SHARING insights on the theme of obesity, the 29th European Congress on Obesity (ECO) was jointly hosted by the European Association for the Study of Obesity (EASO) and International Federation for the Surgery of Obesity and Metabolic Disorders European Chapter (IFSO-EC).
Maastricht is the oldest city in the Netherlands and, with its proximity to cutting-edge facilities for obesity research, it provided an excellent physical space to hold Zoom Forward 2022. The hybrid format ensured that those not yet able to travel due to the COVID-19 pandemic could still attend. Those attending virtually were encouraged to collaborate across platforms.
In a forward-thinking approach, the organisers invited 32 ‘lived experience’ patient representatives from 17 countries across Europe. These individuals, advocating for other patients with obesity, were keen to share their experiences and to foster connections with healthcare professionals.
EASO Congress Chair, Gijs Goossens, joint Chair of the congress alongside Ronald Liem from IFSO-EC, began by speaking about the plenary opening lecture at Zoom Forward 2022. In this session, obesity was described as a “complex, multifactorial, chronically relapsing disease that acts as a gateway to many other common diseases.” Goossens believes that obesity “requires a multidisciplinary, personalised approach” in order to aid patients with the most effective treatment pathways, tailored to their individual needs. The congress programme supported this, with dedicated sessions, collaborative workshops, presentations, and keynote lectures dedicated to many aspects of obesity research and its treatment.
In the introductory session, a nod was given to European obesity professionals, who number around 20,000. These individuals work across a range of areas, from scientists, early career researchers, and students, to healthcare professionals and physicians working in the field.
In this supplement, you will find comprehensive coverage of this year’s event. Summaries of some of the most intriguing keynote lectures are included. Perhaps most topical was a session that focused on severe obesity compromising the efficacy of COVID-19 vaccinations, presented by Volkan Demirhan Yumuk and colleagues from Istanbul University, Turkey. One hundred and thirty-two participants were included in the study, which found that antibody responses to vaccination were significantly lower in this population. Another very relevant feature discussed at the congress is research which shows that vegan diets boost weight loss and lower blood sugar in individuals with obesity, and in those who have Type 2 diabetes.
At Zoom Forward 2022, several sessions were compiled under the theme of childhood obesity, with a particular focus on the Dutch approach to the disease. The programme included fascinating sessions on ‘Amplifying the obesogenic environment lessons learned from the COVID epidemic’ and ‘Metabolic associated fatty liver disease in children’. There is also a lot to learn from the invaluable session entitled ‘MDT approach to screening, indication and follow-up’.
The scientific programme was far-reaching and took into account many aspects of obesity. Indeed, the congress content was organised into five separate broad ‘tracks’, which covered basic science; behavioural and public health; childhood and adolescent obesity; management and intervention; and metabolic surgery. Areas of the extensive programme covered emerging and experimental techniques; new surgical advances; nutrition and the role of dieticians in primary care; mental health and stigma experienced by patients with obesity; genetic, environmental, and risk factors for patients with obesity; patient phenotyping; the impacts of obesity upon fertility; and several sessions on different aspects of metabolism and obesity, amongst other pertinent topics.
We hope that this comprehensive selection of congress highlights covered in this supplement will aid healthcare professionals in the care of patients with obesity, both in regard to advances in treatment approaches and further understanding of the very complex web of comorbidities that can be experienced alongside this disease.
Obesity Linked to Increased Risk of Fatal Prostate Cancer
A NEW study has linked obesity with an increased risk of fatal prostate cancer (PCa). Presented at this year’s ECO in Maastricht, the Netherlands, this Cancer Research UK funded meta-analysis found that every 10 cm of adipose tissue on a man’s waist was associated with a 7% increase in mortality risk from PCa.
With approximately 52,000 cases and 12,000 deaths each year, PCa is the most prevalent cancer in males in the UK. Although a number of cases are slow growing, some can be lethal to patients and could have differing risk factors. Study leader Aurora Pérez-Cornago, Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, UK, noted: “Knowing more about factors that increase the risk of PCa is key to preventing it.”
Although previous studies have labelled high adiposity as a risk factor for fatal PCa, the low mortality rates included in these data have not allowed strong conclusions to be drawn. This prospective Cancer Research UK study incorporated existing data from 2.5 million males, as well as novel data from over 200,000 males in the UK Biobank database.
