Did 24 Coke-Funded Studies on Childhood Obesity Fail to Disclose Coke’s Influence?
How accurate were conflict of interest disclosures in at least 40 childhood obesity studies funded by The Coca-Cola Company? Not so accurate, according to a paper published in the Journal of Public Health Policy that analyzed studies from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), funded with a $6.4 million grant from Coca-Cola.
The ISCOLE study found that physical inactivity is a key predictor for childhood obesity. Coca-Cola appears to have financed and promoted research tying childhood obesity to causes other than soda consumption.
For 24 of the ISCOLE studies, the COI disclosures report this, or a close variant: “ISCOLE is funded by The Coca-Cola Company. The study sponsor has no role in study design, data collection, analysis, conclusions or publications. The only sponsor requirement was that the study be global in nature.”
However, a Freedom of Information Act request by U.S. Right to Know, a food industry watchdog group, uncovered evidence suggesting that Coca-Cola influenced the studies’ design, raising questions about corporate influence and truthfulness in the Coke-funded papers.
“It appears that many of the ISCOLE scientists did not declare the full extent of Coca-Cola’s involvement in their childhood obesity studies,” said Gary Ruskin, co-director of U.S. Right to Know. “This raises questions not only about these Coke-funded studies, but also more generally about the accuracy of conflict of interest disclosures in other scientific studies funded by corporations.”
“What these emails reveal is how complex conflicts of interest are and how poorly they are currently managed,” said David Stuckler, Professor at the Research Centre Dondena, at Bocconi University. “There is a danger that vested interests such as Coca-Cola pollute the scientific literature with research serving a hidden agenda.”
“In recent years, large corporations have been seeking to minimize concerns about conflicts of interest in the research they fund,” said Martin McKee, Professor of European Public Health at the London School of Hygiene & Tropical Medicine. A recent example is the Brussels Declaration, which said “commercial conflicts of interests are fairly easy to deal with if they are properly declared”. “As our paper shows, the situation is actually much more complicated and there is a need for considerable caution,” McKee said.
Regarding the ISCOLE emails obtained by FOIA, the Journal of Public Health Policy paper reports:
The emails suggest that the researchers did consult and include Coca-Cola representatives in making strategic decisions about study design. In the early stages of planning the study, for example, the parties debated which and how many countries are to be included. [Coca-Cola Chief Science and Health Officer Rhona] Applebaum emailed [ISCOLE Co-Principal Investigator Peter] Katzmarzyk on 26 March 2012 saying: “Ok—so with Russia and Finland we are at 13? Or no Finland and at 12. Seriously–our CEO hates the #13”…. She continued, “Serious about this 13 business. We have no FL [floor?] 13 at Coke”. Applebaum asked Katzmarzyk: “What other country should we look at?”, to which he responded, “We should talk about Russia as well—do you have contacts there already?”
The Journal of Public Health Policy paper was authored by David Stuckler, Professor at the Research Centre Dondena, Bocconi University, Milan, Italy; Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine, London, UK; and Gary Ruskin, co-director of U.S. Right to Know, in Oakland, California.
U.S. Right to Know is a nonprofit organization that investigates the risks associated with the corporate food system, and the food industry’s practices and influence on public policy. For more information, see usrtk.org.
Canadians Lack Access to Obesity Treatments and Support: Report Card
EDMONTON, April 25, 2017 /CNW/ - Canadians living with obesity are gravely underserved by Canada's public health systems and private benefits plans, according to a report released today by the Canadian Obesity Network (CON-RCO).
The Canadian and American Medical Associations, the World Health Organization, the Canadian Obesity Network and other groups now consider obesity to be a chronic disease, like diabetes and cancer. However, many health systems, as well as private and public payers and policy makers, have yet to embrace this definition and dedicate sufficient resources in support of patients.
