Cost-Effectiveness and Long-Term Savings of the Bright Bodies Intervention for Childhood Obesity

OBJECTIVES

To estimate the cost and cost-effectiveness of Bright Bodies, a high-intensity, family-based intervention that has been demonstrated to improve body mass index (BMI) among children with obesity in a randomized controlled trial.

METHODS

We developed a microsimulation model to project 10-year BMI trajectories of 8 to 16-year-old children with obesity, using data from the National Longitudinal Surveys and Centers for Disease Control and Prevention growth charts, and we validated the model using data from the Bright Bodies trial and a follow-up study. We used the trial data to estimate the average reduction in BMI per person-year over 10 years and the incremental costs of Bright Bodies, compared with the traditional clinical weight management (control), from a health system's perspective in 2020 US dollars. Using results from studies of Medical Expenditure Panel Survey data, we projected the long-term obesity-related medical expenditure.

RESULTS

In the primary analysis, assuming depreciating effects postintervention, Bright Bodies is expected to reduce a participant's BMI by 1.67 kg/m2 (95% uncertainty interval 1.43-1.94) per year over 10 years as compared with control. The incremental intervention cost of Bright Bodies was $360 ($292-$421) per person compared with the clinical control. Nevertheless, savings in obesity-related healthcare expenditure offset these costs and the expected cost-savings of Bright Bodies is $1126 ($689-$1693) per person over 10-years. The projected time to achieve cost-savings compared with clinical control was 3.58 (2.63-5.17) years.

CONCLUSIONS

Although resource-intensive, our findings suggest that Bright Bodies is cost-saving compared to the clinical control by averting future obesity-related healthcare costs among children with obesity.

A Single-Center Study Evaluating the Effects of a Topical Serum Combining Postbiotics, Peptides, and Botanical Extracts on Skin

Background

Aging, influenced by intrinsic and extrinsic factors, leads to visible skin changes such as dryness, surface roughness, and loss of luminosity. Proper skin care can mitigate some of these effects, with topical combination products offering support through complementary mechanisms.

Objectives

To test efficacy and safety of GSYBS-7 (Goop Beauty Youth-Boost Peptide Serum; Goop Inc., Santa Monica, CA), a topical postbiotic and botanical combination serum, used twice daily on facial skin for 6 weeks.

Methods

In this 19-patient pilot study, the primary efficacy measure was improvement on the Global Ranking Scale (GRS) at 42 days. A 12-point patient satisfaction survey and the serum's effect on healing after ablative laser treatment served as secondary and exploratory measures, respectively.

Results

Statistically significant improvements in all GRS domains were observed as early as day 7 with ongoing improvement up to day 42. A >1-point improvement was observed for dehydration (1.8; 95% CI, 1.5-2.2), visible pores (1.6; 95% CI, 1.3-2.0), surface roughness (1.6; 95% CI, 1.3-1.9), imbalance (1.3; 95% CI, .9-1.7), static wrinkles (1.3; 95% CI, .9-1.6), pigmentation (1.3; 95% CI, 1.0-1.5), and vasculature (1.2; 95% CI, .8-1.5). Independent photographic review and patient satisfaction surveys corroborated these findings. At day 42, 94.4% of patients were very satisfied with the results, and 88.9% would recommend GSYBS-7 to family and friends. No adverse events were reported, and 100% of patients indicated that GSYBS-7 was gentle enough for everyday use.

Conclusions

GSYBS-7 appears to be an effective and well-tolerated combination topical for the management of age-related and environment-induced skin changes.

Level of Evidence 4

The COVID-19, Obesity, and Food Insecurity Syndemic

PURPOSE OF REVIEW

To introduce and provide evidence for the new Syndemic of COVID-19, Obesity, and Food Insecurity and propose strategies for mitigating its impact, particularly among vulnerable populations.

RECENT FINDINGS

The COVID-19 pandemic has exacerbated obesity, food insecurity, and the existing inequities in the essential workforce. Food insecurity is driven by unsustainable dietary patterns and is associated with higher rates of obesity, which increases the risk of COVID-19 infections, hospitalizations, and deaths. The COVID-19 pandemic has disproportionately impacted the essential food supply chain workforce. Strengthening the social safety net and expanding worker protections will increase food security and secure livelihoods during and beyond the scope of the COVID-19 pandemic. Strengthening local and regional food systems provides a common solution to both the new Syndemic of COVID-19, Obesity, and Food Insecurity and the Global Syndemic of Obesity, Undernutrition, and Climate Change by promoting sustainable food production and consumption, and prioritizing the food supply chain workforce.

