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Negative effects of obesity on the brain can start during adolescence

An important discussion on obesity, without judgement or shame

Today’s youth are faced with a dangerous epidemic: obesity. Clinically defined by the CDC as having a Body Mass Index (BMI) of 30% or above, rates of obesity in children and adults have tripled in the United States alone since the 1970s.The issue remains widespread and continues to affect more and more young people across the globe at an alarming rate. ##Obesity Linked to Brain Damage in Youth In a shocking study published by the [Radiological Society of North America](https://www.rsna.org/) (RSNA), researchers found signs of brain damage that may be related to inflammation in the brains of obese adolescents. Using Diffusion Tensor Imaging (DTI) – which is similar to MRI technology – researchers examined the white matter tracts within the brains of 59 obese adolescents and 61 healthy adolescents, ages 12 to 16 years. The results revealed that obesity triggers inflammation in the nervous system that could damage important regions of the adolescent brain, specifically regions responsible for control of appetite, emotions and cognitive functions. The results showed that the obese adolescents had an increase of damage in the white matter in regions located in the corpus callosum, a bundle of nerve fibers that connect the left and right hemispheres of the brain. An increase of damage in the white matter was also found in the middle orbitofrontal gyrus, a brain region related to emotional control and the reward circuit. In fact, all of the brain regions in obese patients showed an increase of damage in the white matter. Additionally, the study revealed that worsening condition of the white matter was also associated with levels of insulin, a hormone produced in the pancreas that helps regulate blood sugar levels. Obesity often causes insulin resistance, a state in which the body is resistant to the effects of the hormone. ##Obesity, Insulin and the Adolescent Brain "Our maps showed a positive correlation between brain changes and hormones such as leptin and insulin," Dr. Pamela Bertolazzi, study co-author, biomedical scientist and Ph.D. student from the University of São Paulo in Brazil concluded. "Furthermore, we found a positive association with inflammatory markers, which leads us to believe in a process of neuroinflammation besides insulin and leptin resistance." Additional research from JAMA Pediatrics shows that many children are not only at risk for diabetes but also currently experiencing prediabetes. [CNN](https://edition.cnn.com/2019/12/02/health/prediabetes-adolescents-study/index.html) recently reported that “nearly a quarter of young adults and a fifth of adolescents in the United States have prediabetes.” In fact, a national survey conducted from 2005 to 2016 showed that male adolescents were almost twice as likely to have prediabetes than females (interestingly, the [CDC](https://www.cdc.gov/diabetes/data/statistics-report/prevalence.html) confirmed that more adult men than women have prediabetes). An additional concern is that most of the adolescents and adults with prediabetes don’t even know they have the condition. If prediabetes in young children isn’t concerning enough, those children who are currently already obese are also being affected by the secondary consequences of obesity, including type 2 diabetes, high cholesterol and high blood pressure. Obesity has long been linked to secondary health conditions, such as diabetes, heart disease and certain cancers, however we are now seeing more evidence with these studies that obesity also impacts the brain on multiple levels, including molecular and structural, and that damage starts very early. ![Prevention starts early](https://i.imgur.com/qsNcRuS.png) ##Obesity’s Lasting Effects While the DTI results in RSNA study are significant and compelling on their own, the study authors believe that the combined cumulative effect may be significantly worse than what is seen solely on the imaging findings. The effect may be the beginning of diseases such as vascular dementia, stroke, cognitive stunting and mood disorders such as depression, anxiety and attention deficit that can last well into a child’s later years. This finding is in line with research conducted by the [American Psychological Society](https://www.physiology.org/doi/full/10.1152/physrev.00032.2015), which reported that, “Disturbances in brain insulin action can be observed in obesity and type 2 diabetes (T2D), as well as in aging and dementia.” The study found that disruptions to metabolic and cognitive processes were likely to be linked to increased brain insulin resistance. One of the study’s conclusions highlighted an important link to a predisposition of insulin resistance over time in babies as well, noting, “Preliminary findings in the human fetus suggest that brain insulin resistance plays a role in prenatal development. Hence, it is conceivable that brain insulin resistance is a cause rather than a consequence of obesity/T2D and that it is perhaps even a precursor to dementia.” All of this research confirms our belief that obesity is a growing epidemic with widespread health repercussions that can begin at an early age and affect children throughout their lives into their senior years. Our [own research](https://www.sciencedirect.com/science/article/abs/pii/S0022510X17344647) into insulin resistance in relation to older adults shows that even when controlling for diabetes, stroke or heart disease, insulin resistance by itself is predictive of lower cognitive test performance (CTP) in adults 60 years old or older. This continued research is significant as part of our [recommendations](https://journals.sagepub.com/doi/abs/10.1177/1559827619843465) to help prevent diseases such as Alzheimer’s. Overall, education and a philosophy of prevention should be considered a priority and introduced to children at the elementary school level. Discussing the epidemic of obesity in an environment free of judgement and shame while also allowing acknowledging the root causes of the disease – primarily unhealthy food choices and lack of exercise – will empower our youth to understand the risks of this epidemic and reduce the prevalence of obesity and chronic diseases that can and will follow them into adulthood if they don’t take action now. Author(s): Dean Sherzai MD, PhD (c), MPH, MAS

