Young teens’ weight terror ‘common’

About 10% of 13-year-old girls are “terrified” about putting on weight, the first UK study looking for warning signs of eating disorders suggests.

Doctors said they were “worried” by the high degree of weight fixation found in 13-year-old girls, years before eating disorders typically start.

Researchers say it might be possible to stop full eating disorders developing.

Their findings, in the Journal of Adolescent Health, came from interviews with the parents of 7,082 13-year-olds.

Eating disorders, such as anorexia, tend to start in the mid-teenage years, although they can begin before then.

“Start Quote

For me the results were particularly worrying”

Dr Nadia Micali

The study, by University College London and the London School of Hygiene and Tropical Medicine, looked at the years before those disorders tend to start.

Interviews with the parents of 7,082 13-year-old schoolchildren showed:

  • Nearly 12% of girls and 5% of boys were “terrified” by the thought of getting fat
  • 52% of girls and a third of boys said they were “a little worried” about getting fat
  • One in three girls and one in five boys were “distressed” by their body shape
  • 26% of girls and 15% of boys had “eating disorder behaviours” such as fasting
  • Some habits, such as uncontrolled bingeing, were linked to higher weight two years later

One of the researchers, Dr Nadia Micali, told the BBC she was surprised children were so concerned about weight at such a young age.

“For me the results were particularly worrying, I wouldn’t have thought they’d be so common at this age.

“Part of me thinks it’s a shame we didn’t ask earlier, we don’t know when this behaviour starts.

“Quite a large proportion will develop full-blown eating disorders, maybe more than half.”

However, she said there might be an opportunity to help children before they develop an eating disorder if a reliable set of warning signs could be developed for parents and teachers.

In a statement the eating disorder charity Beat said it was an interesting and important study.

“This is the first time a study like this has been carried out so we have nothing to compare it to and therefore don’t know if the problem is increasing or getting worse.

“However it is striking and worrying how many young people had concerns about their weight from such a young age.

“It does not mean that they will all go on to develop eating disorders, but they could be tempted by unhealthy ways to control their weight and shape.”

The findings came through data collected from the Children of the 90s study.


A separate analysis of those children, by a team at the University of Warwick, suggested bullying was linked to an increased risk of psychotic experiences, such as hearing voices, and paranoia.

Lead researcher Prof Dieter Wolke said: “We want to eradicate the myth that bullying at a young age could be viewed as a harmless rite of passage that everyone goes through – it casts a long shadow over a person’s life and can have serious consequences for mental health.

“It strengthens on the evidence base that reducing bullying in childhood could substantially reduce mental health problems.

“The benefit to society would be huge, but of course, the greatest benefit would be to the individual.”

Smoking ban ‘cuts premature births’.

The theory that public smoking bans cut the number of children born prematurely has been strengthened by new research.

Baby exposed to cigarette smoke

The study of 600,000 births found three successive drops in babies born before 37 weeks – each occurring after a phase of a public smoking ban was introduced.

There was no such trend in the period before the bans were put in place, the British Medical Journal reported.

The study, by Hasselt University in Belgium, comes after Scottish research in 2012 found a similar pattern.

But experts could not fully state the smoking ban was the cause of the change because pre-term births had started to drop before the ban.

It is already well established that smoking leads to reduced birth weight and an increased risk of premature birth.

Successive drops

In the latest study researchers were able to look at the rate of premature births after each phase of a smoking ban came into force in Belgium.

Public places and most workplaces were first to introduce smoke-free rules in 2006, followed by restaurants in 2007 and bars serving food in 2010.

The rate of premature births was found to fall after each phase of the ban with the biggest impact seen after the second two bans with restaurants and bars introducing no smoking rules.

After the bans in 2007 and 2010, the premature birth rate dropped by around 3% each time.

Overall it corresponds to a fall of six premature babies in every 1,000 births.

The changes could not be explained by other factors – such as mother’s age and socioeconomic status or population effects such as changes in air pollution and influenza epidemics.

There was no link found with birth weight.

Study leader Dr Tim Nawrot from Hasselt University said that even a mild reduction in gestational age has been linked in other studies to adverse health outcomes in early and later life.

“Because the ban happened at three different moments, we could show there was a consistent pattern of reduction in the risk of preterm delivery.”

He added: “It supports the notion that smoking bans have public health benefits even from early life.”

Patrick O’Brien, spokesperson for the Royal College of Obstetricians and Gynaecologists said: “It is very gratifying to see further strong evidence that smoking bans have had a beneficial impact on pregnant women and their babies.”