How Can We Act to Mitigate the Global Syndemic of Obesity, Undernutrition, and Climate Change?

PURPOSE OF REVIEW

The goal of this manuscript is to identify dietary and active transport strategies that reduce greenhouse gases and obesity, and thereby mitigate the effects of climate change on crop yields and micronutrient content.

RECENT FINDINGS

This report builds on our earlier publication that described the Global Syndemic of Obesity, Undernutrition, and Climate Change. We focus here on the contributions that the USA makes to the Global Syndemic and the policy solutions necessary to reduce the effects of the transport and food and agriculture systems on greenhouse gas emissions and environmental degradation. A recent study suggests that people are interested and ready to address local solutions to climate change. Changing the individual behaviors that sustain the US transport and food and agriculture systems is the first step to the broader engagement necessary to build the political will that to achieve institutional, municipal, state, and federal policy.

Food Insecurity and Childhood Obesity: A Systematic Review

BACKGROUND AND OBJECTIVES

Addressing food insecurity while promoting healthy body weights among children is a major public health challenge. Our objective is to examine longitudinal associations between food insecurity and obesity in US children aged 1 to 19 years.

METHODS

Sources for this research include PubMed, CINAHL, and Scopus databases (January 2000 to February 2022). We included English language studies that examined food insecurity as a predictor of obesity or increased weight gain. We excluded studies outside the United States and those that only considered the unadjusted relationship between food security and obesity. Characteristics extracted included study design, demographics, methods of food security assessment, and anthropometric outcomes.

RESULTS

Literature searches identified 2272 articles; 13 met our inclusion criteria. Five studies investigated the relationship between food insecurity and obesity directly, whereas 12 examined its relationship with body mass index or body mass index z-score. Three studies assessed multiple outcomes. Overall, evidence of associations between food insecurity and obesity was mixed. There is evidence for possible associations between food insecurity and obesity or greater weight gain in early childhood, for girls, and for children experiencing food insecurity at multiple time points. Heterogeneity in study methods limited comparison across studies.

CONCLUSIONS

Evidence is stronger for associations between food insecurity and obesity among specific subgroups than for children overall. Deeper understanding of the nuances of this relationship is critically needed to effectively intervene against childhood obesity.

The occurrence of sleep-disordered breathing among patients with head and neck cancer

OBJECTIVE

To identify the incidence of obstructive sleep apnea (OSA) in patients treated for head and neck cancer. Obstructive sleep apnea is a relatively common and highly morbid condition that affects 9.1% of male and 4% of female middle-aged adults.1 Patients who have been successfully treated for head and neck cancer may often have a partially obstructed upper airway which is functional during the day, but collapses during sleep.

STUDY DESIGN/METHODS

Twenty-four patients successfully treated for tumors of the tongue-base, pharynx, or supraglottic larynx were enrolled. Through OSA-related questionnaires, physical examination, and polysomnography, the incidence of OSA in this patient population was determined and compared with that of the general population.

RESULTS

The incidence of OSA (91.7%) in this head and neck cancer patient population was found to be significantly (P =.001) higher than that of the general population. (In a random sampling of middle-aged adult males between the ages of 30 and 60 years old with a respiratory disturbance index (RDI) >15, the prevalence was previously reported to be 9.1%.1) Sixteen of 24 patients (72.7%) had clinically defined symptoms of sleep apnea. Ten of 24 patients (41.7%) received radiation therapy; all had an RDI >15. Eleven of the 14 patients (78.5%) who did not receive radiation therapy also had an RDI >15. Eight patients (33.3%) continue to regularly use continuous positive airway pressure with significant improvement in symptoms.

CONCLUSIONS

Identification and treatment of OSA may be an important factor in improving quality of life for patients with head and neck cancer.

