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Deprivation in childhood linked to impulsive behaviour in adulthood – new study
Inflation is running high around the globe, largely fuelled by Russia’s war in Ukraine and the COVID pandemic. As a result, many households are having to choose between eating and heating. Deprivation has a terrible immediate effect on children – as anyone who has experienced real hunger knows – but it can also affect things like impulsive behaviour in later life. “Trait impulsivity”, the preference for immediate gratification, has been linked to spending more on food, especially unhealthy, highly calorific food. Studies have shown that children who experience poverty and food insecurity tend to have a higher body-mass index as adults than those who do not. In a study published in Scientific Reports earlier this year, my colleagues and I showed that children who experience deprivation make more impulsive choices than children who don’t. We studied 146 children, with an average age of eight, living in some of the most deprived areas of England and compared them with children living in some of the most affluent neighbourhoods. Children were given a choice between taking home a small amount of money (for example, £1) or getting £10 a week, or even more a year later. How long a person is willing to wait for the larger amount of money can be used to calculate a “discount rate” that shows how much the waiting time reduces the value of the money. An impulsive person might prefer £1 now because the value of £10 in six months is “discounted” to less than £1 right now. This means that, for them, the £10, is discounted by £9 over the six-month wait. A less impulsive person might be willing to wait six months for £10, but not wait for a whole year for £15. This means that, for them, the value of the £15 is discounted by £5 over the additional six-month wait. This discount rate is a measure of how impulsive someone is. The results showed that children living in the most deprived areas had significantly higher discount rates than children living in the least deprived areas, regardless of age or intelligence, indicating that deprivation was the causal factor in the children’s choice. A stable trait This preference for immediate outcomes is a stable personality trait that remains constant throughout a person’s life. In our most recent study, published by the Royal Society, we investigated impulsivity in over 1,000 older adults aged between 50 and 90. We found that older adults, living in the most deprived areas, show the same preference for smaller-sooner financial outcomes as the children in our first study. We also found that a person’s job predicted the choices they made. Adults working in technical or routine occupations, such as mechanics or cleaners, chose to receive smaller amounts of money than wait for larger amounts compared with people in professional occupations, such as engineers or scientists. These findings are concerning because impulsivity doesn’t just predict obesity. These findings tell us a lot about why people living in poorer areas tend to be unhealthier than people living in wealthy areas. People who experience deprivation as children are more likely to choose to do things that, although they might be pleasurable in the short term, are unhealthy in the long run. This includes overeating, taking drugs, smoking cigarettes and gambling. We know too, that impulsivity can help to explain why some people go on to become addicts, while other people can avoid some of the more harmful effects of drugs and alcohol. Deprivation is one of many factors that can lead to impulsive behaviour throughout a person’s lifetime. Genetics also plays a role in impulsivity. Policymakers can’t do anything about a person’s genes but they can influence the nation’s long-term mental and physical health by minimising child poverty. Failing to do so will have long-term implications for the children living through today’s cost of living crisis.
