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School Closures During The Coronavirus Pandemic Might Worsen The Epidemic Of Childhood Obesity

The World Obesity Federation estimates that globally there are over 223 million school children who are obese. That number is expected to increase to 268 million by 2025. During the coronavirus pandemic, the World Health Organization recommended school closures to prevent any further transmission of the virus. In the U.S., and also globally, schools are not expected to re-open any time soon. While children are forced to remain indoors, some researchers are growing concerned that pandemic’s longer-term effects on children’s health due to school closures might exacerbate the epidemic of childhood obesity. The researchers argue that data from previous studies show most children tend to gain weight, not during the school year. But rather, during summer vacation which lasts for at least two to three months. “Although we criticize schools a lot for poor nutrition and physical activity, children actually tend to gain weight during the summer months, when school is out of session,” says Andrew Rundle, associate professor of epidemiology at Columbia University’s Mailman School of Public Health and lead author of the recent study that was published in the journal, Obesity. Today In: Healthcare COVID-19 Crowding Out Non-COVID-19 Healthcare And Drug Development Heart Drugs May Influence Gut Microbiome In Obese People, Says New Study It's Not Hopeless: These Doctors Explain What COVID-19 Has In Common With Diseases We Know How To Manage Rundle and his wife, Yoosun Park, who is the second author of the study, observed that whenever they went grocery shopping, there was always plenty of fresh produce available. “But the things that were missing were the microwave dinners, cookies, and other high energy and high calories snack foods items. Those are what people seem to be loading up on because the Center for Disease Control and Prevention (CDC) told us to buy stable shelf foods that last for long,” adds Rundle. Initially, everyone was under the impression that the lockdown and school closures would not last for long. And so, Rundle says, parents and children alike looked at it as another period between Thanksgiving and Christmas when they have the license to eat more calories-rich food than usual. PROMOTED Many schools have already been closed for more than a month, and may not reopen until the fall. The researchers started looking at trade magazines and analyzed what kind of food was being sold and also, the statistics on online gaming. “What we're seeing is that yes, people were buying lots of energy-dense foods. The data on online gaming has also been going up,” explains Rundle. “The school closures are making it harder for kids to be physically active and that means, there’s also going to be a lot more snacking on unhealthy foods.” To add to that, the current economic crisis is also resulting in an increasing number of families facing food insecurity. The researchers point out that is another major risk factor for weight gain among children. Rundle further says the disparities of obesity risk among children are going to increase as the economic crisis is hitting lower-income households a lot more. “The lower your resources are, the more difficult it is to prevent children from becoming overweight. For example, for a low-income family living in a small apartment in Brooklyn or the Bronx, there's no place for the kids to be physically active. They can't run around inside the apartment and there is a lack of open spaces to be physically active whilst social distancing,” adds Rundle. “It's just harder to eat healthy when you are food