68 percent of Philadelphians and 70 percent of Americans are overweight or obese: “Public health initiatives are fantastic for prevention, but there’s a huge portion of the population that needs treatment,” she says.

“One of the reasons I chose public health — and one of the reasons I chose Temple’s graduate program — is that weight problems affect just about everyone,” she says. “And I’m fascinated by how everything is tied to nutrition — economics, cognition, physical and psychology health, interpersonal connections. Obesity requires a multidisciplinary approach, and it has to integrate research and practice. As a dietician, I’m at my most effective if I collaborate with people from other specializations.”