Research suggests nutrition education should be on the curriculum of all medical students as well as other healthcare professionals Association for Nutrition develops new curriculum ready for medical students Aston University is one of the pioneers in delivering and embedding nutrition education as part of its medical school undergraduate programme. All healthcare professionals should study a curriculum of nutrition education during their studies in order to help better support public health – new paper suggests. Nutritional researchers from Aston University, with colleagues from other universities and leading nutritional groups, worked with the Association of Nutrition (AfN) to help develop a curriculum that can be rolled out amongst all undergraduate medical school students with potential for modules to be taught to other healthcare professional courses. The paper jointly published in the British Journal for Nutrition and BMJ Nutrition, Prevention and Health examined the development of a new curriculum aimed at undergraduate medical students and made recommendations on its roll out nationally, with a view to it subsequently being implemented into other healthcare courses. The AfN Undergraduate Curriculum in Nutrition for medical doctors has been designed to be presented to medical students as an integral part of their general undergraduate training, making it clear how nutrition interrelates with the study of other systems and contributes to an inclusive understanding of health and disease. Dr Duane Mellor, clinical dietitian and senior lecturer at Aston Medical School at Aston University and co-author on the paper, said: “At present, lifestyle related health problems from living with obesity, through to high blood pressure, type 2 diabetes, heart disease and several cancers can all be linked to diet across our communities. Whereas in hospitals around a third of patients coming in can be undernourished. “Nutrition and food play a key role to both keeping us healthy and helping to manage disease, which is why it is imperative we educate our future doctors and other health professionals about the role of nutrition in patient care.” The paper sets out not only the need for nutrition education and the gaps, but how it can be included as part of what is already a very busy and content heavy curriculum. It builds on areas of the curriculum where nutrition could even be used to help teach concepts such as epidemiology. It highlights how historically medical education along with the education of many health professionals not specialising in nutrition often have only a few hours of teaching on the subject. Dr Glenys Jones, deputy chief executive at the Association for Nutrition, who led the curriculum development project and is co-author on the recent paper, said: “Nutrition is a key and modifiable determinant of health and wellbeing, therefore it is essential our future medical and healthcare professionals are equipped to be able to identify when nutrition could be involved in a patient’s condition in order for this to form part of their care. “The curriculum is not designed to turn our doctors into nutritionists or dietitians, but to give them the knowledge and skills to be able to think about whether nutrition could be playing a role and having the confidence and knowledge of who, when and how to refer on to suitable nutrition professionals when this is needed.” Aston University is a pioneer in the key area of nutrition education of the future healthcare workforce. As one of few UK universities with a dietitian or nutritionist as part of the teaching team within its medical school, these skills are now being developed to benefit the training of other health professionals. Dr Mellor added: “As one of a few dietitians and nutritionists embedded into the teaching team at Aston Medical School, we have been able to integrate nutrition across our curriculum. “It is great to be able to highlight how nutrition links to the basic science areas such as biochemistry through to how you can encourage a patient to think about changing their diet in clinical skills". Aston University has also started to explore with the Association for Nutrition the potential need for nutrition education in other professions. From this an outline of a core curriculum for nutrition for a range of health professionals is in development. Dr Mellor also plans to work with colleagues to further develop nutrition teaching at Aston University, thus helping students across subjects such as optometry and pharmacy to gain a better understanding of nutrition and how it impacts on their areas of expertise. For more information about Aston Medical School please visit our website.
Livestreamed public lecture: How to help children develop healthier eating habits
Aston Institute of Health and Neurodevelopment to host second in a series of livestreamed public lectures Molecules to Minds will explore Professor Jackie Blissett’s research into understanding and supporting children’s healthy eating behaviour The one-hour livestream will be followed by a Q&A and round table discussion Aston Institute of Health and Neurodevelopment (IHN) will host its second livestreamed public lecture in the series Molecules to Minds on Aston University’s digital channel Aston Originals on Thursday 5 May 2022. Professor Jackie Blissett, the Institute’s co-director, will present her lecture: Understanding and supporting children's healthy eating behaviour. Jackie will discuss how ‘one size does not fit all’ when it comes to supporting children to develop healthier eating habits. Jackie and her team from the Aston University Psychology of Eating in Adults and Children (PEACh) group will explore how we can better understand and support children's healthy eating habits. The lecture will draw on the latest research undertaken by Jackie as part of the PEACh group. After the one-hour livestreamed lecture, Professor Blissett and members of the Aston University PEACh team, Dr Abigail Pickard and Dr Megan Jarman, will host a Q&A and round table discussion, where audience members can address researchers with their questions. Professor Blissett, co-director of IHN, said: “Why children eat what they eat, and why it is so difficult to change, is much more complicated than many people assume. Our goal is to better understand the complex factors which predict children’s eating so we can design interventions that are more likely to work.” With more than 20 years of experience working in this field, much of Jackie's research has focused on biological, affective and cognitive factors affecting eating and feeding in parents and their children. Jackie’s main interests are in children’s fussy eating, including fruit and vegetable acceptance, emotional eating and obesity. The livestream will take place at 16:00 – 17:00 BST on Thursday 5 May on the Aston Originals YouTube channel. To register for this event please visit our Eventbrite page. For more information about Aston Institute of Health and Neurodevelopment (IHN) please visit our website.