insecure. And so, we expect that this will increase the disparities in weight gain between high and low-income families.” Dr Samantha Marsh, a research fellow in population health at The University of Auckland in New Zealand, says it is still too early to predict whether school closures during the coronavirus pandemic are going to exacerbate the obesity epidemic or not. She further says that a stressed home environment means family routines may be more difficult to maintain, including those routines that impact health-related behaviors associated with obesity, such as sleep, screen use, and family meals. “Stress also impacts the the emotional environment at home, which can interfere with parent-child interactions and, in turn, positive engagement in health-related behaviors,” she explains. While she maintains that in New Zealand, there is plenty of open space and a low population density, even in such a developed nation, certain population groups fall under the high-risk section for childhood obesity. For instance, the Maori people are the indigenous people of New Zealand. They also fall under the lower socio-economic groups who are at a higher risk of childhood obesity. “They're more likely to be living in crowded houses, apartments, or state homes. They may not have access to a lot of outdoor space either,” says Marsh. The author of one of the studies on how school children tend to gain weight more during summer break, Paul Von Hippel, who is also the associate professor at LBJ School of Public Affairs, University of Texas, Austin, says it is likely that adults and children alike will try to relieve stress by binge eating comfort food – most of which are high in fat and simple carbohydrates. “We also know that the sales of flour and yeast are way up. People are watching more television, which is a strong predictor of obesity. Netflix has been one of the better-performing stocks. With these consumption patterns, there is going to be weight gain and the risk of obesity not just among children, but also adults,” says Hippel. He suggests that even for those who live in small apartments, to go for regular walks around the block while practising social distancing, doing simple exercises at home like jumping jacks, burpees and push-ups. Also, being creative at home and using home items like toilet paper to practice rigorous exercises. Childhood obesity is known to cause other health complications like type-2 diabetes, liver disease, bone, and joint problems, high blood pressure, elevated blood cholesterol, sleep apnea, liver disease, and also respiratory problems such as asthma, according to the Childhood Obesity Foundation. “It can all seem pretty doom and gloom sometimes but we should always consider the construct of resilience in situations like this. Although there are kids who will have a negative outcome like weight gain as a result of COVID and disease-containment responses like school closures, there will also be kids who won’t have this negative outcome,” adds Marsh. “This tells us that despite the seemingly insurmountable structural barriers to health that these families face, many will still be able to find solutions that enable them to meet the needs of their children and, as a result, obtain a positive outcome, like no weight gain.” Follow me on Twitter. Anuradha Varanasi Anuradha Varanasi I am a freelance science writer with an MA degree in Science Journalism from The Columbia University Graduate School of Journalism in New York City. I write on the… Read More Print Site Feedback Tips Corrections Reprints & Permissions Terms Privacy © 2020 Forbes Media LLC. All Rights Reserved. AdChoices Replay Unmute Current Time 1:00 / Duration 1:00 Share Fullscreen

