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Tuesday, April 16, 2024
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Researchers have raised alarm over rising cases of hypertension among teenagers and adolescents especially those in secondary schools across the nation.

In fact, several studies concluded that the prevalence of hypertension in Nigerian children is high and appears to be increasing and there is need for routine Blood Pressure (BP) and urinalysis check for all children in especially those in clinics and wards.

Indeed, studies suggest a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. They say efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity.

According to a study published in the journal The Lancet Public Health and titled “Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis”, hypertension in children and adolescents is becoming a major concern, not only because of its rising prevalence, but also because of evidence suggesting that hypertension tracks from childhood to adulthood. Almost half of adults with hypertension had elevated blood pressure values during childhood.x

Furthermore, several studies have suggested that elevated blood pressure in childhood correlates with carotid intima-media thickness, atherosclerosis, left ventricular hypertrophy, and kidney failure in adulthood. Consequently, the study recommended early diagnosis and control of hypertension in childhood are likely to have an important effect on long-term outcomes of hypertension-related cardiovascular complications.

A recent study published in European Journal of Medical and Health Sciences concluded: “There is a noteworthy prevalence of hypertension among adolescent public secondary school students in Nnewi. This was significantly higher among the female gender, lower socioeconomic level and students with minimal physical activity. Waist circumference in the obese/overweight category very likely predicts hypertension.”

The study titled “Blood Pressure Profiles And Determinants Of Hypertension Among Public Secondary School Students In Nnewi, Southeast Nigeria” was conducted by Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.

According to the researchers, hypertension and associated factors among adolescents have not been given the deserved attention in health care, more so as hypertensive children end up as hypertensive adults with serious co-morbidities. This is even more expedient among public school students, who in our environment are generally of lower socioeconomic status than those in private schools.

The researchers set out to determine the Blood Pressure (BP) profiles and association of obesity indicators, socioeconomic level and physical activity with hypertension among public secondary school students.

A cross-sectional school-based assessment of blood pressure (BP), body mass index (BMI), weight to height ratio (WHR), waist circumference (WC), physical activity and socioeconomic level among 593 students aged 10 – 17 years in public schools in Nnewi, Southeast Nigeria was carried out.

The results of the study showed the mean systolic BP increased with age and was higher for girls than for boys.x

“The prevalence of systolic hypertension and prehypertension were 8.4 per cent and 6.6 per cent respectively, while that of diastolic hypertension and prehypertension were 5.7 per cent and 11.8 per cent respectively. Both systolic and diastolic hypertension occurred in 2.4 per cent of students. Girls had a higher prevalence of hypertension – both systolic and diastolic. There was no significant gender difference in the prevalence of systolic hypertension and prehypertension between early and late adolescents.

Early adolescent males were more likely to have diastolic hypertension and prehypertension compared to late adolescent males, while no difference in prevalence was noted among the females. Systolic hypertension was more evident in the lower socioeconomic level, those with minimal physical activity, and those in the obese/overweight categories of BMI, WC, and WHR,” the researchers noted.

Blood pressure is recorded as two numbers: Systolic blood pressure (the first number) – indicates how much pressure your blood is exerting against your artery walls when the heart beats.

Diastolic blood pressure (the second number) – indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

Which number is more important? According to studies, typically, more attention is given to systolic blood pressure (the first number) as a major risk factor for cardiovascular disease for people over 50. In most people, systolic blood pressure rises steadily with age due to the increasing stiffness of large arteries, long-term buildup of plaque and an increased incidence of cardiac and vascular disease.

However, either an elevated systolic or an elevated diastolic blood pressure reading may be used to make a diagnosis of high blood pressure. According to recent studies, the risk of death from ischemic heart disease and stroke doubles with every 20 mm Hg systolic or 10 mm Hg diastolic increase among people from age 40 to 89.