Sweeteners may be linked to increased cancer risk – new research
Sweeteners have long been suggested to be bad for our health. Studies have linked consuming too many sweeteners with conditions such as obesity, type 2 diabetes and cardiovascular disease. But links with cancer have been less certain. An artificial sweetener, called cyclamate, that was sold in the US in the 1970s was shown to increase bladder cancer in rats. However, human physiology is very different from rats, and observational studies failed to find a link between the sweetener and cancer risk in humans. Despite this, the media continued to report a link between sweeteners and cancer. But now, a study published in PLOS Medicine which looked at over 100,000 people, has shown that those who consume high levels of some sweeteners have a small increase in their risk of developing certain types of cancer. To assess their intake of artificial sweeteners, the researchers asked the participants to keep a food diary. Around half of the participants were followed for more than eight years. The study reported that aspartame and acesulfame K, in particular, were associated with increased cancer risk – especially breast and obesity-related cancers, such as colorectal, stomach and prostate cancers. This suggests that removing some types of sweeteners from your diet may reduce the risk of cancer. Cancer risk Many common foods contain sweeteners. These food additives mimic the effect of sugar on our taste receptors, providing intense sweetness with no or very few calories. Some sweeteners occur naturally (such as stevia or yacon syrup). Others, such as aspartame, are artificial. Although they have few or no calories, sweeteners still have an effect on our health. For example, aspartame turns into formaldehyde (a known carcinogen) when the body digests it. This could potentially see it accumulate in cells and cause them to become cancerous. Our cells are hard-wired to self-destruct when they become cancerous. But aspartame has been shown to “switch off” the genes that tell cancer cells to do this. Other sweeteners, including sucralose and saccharin, have also been shown to damage DNA, which can lead to cancer. But this has only been shown in cells in a dish rather than in a living organism. Sweeteners can also have a profound effect on the bacteria that live in our gut. Changing the bacteria in the gut can impair the immune system, which could mean they no longer identify and remove cancerous cells. But it’s still unclear from these animal and cell-based experiments precisely how sweeteners initiate or support cancerous changes to cells. Many of these experiments would also be difficult to apply to humans because the amount of sweetener was given at much higher doses than a human would ever consume. The results from previous research studies are limited, largely because most studies on this subject have only observed the effect of consuming sweeteners without comparing against a group that hasn’t consumed any sweeteners. A recent systematic review of almost 600,000 participants even concluded there was limited evidence to suggest heavy consumption of artificial sweeteners may increase the risk of certain cancers. A review in the BMJ came to a similar conclusion. Although the findings of this recent study certainly warrant further research, it’s important to acknowledge the study’s limitations. First, food diaries can be unreliable because people aren’t always honest about what they eat or they may forget what they have consumed. Although this study collected food diaries every six months, there’s still a risk people weren’t always accurately recording what they were eating and drinking. Though the researchers partially mitigated this risk by having participants take photos of the food they ate, people still might not have included all the foods they ate. Based on current evidence, it’s generally agreed that using artificial sweeteners is associated with increased body weight – though researchers aren’t quite certain whether sweeteners directly cause this to happen. Although this recent study took people’s body mass index into account, it’s possible that changes in body fat may have contributed to the development of many of these types of cancers – not necessarily the sweeteners themselves. Finally, the risk of developing cancer in those who consumed the highest levels of artificial sweeteners compared with those who consumed the lowest amounts was modest – with only at 13% higher relative risk of developing cancer in the study period. So although people who consumed the highest amounts of sweetener had an increased risk of developing cancer, this was still only slightly higher than those with the lowest intake. While the link between sweetener use and diseases, including cancer, is still controversial, it’s important to note that not all sweeteners are equal. While sweeteners such as aspartame and saccharin may be associated with ill health, not all sweeteners are. Stevia, produced from the Stevia rebaudiana plant, has been reported to be useful in controlling diabetes and body weight, and may also lower blood pressure. The naturally occurring sugar alcohol, xylitol, may also support the immune system and digestion. Both stevia and xylitol have also been shown to protect from tooth decay, possibly because they kill bad oral bacteria. So the important choice may be not the amount of sweetener you eat but the type you use.
