Malcolm Read Scholarship Winner 2008 – Dr Eleanor Tillett

Dr Eleanor Tillett MBBS MSc MFSEM
Principal Clinical Teaching Fellow & Honorary Consultant in SEM, UCL

Abstract

Fructose and stress – the drivers of obesity? (And where does physical activity fit in?)

I visited 3 leading centres in the USA managing paediatric obesity. Two (1,2) visits focused on the pathophysiology of obesity. Their treatment focused on manipulating a patient’s biochemistry in order to change their eating habits – rather different from the traditional view of behaviour driving weight gain (1). The increase in circulating insulin levels (even without resistance) and the increased dietary intake of fructose were highlighted as key aetiopathological factors. Management was conducted within a multidisciplinary context, with input from dieticians, psychologists and physical therapists as well as physicians.

The third centre (3) I visited gave me a chance to see more community and school based interventions. Again, there was a multidisciplinary focus, but more organised physical activity programmes were available. One study they had undertaken looked at the use of junior and middle school curriculum specific energisers (2). These were 10 minute high intensity physical educational activities that could be led by teachers within a lesson. As well as increasing physical activity during the school day, they also improved concentration during lessons, belaying teachers’ fears that introducing more physical activity into the curriculum would mean valuable teaching time was lost.

They had also undertaken research into the ‘obesogenic gait’. Their motion analysis studies suggest obese children demonstrate greater hip adduction and knee valgus during stance phase, with compensatory greater rear foot inversion than do children of healthy weight (3). This has implications for injury risk and as a potential factor in why they are less active in the first place.

References

  1. Lustig RH. Childhood obesity; behavioural aberration or biochemical drive? Reinterpreting the first law of thermodynamics. www.nature.com/clinicalpractice doi:10.1038/ncpendmet0220
  2. Mahar MT, Murphy SK, Rowe DA et al. Effects of a classroom-based program on physical activity and on-task behaviour. Med Sci Sports Exerc 2006 Dec; 38(12):2086-84
  3. Gross McMillan A, Auman NL, Collier DN et al. Frontal plane lower extremity biomechanics during walking in boys who are overweight versus healthy weight. Pediatr Phys Ther 2009;21:187-193

Centres Visited

  1. University of California San Francisco, WATCH clinic – Prof Rob Lustig
  2. Children’s Hospital Boston, OWL clinic – Dr David Ludwig
  3. University of East Carolina, Paediatric Healthy Weight Research & Treatment Centre – Dr David Collier

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