The abbreviation mm Hg means millimeters of mercury. Mercury was used in the first accurate pressure gauges and is still used in medicine today as the standard unit of measurement for pressure.x

Another study titled “Hypertension and prehypertension among adolescents in secondary schools in Enugu, South East Nigeria” and published in Italian Journal of Pediatrics concluded: “Our study revealed a relatively high prevalence rate of hypertension and prehypertension among adolescents studied and these were more common among female subjects.

“It is therefore recommended that periodic screening and monitoring of blood pressure of adolescents should be incorporated into the school health programme, while general public health education on hypertension and its associated risk factors should be strengthened.”

The researchers are from University of Nigeria Teaching Hospital (UNTH) Enugu.

According to the researchers, hypertension is a prevalent cardiovascular disease risk factor among blacks and adolescent hypertension can progress into adulthood.

To determine the prevalence of hypertension and prehypertension among secondary school adolescents in Enugu State, a study of 2,694 adolescents aged 10-18 years in Enugu metropolis was carried out. Socio-demographic profile anthropometric and blood pressure readings were obtained. Derived measurements such as prehypertension, hypertension and BMI were obtained.x

The results showed that the mean systolic blood pressure and diastolic blood pressure for males were 106.66+ 11.80 mmHg and 70.25 + 7.34 mmHg respectively. The mean SBP and DBP for females were 109.83+ 11.66 mmHg and 72.23 + 8.26 mmHg respectively (p < 0.01). Blood pressure was found to increase with age. Prevalence of hypertension and prehypertension was 5.4 per cent and 17.3 per cent respectively with a higher rate in females (6.9 per cent) than males (3.8 per cent). Prevalence of prehypertension among males and females were 14.3 per cent and 20.1 per cent respectively. The prevalence of obesity was 1.9 per cent. Modifiable risk factors exist among adolescents. Early lifestyle modification and a strengthened school health are recommended.

Meanwhile, hypertension has been defined by levels of BP above, which lowering BP will reduce the cardiovascular risk associated with elevated BP and this level has been classically documented at 140/90 mmHg in adults. The new 2017 American College of Cardiology/American Heart Association guideline set hypertension stage 1 at greater than 130/80 mmHg rather than 140/90 mmHg as in the European guidelines.

According to a study titled “Hypertension in children: Could the prevalence be on the increase?” and published in the Nigerian Medical Journal, factors such as age, height, and gender are important factors in interpreting BP values in children. The most widely used definition of hypertension in children is delineated as BP greater than 95 per cent of expected BP for age, gender, and height.

The researchers from the Departments of Paediatrics, College of Medicine, Enugu State University of Technology and College of Medicine, University of Nigeria, Nsukka, Nigeria; and Child Survival Unit, Medical Research Council, Fajara, The Gambia, said unlike in adults where essential hypertension is very common, both secondary and essential (primary) hypertension are seen in children– primary hypertension being influenced by factors such as birth weight, maturity during birth, heredity, and diet while secondary is influenced by renal abnormalities, coarctation of the aorta, medications, neoplasm, etc.

Worldwide, the prevalence of hypertension in children ranges between one per cent and five per cent, with a significant proportion of them under-diagnosed. The prevalence of hypertension in children and adolescents in the United States of America is 3.3 per cent, whereas in Europe, prevalence ranging from 2.2 per cent to 22 per cent has been documented. Across Africa, the prevalence also varies between 0.2 per cent and 24.8 per cent, with a pooled figure of 5.5 per cent.

In Nigeria, various studies have also demonstrated similar prevalence rates in the neighborhood of 3.5 per cent and six per cent. In 2013, in Enugu, southeast Nigeria, Ujunwa et al. reported a prevalence of 5.4 per cent. A similar study in 2014 on pre-school children in Enugu, Nigeria, noted a comparatively low prevalence rate of elevated BP prevalence of 1.9 per cent.x

The authors opined that the prevalence of hypertension in children mighy still be on the increase. A higher prevalence value, however, may be expected when other groups of children are considered since BP increases with growth and development and results in hypertension during the first two decades of life. Although the pathogenesis of raised BP in obese children is not widely understood, evidence abounds on other comorbid conditions, which further accentuate the risk of hypertension. Aside from the risks associated with it, childhood hypertension is a major killer and one of the most common health concerns in children worldwide.