Two glasses of wine might add more sugar to your diet than eating a doughnut
Soft drinks have been the focus of the UK government’s attempts to curb people’s sugar intake in recent years, but the same approach has not yet been applied to the sugar content in alcoholic drinks. The government introduced “sugar taxes” on soft drinks in 2018, meaning manufacturers are charged a levy of up to 24p per litre of drink if it contains eight grams of sugar per 100 millilitres. This was done in order to attempt to reduce the public’s sugar intake in light of increases in childhood obesity. But a new report from Alcohol Health Alliance UK has suggested that just two glasses of wine contains enough sugar to meet the maximum recommended daily intake level – even more than a glazed doughnut. The report found that some bottles of wine contain as much as 59 grams of sugar per bottle. A standard bottle of wine contains 750 millilitres, which is equivalent to three large glasses of wine. This means in some cases a single large glass of wine can contain just under 20 grams of sugar, almost twice the sugar content of that glazed doughnut. So, when it comes to alcoholic drinks, how much sugar do they contain? Consumption of sugar-sweetened drinks has been linked to an increased risk of weight gain and obesity, and associated conditions such as type 2 diabetes. Most research into sugary drinks has focused on soft drinks, such as colas. Alcohol, or ethanol to give it it’s proper name, is itself calorific. Alcohol is second only to fats in terms of its calorie content per gram. On top of this potentially significant calorie content is the sugar that is contained in many alcoholic drinks. This includes the non-fermented starches and sugars found in beers and wines, or sugars added to some drinks such as cocktails or mixers to add flavour. It is unsurprising therefore that alcohol consumption has been associated with weight gain. Sugar levels in cocktails Surveys have reported that alcoholic drinks account for 10% of daily intake of added sugar in the UK for 29 to 64-year-olds, and 6% for the over 65s. This difference may be explained by the alcoholic drinks chosen by these different age groups. Near the top of the list of sugary drinks is likely to be the recent phenomenon of pre-made cocktails in a can, with some containing a staggering 49 grams of sugar per serving. Other more traditional cocktails also fare poorly when scrutinised for sugar content, a summer fruit cup cocktail, for example, may contain more than 25g of sugar per serving. This figure could be higher at home, depending on who makes the drink, and what is considered a serving. Having several of these cocktails won’t just make you merry, but will also provide more sugar than eating several chocolate bars. Wine can vary dramatically in sugar content, with the seemingly healthier lower strength alcohol wines often having more sugar and therefore not necessarily being healthier. In general, dry wines or red wines generally have lower sugar levels. For those of us who enjoy beers and ciders, these drinks can contain even more sugar per serving than wine. A pint of cider, for example, contains more than 25g of sugar, with some ciders containing an eye watering 46g of sugar per serving. Because spirits such as gin, vodka, whisky and rum are highly distilled their sugar content should be negligible. Without mixers, these drinks are clearly the healthiest in terms of both sugar and calorie content. The mixers they come with can however be sugar-sweetened so if you want to avoid sugar, having your gin neat or on the rocks is the best way forward. Better labelling It is clear that more can be done to alert people to the sugar content of alcoholic drinks. The first step would be to mandate that alcohol producers accurately label their products, not just with alcohol content by volume, but also sugar and calorie content, so consumers can make informed choices. Equally, altering the sugar levy to target alcoholic drinks more specifically would likely cause drinks manufacturers to alter their recipes to have less sugar content. The levy on soft drinks has shown this can work, with significant reductions in consumption of sugar-sweetened non-alcoholic drinks since 2018. The government claimed that the tax on soft drinks resulted in more than 50% of manufacturers reducing sugar content in drinks between March 2016, when it was announced, and its introduction in 2018. In the UK more than 20% of people regularly drink alcohol at levels that increase their health risk. People should also be aware of the less obvious risks posed by drinking alcohol, including the sugar content, and take this into account when choosing their tipple, especially if they are trying to lose weight.