Comment Published: 23 April 2020 Obesity and impaired metabolic health in patients with COVID-19

reliminary data suggest that people with obesity are at increased risk of severe COVID-19. However, as data on metabolic parameters (such as BMI and levels of glucose and insulin) in patients with COVID-19 are scarce, increased reporting is needed to improve our understanding of COVID-19 and the care of affected patients. In China, older age (≥65 years) and the presence of comorbidities are associated with a more severe course of COVID-19 in patients infected with the novel coronavirus (SARS-CoV-2). Among the comorbid conditions, the highest fatality rate was found for cardiovascular disease (CVD) (10.5%) and diabetes mellitus (7.3%), followed by chronic respiratory diseases (6.3%), hypertension (6.0%) and cancer (5.6%)1. A direct endocrine and metabolic link between hypertension and diabetes mellitus and coronavirus infection, which might involve angiotensin-converting enzyme 2, is being discussed2. Early data Studies from China1 and the Lombardy region of Italy3 that have reported comorbidities in patients with COVID-19 did not provide data on body weight and height, which are used to estimate adipose tissue mass by calculating the BMI. A descriptive study of a small sample of 24 (63% were men) critically ill patients diagnosed with COVID-19 in the Seattle region was among the first to report BMI data (3 patients with a BMI in the normal category, 7 with overweight, 13 with obesity and 1 with missing data). Although the numbers are too small for meaningful statistical analyses, 85% of the patients with obesity required mechanical ventilation and 62% of the patients with obesity died. These proportions are greater than those in the patients without obesity, in which 64% required mechanical ventilation and 36% died4. As CVD and diabetes mellitus are strongly associated with elevated adipose tissue mass5, a high BMI might be an important risk factor for a severe course of disease, particularly of pneumonia, in these patients. Concern about the effects of BMI is further substantiated by preliminary data from Shenzhen, China, and New York City, USA (the data have not been peer-reviewed). Among 383 patients from Shenzhen with COVID-19, overweight was associated with an 86% higher, and obesity with a 142% higher, risk of developing severe pneumonia compared with patients of normal weight in statistical models that controlled for potential confounders6. Among 4,103 patients with COVID-19 at an academic health system in New York City, BMI >40 kg/m2 was the second strongest independent predictor of hospitalization, after old age7. Furthermore, in a small study from a university hospital in Lille, France, reporting data from 124 patients with COVID-19, the need for invasive mechanical ventilation was associated with a BMI ≥35 kg/m2, independently of other comorbidities8. The parameters mediating this high risk are thought to include impaired respiratory mechanics, increased airway resistance and impaired gas exchange, as well as other pathophysiological features of obesity, such as low respiratory muscle strength and lung volumes9. The obesity paradox Conversely, an obesity survival paradox has been observed in patients with pneumonia. That is, despite the increased risk of pneumonia and difficulties of intubation and mask ventilation, the risk of death in patients with obesity and pneumonia might be decreased10. Potentially counter-balancing effects of obesity might include the more aggressive treatment provided to these patients, their increased metabolic reserve or other unidentified factors10. Thus, as a result of a potentially critical role of body weight or adiposity in determining the incidence and severity of pneumonia (and possibly other complications), it is important to collect anthropometric information for patients with COVID-19. Furthermore, the impaired metabolic health (characterized by hypertension, dyslipidaemia and hyperglycaemia) associated with obesity might also be present in those with normal weight or overweight5. Prediabetes, which is present in 38% of the adult population in the USA, was identified as an important risk factor for CVD and renal disease5. To what extent these cardiometabolic risk factors predispose individuals to severe disease independently of BMI remains to be determined. Conclusions In conclusion, to better estimate the risk of complications in patients with COVID-19, in addition to evaluation of standard hospital parameters (such as the Sequential Organ Failure Assessment, d-dimer and pro-inflammatory markers), the measurement of anthropometrics and metabolic parameters is crucial. These parameters include BMI, waist and hip circumferences and levels of glucose and insulin. The latter two parameters can be used for the estimation of insulin resistance, for example by calculation of the HOMA-IR. Knowledge about insulin resistance is important, because it is among the strongest determinants of impaired metabolic health, cardiac dysfunction and CVD-related mortality5. Such measurements might be useful both in a primary care setting and in a hospital setting to assess the risk of a complicated course of disease in patients with a positive SARS-CoV-2 test (Fig. 1). Fig. 1: Obesity-related comorbidities and mechanisms of a severe course of COVID-19. figure1 Patients with obesity often have respiratory dysfunction, which is characterized by alterations in respiratory mechanisms, increased airway resistance, impaired gas exchange and low lung volume and muscle strength. These individuals are predisposed to hypoventilation-associated pneumonia, pulmonary hypertension and cardiac stress. Obesity is also associated with an increased risk of diabetes mellitus, cardiovascular disease and kidney disease, comorbidities that are considered to result in increased vulnerability to pneumonia-associated organ failures. However, even in the absence of comorbidities of obesity, the presence of hypertension, dyslipidaemia, prediabetes and insulin resistance might predispose individuals to cardiovascular events and increased susceptibility to infection via atherosclerosis, cardiac dysfunction and impaired immune response. Full size image In conclusion, while it is widely recognized that the presence of comorbidities such as hypertension, diabetes mellitus and CVD is associated with a more severe course of COVID-19, obesity has hardly been investigated so far. Obesity is a main risk factor for these comorbidities and more generally for impaired metabolic health (such as dyslipidaemia and insulin resistance) and is also linked to an increased risk of pneumonia. Measurement of anthropometric characteristics and metabolic parameters is crucial to better estimate the risk of complications in patients with COVID-19.