There is also substantive evidence linking it with long-term cardiovascular risk in adulthood. Therefore, it is of public health importance.

The researchers noted: “BP measurement is usually done for adults and has proven to be crucial in the assessment of cardiovascular health. This important measurement is not usually done routinely for children, although childhood hypertension detection is a measurement identifying potential future morbidity (essential hypertension) or existing underlying disease (secondary hypertension). In general, screening of children for hypertension is focused on essential hypertension since this is usually asymptomatic in children and may go unnoticed, but later becomes a risk in adulthood. Secondary hypertension comes to the fore with the presentation of the underlying disease. Consequently, childhood essential hypertension has been termed a strong predictor of hypertension in the adult population.

“Interestingly, identifying children with elevated BP and successfully treating them will have an impact on long-term outcomes of cardiovascular disease as well as a sizeable effect on hypertension-related morbidity and mortality. The cost implication of treating adults with raised BP will be addressed when attention is paid to childhood primary hypertension. To further understand the degree of attention that should be given to hypertension in childhood, knowledge of its prevalence and factors associated with it need to be continuously emphasized. It can also inform the need for routine BP check in children and adolescents in the routine children’s clinic.”

Meanwhile, as part of efforts to curb non communicable diseases including hypertension, the World Health Organisation (WHO) on Tuesday, launched a year-long global campaign for World No Tobacco Day 2021 – “Commit to Quit.” The new WHO Quit Challenge on WhatsApp and publication “More than 100 reasons to quit tobacco” are being released today to mark the start of the campaign.

The COVID-19 pandemic has led to millions of tobacco users saying they want to quit. The campaign will support at least 100 million people as they try to give up tobacco through communities of quitters.

“Commit to Quit” will help create healthier environments that are conducive to quitting tobacco by advocating for strong tobacco cessation policies; increasing access to cessation services; raising awareness of tobacco industry tactics, and empowering tobacco users to make successful quit attempts through “quit & win” initiatives.

WHO, together with partners, will create and build-up digital communities where people can find the social support they need to quit. The focus will be on high burden countries* where the majority of the world’s tobacco users live.

WHO welcomes new contributions from partners, including private sector companies that have offered support, including Allen Carr’s Easyway, Amazon Web Services, Cipla, Facebook and WhatsApp, Google, Johnson & Johnson, Praekelt, and Soul Machines.x

Quitting tobacco is challenging, especially with the added social and economic stresses that have come as a result of the pandemic. Worldwide around 780 million people say they want to quit, but only 30 per cent of them have access to the tools that can help them do so. Together with partners, WHO will provide people with the tools and resources they need to make a successful quit attempt.

“Smoking kills eight million people a year, but if users need more motivation to kick the habit, the pandemic provides the right incentive,” said WHO Director-General, Dr. Tedros Adhanom Ghebreyesus.

WHO released a scientific brief earlier this year showing that smokers are at higher risk of developing severe disease and death from COVID-19. Tobacco is also a major risk factor for noncommunicable diseases like cardiovascular disease, cancer, respiratory disease and diabetes. Moreover, people living with these conditions are more vulnerable to severe COVID-19.

Both global and regional cessation tools will be rolled out as part of the campaign. WHO’s 24/7 digital health worker to help people quit tobacco is available in English and will soon be released to support people in Arabic, Chinese, French, Russian, and Spanish.

“Millions of people worldwide want to quit tobacco – we must seize this opportunity and invest in services to help them be successful, while we urge everyone to divest from the tobacco industry and their interests,” said Dr. Ruediger Krech, Director of Health Promotion.

To create environments conducive to quitting tobacco, WHO has worked with partners and countries around the globe to implement tobacco control measures that effectively reduce the demand for tobacco.