Adiposity was measured using four different methods at the beginning of each study included BMI, waist circumference, waist-to-hip ratio, and body fat percentage. The researchers found that every five-point increase in BMI was found to increase the risk of mortality from PCa by 10%, and a 5% increase in body fat percentage heightened the risk by 3%. The study data also indicated that if the average male BMI was five points lower, there would be 1,300 fewer deaths attributed to PCa per year.
The researchers concluded that males with a “higher total and central adiposity have a higher risk of dying from PCa than males with a healthy weight.” Although the factors behind the link are not clear, Pérez-Corgano explained: “Several biological mechanisms have been proposed. It is likely, however, that differences in detection also play a role. The disease may be harder to detect in males with obesity, leading to it being diagnosed later when it is harder to treat.” Further research is needed to define whether the risks are due to biological factors or a delayed diagnosis in males with high adiposity. Pérez-Corgano added that by “building on these useful findings in future, scientists can start to unpick what the mechanism of PCa and obesity could be helping them to better understand who is at an increased risk of getting and dying from the disease.”
Vegan Diets for the Management of Overweight and Type 2 Diabetes
ACCORDING to research findings shared at this year’s ECO, a 12-week vegan diet may result in clinically meaningful weight loss and improve glucose control in adults who are overweight and people with Type 2 diabetes. This study was conducted by Anne-Ditte Termannsen and collaborators from the Steno Diabetes Center, Copenhagen, Denmark.
Results were obtained from a systematic review and meta-analysis of 11 randomised trials that compared the effects of a vegan diet with other types of diet on cardiometabolic risk factors. Vegan diets were compared with participants continuing normal diet with no dietary changes (passive control group) or participants following other dietary interventions, such as Mediterranean or portion-controlled diets (active control group).
The 11 included trials involved 796 individuals (average age: 48–61 years) who were overweight or had Type 2 diabetes. The average trial duration was 19 weeks. A weight loss of at least 5 kg was accepted as clinically meaningful.
Vegan diets significantly reduced body weight (effect average: -4.1 kg) and BMI (-1.38 kg/m2) compared with control diets. Changes in blood sugar level, total cholesterol, and low-density lipoprotein cholesterol were relatively small. Interestingly, the greatest reductions in body weight and BMI were observed when comparing vegan diets with continuing a normal diet without dietary changes (-7.4 kg and -2.78 kg/m2, respectively).
Termannsen highlighted the wider relevance of the results: “Adhering to a vegan diet for at least 12 weeks may result in clinically meaningful weight loss and improve blood sugar levels and, therefore, can be used in the management of [individuals who are] overweight and [with] Type 2 diabetes.”
The researchers acknowledged multiple study limitations. Notably, vegan diets varied markedly in terms of carbohydrate, protein, and fat content. Further, prescribed control diets did not exactly match the intervention diet in all other aspects expect veganism. Consequently, the observed effects of vegan interventions on cardiometabolic health might partly be due to differences in energy intake and micronutrient composition between the groups.
Severe Obesity Could Compromise SARS-CoV-2 Vaccinations
ADULTS with severe obesity (BMI: >40 kg/m2) have a significantly weaker immune response to COVID-19 vaccinations compared with individuals with a normal weight (BMI: <25 kg/m2). Volkan Demirhan Yumuk, Istanbul University, Turkey, and colleagues presented their findings at the ECO 2022.
Obesity complicates the course of COVID-19 and could compromise an individual’s antibody response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations.
The researchers measured antibody levels from blood samples taken from 124 adult patients with severe obesity (average age: 42–63) who visited the Obesity Center, Istanbul University-Cerrahpaşa, Turkey, between August and November 2021. They also measured antibody levels from a control group, which consisted of 166 adults with normal weight (average age: 39–47), who visited Cerrahpaşa Hospital’s Vaccination Unit.
In total, 130 participants were tested after receiving two doses of the Pfizer/BioNTech BNT162b2 (Pfizer, New York City, USA, and BioNTech, Mainz, Germany) mRNA vaccination and 160 after two doses of the CoronaVac (Sinovac Biotech, Beijing, China) inactivated SARS-CoV-2 vaccination.
The researchers found that patients who had received the Pfizer/BioNTech vaccination and had no history of COVID-19 infection had 3 times lower antibody levels than the controls (average: 5,823 versus 19,371 AU/mL). However, antibody levels in patients were 27 times lower than control after the CoronaVac vaccination (average: 178 versus 4,894 AU/mL).