School Closures During The Coronavirus Pandemic Might Worsen The Epidemic Of Childhood Obesity

.The World Obesity Federation estimates that globally there are over 223 million school children who are obese. That number is expected to increase to 268 million by 2025. During the coronavirus pandemic, the World Health Organization recommended school closures to prevent any further transmission of the virus. In the U.S., and also globally, schools are not expected to re-open any time soon. While children are forced to remain indoors, some researchers are growing concerned that pandemic’s longer-term effects on children’s health due to school closures might exacerbate the epidemic of childhood obesity. The researchers argue that data from previous studies show most children tend to gain weight, not during the school year. But rather, during summer vacation which lasts for at least two to three months. “Although we criticize schools a lot for poor nutrition and physical activity, children actually tend to gain weight during the summer months, when school is out of session,” says Andrew Rundle, associate professor of epidemiology at Columbia University’s Mailman School of Public Health and lead author of the recent study that was published in the journal, Obesity. Today In: Healthcare Rundle and his wife, Yoosun Park, who is the second author of the study, observed that whenever they went grocery shopping, there was always plenty of fresh produce available. “But the things that were missing were the microwave dinners, cookies, and other high energy and high calories snack foods items. Those are what people seem to be loading up on because the Center for Disease Control and Prevention (CDC) told us to buy stable shelf foods that last for long,” adds Rundle. Initially, everyone was under the impression that the lockdown and school closures would not last for long. And so, Rundle says, parents and children alike looked at it as another period between Thanksgiving and Christmas when they have the license to eat more calories-rich food than usual. PROMOTED Many schools have already been closed for more than a month, and may not reopen until the fall. The researchers started looking at trade magazines and analyzed what kind of food was being sold and also, the statistics on online gaming. “What we're seeing is that yes, people were buying lots of energy-dense foods. The data on online gaming has also been going up,” explains Rundle. “The school closures are making it harder for kids to be physically active and that means, there’s also going to be a lot more snacking on unhealthy foods.” To add to that, the current economic crisis is also resulting in an increasing number of families facing food insecurity. The researchers point out that is another major risk factor for weight gain among children. Rundle further says the disparities of obesity risk among children are going to increase as the economic crisis is hitting lower-income households a lot more. “The lower your resources are, the more difficult it is to prevent children from becoming overweight. For example, for a low-income family living in a small apartment in Brooklyn or the Bronx, there's no place for the kids to be physically active. They can't run around inside the apartment and there is a lack of open spaces to be physically active whilst social distancing,” adds Rundle. “It's just harder to eat healthy when you are food insecure. And so, we expect that this will increase the disparities in weight gain between high and low-income families.” Samantha Marsh, a research fellow in population health at The University of Auckland in New Zealand, says it is still too early to predict whether school closures during the coronavirus pandemic are going to exacerbate the obesity epidemic or not. She says that if parents are stressed out and behaving a certain way, their children will inevitably pick up on that. While she maintains that in New Zealand, there is plenty of open space and a low population density, even in such a developed nation, certain population groups fall under the high-risk section for childhood obesity. “The Maori people are the indigenous Polynesian people of New Zealand. They also fall under the lower socio-economic groups who are at a higher risk of childhood obesity. For example, they're more likely to be living in crowded houses, apartments, or state homes. They may not have access to a lot of outdoor space either,” adds Marsh. The author of one of the studies on how school children tend to gain weight more during summer break, Paul Von Hippel, who is also the associate professor at LBJ School of Public Affairs, University of Texas, Austin, says it is likely that adults and children alike will try to relieve stress by binge eating comfort food – most of which are high in fat and simple carbohydrates. “We also know that the sales of flour and yeast are way up. People are watching more television, which is a strong predictor of obesity. Netflix has been one of the better-performing stocks. With these consumption patterns, there is going to be weight gain and the risk of obesity not just among children, but also adults,” says Hippel. He suggests that even for those who live in small apartments, to go for regular walks around the block while practising social distancing, doing simple exercises at home like jumping jacks, burpees and push-ups. Also, being creative at home and using home items like toilet paper to practice rigorous exercises. Childhood obesity is known to cause other health complications like type-2 diabetes, liver disease, bone, and joint problems, high blood pressure, elevated blood cholesterol, sleep apnea, liver disease, and also respiratory problems such as asthma, according to the Childhood Obesity Foundation. “It can all seem pretty doom and gloom sometimes but we should always consider the construct of resilience in situations like this. Although there are kids who will have a negative outcome like weight gain as a result of COVID and disease-containment responses like school closures, there will also be kids who won’t have this negative outcome,” adds Marsh. “This tells us that despite the seemingly insurmountable structural barriers to health that these families face, many will still be able to find solutions that enable them to meet the needs of their children and, as a result, obtain a positive outcome, like no weight gain.”

Teens who learn healthy cooking skills at home are more likely to plan balanced meals throughout life. Help your teen get #cooking by stocking your kitchen with these easy-to-prepare staples!