Scans show premature-baby brain arrested development.

Premature birth may interrupt vital brain development processes, medical scans reveal.

Researchers at King’s College London scanned 55 premature infants and 10 babies born at full term, using a novel type of MRI scan.

Premature baby in hospital

The brain scans showed arrested development in the premature babies at a key stage of maturation.

Experts say the work, in PNAS, could further understanding, but that parents should not be alarmed by the findings.

In recent decades there have been big advances in caring for premature babies, which mean most can go on to live a healthy life.

“Start Quote

Most premature babies are unaffected by their early arrival and families of these babies should not be unduly concerned”

Andy Cole Bliss

The researchers say the new type of imaging – which tracks the movement of water in the brain – will enable them to explore how the disruption of key processes might cause conditions such as autism.

It could also be used to monitor possible treatments to prevent brain damage.

Interrupted development

The scans showed cortical development was reduced in the preterm babies compared with those born at full term, with the greatest effect in the most premature infants – those born at about 27 weeks.

The brain regions affected govern social and emotional processing, as well as memory.

The same children were assessed at two years of age and those who had been born prematurely performed less well on neurodevelopmental tests, which the researchers say suggests the weeks a baby loses in the womb may matter.

Lead investigator Prof David Edwards said: “The number of babies born prematurely is increasing, so it has never been more important to improve our understanding of how preterm birth affects brain development and causes brain damage.

“We know that prematurity is extremely stressful for an infant, but by using a new technique we are able to track brain maturation in babies to pinpoint the exact processes that might be affected by premature birth.”

Andy Cole, chief executive of the premature baby charity Bliss, said: “It is very exciting that this ground-breaking research is being driven forward here in the UK.

“A better understanding of the way that preterm babies’ brains develop is an important step for doctors to help identify improvements in care that will benefit the 60,000 preterm children born every year.

“It is important to mention that most premature babies are unaffected by their early arrival and families of these babies should not be unduly concerned.”

More than one in 10 babies worldwide born prematurely.

Fifteen million babies, one in 10 births, are born prematurely every year, a global project suggests.

Baby in mother's arms in Nepal

One million of these babies die soon after birth. The joint report, led by the WHO, says three quarters of deaths could be prevented with basic care.

For the first time premature birth rates have been estimated by country, with the highest risk being in Africa.

In the UK about 8% of babies are born too soon and this rate is rising partly due to obesity and later motherhood.

There are nearly 60,000 premature births every year in the UK.

Andy Cole, from premature baby charity Bliss, said “it is worrying that the UK’s preterm birth rate is significantly higher than countries such as Sweden, Norway and Ireland, and highlights the need for well-co-ordinated and high-quality antenatal care for all women identified as high risk”.

“Start Quote

Being born too soon is an unrecognised killer”

Dr Joy Lawn Co-editor of the report

Worldwide problem

A premature or preterm baby is one that is born before 37 weeks after the first day of the mother’s last period. A full term baby is when pregnancy lasts 40 weeks.

Forty-four organisations contributed to The Born Too Soon report, which estimated premature birth rates – the number of babies born too soon, out of the total of number of live births – for 184 individual countries, in the first study of its kind.

Of the 11 countries where over 15% of babies are born too early, all but two are in sub-Saharan Africa. However, the report highlights it is a problem worldwide.

“It is very striking to see that preterm births have a similar burden all around the world – but due to different reasons,” Dr Lale Say from the WHO said.

“In developing countries it is due to things like infections, HIV, malaria and poor nutrition.

Baby in arms
Premature babies are likely to have developmental problems as they grow up

“In developed countries there are totally different risk factors – an older delivery age, diabetes, obesity and multiple births due to IVF.”

The report also mentions caesarean sections before full term, which are not always medically needed, as a reason for increasing premature baby rates.

A leading cause of death

Dr Joy Lawn, co-editor of the report and Director for Save the Children said: “This report shows the problem is much bigger than expected or realised. Being born too soon is an unrecognised killer.”

In children under five, prematurity is the leading cause of death worldwide, after pneumonia. Many premature babies that do survive develop learning difficulties and visual and hearing problems.

“This has been a shocker to those who work in child survival programmes – people were almost falling off their chairs when I reported back our findings,” said Dr Lawn.

“We have been working on problems identified 20 years ago. There has been progress in pneumonia, and diarrhoea as a cause of death has seen a major drop, but preterm birth has not been on anyone’s ‘to do’ list.”

“There is no excuse for 80% of babies, who are less than eight weeks early, to die – it’s lack of food and warmth, not lack of intensive care.”