How potato milk measures up against other plant-based milk alternatives
It seems like almost every plant-based food is being turned into “milk” these days, the latest being potato milk. It’s not surprising that potatoes have been chosen to be the latest plant-based milk. After all, potatoes have many health benefits because they’re full of important vitamins and nutrients. But how do they measure up to other popular plant-based milks? Protein content No matter the type of plant-based milk, they only contain a fraction of the ingredient they’re derived from. For example, only 10% of the volume of a carton of rice or oat milk comes from these grains. Soy drinks contain between 5%-8% of the actual soya bean, and almond milks contain as little as 2% of the actual nut. Since coconut uses the cream or milk from the fruit, it contains between 5%-13%, depending on how creamy the product is. And based on the current potato milk products out there, a one-litre carton only contains around 60g of an actual potato – a small potato. The problem with this is that these milks now contain far fewer vitamins and nutrients than the raw ingredient would. This may make them less nutritious than they would be if you ate the ingredient whole. Take protein, for example. Ingredients like almonds are naturally great sources of protein containing over 20g of protein per 100g of almonds. But after processing, 100 millilitres of almond milk only contains around one gram of protein. This is actually the same amount of protein you’d find in the same amount of oat milk – even though oats contain far less protein (13.5g per 100g). Soya milk is better as it contains more of the soya beans compared with almond milk. In fact, soya milk gives around 3-3.5g of protein per 100ml. This is about as much protein as you get in the same amount of cow’s milk. And like cow’s milk, soya milk contains essential amino acids which our body isn’t able to naturally produce. Amino acids are important as they ensure our body works properly – such as by helping our muscles keep moving. Potatoes are already low in protein. This means that after processing, potato milk contains about as much protein as coconut and rice milk – less than 0.5g of protein per 100ml. But some potato milk brands do supplement with pea protein, which makes a 100ml serving have around 1.3g of protein. So if you’re choosing your plant-based milk for protein content, you might be best sticking with soya or almond milk over potato milk. Added sugars As with cow’s milk, plant-based milks can also contain added sugars. We are encouraged to limit our added sugar intake to no more than five to six teaspoons a day. This is because eating too much sugar is linked to an increased risk of obesity as well as tooth decay. But given many products sell both sweetened and unsweetened versions, it’s easier for someone to buy a product that contains no sugar. Sweetened potato milk contains about 1.8g of sugar per 100ml. This is a little less than other plant-based milks which contain around 2 to 3.5g of added sugar per 100ml. So in this category, potato milk comes out on top. Although some plant-based milk uses natural sugars from fruit, this is still considered added sugar and should be limited. Fat content Since potatoes are naturally low in fat, potato milk would have a texture more akin to water. This is why extra fat is added to it. A similar thing is done with rice and oat milk, where oil (such as sunflower oil) is added. This brings the fat content up so that it’s closer to semi-skimmed milk (about 1.5g per 100ml). For potato milk, rapeseed oil is added. Almond and soya both tend to contain fat already, so no additional oil is added. This means that compared with other plant-based milks, potato milk is higher in monounsaturated fats, which are thought to be better for your heart. They’re also lower in saturated fats than cow’s milk, which is thought to be less healthy for our hearts. A “barista version” of milk alternatives needs to contain a combination of both protein and fat in order for the milk to foam, so have slightly more fat added to them. Added vitamins When it comes to vitamins and minerals, many plant-based milks have these added to them, as they simply don’t have as many as cow’s milk naturally does. Vitamins like riboflavin, B12 and D alongside calcium are added to potato milks. The same is also true for other plant-based milks – although organic versions may not have added vitamins often due to organic food rules and trying to keep the label clean of additives. As many of us struggle to get enough vitamin D – which is essential for healthy bones and immune system – and many vegans and vegetarians can have low B12 levels (which is needed to keep our blood cells and nerves healthy) going for milk alternatives with these added vitamins and minerals can be a good idea. Potato milk is yet another option for those wanting an alternative to cow’s milk or other plant-based milks, or those looking for a more environmentally friendly milk product. Nutritionally, it may not contain the protein of soya milk, but many products are fortified, so they still contain important vitamins and minerals. But since it contains several refined ingredients, such as oils and protein isolates (proteins extracted from foods), it may technically count as an ultra-processed food. There are some concerns about ultra-processed foods, which have been linked to chronic disease – so it is yet to be seen whether potato milk has similar risks.
