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Super Size Me and The Fats of Life:
The Obesity Epidemic

ACB South West and Wessex Scientific Meeting

Tuesday 22nd February 2005

Postgraduate Medical Centre, Derriford Hospital, Plymouth

Meeting report by Alexandra Oliver, Royal Cornwall Hospital.

Whilst the rest of the country struggled with snow and ice, most members of the South West and Wessex ACB region, made the long trip southwest to blue-skied, sunny Derriford Hospital, Plymouth. The meeting covered a large range of obesity related subjects ranging from bariatric surgery to inherited syndromes of insulin resistance.

The day started with Dr John Gregory from University Hospital of Wales, who had kindly interrupted his paternity leave, to give a fascinating talk into exagerrated adrenarche, and the links with child growth. He presented an overview of adrenarche   (unique in humans), stressing that although it leads to pubarche, no genital maturity is seen, and although there is an increase in growth velocity between the ages of 6- 8 years there is very little effect on adult height.

Dr Gregory then presented work on the links between Intra-uterine growth retardation, the “ thrifty phenotype” hypothesis, resulting in high levels of DHEAS, and a greater risk of adrenarche and metabolic syndrome in later life.

Post menarche patients who developed premature adrenarche were more likely to have been born with low birth weight, were more likely to have a higher concentration of insulin and triglycerides in later life, suggesting   that it may be a forerunner for metabolic syndrome.

Insulin resistance in children was also discussed in Professor Terry Wilkin's review of the interesting findings from the on going EarlyBird study. In 2000 they enrolled 300 children aged 5 years and will study them   annually until 16 years of age, primarily looking into factors that cause NIDDM in the young. Presently they measure a plethora of different blood analytes (with all samples stored for retrospective analysis) alongside other factors such as physical activity, measured by the rather excitingly named accelerometer, which cleverly measures intensity and duration of any movements made by the child throughout the day. Even in the first five years the Early Bird study is producing a variety of interesting observations, linked with the development of type 2 DM in young adults, by 5years, girls show more evidence of insulin resistance than boys, but as children approach puberty insulin resistance   falls but glucose levels increase, due to a reduction in b -cells.

They also manage 96% success rate in collecting blood from their study children!

The Early Bird study uses the HOmeostasis Model Assessment (HOMA) to calculate percentage b -cell function and insulin sensitivity. Dr Sue Manley from Selly Oak Hospital explained how the mathematical HOMA model works and its clinical uses. Insulin assays varibility hindered the clinical and research use of the HOMA model.

To combat this problem, Dr Manley and her team compared 10 widely used insulin assays. This work should be published shortly and   they hope their results will overcome the problem of different insulin assays, giving different HOMA scores.

Dr Robert Semple from the University of Cambridge gave us a comprehensive insight into clinical signs and the molecular biology seen in syndromes of severe insulin resistance. Clinically these patients often present with fasting or reactive hypoglycaemia, PCOS, impaired linear growth and acanthosis nigricans. They can also present with lipodystrophy, dyslipidaemias, and steatohepatitis.

Studying potential candidate gene involved in these rare inherited syndromes of insulin resitance, may give us a broader insight into Type   diabetes.

  He left us with a short appeal that, if as biochemists we came across, result that may be suggestive of a severe insulin receptor defects, as defined by the criteria:

to contact him for further discussion

On either side of a delicious lunch, we were presented with lectures by Dr Jon Pinkney (University Hospital Aintree) on Bariatric surgery, followed   the by Dr Carl Le Roux on how the Gut talks to the brain.

Dr Pinkney gave an eye opening talk on the different methods of bariatric surgery, and gave quite a convincing argument for it being used in the treatment of diabetes. He pointed out the remarkable reduction in insulin resistance on patients that lose weight due to bariatric surgery compared to diet and exercise, and argued that treatment of type 2 diabetes is “ too HbA1c orientated”, and the option of bariatric surgery should be considered in cases where BMI is >40 or >35 and the patient is at high risk due to diabetic complications.

Dr Pinkney's argument was emphasized even further by Dr Carl le Roux from Hammersmith, whose talk expressed how gut hormones, particularly PYY, (peptide YY) regulate appetite and satiety. Levels of PYY have been shown to be lower in obese patients, hence meaning levels of satiety are reached after a greater calorific load. Dr le Roux showed data from patients who had under gone a Roux-en Y gastric by-pass; PYY concentrations increased post surgery, and patients reached satiety after a smaller calorific load, hence aiding their weight loss, and reducing their insulin resistance.

The whole day was brought to a close by an entertaining and thought provoking summary by Dr Ruth Ayling, who also arranged the programme meeting.

Dr Ayling discussed obesity throughout the ages and its economic cost, at both laboratory and social level. This was followed by open discussion, before all delegates not attending the AGM then made their long journey home.

I am sure all who came to the first meeting to be held in Plymouth would agree that it was great success, very informative (and worth the drive!).