Today’s youth are faced with a dangerous epidemic: obesity. Clinically defined by the CDC as having a Body Mass Index (BMI) of 30% or above, rates of obesity in children and adults have tripled in the United States alone since the 1970s.The issue remains widespread and continues to affect more and more young people across the globe at an alarming rate. ##Obesity Linked to Brain Damage in Youth In a shocking study published by the [Radiological Society of North America](https://www.rsna.org/) (RSNA), researchers found signs of brain damage that may be related to inflammation in the brains of obese adolescents. Using Diffusion Tensor Imaging (DTI) – which is similar to MRI technology – researchers examined the white matter tracts within the brains of 59 obese adolescents and 61 healthy adolescents, ages 12 to 16 years. The results revealed that obesity triggers inflammation in the nervous system that could damage important regions of the adolescent brain, specifically regions responsible for control of appetite, emotions and cognitive functions. The results showed that the obese adolescents had an increase of damage in the white matter in regions located in the corpus callosum, a bundle of nerve fibers that connect the left and right hemispheres of the brain. An increase of damage in the white matter was also found in the middle orbitofrontal gyrus, a brain region related to emotional control and the reward circuit. In fact, all of the brain regions in obese patients showed an increase of damage in the white matter. Additionally, the study revealed that worsening condition of the white matter was also associated with levels of insulin, a hormone produced in the pancreas that helps regulate blood sugar levels. Obesity often causes insulin resistance, a state in which the body is resistant to the effects of the hormone. ##Obesity, Insulin and the Adolescent Brain "Our maps showed a positive correlation between brain changes and hormones such as leptin and insulin," Dr. Pamela Bertolazzi, study co-author, biomedical scientist and Ph.D. student from the University of São Paulo in Brazil concluded. "Furthermore, we found a positive association with inflammatory markers, which leads us to believe in a process of neuroinflammation besides insulin and leptin resistance." Additional research from JAMA Pediatrics shows that many children are not only at risk for diabetes but also currently experiencing prediabetes. [CNN](https://edition.cnn.com/2019/12/02/health/prediabetes-adolescents-study/index.html) recently reported that “nearly a quarter of young adults and a fifth of adolescents in the United States have prediabetes.” In fact, a national survey conducted from 2005 to 2016 showed that male adolescents were almost twice as likely to have prediabetes than females (interestingly, the [CDC](https://www.cdc.gov/diabetes/data/statistics-report/prevalence.html) confirmed that more adult men than women have prediabetes). An additional concern is that most of the adolescents and adults with prediabetes don’t even know they have the condition. If prediabetes in young children isn’t concerning enough, those children who are currently already obese are also being affected by the secondary consequences of obesity, including type 2 diabetes, high cholesterol and high blood pressure. Obesity has long been linked to secondary health conditions, such as diabetes, heart disease and certain cancers, however we are now seeing more evidence with these studies that obesity also impacts the brain on multiple levels, including molecular and structural, and that damage starts very early. ![Prevention starts early](https://i.imgur.com/qsNcRuS.png) ##Obesity’s Lasting Effects While the DTI results in RSNA study are significant and compelling on their own, the study authors believe that the combined cumulative effect may be significantly worse than what is seen solely on the imaging findings. The effect may be the beginning of diseases such as vascular dementia, stroke, cognitive stunting and mood disorders such as depression, anxiety and attention deficit that can last well into a child’s later years. This finding is in line with research conducted by the [American Psychological Society](https://www.physiology.org/doi/full/10.1152/physrev.00032.2015), which reported that, “Disturbances in brain insulin action can be observed in obesity and type 2 diabetes (T2D), as well as in aging and dementia.” The study found that disruptions to metabolic and cognitive processes were likely to be linked to increased brain insulin resistance. One of the study’s conclusions highlighted an important link to a predisposition of insulin resistance over time in babies as well, noting, “Preliminary findings in the human fetus suggest that brain insulin resistance plays a role in prenatal development. Hence, it is conceivable that brain insulin resistance is a cause rather than a consequence of obesity/T2D and that it is perhaps even a precursor to dementia.” All of this research confirms our belief that obesity is a growing epidemic with widespread health repercussions that can begin at an early age and affect children throughout their lives into their senior years. Our [own research](https://www.sciencedirect.com/science/article/abs/pii/S0022510X17344647) into insulin resistance in relation to older adults shows that even when controlling for diabetes, stroke or heart disease, insulin resistance by itself is predictive of lower cognitive test performance (CTP) in adults 60 years old or older. This continued research is significant as part of our [recommendations](https://journals.sagepub.com/doi/abs/10.1177/1559827619843465) to help prevent diseases such as Alzheimer’s. Overall, education and a philosophy of prevention should be considered a priority and introduced to children at the elementary school level. Discussing the epidemic of obesity in an environment free of judgement and shame while also allowing acknowledging the root causes of the disease – primarily unhealthy food choices and lack of exercise – will empower our youth to understand the risks of this epidemic and reduce the prevalence of obesity and chronic diseases that can and will follow them into adulthood if they don’t take action now. Author(s): Dean Sherzai MD, PhD (c), MPH, MAS

12/23/2019
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