Easy care

Experts at the UN say simple and inexpensive care, like antiseptic cream to prevent cord infection, one US dollar (60 pence) steroid injections given to mothers to help foetal lung development, and antibiotics to fight infection, can help keep premature babies alive.

They also advocate the use of kangaroo care – where the baby is tied, skin to skin, on the mothers’ front – which reduces infection, keeps the baby warm and makes it easy to breastfeed. This has been proven to dramatically reduce newborn death.

Not surprisingly, there are big inequalities in survival rates around the world.

Countries with the highest premature birth numbers (2010)

Source: World Health Organization

This is highlighted in the US – as, while it is makes the top ten for the highest number of premature births in the world, it is only number 37 for deaths – because of very effective and expensive intensive care.

Dr Christopher Howson, from March of Dimes, a baby charity which collaborated on the study said: “In low income countries, more than 90% of extremely preterm babies die within the first few days of life, while less than 10% die in high income countries.”

“However, this is a solvable problem. A number of countries, for example, Ecuador, Botswana, Turkey, Oman and Sri Lanka have halved their neonatal deaths from preterm birth through improving [care for] serious complications like infections and respiratory distress.”

It is hoped the report will spotlight premature births, especially in sub-Saharan Africa, and make it an urgent priority to help reach the UN Millennium Development Goal 4 set in 2000 – which calls for the reduction of young child deaths by two-thirds in 2015.

Map of premature birth rates across the world Premature birth rates across the world (2010)

‘Kangaroo care’ key for prem babies.

Mothers carrying babies skin-to-skin could significantly cut global death and disability rates from premature birth, a leading expert has said.

Prof Joy Lawn says “kangaroo care“, not expensive intensive care, is the key.

Premature baby in an incubator

The 15 million babies every year born at or before 37 weeks gestation account for about 10% of the global burden of disease, and one million of them die.

Of those who survive, just under 3% have moderate or severe impairments and 4.4% have mild impairments.

“Start Quote

Unless there are those breathing problems, kangaroo care is actually better ”

Prof Joy Lawn London School of Hygiene & Tropical Medicine

Prof Lawn, from the London School of Hygiene and Tropical Medicine (LSHTM), said: “The perception is you need intensive care for pre-term babies,

“But 85% of babies born premature are six weeks early or less. They need help feeding, with temperature control and they are more prone to infection.

“It’s really only before 32 weeks that their lungs are immature and they need help breathing,

She added: “Unless there are those breathing problems, kangaroo care is actually better because it promotes breastfeeding and reduces infection.”

Speaking ahead of World Prematurity Day on Friday, UN Secretary General Ban Ki-moon, who leads the Every Woman Every Child movement, which promotes improvements to healthcare for women and children, said: “Three-quarters of the one million babies who die each year from complications associated with prematurity could have been saved with cost-effective interventions, even without intensive care facilities.”

Duncan Wilbur, from the UK charity Bliss, said, “While kangaroo care saves lives in countries such as Africa, it is also incredibly important for babies born too soon all over the world.

“Here in the UK our medical technology is extremely advanced but simply giving a baby kangaroo care or skin-to-skin can help make a baby’s breathing and heart rate more regular, it can help a baby’s discomfort during certain medical procedures and importantly can benefit breastfeeding and bonding between the baby and parents.”

Pregnancy risks

Studies to be published this weekend in the Pediatric Research journal show boys are 14% more likely to be born prematurely – and boys who are premature are more likely to die or experience disability than girls.

Common disabilities include learning disorders and cerebral palsy.

Prof Lawn said: “One partial explanation for more preterm births among boys is that women pregnant with a boy are more likely to have placental problems, pre-eclampsia, and high blood pressure, all associated with preterm births.”

She added: “Baby boys have a higher likelihood of infections, jaundice, birth complications, and congenital conditions, but the biggest risk for baby boys is due to preterm birth.

“For two babies born at the same degree of prematurity, a boy will have a higher risk of death and disability compared to a girl.

“Even in the womb, girls mature more rapidly than boys, which provides an advantage, because the lungs and other organs are more developed.

Food production and obesity linked to climate change.


Horse meat sold as beef has made headlines and provoked consumer outrage in the UK, but the contribution of global food production—and particularly meat—to climate change is the larger scandal, according to experts who spoke to The Lancet Respiratory Medicine.

“Meat and dairy are a hotspot for ecological public health”, notes Timothy Lang (Centre for Food Policy, City University London, London, UK). “About half the world’s grain is fed to animals. The land and water use for such production systems are enormous. But this has created a situation where supposedly efficient modern agricultural systems have turned domestic animals as sources of cheap meat into direct competitors with humans for dominance in the ecological space.”