Participants were classified by whether they had already been infected with COVID-19 (n=70). However, antibody levels were not significantly different from the control group whether the individual was vaccinated with Pzifer/BioNTech or CoronaVac (average: 39,043 versus 14,115 AU/mL; 3,221 versus 7,060, respectively).
Yumuk stated that this study confirms that “immune memory induced by prior infection alters the way in which people respond to vaccination” and that two doses of Pfizer/BioNTech vaccination may generate more antibodies than the CoronaVac vaccination in adults with severe obesity. However, Yumuk concluded that more research is needed to determine whether higher antibody levels provide more protection against COVID-19.
Cardiometabolic Risk Markers Detected in Childhood
MARKERS of cardiometabolic health are detectable from the age of 6 in children who are overweight, new research has found. Childhood obesity can lead to numerous short- and long-term complications, most importantly when it persists into adulthood, where it is associated with an increased risk of heart disease, liver disease, and metabolic conditions.
This study, presented at the ECO, was aimed at investigating the effectiveness of using existing health services and routine check-ups to evaluate the degree of obesity in children and improve detection from an early age. The research involved 992 participants: 335 pre-school children (2.5–5 years old) and 657 school-age children (6–8 years old). The assessments were carried out by dental and public health nurses at regular dental appointments and health visits in schools, by measuring BMI. Additionally, 392 school-age children had their blood tested for indicators of cardiovascular health and diabetes. At the start of the investigation, 13.7% of children were overweight in both the pre-school- and school-age groups; however, the percentage rose to 17.0% after 1 year in school children and remained unvaried in pre-school children. Furthermore, overweight children in the school-age group displayed higher levels of fasting glucose, insulin, triglycerides, and alanine aminotransferase, which indicate a higher risk of developing Type 2 diabetes, cardiovascular disease, and liver disease.
The authors stated: “We found rises in risk markers for heart and liver disease and diabetes in schoolchildren with overweight. These changes were not detectable just a few years earlier in pre-schoolers with overweight and suggests that pre-school, as early as 2.5 years of age, could provide a critical window to detect and manage overweight.” The researchers also highlighted the importance of their work: “This would, in turn, allow weight loss interventions to start early and reduce the risk of a child with overweight becoming an adult, or even an adolescent, with overweight and other conditions such as Type 2 diabetes.”
Mediterranean Diet Linked to Cardiovascular Health
NEW research exploring the relationship between key nutrients, including protein, zinc and niacin, and heart health have revealed important links. The recent study, presented at the ECO, explored whether the regular improvements seen in metabolic and cardiovascular health when an individual loses weight are dependent upon changes in the make-up of nutrients in diet, as well as the associated reduction in glucose, blood pressure, and blood fats.
Researchers from the Sagol Centre for Metabolic Syndrome, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv, Israel, recruited a total of 72 participants with metabolic syndrome and obesity. The participants were enrolled in a 1-year intensive, multidisciplinary, weight loss programme, which included personalised diet and exercise plans alongside regular consultations from a physician.
One year on the average BMI had fallen 9.4% and blood vessel flexibility, used as a proxy for cardiovascular health, had improved. Blood vessel flexibility was measured through three different parameters, pulse wave velocity (PWV), common carotid artery intima media thickness (IMT), and flow mediated dilation (FMD). Over the course of the year, FMD improved by 47% on average, PWV by 13%, and IMT by 1%.
Researchers linked the improvements in function to changes in nutrient intake. Improvements in PWV were associated with reductions in calorie and saturated fat intake, combined with increases in zinc intake. This is due to key role zinc plays in the synthesis of nitic oxide, allowing for the relaxation of the inner muscle of blood vessels. IMT improvements were linked to reduction in calorie and saturated fat intake and increased intake of protein. Finally, FMD improvements were linked to increases in vitamin B3 (niacin) intake, due to niacin’s role in vasodilation.
“We found changes in the consumption of specific food components to be linked to better vascular structure and function,” explained lead researcher Bruya Tal, Tel Aviv-Souraski Medical Center, Israel. “A Mediterranean diet, rich in protein (lean dairy products, fish, poultry, and eggs), rich in vegetables, nuts, seeds, and with moderate consumption of fruits and grains, can contribute to improving vascular flexibility, thus indirectly protecting the cardiovascular system. The zinc-rich foods in the diet plan were sunflower seeds, pumpkin seeds, nuts, and meat. Meat and fish provided niacin.”