WHO calls on all governments to ensure their citizens have access to brief advice, toll-free quit lines, mobile and digital cessation services, nicotine replacement therapies and other tools that are proven to help people quit. Strong cessation services improve health, save lives and save money.

Nigeria is one of the 22 campaign focus countries.

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1166653998 Tiarna Lodge / EyeEm/Getty Images

Vitamin D deficiency is associated with cancer, cardiovascular disease, and osteoporosis, but clinical trials of vitamin D supplements have yielded mixed results. A new study that found links between the active form of the vitamin and gut bacteria may help explain why.

Vitamin D is essential for strong immunity and maintaining healthy bones and teeth.

Several studies have found that low levels of vitamin D in the blood correlate with a wide range of illnesses, including cancer, cardiovascular disease, diabetes, and osteoporosis.

A few studies have even hinted that low vitamin D levels are associated with severe COVID-19, although the research is inconclusive.

Despite these associations, evidence for the benefits of widespread vitamin D supplementation to prevent disease in otherwise healthy people has been mixed.

For example, a large clinical trial found no evidence that a vitamin D supplement prevented cardiovascular disease and cancer in older adults. Another trial found no evidence that taking a supplement improved bone health.

This apparent lack of health benefits from widespread vitamin D supplementation has baffled medical researchers.

Scientists at the University of California (UC) San Diego in La Jolla have now discovered a possible explanation. Their findings appear in Nature Communications.

The paper suggests that gut bacteria may play a vital role in converting inactive vitamin D into its active, health-promoting form.

Stores of inactive vitamin D

When healthcare professionals and medical researchers want to determine an individual’s vitamin D status, they measure serum levels of the inactive precursor, because this reflects how much vitamin D the body stores.

However, the crucial factor may be how the vitamin is metabolized rather than how much of it is stored.

When measuring how much active vitamin D older males had in their blood, the UC San Diego researchers found that its levels correlated with the diversity of the community of bacteria living in their gut, or gut microbiome.

Levels of active vitamin D also correlated with the number of “friendly” bacteria in their gut.

By contrast, there was not a strong association between the inactive, precursor form of the vitamin and bacterial diversity or friendly bacteria.

“We were surprised to find that microbiome diversity — the variety of bacteria types in a person’s gut — was closely associated with active vitamin D but not the precursor form,” says senior author of the study Dr. Deborah Kado, director of the Osteoporosis Clinic at UC San Diego Health.

“Greater gut microbiome diversity is thought to be associated with better health in general,” she adds.

Sunlight exposure

The correlation between microbial diversity and active vitamin D remained even after adjusting for factors known to determine microbial diversity. These included the participants’ age, where in the United States they lived, their ethnic background, and their antibiotic use.

In fact, the participants’ levels of active vitamin D correlated much more strongly with microbiome diversity than any of these other factors.

This is particularly remarkable given that people who live in sunnier places, such as California, are able to synthesize more of their own vitamin D through the action of ultraviolet light on their skin.

“It seems like it does not matter how much vitamin D you get through sunlight or supplementation, nor how much your body can store.” – Dr. Deborah Kado

“It matters how well your body is able to metabolize that into active vitamin D, and maybe that is what clinical trials need to measure in order to get a more accurate picture of the vitamin’s role in health,” Dr. Kado explains.

The researchers say more studies are needed to investigate the role of bacteria in vitamin D metabolism. They speculate that changing patients’ microbiota could augment existing treatments for improving bone density, and possibly other health outcomes.

Osteoporosis study

The team analyzed stool and blood samples from 567 men living in six U.S. cities who were taking part in a study called the Osteoporotic Fractures in Men Study (MrOS).

The mean age of the participants was 84 years, and most of them reported being in good or excellent health.

To identify and quantify bacteria in the stool samples, the researchers sequenced copies of a bacterial gene that delineates different species.

They also measured the amounts of three vitamin D metabolites — the precursor, the active vitamin, and a breakdown product — in the blood samples.

Reporting their results, the authors write:

“The significant correlation between amplified vitamin D activation and greater individual stool microbial diversity supports the idea that increased microbial diversity reflects a healthy state.”

