Disease Management Update
Volume IV, No. 28
November 1, 2007

Dear Healthcare Intelligence Network Client,

This week's Disease Management Update focuses on obesity, a growing epidemic in the United States. While one organization is working on new ways to prevent weight gain, another is studying obesity-related hormones in children with Down syndrome.

And, on a related note, can weight increase one's risk of cancer? Visit HIN's blog to find out.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at:

Table of Contents

  1. Obesity-Related Hormone is Higher in Children with Down Syndrome
  2. Disease Management Q&A: Childhood Obesity Program Starts with Parents
  3. HealthSounds Podcast: Live Health-Coaching Session for Weight Management
  4. ‘Knocking Out’ Cell Receptor May Help Block Fat Deposits in Tissues, Prevent Weight Gain
  5. Survey of the Month: MRSA Education and Prevention
  6. The Business Case for Employer-sponsored Weight Management Programs

1. Obesity-Related Hormone is Higher in Children with Down Syndrome

Children with Down syndrome are more likely than their unaffected siblings to have higher levels of a hormone associated with obesity, according to pediatric researchers. The hormone, leptin, may contribute to the known higher risk of obesity among children and adults with Down syndrome. Researchers from the Children’s Hospital of Philadephia (CHOP) studied 35 children with Down syndrome and 33 of their siblings. All of the children were between the ages of four and 10 and were from the Philadelphia area. The researchers intentionally did not include severely obese children in the study, in order to focus on risk factors for obesity before obesity occurred.

The children with Down syndrome had significantly higher body mass index, a higher percentage of body fat and higher levels of leptin compared to their siblings. The higher leptin levels persisted even when the researchers adjusted for the effect of percentages of body fat, suggesting that differences in body composition did not account for the difference in leptin levels.

"The normal role of leptin is to suppress appetite and regulate body weight," said senior author Nicolas Stettler, M.D., MSCE, a pediatric nutrition specialist at CHOP. "In general, obese people have higher levels of leptin, which suggests that they have some leptin resistance — their bodies do not respond to the hormone properly. Because Down syndrome is a chromosome disorder, children with Down syndrome may have a genetic predisposition to more severe leptin resistance."

To see more of this study's results, please visit:

2. Disease Management Q&A: Childhood Obesity Program Starts with Parents

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Barbara Moore, Ph.D., president and chief executive officer of Shape Up America!, a national campaign.

Question: What kind of programs would have the greatest impact most quickly for childhood obesity problems? If you could only do one or two initiatives, what would you start with?

Response: (Barbara Moore) I would start with parenting skill-building. This process should begin prior to conception. You should be counseling parents who are trying to conceive. You should also counsel pregnant women because there’s some evidence that they are more open to suggestions and behavioral lifestyle changes while they are pregnant and anticipating the birth of the new baby. There’s evidence that the pregnancy to pre-school period is a critical period for what we call self-regulation.

There are also studies regarding the ability of a child to regulate his or her own intake. When you place a large plate of food in front of a three-year-old, that three-year-old will not overeat. But if you do the same thing to a five-year-old, that five-year-old will overeat. That suggests that some of the neurological structures that are developing in children that relate to appetite and the regulation of energy balance are being shaped during this period between the ages of three and five.

There are also very good interventions that have shown that vigorous physical activity — after-school programs where the kids have their heart rates up for as much as 90 accumulated minutes — have a powerful beneficial impact on body fat in teenagers as well as in preteens. Children are not as turned off to vigorous physical activity as adults are. They aren’t afraid of the word “exercise” the way adults are. There are data supporting the value of vigorous activity for the regulation of energy balance. Exercising and healthy eating go hand in hand. There is good evidence that if you get kids to exercise vigorously and do not pay attention to their nutritional status you can actually cause a decrease in bone mineral density of these children.

This study showed that if children were consuming fewer than 800 milligrams of calcium a day in their diet, they would experience a decrease in bone mineral density with exercise. The subjects who were getting enough calcium from milk and milk products experienced an increased bone mineral density with increasing levels of vigorous activity. Any program that would emphasize one over the other is making a mistake.

For more details on childhood obesity, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Live Health-Coaching Session for Weight Management

In a live coaching demo, "Coach Meg" (Wellcoaches CEO Margaret Moore) helps volunteer client Kathy Smith (not her real name) identify life issues that are keeping her from being her "best self" in managing her thyroid condition and weight issues. You'll hear how Coach Meg builds positive psychology into this real-life health coaching session, which was conducted as part of "Teaching Health Coaches to Integrate Positive Psychology with Physical Health to Improve Disease Management Outcomes," an audio conference now available on CD-ROM or via an On Demand re-broadcast on the Web.

To listen to this complimentary HIN podcast, please visit:

4. ‘Knocking Out’ Cell Receptor May Help Block Fat Deposits in Tissues, Prevent Weight Gain

University of Cincinnati (UC) pathologists have identified a new molecular target that one day may help scientists develop drugs to reduce fat transport to adipocytes (fat cells) in the body and prevent obesity and related disorders like diabetes.

The findings about a specific cell receptor, known as the adipocyte LDL receptor-related protein 1 (LRP1), provide important clues about the underlying biological mechanisms that control fat transport in the body. Using genetically altered mice, the UC team demonstrated that “knocking out” the LRP1 in fat cells has a direct impact on how many lipids (fats and fat-like substances) are transferred and deposited to different tissues. Results show that the experimental mice gained less weight, stored less fat, tolerated glucose better and expended more energy (due to increased muscle activity) when compared with a control group.

“This receptor is expressed in numerous tissues throughout the body — including the heart, muscles, liver and vascular wall — but its specific functions in the different tissues are still relatively unknown,” David Hui, Ph.D., corresponding author of the study and professor of pathology and laboratory medicine at UC. “Our study has shown that this molecule directly impacts the rate of fat transport in the body, so with further study it could be a new target for drugs aimed at controlling obesity.”

To see more of this study's results, please visit:

5. Survey of the Month: MRSA Education and Prevention

Complete our survey on MRSA education and prevention and you'll get a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Employer-sponsored Weight Management Programs

This new white paper details the significant benefits to organizations that invest in proven weight control strategies at work. The paper cites more than a dozen studies highlighting the return on investment in terms of health risks, costs, and worker productivity and offers employers solutions to the growing crisis.

To download this complimentary white paper, please visit:
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