The Report Card On Access To Obesity Treatment For Adults In Canada 2017 identifies substantial shortfalls in access to treatments outlined in Canadian clinical practice guidelines established in 2006, including behavioural interventions, medically supervised weight management using meal replacements, anti-obesity medications and bariatric surgery.
The report makes seven key recommendations to improve Canada's response to obesity, chief among them being the adoption of a true chronic disease approach to provide treatment and ongoing support for those with the disease.
Among the key findings are:
There is a profound lack of interdisciplinary healthcare services for obesity management in Canada.
A very limited number of Canadian physicians are pursuing formal training and certification in obesity management.
Canadians who may benefit from medically-supervised weight management programs with meal replacements are expected to pay out-of-pocket for the meal replacements, in sharp contrast with coverage available for meal replacements used in diabetes, cystic fibrosis and cancer care.
Those who rely on public coverage for prescription drug costs do not have access to the two prescription anti-obesity medications in Canada. Pharmacare programs in all the provinces and territories, as well as federal public drug benefit programs, receive a grade of F.
Less than 20% of the Canadian population with private drug benefit plans have access to these medications.
Nationally, bariatric surgery is available to only 1 in 183 adults (or 0.54%) every year who may be eligible for it. There are vast differences in access to bariatric surgery from one province to the next.
Wait times between referral to bariatric surgery and consultation with a surgical team receive a grade of F in all provinces; wait times between consultation and bariatric surgery receive a C grade in Newfoundland, New Brunswick, Manitoba and Alberta, and a B grade in Nova Scotia, Quebec, Ontario, Saskatchewan and British Columbia.
"Treating obesity should only be initiated in patients when abnormal or excessive fat accumulation impairs health – in other words, not everyone of a certain weight or waist circumference needs medical interventions," says CON-RCO Scientific Director Dr. Arya M. Sharma. "However, more than 1.5 million Canadians are classified as having Class II or III obesity*, which is associated with negative health outcomes. Clearly, we need to do a much better job of helping them with the tools at our disposal."
Research suggests that obesity can be successfully managed using the interventions outlined in the Canadian guidelines. If left untreated, obesity can result in significant illness, a profound reduction in quality of life, and increased mortality.
Canadians living with obesity struggle with related health issues, rampant weight bias and discrimination and a lack of access to evidence-based management resources, says Marty Enokson, chair of CON-RCO's Public Engagement Committee and an outspoken obesity care advocate.
"We have a long way to go in Canada before we can say we properly support people with obesity, not just with evidence-based medical interventions, but also with the respect and dignity that any person deserves," Mr. Enokson says. "We don't blame people living with cancer, heart disease or diabetes for their disease, and we don't make them fend for themselves in terms of finding help.
"We have some treatments available for obesity, and there are more on the way – we need to be willing to use them, and we need to make them as accessible as possible, as we would for any other chronic illness," he adds.
To view the recommendations, the full report, online summaries and other materials including study methodology, go to: www.obesitynetwork.ca/reportcard.
The Report Card On Access To Obesity Treatment For Adults In Canada 2017 was produced by the Canadian Obesity Network with the support of an unrestricted grant from Novo Nordisk Canada Inc.
The Canadian Obesity Network is Canada's largest professional obesity association for health professionals, researchers, policy makers and obesity stakeholders, with 15,000+ members. www.obesitynetwork.ca
*Class II obesity defined as BMI: 35.00 kg/m2–39.99 kg/m2; Class III obesity is BMI: ≥ 40.00 kg/m2
SOURCE The Canadian Obesity Network
Texas A&M research shows standing desks lead to improved BMI
(COLLEGE STATION, Texas) — Texas A&M researchers have shown, for the first time, evidence that standing desks in classrooms can slow the increase in elementary school children’s body mass index (BMI)—a key indicator of obesity—by an average of 5.24 percentile points. The research was published today in the American Journal of Public Health.