Not only did males with the highest levels of active vitamin D in their blood have the greatest microbiome diversity, but also their gut harbored more friendly bacterial species that produce butyrate.

This short-chain fatty acid, which some types of bacteria in the colon generate when they digest fiber, has a wide range of potential health benefits. Research suggests that butyrate helps prevent colon cancer, lower blood cholesterol, and combat insulin resistance, for example.

Cause or effect?

The authors stress that their study was unable to determine whether high levels of active vitamin D allow butyrate-producing bacteria to thrive or whether these bacteria promote the conversion of the vitamin to its active form.

By the same token, the study could not prove that having a more diverse gut microbiome leads to better vitamin D metabolism. It only found an association between the two.

Another limitation of the study was that the participants were predominantly older white males.

In addition, around 75% of them reported that they were taking some form of vitamin D supplement. Only 7% of all the participants met the standard definition of vitamin D deficiency.

The findings of the study may therefore not hold true for other populations, for people who do not take the supplement, or for those who are classified as being deficient in the vitamin.

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Do you suffer from gas, bloating, or other digestive issues? You’re definitely not the only one out there – but it doesn’t have to be this way.

We all know the foods we like and dislike, and some of us are even in tune enough to know the foods that do and don’t sit well within our body – but how well do we really understand the process of our own digestion? Certain physical cues often indicate whether everything is running, ahem, smoothly, and others are often common signs that your digestive system isn’t working properly.

I’m hesitant to choose a favorite system of the human body, but the intricacies and needs of our digestive system are fascinating. The very process of digestion itself involves taking all our wonderful, nutritious foods (or those less so), and breaking them down into the minuscule monomers needed for our body’s day-to-day functioning. When you consider every reaction in the human body, right down to a cellular level, that has to go right for this process to work, it can be very humbling.

Digestion is arguably one of the most important functions of the human body. But when something’s not going right with the system, such as an underlying issue or illness, all the wonderful foods won’t be absorbed in the way they should. Luckily, there are a number of signs and indicators that you’ll likely recognize in your own body to suggest your digestive system might not be flourishing.

1. Changes To Bowel Movements

While we all have different experiences of what it means to be ‘regular’, we do have our own natural digestive rhythm. Your bowel movements are one of the best indicators of what’s going on inside your body, and while changes to your usual schedule will come and go – anything significant is usually a symptom of a malfunctioning digestive system. Laurentine has written this amazing article that goes into the details of how to understand what it all means for your health, and how to navigate the Bristol Stool Scale, to shed some more insight on what your movements actually mean.

2. Reflux & Heartburn

Resting at the other end of the gastrointestinal tract (GIT) is our esophagus, and there are a few issues that can be another indication that something isn’t sitting right with our digestive system. Primarily, these are often reflux or heartburn, coupled with excessive burping in some instances. These symptoms can be caused by a number of digestive issues, ranging from simple food intolerances to bacteria overgrowths or stomach ulcers. If you’re experiencing persistent reflux or heartburn, start by first noticing any patterns with your triggers, and if removing these triggers is unsuccessful, like always, I recommend consulting with a qualified practitioner.

3. Bloating, Cramping & Uncomfortable Gases

Bloating happens when your GIT fills with gases, oftentimes caused by something as simple as a chemical reaction to the food you eat. Common occurrences include both lactose and gluten intolerances, as the digestive system lacks all the tools it needs to break down these foods efficiently. Many allergies and intolerances will also lead to cramping as the tissues in your abdomen struggle to deal with the food that has been put into it, however cramping may also be indicative of conditions such as IBS or gastritis.

4. Changes In Appetite

Much like other aspects of our digestive system, our body will often come to understand what normal looks like. You are the most qualified person to talk about your normal eating habits and patterns, the foods that make you feel good, and those that bring you down. And just as you know what’s normal, it’s good to check-in and ask yourself if there have been any changes of late? This might mean the size and frequency of meals, changes in how your body responds to a certain food, or even skipping meals altogether. These changes could be for any number of reasons, ranging from a shift in our energy expenditure levels to binge eating disorder, or perhaps an underlying chronic illness. So once you begin to identify these changes, whether they’re long-term or just temporary, seek out the protocol best suited to helping you figure out why these are occurring – just to be on the safe side.

