Can obesity surgery for mothers prevent obesity in their children?

…And we’re back!  After a month in exile from the blogging world my comprehensive exams are done!… for now.  Assuming that my committee finds my answers satisfactory I will move on to an oral exam sometime between now and the holiday season.  The good news is that I have read a ton of papers in the past few months (probably somewhere north of 200) so I’ve found plenty of interesting things to blog about well into the new year!

Out of all of these papers , one of the most interesting was published in Pediatrics by Dr John Kral and colleagues at the State University of New York and Laval University.  First, a bit of background:  It is becoming relatively well established that the environment that a fetus experiences in the womb can have a dramatic impact of their health well into adulthood.  So for example, when pregnant animals are overfed, their offspring are more likely to experience both obesity and metabolic dysfunction than the offspring of animals who were not overfed.  Not surprisingly then, the children of obese women are more than 4x more likely to be obese themselves, compared to children of non-obese parents.  Of course there are likely other mechanisms involved here as well (e.g. learned behaviours), but there does seem to be a pretty strong relationship between the prenatal environment and subsequent risk of obesity.

What Dr Kral and colleagues did that was so interesting, was to compare the obesity rates of siblings born to mothers before and after large weight loss due to bariatric surgery.  Among children born before their mothers had surgery, the prevalence of obesity was 41%.  In contrast, the prevalence was reduced to just 17% among children born to mothers post surgery.  That is still very high, but reducing the prevalence of obesity in any group by two-thirds is pretty impressive!  Even more interesting, when matching women for BMI at the time of conception, children born in the post-surgery group were still half as likely to be obese compared to those born pre-surgery.  The authors suggest that these benefits were likely due to both a healthier metabolic environment post surgery, as well as small weight gain during pregnancy (which could explain why there were benefits even when matching for BMI).

My research focuses entirely on the importance of lifestyle factors (e.g. diet and exercise), so I’ve been a reluctant convert to the benefits of obesity surgery.  But I’ve got to say that anything that reduces the risk of childhood obesity by 50-65% is incredibly impressive.   This study also poses an interesting conundrum for those who argue against increasing access to bariatric surgery on the basis that obesity is a matter of “personal choice” – how can obesity be a matter of choice when the prenatal environment plays such an important role? I know that some people remain hesitant to embrace bariatric surgery as a treatment strategy for adult obesity, but it may be hard to ignore its value in preventing childhood obesity – a condition which is both extremely difficult to treat, and which predisposes to excess risk of death and disability well into adulthood.

I know that this is just one relatively small study, but I’m curious to hear what people think of it.  And for those who are interested in the relationship between the prenatal environment and future risk of obesity, I’ll be posting an interview with a researcher whose work focuses on this area later in the week.

Have a good afternoon!

Travis

ResearchBlogging.orgKral, J., Biron, S., Simard, S., Hould, F., Lebel, S., Marceau, S., & Marceau, P. (2006). Large Maternal Weight Loss From Obesity Surgery Prevents Transmission of Obesity to Children Who Were Followed for 2 to 18 Years PEDIATRICS, 118 (6) DOI: 10.1542/peds.2006-1379

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17 Responses to Can obesity surgery for mothers prevent obesity in their children?

  1. WRG says:

    Then there’s an interesting little article that appeared in the New York Times recently that reported that children born to women who were pregnant and starving during the Biafran crisis are more prone to obesity (http://www.nytimes.com/2010/11/02/health/02global.html). Could this be because a starving body learns to expend as few calories as possible (in other words, slows down its metabolism) to conserve energy and passes this ability on to the foetus?

    We (yes, all of us) are all grasping at straws to figure out how to fight obesity and the more we grasp, the more we see just how incredibly and depressingly difficult the fight is.

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    • Travis Saunders, MSc, CEP says:

      @ WRG,

      That’s a very interesting situation you bring up, and one that comes up in one of my other posts later this week. From my understanding it’s more that fetus itself adapts to insufficient nutrient availability, rather than the mother who then passes it on to the fetus, although the result is much the same. Anyone else with more experience in the area of fetal plasticity and the Barker hypothesis, feel free to jump in.

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  2. Hi Travis,

    Haven’t read the study, but unless they controlled for dietary environment in the home before and after the study, I wouldn’t get too excited.

    Having seen dozens and dozens of folks have bariatric surgery I can tell you that the foods and lifestyles of the families before their mother or father had the surgery versus after are as dramatically different as their weight losses.

    Yoni

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    • theshortearedowl says:

      Why? The point of bariatric surgery is to “force” people to eat less, and less fat in particular. So yes, there is a difference in diet – that’s the idea! What the result says is that the changes following bariatric surgery reduce the likelihood of obesity in children conceived after surgery. If there was an additional result due to the surgery over equivalent changes in diet without surgery, that would be interesting but not vital to the conclusions.

