Metabolic changes with intermittent fasting.

BACKGROUND: The prevalence of obesity is rising globally and effective strategies to treat obesity are needed. Intermittent fasting, a dietary intervention for weight management, has received growing interest from the general public, as well as healthcare professionals, as a form of lifestyle intervention. METHODS: We executed a rapid review using PUBMED database to identify systematic reviews that examined the impact of intermittent fasting on metabolic indices, published between 2011 and 2022. RESULTS: Intermittent fasting leads to weight loss of a similar magnitude to continuous energy restriction. Most of the evidence shows that intermittent fasting leads to greater fat loss as measured by fat mass (kg) or body fat percentage compared to an ad libitum diet, but fat loss attained during intermittent fasting is not significantly different to continuous energy restriction, although recent evidence shows intermittent fasting to be superior. There is mixed evidence for the impact of intermittent fasting on insulin resistance, fasting glucose and lipid profile. Some studies focused on populations of Muslim people, which showed that Ramadan fasting may lead to weight loss and improvement of metabolic parameters during fasting, although the effects are reversed when fasting is finished. CONCLUSIONS: Intermittent fasting is more effective than an ad libitum dietary intake, and equally or more effective as continuous energy restriction, for weight management. However, there is inconclusive evidence on whether intermittent fasting has a clinically beneficial effect on glucose and lipid metabolism.

Obesity Stigma: Causes, Consequences, and Potential Solutions.

PURPOSE OF REVIEW: This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population. RECENT FINDINGS: We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual's control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.

How distorted food prices discourage a healthy diet.

Public policy making for the prevention of diet-related disease is impeded by a lack of evidence on whether poor diets are a matter of personal responsibility or a choice set narrowed by environmental conditions. An important element of the environment is market imperfections in food retail that distort prices. We use a rich dataset on quantities and prices of food purchases in the United States and a structural model of dietary choices to examine variation in diets across households that have different levels of income and live in different neighborhoods. We find that price distortions account for one-third of the gap between the recommended and actual intake of fruits and vegetables. A feasible fiscal intervention that remedies these distortions makes all consumers better off.

A rapid review of the evidence for children's TV and online advertisement restrictions to fight obesity.

The World Health Organisation has urged all governments to address rising rates of obesity by implementing population-based interventions, such as restrictions on the marketing to children of unhealthy food and beverage items. However, the relationship between unhealthy food advertisements and childhood obesity is disputed by industry-sponsored reports, which recommend promoting physical activity and weight loss campaigns rather than policies to limit exposure to advertisements. We aimed to elucidate this debate by providing a narrative review of the evidence on the relationship between unhealthy TV and online food advertisements, short-term food consumption and childhood obesity. We also examined the impact of unhealthy food advertisements on vulnerable groups and identified which policy interventions are supported by current evidence. We conducted a rapid overview of reviews published since 2006. From a synthesis of 18 reviews meeting the inclusion criteria, we conclude that exposure to unhealthy TV and online food advertising is a contributing factor to childhood obesity. Evidence of a relationship between exposure to unhealthy food advertisements and childhood obesity was evident at all stages of the causal pathway, including a clear dose-response relationship. The evidence base was particularly strong for children aged 3-12 years of age and for children from socio-economically disadvantaged and minority ethnic backgrounds. The introduction of statutory regulation is a potentially cost-effective policy option, in terms of healthcare savings outweighing the costs of implementing the policy, although voluntary codes were shown to be ineffective, with exposure to unhealthy food advertisements similar in countries before and after their introduction. Food advertising, however, is just one factor in the wider obesogenic environment and further advertising restrictions must be implemented alongside population-based interventions that aim to address systemic causes of poor diet.

COVID-19 Outcomes in Minority Ethnic Groups: Do Obesity and Metabolic Risk Play a Role?

PURPOSE OF REVIEW: Globally, minority ethnic groups have been at higher risk of COVID-19 mortality and morbidity than majority populations. This review outlines factors that may interact to create these inequalities and explores the hypothesis that differing levels of cardio-metabolic risk, according to ethnic group, play a role. RECENT FINDINGS: Two UK Biobank studies have reported that the body mass index is more strongly associated with an increased risk of COVID-19 infection and mortality in minority ethnic populations than in White populations. A study of UK patients found that the strongest association between obesity and adverse COVID-19 outcomes was in people of Black ethnicity. Differences in the prevalence of obesity and its metabolic sequelae have been shown to partly mediate ethnic inequalities in COVID-19 outcomes, although not always consistently. It is possible that ethnic differences in the consequences of obesity may explain some of the remaining disparity in COVID-19 risk.

Healthy diets, lifestyle changes and well-being during and after lockdown: longitudinal evidence from the West Midlands.

Background: 'Lockdowns' to control the spread of COVID-19 in the UK affected many aspects of life and may have adversely affected diets. We aimed to examine (1) the effect of lockdowns on fruit and vegetable consumption, as a proxy for healthy diets more generally, and on weight and well-being, (2) whether any subgroup was particularly affected and (3) the barriers and facilitators to a healthy diet in lockdown. Methods: We conducted a mixed-method longitudinal study, involving an online survey of 1003 adults in the West Midlands, UK, 494 of whom were surveyed at two different points in time. Our first time point was during stringent COVID-19 lockdown and the second during a period of more relaxed restrictions. We asked quantitative questions about fruit and vegetable consumption; physical activity, sociodemographic characteristics, body mass index and well-being and qualitative questions about the reasons behind reported changes. Results: We find no evidence for decreased fruit and vegetable consumption during lockdown compared with afterwards. If anything, consumption increased by half a portion daily among women, particularly among those who normally have a long commute. This finding, combined with a significant increase in physical activity, suggests that behaviours were healthier during lockdown, consistent with higher self-reported health. However, well-being deteriorated markedly, and participants reported being heavier during the lockdown as well. Our qualitative data suggest that an abundance of resources (more time) supported higher fruit and vegetable consumption during lockdown, despite increased access issues. Conclusions: Our results may assuage concerns that lockdowns adversely affected diets. They may point to the impact of commuting on diet, particularly for women. We add longitudinal evidence to a growing body of literature on the adverse effect of lockdown on mental health.