5. Malabsorption Of Nutrients

Unless you’ve got a pathology lab in your attic, this can be a little more difficult to diagnose. And as a full disclaimer, Food Matters always recommends you do diagnose and begin treatment plans with a licensed practitioner that works for you. However, some examples of instances include difficulty absorbing iron due to a multitude of underlying causes, or damage caused to the intestines by an autoimmune condition like celiac disease. But the main takeaway is any ongoing malabsorption issues indicate your body may need a deep reset before rebuilding your digestion.

While the causes for your digestive concerns will vary from person to person, there’s one protocol we always suggest for a total reset before taking more extreme measures. A gentle detox is one way to give the digestive system a much-needed rest and reset from life’s daily stressors – including any aggravating foods.

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1127940779 Image credit: PamelaJoeMcFarlane / Getty Images.

A study finds that when people crave company, the same part of their brain lights up as when they crave food. The research supports the intuitive notion that socializing is a basic human need, akin to eating.

There is ample evidence that chronic loneliness is bad for our physical and mental health.

Studies reported by Medical News Today in the past few years suggest that loneliness weakens the immune system, and has links to diabetes, dementia, and mental illness.

As people worldwide forego meeting friends and family to combat the spread of COVID-19, it is more important than ever to look out for signs of loneliness and stay connected.

Research in social animals has found that positive social interaction is an inherently rewarding activity, similar to eating and sleeping.

A previous study led by the Massachusetts Institute of Technology (MIT) in Cambridge, MA, found that when isolated mice “crave” the company of other mice, a cluster of dopamine neurons in a region of their brains called the dorsal raphe nucleus becomes active.

However, researchers knew little about the neuroscience of acute loneliness in people.

Another study team at MIT has now compared the brain activity of people after they fasted for 10 hours with activity after being deprived of social contact of any kind for 10 hours.

“It’s a stronger intervention of social isolation than anyone had tried before,” says the study’s senior author Rebecca Saxe, from the Department of Brain and Cognitive Sciences at MIT.

Favorite food and social activities

The neuroscientists used functional magnetic resonance imaging (fMRI) to identify any changes in the volunteers’ brain activity, compared with a normal day, when they looked at pictures of their favorite food or people enjoying socializing.

They discovered that a tiny region in the middle of the brain called the substantia nigra, which shares evolutionary roots with the dorsal raphe nucleus in mice, was involved in craving both food and human contact.

The substantia nigra, which contains dopamine neurons, has previously been linked to cravings for addictive drugs.

The region became more active not only when socially isolated participants looked at images of socializing, but also when hungry subjects looked at pictures of food. Neutral images of flowers, used as a control condition, failed to activate the substantia nigra.

“People who are forced to be isolated crave social interactions similar to the way a hungry person craves food,” says Saxe. “Our finding fits the intuitive idea that positive social interactions are a basic human need, and acute loneliness is an aversive state that motivates people to repair what is lacking, similar to hunger.”

The research appears in Nature Neuroscience.

Personalized images

For their study, the researchers recruited 40 participants aged 18–40 years, who were mostly college students.

The scientists asked each participant to list their top 20 favorite foods and social activities, which they then used to find pictures that would provoke cravings during scanning sessions.

To create feelings of social isolation, the volunteers had to surrender their cell phones and laptops to the researchers before spending 10 hours alone in a windowless room without email or social media access.

“There were a whole bunch of interventions we used to make sure that it would really feel strange, different and isolated […] They had to let us know when they were going to the bathroom so we could make sure it was empty. We delivered food to the door and then texted them when it was there so they could get it. They really were not allowed to see people.” – Rebecca Saxe

To occupy themselves, the volunteers could solve puzzles, play simple computer games, or read pre-agreed written texts that contained no social content.

