Beyond Obesity and Overweight: the Clinical Assessment and Treatment of Excess Body Fat In Children : Part 2 - the Prescription of Low-Carbohydrate Eating as the First Approach.

PURPOSE OF REVIEW: Pediatric obesity and comorbidities related to insulin resistance continue to be a growing public health crisis. If lifestyle measures are unsuccessful, pharmacological and surgical interventions are offered. In this paper, we describe the driving force of the obesity crisis: hyperinsulinemia and the development of insulin resistance. We give historical background of key policy issues which have contributed to this pandemic as well as the physiologic mechanisms of insulin resistance. The prevalence of obesity will continue to rise unless the root cause of hyperinsulinemia is addressed. RECENT FINDINGS: Current research on insulin resistance demonstrates that a decreased consumption of carbohydrates is an effective first-line dietary intervention for the treatment of obesity and related metabolic diseases. Evidence shows it is safe and beneficial. A low-carbohydrate eating pattern can be helpful to address pediatric obesity. However, there must be policy guardrails in place to ensure that this is a sustainable and viable option for children and their families. There must be a change in the nutritional environment to help individuals battle the chronic disease of obesity.

Beyond Obesity and Overweight: The Clinical Assessment and Treatment of Excess Body Fat in Children : Part 1 - Insulin Resistance as the Root Cause of Pediatric Obesity.

PURPOSE OF REVIEW: Pediatric obesity and comorbidities related to insulin resistance continue to be a growing public health crisis. If lifestyle measures are unsuccessful, pharmacological and surgical interventions are offered. In this paper, we describe the driving force of the obesity crisis: hyperinsulinemia and the development of insulin resistance. We give historical background of key policy issues which have contributed to this pandemic as well as the physiologic mechanisms of insulin resistance. The prevalence of obesity will continue to rise unless the root cause of hyperinsulinemia is addressed. RECENT FINDINGS: Current research on insulin resistance demonstrates that a decreased consumption of carbohydrates is an effective first-line dietary intervention for the treatment of obesity and related metabolic diseases. Evidence shows it is safe and beneficial. A low-carbohydrate eating pattern can be helpful to address pediatric obesity. However, there must be policy guardrails in place to ensure that this is a sustainable and viable option for children and their families. There must be a change in the nutritional environment to help individuals battle the chronic disease of obesity.

High Prevalence of Positive Genetic Obesity Variants in Postoperative Bariatric Surgery Patients with Weight Regain Presenting for Medical Obesity Intervention.

INTRODUCTION: Genetic obesity susceptibility in postoperative bariatric surgery weight regain (PBSWR) remains largely unexplored. METHODS: A retrospective case series of adult (N = 27) PBSWR patients who had undergone genetic obesity testing was conducted between Sept. 2020 and March 2022. PRIMARY OUTCOME: frequency of genetic variants in patients experiencing weight regain following bariatric surgery. SECONDARY OUTCOMES: prevalence of obesity-related comorbidities, nadir BMI achieved post-bariatric surgery, and percent total body weight loss (%TBWL) achieved with obesity pharmacotherapies. RESULTS: Heterozygous mutations were identified in 22 (81%) patients, with the most prevalent mutations occurring in CEP290, RPGR1P1L, and LEPR genes (3 patients each). Median age was 56 years (interquartile range (IQR) 46.8-65.5), 88% female. Types of surgery were 67% RYGB, 19% SG, 4% gastric band, and 13% revisions. Median nadir BMI postoperatively was 34.0 kg/m2 (IQR 29.0-38.5). A high prevalence of metabolic derangements was noted; patients presented median 80 months (IQR 39-168.5) postoperative for medical weight management with 40% weight regain. BMI at initiation of anti-obesity medication (AOMs) was 41.7 kg/m2 (36.8-44.4). All received AOM and required at least 3 AOMs for weight regain. Semaglutide (N = 21), topiramate (N = 14), and metformin (N = 12) were most prescribed. Median %TBWL for the cohort at the first, second, and third visit was 1.7, 5.0, and 6.5 respectively. Fourteen (52%) achieved 5%TBWL, 10 (37%) achieved 10%TBWL, and 4 (15%) achieved 15%TBWL with combination AOMs and supervised medical intervention. CONCLUSION: An unusually high prevalence of genetic obesity variants in PBSWR was found, warranting further research.

Modulation sensitivity in the perceptual organization of speech.

In a spoken utterance, a talker expresses linguistic constituents in serial order. A listener resolves these linguistic properties in the rapidly fading auditory sample. Classic measures agree that auditory integration occurs at a fine temporal grain. In contrast, recent studies have proposed that sensory integration of speech occurs at a coarser grain, approximate to the syllable, on the basis of indirect and relatively insensitive perceptual measures. Evidence from cognitive neuroscience and behavioral primatology has also been adduced to support the claim of sensory integration at the pace of syllables. In the present investigation, we used direct performance measures of integration, applying an acoustic technique to isolate the contribution of short-term acoustic properties to the assay of modulation sensitivity. In corroborating the classic finding of a fine temporal grain of integration, these functional measures can inform theory and speculation in accounts of speech perception.

Estimating speech spectra for copy synthesis by linear prediction and by hand.

Linear prediction is a widely available technique for analyzing acoustic properties of speech, although this method is known to be error-prone. New tests assessed the adequacy of linear prediction estimates by using this method to derive synthesis parameters and testing the intelligibility of the synthetic speech that results. Matched sets of sine-wave sentences were created, one set using uncorrected linear prediction estimates of natural sentences, the other using estimates made by hand. Phoneme restrictions imposed on linguistic properties allowed comparisons between continuous and intermittent voicing, oral or nasal and fricative manner, and unrestricted phonemic variation. Intelligibility tests revealed uniformly good performance with sentences created by hand-estimation and a minimal decrease in intelligibility with estimation by linear prediction due to manner variation with continuous voicing. Poorer performance was observed when linear prediction estimates were used to produce synthetic versions of phonemically unrestricted sentences, but no similar decline was observed with synthetic sentences produced by hand estimation. The results show a substantial intelligibility cost of reliance on uncorrected linear prediction estimates when phonemic variation approaches natural incidence.