7 Kitchen Staples for Teen-Friendly Meals By Karen Ansel, MS, RDN, CDN Published March 9, 2018 Reviewed February 2018 Teens looking for a snack - 7 Kitchen Staples for Teen-Friendly Meals BananaStock/Thinkstock If you have teenage children, you've heard it before: "There's nothing to eat in this house!" Sure, you can do your part by buying lots of healthy foods. But your teen can get involved too, by helping to prepare some of those foods. Why? When teens learn healthy cooking skills at home, they'll be more likely to plan balanced meals when they become responsible for their own food choices after they leave home. To help your teen get cooking, stock your kitchen with these easy-to-prepare staples. Popcorn What teen doesn't crave crunchy snacks? Skip the chips and pretzels and invest in a popcorn popper. Popcorn is a whole grain, plus it's loaded with fiber for a healthy digestive system. Three air-popped cups deliver nearly four grams of fiber. Canned Beans When it comes to making a quick meal, it doesn't get much easier than canned beans — just rinse, drain and heat! They're perfect for burritos, mashed on a tortilla, or added to canned soup for extra protein. Nut Butters Even if teens have no clue how to cook, that doesn't mean they can't whip up a simple meal or snack. Nut and seed butters — such as peanut, almond or sunflower butter — all are perfect no-fuss foods for the novice cook. They're a cinch to spread on French toast with sliced bananas or make a tasty dip for apples, celery or bell pepper strips. Eggs Whether fried, scrambled or hard-boiled, eggs are an easy protein food for teen cooks. With a prep and cook time of less than five minutes, eggs are an easy addition to any meal. They are a great source of protein, vitamin B12, choline and phosphorus – all essential nutrients for teens. Prepped Vegetables It doesn't matter whether they're fresh, frozen or canned, the more pre-prepped vegetables you have on hand, the more likely your teen will eat them. Think pre-cut baby carrots and grape tomatoes for snacks, frozen edamame and peas to add to pasta and diced tomatoes for chili. Grains Busy teens don't have a lot of time to spend in the kitchen, but that doesn't mean dinner has to be a sandwich. Quick-cooking whole grains such as quinoa, instant brown rice and whole-wheat couscous take less than 15 minutes from start to finish. For a speedy meal, teens can toss cooked whole grains with microwaved frozen vegetables, season them with less-sodium soy sauce, and add a convenient source of protein, such as cooked frozen or canned chicken or seafood, canned beans or tofu. Lean Protein When you teach teens basic cooking techniques you'll be amazed by how quickly they catch on. Start by showing them how to grill, bake or broil marinated chicken, fish or beef. Or, demonstrate how to sauté ground chicken or turkey, tempeh or tofu to add to spaghetti sauce, chili or tacos. Before you know it, your teen will be telling you what's for dinner. Karen Ansel, MS, RDN, CDN is a nutrition consultant, journalist and author specializing in nutrition, health and wellness. Tags

a campaign to empower moms to take small steps to make healthy eating fun and easy for their kids! What healthy steps can you make this month? Get off to a great start with this Healthy Choices game!

Just because it is a “kid’s drink” does not mean that it is actually healthy for kids. Here are 5 tips for healthy kids drinks

Why Do So Many Parents Miss To See Their Child's Obesity?

Researches say that parents are unlikely to recognise their child's obesity

One of the health concerns in children which is increasing day by day is childhood obesity. We all know that obesity leads to a lot of health issues, especially when developed at a very young age. Every parent is concerned about their children's health, but researchers have found that most often they are unable to recognise their child's obesity. In a recent study published in The British Journal of General Practice, it has highlighted that parents are unlikely to recognise childhood obesity in their kids. Play Video 1m 5s Why do so many parents miss their kid's obesity? Research says that parents are unlikely to recognize childhood obesity in their children, which could lead to health concerns. About The Study A study showed that parents are less likely to recognise childhood obesity in their kids. Obesity is one of the major lifestyle diseases in today's time, causing large number of deaths globally. Not only just adults, overweight children are at increased risk of mortality and disease too. (Also read: 6 Activities To Do With Kids When You Are Stuck At Home) jrkc2138 Parents ignore their kid's obesity The study result showed that 31 percent of parents have underestimated their child's weight and 1 percent overestimated this. In terms of acknowledging the extent of a child's obesity, only four parents out of 396 kids with clinical obesity described their child "as being very overweight." Also, the researchers said that parents with a higher body mass index (BMI) were more likely to struggle with the reality of a child's weight. Understanding parents' perceptions, beliefs and attitudes are important in the prevention and intervention of childhood obesity. Researchers also said that parents turn a blind eye to the issue since it's somewhat acceptable in society