“Research around the world has shown that standing desks are positive for the teachers in terms of classroom management and student engagement, as well as positive for the children for their health, cognitive functioning and academic achievement,” said Mark Benden, PhD, CPE, an associate professor in the Department of Environmental and Occupational Health at the Texas A&M School of Public Health and an author of the study. “It’s literally a win-win, and now we have hard data that shows it is beneficial for weight control.”
Twenty-four classrooms at three elementary schools (eight in each of the three schools) in College Station, Texas, participated in the study. At each school, four classrooms were outfitted with stand-biased desks (which allow students to sit on a stool or stand at will) and four classrooms in each school acted as a control and utilized standard classroom desks. The researchers followed the same students—193 in all—from the beginning of third grade to the end of fourth grade.
The researchers found that the students who had the stand-biased desks for both years averaged a three percent drop in BMI while those in traditional desks showed the two percent increase typically associated with getting older. However, even those who spent just one year in classrooms with stand-biased desks had lower mean BMIs than those students in traditional seated classrooms for their third and fourth grade years. In addition, there weren’t major differences between boys and girls, or between students of different races, suggesting that this intervention works across demographic groups.
“Classrooms with stand-biased desks are part of what we call an Activity Permissive Learning Environment (APLE), which means that teachers don’t tell children to ‘sit down,’ or ‘sit still’ during class,” Benden said. “Instead, these types of desks encourage the students to move instead of being forced to sit in poorly fitting, hard plastic chairs for six or seven hours of their day.”
Previous studies from Benden’s lab have shown that children who stand burn 15 percent more calories, on average, than those who sit in class, but this is the first study showing, over two years, that BMI decreases over time (versus controls) when using a stand-biased desk.
“It is challenging to just measure weight loss with children,” Benden said, “because children are supposed to be gaining weight as they get older and taller.”
At the beginning of this study, which was funded by the National Institutes of Health (NIH), roughly 79 percent of the students were of normal weight category, 12 percent were overweight and nine percent were obese, according to height and weight measurements made by the researchers. These are better numbers than nationally, where 14.9 percent of children were overweight and 16.9 percent were obese in 2012. The fact that the students who started at a healthy weight benefited from stand-biased desks as much as they did might indicate that these desks help students who aren’t overweight maintain their BMI, while at the same time help those who start out overweight or obese get to a healthier weight.
These desks, designed by Benden and his team, are called stand-biased, not “standing” because they do include a tall stool the students can perch on if they so choose. They also include a footrest, a vital feature because it allows children to get their lower backs out of tension and reduce leg fatigue to stand more comfortably over time. These United States-patented desk designs are now licensed to Stand2Learn, which has commercialized the products through translational research focused on moving university studies to publicly available solutions.
CORVALLIS, Ore. – A growing body of evidence suggests that two natural compounds, vitamin D and xanthohumol, have the ability to address imbalances in gut microbiota that may set the stage for obesity and metabolic syndrome - problems that affect about one out of every three adults in the United States.
To explore and identify the specific mechanisms by which these compounds have beneficial effects, researchers in the Linus Pauling Institute at Oregon State University have received a new five-year, $2.64 million grant from the National Institutes of Health.
The possible payoff of this research, they say, may be an entirely new way to reduce or prevent some of the major diseases that are killing millions of people every year, such as heart disease and type-2 diabetes.
The new approach would attempt, using high dose supplementation, to prevent disease from developing, instead of treating it after the fact.
“The benefits of xanthohumol and vitamin D have been clearly shown in laboratory studies to reduce weight gain and improve gut barrier defenses,” said Adrian Gombart, an associate professor of biochemistry and biophysics in the OSU College of Science, and a principal investigator with the Linus Pauling Institute. “These compounds appear to activate nuclear receptors and pathways that may affect microbe composition, and in the process reduce the damage from metabolic syndrome.”