Although many people understand the threats that are posed to food systems by rising temperatures, extreme weather, and changing precipitation patterns, few seem to appreciate the degree to which human food production contributes to global climate change and the resulting health risks.

“It is bizarre that so many people in public health seem barely aware of food’s massive contribution to climate change”, remarks Lang. “This is not just unfortunate but downright irresponsible.”

An estimated 14% of greenhouse gas emissions come directly from agriculture (putting it on par with transportation emissions). Increasing transportation distances to market worsens food’s carbon footprint—a factor for which Lang coined the term “food miles.”

“A policy shift toward horticulture rather than animal-oriented agriculture is long overdue and is set to be a key challenge for the 21st century”, Lang believes. Public education campaigns to encourage people to eat less meat would seem to be the obvious direction for public health and environmental interventions meant to mitigate climate change. But public education is more easily advocated than implemented.

“In the past few years, several attempts to generate sustainable dietary advice for populations have come up against some big food-industry vested interests”, Lang says, citing recent controversies in Sweden, the UK, and Australia over proposed consumer advisories and nutritional guidelines. “Powerful interests will fight hard not to address the challenge of sustainability.”

Food production and agricultural and trade policies have been hijacked by a small number of large corporations in recent decades, agrees Wenonah Hauter (Food & Water Watch, Washington, DC, USA), whose father fled Oklahoma in the 1930s because of the so-called Dust Bowl—severe dust storms largely driven by agriculture.

In the USA, “20 large food processors own most brands on retail shelves”, notes Hauter. “Our political system is set up to allow companies to become larger and larger. During the Reagan administration, antitrust law was one of the main targets of the deregulatory agenda. They cut staff and enforcement budgets at regulatory agencies, and narrowed the definition of what constitutes an antitrust violation. Predictably, these companies became so large they’re able to dictate food and farm policy on everything from what pesticides we’re exposed to, to the way that food is made and labelled.”

US agriculture policy was further deregulated under the Clinton administration in the mid 1990s “to get in line with trade policy”, Hauter says. Deregulation of grain commodities during the 1990s saw increased corporate consolidation of corporate meat production, with the “factory farms” proportion of pork production, for example, rising from 30% in 1995 to 95% by 2005.

Under President Obama, efforts to curb junk food advertisements aimed at children yielded only “very weak voluntary guidelines”, Hauter says, which is testament to food industry lobbyists’ sway in Washington DC.

“Governments don’t govern; they follow”, cautions Lang. “Too often they are timid with regard to health and environment. The neoliberal perspective dominates: leave it to the consumer. But consumers are in the dark about the impact their food has on the planet, and the avalanche of cheap calories [in developed countries] acts as the model for what consumerism aspires to. But increasingly, scientists are aware that we need a new direction for food. We have to link human and environmental health.”

The interactions between abundant cheap calories, obesity, and the environment can generate complex feedback loops between climate, food, and epidemiology. The industrial production and global transportation of food contributes to global climate change, which affects agriculture through changes in precipitation and temperature, and extreme weather events. The effects will be felt unevenly around the planet, further impoverishing Africa’s agricultural base, for example. Overweight and obese people consume more food than others and rely disproportionately on travel by car, which together increases their carbon footprint to make obesity itself a serious global environmental problem, according to a 2009 study by scientists at the London School of Hygiene & Tropical Medicine.

The burden of respiratory disease is expected to increase with global temperatures, and the link between respiratory disorders, such as asthma and sleep apnoea, could be compounded by the environmental consequences of climate change. Extreme heat, air pollutants such as ozone and particulate matter, and increased production of plant and fungal allergens, will all conspire to drive up respiratory morbidity and mortality rates.

Early modelling studies predict that concentrations of pollen from common tree species such as oak and birch, and weeds such as the highly-allergenic ragweed, will increase by 20—30% by 2020, and will continue climbing for decades to follow, notes Leonard Bielory (Center for Environmental Prediction, Rutgers University, Springfield, NJ, USA). The US Environmental Protection Agency is funding research at Rutgers University to assess the effect of climate change on allergenic airway disease, says Bielory.

Respiratory syncytial virus infections are more common when temperatures are higher. Prolonged drought and increased airborne levels of particulate matter from wildfire smoke and dust—including the intercontinental movement of dust from growing expanses of African desert—are expected to exacerbate asthma and COPD symptoms.