The Rise of "Don't Weigh Me" Cards
Stepping on the scale is an inherent part of the American healthcare experience. But does it have to be? Healthcare professionals and patients say not necessarily. For patients struggling with mental health, eating disorders, or other body-related concerns, being forced to step on the scale may cause significant distress. Because of this, the "don't weigh me" card has become increasingly popular. Born from the desire to make a trip to the doctor a more inclusive, less stressful experience, the cards sit in waiting rooms across the country and allow patients to discreetly make a choice: Would I like to be weighed today? Similar in size and shape to a business card, patients may grab a card and hand it to the provider before the start of the appointment, indicating the patient should not be weighed and that any discussion around weight should only occur if permission is given. According to Rebecca Shenkman, MPH, RDN, LDN, director of the MacDonald Center for Obesity Prevention and Education at Villanova University, "to be effective and emphatic providers, it is important to ensure a safe and comfortable environment and for the patient to feel seen and heard—and one such way is asking permission to be weighed (if the medical situation does not require a weight)." "This shows patients that their provider respects their voice and choice” Shenkman says. "'Don't weigh me" cards are a tool that providers should recognize as a good 'pause button' that allows them to re-center patient care on the individual and not have a conversation guided by a scale number or attribute certain symptoms or conditions to weight." Healthcare providers may express weight biases that prevent patients from receiving effective care. The provider may correctly or incorrectly attribute a patient's health concerns to weight and overlook additional factors not correlated with obesity. And while obesity is certainly a chronic and progressive medical disease that should not be ignored, there is more to a patient than a number on a scale. "A barrier to effective healthcare utilization is the prevalence of weight bias towards individuals with obesity. A first step to reducing bias is to acknowledge the issue exists and to recognize one's own biases, which may intentionally or unintentionally result in unfavorable behaviors and attitudes towards individuals with obesity," says Shenkman. While communication about weight-related health is important and many times necessary, to center the dialogue on weight alone means missing out on other potential issues. "By letting patients lead the conversation, having an open dialogue and practicing shared decision-making, and approaching the discussion around eating habits and weight-related behaviors within the broader context of health, patients are likely to be more receptive to medical advice given and seek future care." When patients are allowed to choose to be weighed, they are empowered to make their own decisions surrounding their care. "Don't weigh me" cards help provide peace of mind and a comfortable environment for all people, allowing providers to act more effectively and patients to seek out effective care more often.
Children Face Type 2 Diabetes Health Concerns After a Year at Home
Some children are facing health concerns after a year of attending school online. During the pandemic, research found cases of type 2 diabetes among children more than doubled. Lisa Diewald, MS, RD, LDN, Program Manager for the MacDonald Center for Obesity and Education weighed in on causes and potential prevention methods going forward. “We know that physical activity level, eating habits, weight status and other lifestyle factors play a significant role in the development of type 2 diabetes in adults and in children,” said Diewald. “Because of disruptions for many children in all four factors during the pandemic, (on top of pre-existing challenges), we are starting to see trickle-down health effects involving lifestyle-related chronic diseases, such as type 2 diabetes and children are not immune to these health effects.” Type 2 diabetes is related to obesity, exercise habits and diet. Children who struggle with weight may also have many social, genetic and environmental factors impacted by the accelerated risk seen through the pandemic. For example, the absence of healthy school meals while learning from home negatively impacted some children, as processed foods became replacements. Eating habits are also largely impacted by one’s mental state. “Like adults, children learn to cope with stress and anxiety in different ways. For some, this means reaching for comfort foods, which are often high in refined carbohydrates, saturated fat and sugar-all risk factors for T2 diabetes if consumed in excess,” said Diewald. “These foods can contribute to unhealthy weight gain, especially when physical activity is limited as well. The bad news is that it does not take a lot of weight gain to put a child who is already at risk at greater risk for diabetes.” But families should be aware of the good news that small changes can make a big difference and that prevention is possible. Diewald recommends a few small changes to alter a sedentary routine for parents and schools: • Build 1 minute brain breaks during the day for activity such as stretching or running up and down the stairs • Keep healthy snacks available and sugar sweetened snacks and drinks less visible • Create safe and walkable opportunities for children to add physical activity • Look for outdoor community sponsored activities that encourage physical activity that can provide safe and accessible physical activity opportunities Additional measures for parents to prevent the unhealthy coping with foods including working with children to make a list of fun alternative activities (unrelated to food) to do when boredom kicks in and posting in an accessible place in the home. Parents can act as role models and let children see that parents are working on more effective ways to cope as well. Though the risk of type 2 diabetes has been increasing during the past year, many factors can continually increase a person’s risk. These tips can provide the valuable tools for prevention in the future. “Teaching children healthier ways to cope with boredom and depression than eating are skills that can help for a lifetime, well beyond the pandemic,” said Diewald. To speak with Diewald, email mediaexperts@villanova.edu.