One study published by OSU researchers two years ago in the Journal of Biological Chemistry found that rats given xanthohumol supplements, which are made from hops, had a 14 percent reduction in weight gain, a 25 percent reduction in plasma fasting glucose, and improved lipid metabolism, compared to a control group of rats that ate the same amount of food. They had a higher rate of fatty acid oxidation and energy metabolism. In simple terms, they burned more fat.
In other studies, higher levels of vitamin D status in humans have been associated with reduced risk of obesity, m
etabolic syndrome, cancer, infectious diseases, autoimmune diseases, and other health problems.
Other lead investigators on this research include Claudia Maier, an OSU professor of chemistry; Fred Stevens, a professor in the OSU College of Pharmacy and also a principal investigator with the Linus Pauling Institute; and Balz Frei, a distinguished professor of biochemistry and biophysics, and director of the Linus Pauling Institute.
The OSU researchers believe some of the benefits of vitamin D and/or xanthohumol may be a strong increase in the expression of the cathelicidin antimicrobial peptide, or CAMP gene. The hypothesis to be tested in this research, using animal models, is that higher CAMP levels improve gut epithelial barrier function, reduce inflammation, modify gut microbiota and in the process reduce problems with obesity and metabolic syndrome.
“Some of the benefits we’re seeing are fairly clear and dramatic, and we need to better understand the mechanisms that cause them,” Stevens said.
The compounds may also affect liver function, shutting down metabolic pathways that produce fat and glucose, he said.
Vitamin D can be obtained through either the diet or produced by the skin, with adequate exposure to sunshine. Millions of people who live in temperate zones around the world, however, have been found to have inadequate levels of this vitamin, but this can be corrected by taking a supplement.
Xanthohumol, a flavonoid, is also a natural compound and is found in the hops used to make beer. Researchers point out, however, that the levels of xanthohumol being used in this research greatly exceed any amount that could be obtained by drinking beer.
Direct health care costs arising from obesity and related disorders accounts for almost 10 percent of U.S. health care expenditures each year, the researchers said. The health care costs of diabetes alone were estimated in the U.S. at $176 billion in 2012, and it’s one of the leading causes of death in the nation.
COLUMBIA, Mo. — More than one-third of children in the United States ages 6 to 19 years old are overweight or obese. Over the past 30 years, the number of obese adolescents has more than quadrupled, which also has led to an increase in children diagnosed with diabetes. To combat this trend, Aneesh Tosh, M.D., adolescent medicine physician at University of Missouri Health Care and associate professor of clinical child health at the MU School of Medicine, recommends that sugary drinks be removed from adolescents’ diets.
“The sharp rise in childhood and adolescent obesity is alarming,” Tosh said. “Being overweight is the biggest risk factor for Type 2 diabetes. We want to prevent diabetes in adolescents to avoid the serious medical problems associated with the disease. One very important step to preventing these complications is to stop drinking sugary drinks.”
Through clinical experience and research, Tosh has found that eliminating sugar-sweetened beverages is the most significant lifestyle change that children and adolescents can make to lose weight and improve health. Sugary beverages can add up to 200 empty calories per serving to an adolescent’s diet that provide no nutritional benefits. Sugary beverages include juice, soda, sweet tea, sports drinks, energy drinks and coffee drinks, all of which can be high in calories.
“It is very important that a developing body gets plenty of water and milk,” Tosh said. “We realize those can get boring for some of our patients, so adding zero- or low-calorie flavorings to water is fine every once in a while.”
As adolescents progress toward adulthood, they become increasingly responsible for their own beverage choices. Many of the beverages adolescents have available at school, home and social gatherings contain significant amounts of sugar.
Sports drinks have become the drink of choice for many teenagers because they incorrectly assume the drinks are healthier than soda. Tosh said most children and adolescents, even when involved in athletics, do not actually need the electrolytes in sports drinks, and some of these sports drinks have more calories than regular soda. Energy drinks, which also are rising in popularity, not only contain sugar but also caffeine. Energy drinks can lead to other health problems, such as poor sleep, headaches and heart irregularities.