The various psychological characteristics of children struggling with their weight, such as loneliness, anxiety and shyness, combined with similar characteristics of their parents or guardians and family dynamics affect outcomes of nutritional intervention have been examined by University of Notre Dame researchers. Complexity of Childhood Obesity Unraveled The Centers for Disease Control recently reported an estimated 1 in 5 children in the United States, ages 12-18, are living with prediabetes — increasing their risk of developing type 2 diabetes as well as chronic kidney disease, heart disease and stroke. ‘The World Health Organization has estimated more than 340 million children and adolescents ages 5-19 are overweight or obese, and the epidemic has been linked to more deaths worldwide than those caused by being underweight.’ Efforts to stem the crisis have led clinicians and health professionals to examine both the nutritional and psychological factors of childhood obesity. What they found was a "network effect," suggesting a personalized, comprehensive approach to treatment could improve results of nutritional interventions. "Psychological characteristics clearly have interactional effects," said Nitesh Chawla, the Frank M. Freimann Professor of Computer Science and Engineering at Notre Dame, director of the Center for Network and Data Science and a lead author of the study. "We can no longer simply view them as individualized risk factors to be assessed. We need to account for the specific characteristics for each child, viewing them as a holistic set for which to plan treatment." The Notre Dame team collaborated with the Centre for Nutritional Recovery and Education (CREN), a not-for-profit, nongovernmental nutritional clinic in São Paulo, Brazil, where patients participate in a two-year interdisciplinary treatment program including family counseling, nutritional workshops and various physical activities. Researchers analyzed the medical records and psychological assessments of 1,541 children who participated in the program. The study's key takeaway points to the significant impact parents and guardians have on their child's health when it comes to nutrition. Strong family dynamics, such as concern for behavior and treatment and a sense of protectiveness for the child, led to improved outcomes of nutritional interventions. A lack of authority, however, led to minimal changes in results. "This is quantitative evidence of the success and failure of interactions as they relate to the characteristics and interactions between the child and the parent or guardian," Chawla said. The study also highlights the need for clinics to expand their views on patient populations. For example, while treatment programs that incorporate development of interpersonal relationship — familial and otherwise — may improve outcomes of nutritional interventions, the same treatment plan may not have the same result for children experiencing loneliness coupled with anxiety. "For the group without anxiety, this makes sense when you consider a treatment plan focused on strengthening a child's social circle and address issues stemming from loneliness, such as poor social network, bullying or self-imposed isolation," said Gisela M.B. Solymos, co-author of the study, former general manager of CREN and former guest scholar at the Kellogg Institute for International Studies at Notre Dame and at the Center for Network and Data Science. "But patients feeling loneliness and anxiety actually showed minimal changes to nutritional interventions, and may be more likely to benefit from additional services at clinics like CREN." Co-authors of the study include Keith Feldman, also at Notre Dame, and Maria Paula Albuquerque at CREN. The National Science Foundation partially funded the study.

STIGMA

The NHS currently spends £1m every hour treating diabetes, a condition strongly linked with obesity. Additionally, there is strong evidence emerging that obesity is also a major, preventable risk factor for a variety of cancers. But, stigma is one of the greatest barriers to overcoming obesity. Time to end the stigma of obesity, stop judging and start helping The UK Bariatric Surgery Registry contains data on over 60,000 patients. It clearly demonstrates that modern weight loss operations are highly effective and safe, with the potential to save the health service money by reducing the burden of diseases associated with obesity. However, the annual volume of bariatric surgery in the UK – at under 6,000 operations a year – is five to 10 times less than most European countries. In France, 50% of the population are obese or overweight (compared to two thirds of UK adults), yet more than 60,000 surgeries are carried out each year. Data from 2012 show Belgians and Swedes go under the knife even more frequently (928 and 761 operations per million citizens respectively), yet the UK performed just 117 bariatric procedures per million at that time and numbers have dwindled since. Will obesity bankrupt the NHS? The NHS currently spends £1m every hourtreating diabetes, a condition strongly linked with obesity. A recent study* showed that three-quarters of people with Type 2 diabetes treated with gastric bypass surgery, experienced diabetes remission within one year of treatment – a powerful argument for the NHS to invest to save. People who are seriously obese usually develop other medical conditions too. Worn out knee and hip joints are expensive to replace and there is plenty of evidence that obesity is closely linked to serious conditions such as heart disease, stroke and even cancer. Obesity is a major preventable cause of cancer There is strong evidence emerging that obesity is also a major, preventable risk factor for a variety of cancers, particularly women’s cancers and colon (large bowel cancer) in men. Even fairly mild obesity (BMI 25-35) can increase the risk of uterine (womb) cancer. Obesity may also reduce the chances of responding well to cancer treatment. It is thought that more than one in 20 cancers are directly caused by excess weight. In fact, obesity is now the second biggest preventable cause of cancer in the UK after smoking. Stigma is one of the greatest barriers to overcoming obesity Stigma persists because some members of the public and even some medical professionals still see obesity as a lifestyle choice. But this way of thinking has to stop. Obesity might well have roots in unhappiness, psychological trauma, poverty, poor education or even just plain hedonism, but these triggers cause a catastrophic failure of the physiology that regulates the body’s normal energy intake. Surgery re-boots this natural control system, giving patients the chance of a better life. Severe obesity is a disease state and we need to start treating it as such. Let’s be clear – bariatric surgery isn’t a first-line treatment to aid weight loss (except in the most severe cases), but we should be working hard to remove obstacles to patients accessing effective obesity treatment once all other reasonable and appropriate measures have been tried.