Periodically, they filled out questionnaires rating their social craving, loneliness, discomfort, happiness, and how much they disliked isolation.

The researchers used fMRI to scan participants’ brains after 10 hours of social isolation. They were also scanned on two other occasions: on a normal day, and after 10 hours of fasting.

Craving and the substantia nigra

The amount of activation in the participants’ substantia nigra correlated with how much they reported craving social interaction or food.

Interestingly, after 10 hours of isolation, subjects who said they felt chronically isolated months before the study reported weaker social cravings during the isolation session. There was also less activation in their substantia nigra while looking at the pictures of people socializing.

“For people who reported that their lives were really full of satisfying social interactions, this intervention had a bigger effect on their brains and on their self-reports,” says Saxe.

In contrast to the substantia nigra, craving food or social contact was associated with two distinct patterns of activation elsewhere in the brain, for example, in the striatum and cortex.

“That suggests that those areas are more specialized to respond to different types of longings, while the substantia nigra produces a more general signal representing a variety of cravings,” the authors write.

They now plan to investigate how social isolation affects behavior and whether virtual contact, such as video calls, can ease cravings for social interaction.

The scientists are also interested in discovering how isolation affects different age groups. One of the limitations of the current study was that subjects were generally healthy young adults who were well-connected socially.

Chronic loneliness is known to disproportionately affect older people and adolescents.

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660578615 Design by Diego Sabogal

Although obesity is common, there are many misconceptions associated with it — and these myths often fuel social stigma. In this edition of Medical Myths, we tackle five of the most common misunderstandings about obesity.

According to the Centers for Disease Control and Prevention (CDC), in the United States, 42.4% of adults have obesity. Globally, the World Health Organization (WHO) estimate that around 650 million adults have obesity.

People are growing increasingly aware of the health issues associated with obesity. However, despite public health campaigns, myths continue unabated. Many of the most common myths drive stigma that can impact the mental health of people with obesity.

For instance, the results of one 2020 meta-analysis on the subject indicate “a stronger association between weight stigma and diminished mental health with increasing body mass index [BMI].”

Addressing the myths that surround obesity is important. With this in mind, this article will tackle five of the most prevalent misunderstandings around this condition.

1. To reduce obesity, just eat less and move more

In many cases, consuming more calories than the body needs for a prolonged amount of time is the direct cause of obesity. Indeed, the vast majority of measures for reducing obesity aim to lower caloric intake, increase physical activity, or both.

Although diet and exercise are important factors, several unrelated factors can also play a significant part in obesity.

These factors, which people often forget about, include insufficient sleep, psychological stress, chronic pain, endocrine (hormone) disruptors, and the use of certain medications.

In these cases, overeating, for instance, may be a symptom rather than a cause.

Also, some of these factors work together to increase the chance of obesity. As an example, stress can increase the chance of obesity. Due to the prevalence of weight stigma, obesity can be stressful for some people, thereby increasing stress levels and sparking a negative feedback loop.

Added to this, stress can impact sleep quality, and this, in turn, might cause sleep deprivation, which is another factor in the development of obesity. Sleep deprivation also appears to increase stress levels. As one paper explains, “stress hormone levels correlate positively with decreased sleep duration.”

Sleep apnea, wherein a person stops breathing for short periods during sleep, is more prevalent in people with overweight or obesity. Again, a cycle can form: As they gain weight, their sleep apnea may worsen, which can lead to sleep deprivation, which can lead to further weight gain.

As another example, there appears to be an association between chronic pain and obesity. The reasons for this relationship are sure to be complex and differ from person to person, but they likely include chemical factors, sleep, depression, and lifestyle.

It is not difficult to see how chronic pain would both increase stress levels and impact sleep, adding to the negative loops outlined above.

Stress, sleep, and pain are just three interlinking factors that can drive obesity. Each person’s case will be different, but simply receiving an instruction to “move more and eat less” might not be an adequate intervention.