“It really is about education, because many parents and young patients just don’t realize how many calories there are in sugary drinks,” Tosh said. “My patients who cut sugary beverages are the ones losing weight. Conversely, I’ve found that patients who struggle to switch to water and milk are the ones who have not been successful in losing weight.”
One successful patient is Andrew Roberts. At age 13, Roberts weighed 307 pounds and was in and out of the hospital because of obesity-related health complications.
“It was not uncommon for me to drink 2 liters of soda a day,” said Roberts, who is now a 23-year-old personal trainer. “I lost 115 pounds in about a year and a half by cutting out sugary drinks, junk foods and sweets, and getting exercise.”
Roberts said it was easy to see where excess calories were coming from once Tosh had him keep a food log that included drinks.
“Limiting consumption of sugary drinks to once a week for special events rather than daily is a significant step toward healthy weight loss for many children and teens,” Tosh said. “When children and teens spend time hanging out with their friends — not just when they’re at school — it’s important that sugary drinks aren’t their go-to beverage.”
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About the MU School of Medicine
The MU School of Medicine has improved health, education and research in Missouri and beyond for more than 165 years. MU physicians treat patients from every county in the state, and more Missouri physicians received their medical degrees from MU than from any other university. For more information, visit http://medicine.missouri.edu/.
Highly Innovative Pipeline Could Transform Obesity Treatment Landscape, says GBI Research
NEW YORK (GBI Research), 8 October 2015
While the current obesity treatment market has a high level of unmet need, the therapeutic landscape could be transformed by a highly innovative and diverse pipeline that includes 248 products in active development, according to business intelligence provider GBI Research.
The company’s latest report* states that despite the current market’s clinical and regulatory challenges, the obesity pipeline is robust and contains a high level of diversity in both molecule types and molecular targets, with 39% of the pipeline products with disclosed molecular targets classified as first-in-class.
Angel Wong, Senior Analyst for GBI Research, says that while most pipeline products target gut hormone receptors, the remainder target a wide range of processes thought to be dysregulated in obesity, such as angiogenesis, insulin signaling, inflammation, fat absorption, lipid synthesis, and metabolism.
Wong comments: “The high level of innovation and diversity in molecular target in development is encouraging, with a number of these not only showing close alignment to the disease pathophysiology but also addressing multiple mechanisms underpinning the development of obesity.
“As obesity is a multifactorial disease, targeting multiple systems may potentially avoid compensatory mechanisms that lead to weight regain and achieve sustainable weight loss over the long term.”
The analyst adds that small molecules, accounting for 66% of the overall pipeline, are the dominant molecule type in all stages of development for obesity treatment. Biologic therapeutics, consisting largely of peptides, proteins, antibodies and vaccines, also feature prominently.
GBI Research’s report also states that the long-term treatment options for obesity remain sparse, including the dietary fat absorption inhibitor Xenical (orlistat), and appetite suppressants such as Qsymia (phentermine and topiramate extended release), Belviq (lorcaserin hydrochloride), and the two new market entrants Contrave (naltrexone and bupropion) and Saxenda (liraglutide rDNA origin).
Wong continues: “Prescription of these treatments is generally limited, primarily due to concerns over their long-term safety, with the past decade seeing a number of drug withdrawals in the market as a result of serious cardiovascular risks and psychiatric adverse reactions.
“The uptake of anti-obesity drugs has also been hindered by their modest efficacy in inducing sustained body weight reduction. All of these factors are driving efforts to address the significant unmet need for effective obesity therapeutics with favorable safety profiles,” the analyst concludes.
CORVALLIS, Ore. – A growing body of evidence suggests that two natural compounds, vitamin D and xanthohumol, have the ability to address imbalances in gut microbiota that may set the stage for obesity and metabolic syndrome - problems that affect about one out of every three adults in the United States.