Calorie use and obesity among diabetic and non-diabetic Mvskoke Indians

Type 2 diabetes is a major cause of death among American Indians and obesity and physical inactivity are modifiable risk factors in the development of type 2 diabetes. Physical activity may have both a preventive effect and a secondary preventive effect of lessening insulin resistance in persons with type 2 diabetes. Moreover, for some individuals participation in daily regimens of physical activity is very difficult. Culture-specific physical activity may be an intervention to reduce obesity and prevent diabetes-related complications. Therefore, the research questions for this study were: (1) What is the body fat percentage of diabetic and non-diabetic Mskoke Indians?, (2) How does body fat percentage of Mvskoke Indians compare with recommended percentages for age and gender?, (3) What is the caloric use of Mvskoke Indians during daily and traditional cultural activities of dancing and stickball?, and (4) Are there relationships among body fat percentage, calorie use, gender, and diabetic status? The findings revealed that female diabetics' percentage of body fat in three age cohorts (40-49, 50-59, and 70+) was higher than that of non-diabetic females. By contrast, male diabetics had lower percentage of body fat than non-diabetic males. The actual mean percentage of body fat of the female participants ranged from 38.5% to 44%, roughly twice the standard recommended percentages of body fat of 20-24%. No significant difference was found in calorie use by gender or diabetic status. Analysis of calories during traditional activities revealed that 30 minutes of stickball used an average of 135.7 calories. Dancing for 33 minutes used an average of 149 calories. No significant relationship was found among percentage of body fat, caloric use, gender, and diabetic status.

Ascaris suum, an intestinal parasite, produces morphine

The parasitic worm Ascaris suum contains the opiate alkaloid morphine as determined by HPLC coupled to electrochemical detection and by gas chromatography/mass spectrometry. The level of this material is 1168 +/- 278 ng/g worm wet weight. Furthermore, Ascaris maintained for 5 days contained a significant amount of morphine, as did their medium, demonstrating their ability to synthesize the opiate alkaloid. To determine whether the morphine was active, we exposed human monocytes to the material, and they immediately released nitric oxide in a naloxone-reversible manner. The anatomic distribution of morphine immunoreactivity reveals that the material is in the subcuticle layers and in the animals' nerve chords. Furthermore, as determined by RT-PCR, Ascaris does not express the transcript of the neuronal mu receptor. Failure to demonstrate the expression of this opioid receptor, as well as the morphine-like tissue localization in Ascaris, suggests that the endogenous morphine is intended for secretion into the microenvironment.

Morphine and anandamide stimulate intracellular calcium transients in human arterial endothelial cells: coupling to nitric oxide release

Both morphine and anandamide significantly stimulated cultured endothelial intracellular calcium level increases in a concentration-dependent manner in cells pre-loaded with fura 2/AM. Morphine is more potent than anandamide (approximately 275 vs. 135 nM [Ca]i), and the [Ca]i for both ligands was blocked by prior exposure of the cells to their respective receptor antagonist, i.e., naloxone and SR 171416A. Various opioid peptides did not exhibit this ability, indicating a morphine-mu3-mediated process. In comparing the sequence of events concerning morphine's and anandamide's action in stimulating both [Ca]i and nitric oxide production in endothelial cells, we found that the first event precedes the second by 40+/-8 sec. The opiate and cannabinoid stimulation of [Ca]i was attenuated in cells leeched of calcium, strongly suggesting that intracellular calcium levels regulate cNOS activity.

Diabetes research in an American Indian community

PURPOSE

To describe field experiences of a nurse-led team conducting collaborative research on diabetes with an American Indian community. Diabetes is of epidemic proportions among Indians. Methodological reports can assist nurse researchers to make important contributions to Indian health and diabetes care.

ORGANIZING FRAMEWORK

Wax's stages of fieldwork: Initiation, fieldwork, post-field work. SCOPE AND METHOD: Report of key research experiences from all phases of a study with an Indian community (1988-1996). Based on review of classic literature, field notes, and team meetings.

FINDINGS

Methodological literature on research with Indians and cultural tutelage by Indians were helpful but neither sufficient nor infallible. A long period of investigator presence in the community before beginning the research was extremely useful. The need for researchers to explain their presence and the contribution of research to the community was ongoing.

CONCLUSIONS

Wax's conception of field work as a dialectic process was supported. A collaborative, community focus and willingness to spend much time acquiring cultural knowledge can facilitate successful research on Indian health.

Morphine- and anandamide-stimulated nitric oxide production inhibits presynaptic dopamine release