GP guidance: Diet and weight loss to achieve type 2 diabetes remission
• Research finds diet and weight loss key to remission of type 2 diabetes • Experts conducted a critical narrative review of over 90 research papers including international clinical trials • Researchers advise on reducing blood sugar levels to manage negative effects of type 2 diabetes and reduce risk of complications Achieving ‘remission’ for people with type 2 diabetes through dietary approaches and weight loss should be the primary treatment goal of GPs and healthcare practitioners, concludes a large-scale review of clinical evidence led by researchers at UCL and Aston University. Type 2 diabetes (T2DM) is a serious condition caused when the body resists the insulin produced in the pancreas, and not enough insulin is made. This leads to high levels of sugar (glucose) in the blood and is associated with multiple health problems including increased risk of heart disease, blindness, and amputation. In the UK T2DM affects around 3.9 million people and 179 million globally. Care and treatment of T2DM costs the NHS around £10 billion a year. Corresponding author, Dr Duane Mellor, Aston University said: “Accounting for all the evidence, our review suggests remission should be discussed as a primary treatment goal with people living with type 2 diabetes. There are multiple dietary approaches that have been shown to bring about T2DM remission though at present meal replacements offer the best quality evidence. Low carbohydrate diets have been shown to be highly effective and should also be considered as a dietary approach for remission.” Lead author, Dr Adrian Brown, UCL Division of Medicine said: “Traditionally T2DM has focussed on managing a person’s blood glucose with medication, however the approach doesn’t address the underlying causes of T2DM. There is now a growing body of research that shows losing significant weight, 10-15kg, either through weight loss surgery or dietary approaches, can bring about type 2 diabetes remission (non-diabetic blood sugar levels).” For the study, published in the Journal of Human Nutrition & Dietetics, specialist dietitians and obesity experts conducted a critical narrative review of over 90 research papers covering international clinical trials and clinical practice data of dietary methods used to treat T2DM. The study found that meal-replacement diets helped around one in three (36%) people successfully achieve remission, while low carbohydrate diets were able to help around one in five (17.6 %) people achieve and maintain remission for at least two years. People who lost the most weight and kept the weight off using both of these dietary approaches were able to stay in remission. Calorie restricted and Mediterranean diets were also able to help people achieve remission – but at much lower rates. Only around 5% of people on calorie restricted diets stayed in remission after one year, while only 15% of people on a Mediterranean diet stayed in remission after a year. In reaching their findings, the research team had to account for the fact there is no single definition of remission; it is typically defined as a return to non-diabetic blood sugar levels (glycated haemoglobin less than 48mmol/mol), without the use of diabetes drugs. Other definitions however say weight (especially fat around the midsection) must be lost to achieve remission, and others that medications can continue to be used. In addition, some reports suggest low-carbohydrate diets can normalise blood sugar levels even without weight loss. This happens as when carbohydrates are eaten, they are broken down into sugars which cause our blood sugar levels to rise. A low-carbohydrate diet means less blood sugar appears in the bloodstream, leading to improved blood sugar control. However, if weight loss is not achieved but individuals are able to achieve non-diabetic blood glucose, the authors are suggesting this should instead be called mitigation, as the underlying mechanisms of T2DM are not being addressed. Dr Brown said: “The evidence is clear that the main driver of remission remains the degree of weight loss a person achieved. Therefore, for those not achieving weight loss but achieving a non-diabetic blood glucose we are suggesting this isn’t remission per se, but rather “mitigation” of their diabetes.” The research concludes that while weight loss appears to be the best predictor of remission success, it assumes fat loss from the pancreas and liver. They note, that it will be important for future studies to compare how these diets work for different ethnic groups, as T2DM can happen at lower body weights in different ethnic groups, who may have less weight to lose. Dr Mellor added: “Not everyone will be able to achieve remission, but people who are younger (less than 50), male, have had type 2 diabetes for less than six years and lose more weight are more likely to be successful. “This could be because these people are able to address the causes of their diabetes, therefore recovering more of the pancreas’s ability to make insulin and the liver’s ability to use it. But this doesn’t mean others won’t be successful if they improve their diet and lifestyle and lose weight. “Whether or not a person achieves remission, reducing blood sugar levels is important in managing the negative effects of type 2 diabetes and reducing risk of complications. But when it comes to choosing a diet, the most important thing is to pick one that suits you – one that you’re likely to stick to long term.” The initial meeting which led to the writing of this paper was supported by the British Dietetic Association and Diabetes UK.