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      • theshortearedowl says:

        Oh… you mean control for the kids’ diet? Yes, I see what you’re saying. It’s still a real-world result though, whatever the reason for the difference.

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    • Travis Saunders, MSc, CEP says:

      Fair enough. While I don’t doubt that changes to the food environment could also play a role, I don’t know that there’s any more evidence for that than for the physiological mechanisms discussed in the paper. Here is a more recent paper by the same group which reports no significant change in self-reported diet before and after the surgery, although you know better than I the limitations of self-reported diet info… In the end an impressive result is an impressive result, regardless of the specific mechanisms. Enough to warrant more research, if nothing else.

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  3. Midnyghtchilde says:

    How many people were actually studied? You report on percentages, but not the numbers of people…. I can’t imagine there are a lot of women having an invasive surgery and then having children after it.

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    • Travis Saunders, MSc, CEP says:

      There were 172 kids, the majority of whom were born after the surgery. Keep in mind that the pregnancies didn’t have to be immediately post-surgery (in fact the women were recommended that they not get pregnant for the first 18 months post surgery). This is an area that I know admittedly little about, but I think that the weight loss associated with bariatric surgery actually increases fertility, or at least it’s thought that it might (a full review is here .

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  4. Sarah says:

    As a medical librarian at a hospital that performs a large number of bariatric surgeries each year, I would like to second Yoni’s concern for the influence of pre- and post-operative diet on childhood obesity. One role of my job is to keep our clinicians current on post-op dietary guidelines, which differ significantly from most Americans’ diets, obese or not. These diets continue to differ long after the surgery itself. While the children of bariatric surgery patients are unlikely to eat exactly the same diet as their parents, it seems highly likely that parental dietary patterns will influence their children through determining what food is available in the house and in what quantity.

    Once parental diet pre- and post-op has been thoroughly controlled for, I look forward to the potential insights this research could bring out. Thanks for calling this study to our attention!

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  5. Yes, it is an impressive result, but I’d be willing to wager a great deal that it’s not as a consequence of changes to the pre-natal environment but rather a consequence of changes to the post-natal environment.

    Still a great byproduct of surgery to be sure, but much less exciting than the notion of prenatal impact.

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  6. Kristen says:

    I am curious. I don’t know if there is even a theoretical answer to my questions.

    Obesity runs in my family: my father is over 400lbs, mother near 300, older brother over 300, older sister 250 and younger sister almost 300. I started gaining weight as a teen and when I neared 160 (I am 5’6”) I decided I wasn’t going to be over-weight and have been under 130 for most of my adult life (as low as 115 when training for a marathon).

    My husband and his extended family are over-weight, but not obese.

    Even though I have been able to keep this weight steady, I gained copious amounts of weight during pregnancy. 40lbs with my first child (born at 31 weeks), 50 with my second (term), 60 with my third and 65 with my fourth. I was very careful to eat right and get exercise (I run to keep my weight down).

    But it seemed however much I ate I just gained and gained. I was always afraid of not losing the weight but I was so hungry, craving fatty foods (especially avocados and beef). And I figured if I was hungry the baby needed me to eat. I didn’t eat until I was stuffed, it just seemed their was no filling me up. All of the children were around normal weight at birth, none overly big but my middle daughter was low birth weight even though she was born at 41 weeks.

    I breastfed all (except the first-he died at birth) my children for at least 15 months and always got back under 130lbs between pregnancies.

    That said, what are my children’s chances of being obese as adults? Genetics seem to be against them, but they are all a “normal” weight so far.

    Does the lifestyle I am teaching them cancel out the pregnancy weight gain/genetics? Or will they be more susceptible to overeating and inactivity later in life?

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    • Travis Saunders, MSc, CEP says:

      Thanks for sharing your experience and for the great questions, Kristen. Unfortunately I’m not really equipped to answer them, and I don’t know that anyone could at the moment. There’s plenty of evidence that suggests that lifestyle is extremely important to both health and body weight, which is good since that’s really all that anyone can do. But as for the relative contributions of lifestyle vs genetics, and how the two interact in specific individuals – unfortunately I don’t think we’re that far along yet. What we do know is that regardless of a person’s genes, they are going to be healthier living an active lifestyle than if they were living an inactive one (ditto for diet), so teaching your kids a healthy lifestyle will still have important benefits, regardless of anything else.

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  10. Qualifying for weight loss surgery requires the patient to satisfy certain conditions. One factor is the degree of obesity the potential surgical candidate has.

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