Morphine and anandamide stimulate the release of nitric oxide (NO) in diverse tissues. The present study examines the consequences of this action on neurotransmitter release in ganglia from two invertebrates: ventral chain ganglia from the leech Hirudo medicinalis and the pedal ganglion from the mussel Mytilus edulis. In these ganglia, preloaded serotonin (5-HT) and dopamine (DA) can be released by 50 mM KCl. Anandamide, an endogenous cannabinoid substance, suppresses the potassium-stimulated release of [3H]DA (80%), but not 5-HT, in a concentration-dependent manner, from the neural tissues of both. The effect of anandamide can be antagonized by pre-exposing the neural tissues of both animals to SR 141716A, a potent cannabinoid receptor antagonist. Prior treatment of the ganglia with N-omega-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase inhibitor, significantly diminishes the inhibitory effect of anandamide. Morphine also inhibits [3H]DA release in a naloxone- and L-NAME-sensitive manner. Anandamide and morphine act through separate mechanisms since the respective antagonists show no cross-reactivity. The NO donor, SNAP, depressed the potassium-stimulated release of preloaded [3H]DA, but not 5-HT, in the neural tissues of both animals. D-Ala2-Met5 enkephalinamide (DAMA) also inhibited the potassium-stimulated release of [3H]DA in a naloxone-sensitive process. However, the effect of DAMA was seen in the presence of L-NAME (10(-4) M), indicating that the opioid peptide inhibition of the presynaptic release of DA is not coupled to NO. We postulate that cannabinoids and their endogenous effectors play a prominent role in the regulation of catecholamine release in invertebrates via NO release as is the case for opiate alkaloids.

Schistosoma mansoni: the presence and potential use of opiate-like substances

The present study demonstrates that morphine- and codeine-like molecules are present in Schistosoma mansoni following HPLC separation and identification with an appropriate commercially available antibody. Furthermore, the endogenous material, corresponding to morphine, mimics authentic morphine in its ability to induce immunocyte rounding and immobility, an action that is naloxone sensitive. The codeine-like material is not found at high concentrations compared to the morphine-like material, indicating, as in mammals and Mytilus edulis, the potential rapid conversion of codeine to morphine. Coincubation with human leukocytes increases the endogenous level of this material in adult worms, indicating the presence of a positive feedback loop. Last, EDTA, a chelator of divalent cations, has a strong stimulating effect in the synthesis of morphine-like material by the worm as noted by higher levels of this material in its presence. Taken together, the results suggest that this parasite may utilize this immune downregulating molecule in its effort to escape host immunosurveillance as well as in inhibiting an immune response directed against itself.

Short duration of survival among South African blacks with oesophageal cancer

South African urban Blacks are very prone to oesophageal cancer, and mean age at diagnosis is almost a decade lower than that of White patients (male preponderance is equally marked in both ethnic groups). In recent years the socio-economic position of urban Blacks has improved greatly, with considerable strides being made in literacy and awareness of hospital services. This socio-economic improvement could conceivably improve the extremely short durations of survival among oesophageal cancer patients noted in earlier studies; this, however, has not occurred. Of a series comprising 146 male and 37 female patients, 50% had died after 3,6 and 4,2 months respectively. The corresponding periods noted for White patients are about twice as long.

Ambient temperature and reproductive success in rodents living at different latitudes

The concern of this research was with the susceptibility of rodent reproduction to latitudinal acclimatization. More specifically, the relationship between ambient temperature and reproductive success was examined in house mice and deer mice whose ancestors had been trapped in northern versus southern climates (Alberta vs. Texas). Third generation adults of each of these four populations were paired and challenged to breed at -6 degrees, 3 degrees, 23 degrees or 34 degrees C. A 50-day period of gradual temperature adaptation preceded pairing. House mice, regardless of their geographic origin, were found to be relatively insensitive to extreme temperatures. Many pairs of both the Alberta and Texas stocks of this species still produced offspring when maintained at the experimental extremes of -6 degrees and 34 degrees C. In marked contrast, both northern and southern deer mice exhibited relatively narrow temperature ranges within which maximum breeding occurred: -6 degrees to 3 degrees for Texas deer mice and only at 23 degrees C for Alberta deer mice. Thus there is no evidence in either species that reproduction is either less sensitive to cold in northern latitudes or less sensitive to heat in southern latitudes; indeed, somewhat the reverse situation exists in deer mice. Evolutionarily, latitudinal considerations seem to have been of secondary rather than of primary importance in shaping the relationship between ambient temperature and reproduction in these two species.

Effects of prior intrauterine position and housing on oestrous cycle length in adolescent mice

Female mice that had developed in utero between 2 male (2M females) or 2 female (0M females) fetuses were housed individually at 32 days of age in the presence of a male. The 0M females had a significantly shorter cycle. When the females were housed in groups of 5 in the presence of a male, cycle length in 0M females was significantly longer than that of 2M females for the first cycle recorded, but this relationship reversed completely by the third and fourth cycles. These results are compatible with a hypothesis that former intrauterine proximity to male fetuses affects the intrinsic timing of the oestrous cycle and the capacity to emit oestrus-suppressing cues and/or the sensitivity to such cues.