Concentrations of ground-level ozone, a highly oxidative air pollutant, are expected to rise in some regions and drop in others, leading to increased rates of respiratory distress, exacerbated airway diseases such as asthma, and respiratory infection risks, adds Hans Orru (Department of Public Health, University of Tartu, Estonia). Predicted increases in ground-level ozone will hit central and southern Europe harder than northern Europe, which is likely to see declines in ozone, Orru says.

“There are a number of interactions between plant biology, which will certainly be affected by rising CO2 and increased temperature, and public health concerns. These interactions can run the gamut from aeroallergens to nutrition to pesticide use”, says Lewis H Ziska (Crop Systems and Global Change Laboratory, US Department of Agriculture, Beltsville, MD, USA). “There is initial evidence that all of these issues are already being affected.”

Recent and projected changes in atmospheric CO2 have been shown to change yields of plant food proteins, antioxidants, and omega-3 fatty acids, Ziska points out. “One key question we have is whether or not rising CO2 will also affect food allergies.” Ragweed pollen season has increased by as much as 13—27 days at higher latitudes since 1995, according to a 2011 study by Ziska, Bielory, and colleagues. Increased pollen seasons correspond to an increased number of frost-free days, Bielory notes.

Another key question is whether or not plant pollen might become more allergenic with changing temperatures or CO2 levels. The effects of air pollutants on respiratory health can be compounded by the presence of respiratory allergens, Ziska notes. Pollen sticks to larger particulate matter associated, for example, with diesel fumes. “The particulate matter can act as a platform that attracts pollen and drives it further into the lungs”, Ziska explains. Sensitisation to common seasonal allergens has doubled over the past 20 years along with symptoms, Bielory has found.

In addition to airborne allergens, the effect of climate change on plant communities might lead to larger populations of disease vectors such as mosquitoes, whose larvae can feed on pollen.

AJ McMichael (National Centre for Epidemiology and Population Health, Australian National University, ACT, Australia) and others believe that major civilisational shifts, resulting in starvation, warfare, migration, and revolution, have accompanied abrupt climatic change in the past. A recent report even links droughts in wheat-producing regions of the globe with the Arab Spring uprisings in countries that are among the largest wheat importers.

Climate change will unveil complex interactions between plants and human physiology, Ziska concludes. “We are getting a sense of what some of those interactions are, and how significant they are, but we have a great deal more yet to do”. Untangling these interactions will be a major interdisciplinary endeavour.

Source: lancet


Neonatal Mortality Risk Associated with Preterm Birth in East Africa, Adjusted by Weight for Gestational Age: Individual Participant Level Meta-Analysis.

Low birth weight and prematurity are amongst the strongest predictors of neonatal death. However, the extent to which they act independently is poorly understood. Our objective was to estimate the neonatal mortality risk associated with preterm birth when stratified by weight for gestational age in the high mortality setting of East Africa.

Methods and Findings

Members and collaborators of the Malaria and the MARCH Centers, at the London School of Hygiene & Tropical Medicine, were contacted and protocols reviewed for East African studies that measured (1) birth weight, (2) gestational age at birth using antenatal ultrasound or neonatal assessment, and (3) neonatal mortality. Ten datasets were identified and four met the inclusion criteria. The four datasets (from Uganda, Kenya, and two from Tanzania) contained 5,727 births recorded between 1999–2010. 4,843 births had complete outcome data and were included in an individual participant level meta-analysis. 99% of 445 low birth weight (<2,500 g) babies were either preterm (<37 weeks gestation) or small for gestational age (below tenth percentile of weight for gestational age). 52% of 87 neonatal deaths occurred in preterm or small for gestational age babies. Babies born <34 weeks gestation had the highest odds of death compared to term babies (odds ratio [OR] 58.7 [95% CI 28.4–121.4]), with little difference when stratified by weight for gestational age. Babies born 34–36 weeks gestation with appropriate weight for gestational age had just three times the likelihood of neonatal death compared to babies born term, (OR 3.2 [95% CI 1.0–10.7]), but the likelihood for babies born 34–36 weeks who were also small for gestational age was 20 times higher (OR 19.8 [95% CI 8.3–47.4]). Only 1% of babies were born moderately premature and small for gestational age, but this group suffered 8% of deaths. Individual level data on newborns are scarce in East Africa; potential biases arising due to the non-systematic selection of the individual studies, or due to the methods applied for estimating gestational age, are discussed.


Moderately preterm babies who are also small for gestational age experience a considerably increased likelihood of neonatal death in East Africa.

Source: PLOS