When it comes to marketing, the endgame is almost always to increase brand awareness, strengthen relationships between companies and consumers, and boost market share. But counter-marketing efforts are often employed to reduce consumption of “vice” goods such as cigarettes, sugary sodas, and fast food. Earlier this year, Michael “Mike” Lewis, professor of marketing, faculty director, Emory Marketing Analytics Center, published “Investigating the Effects of Excise Taxes, Public Usage Restrictions, and Anti-Smoking Ads across Cigarette Brands.” in the Journal of Marketing. Mike, along with co-authors, Yanwen Wang PhD14, associate professor of marketing and Canada research chair in Marketing Analytics at the University British Columbia, and Vishal Singh, professor of marketing, Leonard N. Stern School of Business, New York University, took a closer look at the role counter-marketing plays in the consumption of “vice” goods. Given that many “vice” categories are dominated by high-equity brands such as Marlboro, McDonald’s, and The Coca-Cola Company, the authors wanted to explore whether or not strong brands “might also affect the efforts of advocacy groups and regulators to disrupt these relationships and reduce consumption,” they note in their paper. The research focused specifically on the interplay between branding and counter-marketing with respect to cigarette consumption. By focusing on brand manufacturers rather than on regulators and consumers, the authors believe they’ve closed a gap. “The literature on smoking cessation has largely ignored the impact of branding on efforts to reduce cigarette consumption,” they write. “This is an oversight given that marketing researchers have found that brand-consumers’ relationships have significant effects on consumer decision-making.” A full article on the research is attached and is well worth the read. In that piece, readers will learn more about how the researchers expected that strong brands would take advantage of their increased customer loyalty and diminished price sensitivity to protect them from counter-marketing tactics. And while it might be counter-intuitive, the author’s research suggests that market leading cigarette brands would be better off pushing for excise taxes on cigarettes (versus smoking restrictions), as such tax increases would be attractive to government agencies (by increasing government revenue), and big brand cigarette companies would capture more market share. In other words, when it comes to combating counter-marketing efforts, “brand managers may devise strategies or lobbying efforts based on their category position,” suggest the researchers. “This isn’t a clear-cut battle of good versus evil. It’s more a matter of a brand’s people advocating for one position,” said Lewis. “A position that’s going to make them more resilient to some of these tactics.” In addition to big brand cigarette companies, the paper’s findings have implications for brands that anchor other vice categories, such as McDonald’s and The Coca-Cola Company, entities that have been the target of counter-marketing campaigns by various anti-obesity groups. According to Lewis, Wang, and Singh’s research, much of the response by these brands to the counter-marketing attempts has been centered around public relations, but the authors see opportunities to employ “different tactics” that are “appropriate for different brands,” they write. "Relationships between consumers and relatively weak brands may be disrupted using taxes, while for strong brands, the appropriate tactic seems to be usage restriction that limit public consumption. Our results suggest that brand building is the correct response to taxes, whereas usage restrictions would call for other responses, such as lobbying.” If you are a reporter looking to know more about this subject or if you have questions, then let our experts help. Professor Michael Lewis is an Associate Professor of Marketing at Emory University’s Goizueta Business School. In addition to exploring trends in the overall marketing landscape, Lewis is an expert in sports analytics and marketing. He is available for interview - simply click on his icon to arrange a discussion today.