As this article will continue to reiterate, calorie intake and exercise are vital factors in reducing obesity, but they do not tell the whole tale.

2. Obesity causes diabetes

Obesity does not directly cause diabetes. It is a risk factor for type 2 diabetes, but not everyone with obesity will develop type 2 diabetes, and not everyone with type 2 diabetes has obesity.

Obesity is also a risk factor for gestational diabetes, which occurs during pregnancy, but it is not a risk factor for type 1 diabetes.powered by Rubicon Project

3. People with obesity are lazy

An inactive lifestyle is a factor in obesity, and becoming more active can aid weight loss, but there is more to obesity than inactivity.

One 2011 study used accelerometers to measure the activity levels of 2,832 adults, aged 20–79 years, for 4 days. Their step counts reduced as their weight increased, but the differences were not as significant as one might predict, particularly for women.

The list below shows the women’s weights and how many steps they took per day during this study:

  • those with a “healthy” weight: 8,819 steps
  • those with overweight: 8,506 steps
  • those with obesity: 7,546 steps

When one considers that someone with overweight or obesity expends more energy with each step, the difference between the groups’ overall energy expenditures may be even more slight.

This does not mean that physical activity is not essential for good health, but the story is more complex.

Another factor to consider is that not all people are able to perform physical activity. For instance, some physical disabilities can make moving challenging or impossible.

Also, certain mental health issues can severely impact motivation — and there appears to be a relationship between depression and obesity, which further deepens the complexity.

Aside from physical and mental health issues, some people with obesity may also have a negative body image, which might make leaving their home a more daunting prospect.

4. If your close relatives have obesity, so will you

The relationship between obesity and genetics is complex, but someone whose relatives have obesity will not necessarily develop the condition themselves. However, their chance of doing so is higher.

Understanding the role of genes and the environment in isolation is difficult; people who share similar genes often live together and, therefore, may have similar dietary and lifestyle habits.

In 1990, a group of researchers published a study that helped split genes from the environment. The results appeared in The New England Journal of Medicine.

The scientists investigated twins who had been brought up apart and compared them with twins who had been brought up together. In this way, they hoped to tease apart the impact of genetics and the environment. Overall, they conclude:

“[G]enetic influences on [BMI] are substantial, whereas the childhood environment has little or no influence.”

One twin study from 1986 reached similar conclusions. The researchers found that the weights of adopted children correlated with the weights of their biological parents, but not with those of their adoptive parents.

Although more recent studies have identified a more significant role for the environment, genetics do appear to play an important part in obesity.

In recent years, scientists have searched for the genes that influence the chance of obesity. As the CDC explain, in most people with obesity, “no single genetic cause can be identified. Since 2006, genome-wide association studies have found more than 50 genes associated with obesity, most with very small effects.”

One gene that is linked to obesity is a variant of a gene called FTO. This variant, according to one 2011 study, is associated with a 20–30% increased chance of obesity.

Although genetics are important, this does not mean that obesity is inevitable for someone whose relatives have the condition. The above study, which involved individuals with the FTO gene variant, looked at the role of exercise. As the paper explains:

“Using data from over 218,000 adults, the authors found that carrying a copy of the susceptibility gene increased the odds of obesity by 1.23-fold. But the size of this influence was 27% less in the genetically susceptible adults who were physically active.”

A review and meta-analysis that investigated the same gene variant came to a similar conclusion. The authors explain that people with the FTO variant “respond equally well to […] weight loss interventions and thus genetic predisposition to obesity associated with the FTO minor allele can be at least partly counteracted through such interventions.”

However, it is important to reiterate the point that these interventions alone may not be helpful for some people.

5. Obesity does not impact health

This is a myth. There are several conditions associated with obesity. For instance, obesity increases the risk of diabetes, high blood pressure, cardiovascular disease, osteoarthritis, sleep apnea, and some mental health conditions.

That said, even modest weight loss can provide health benefits. According to the CDC, “weight loss of 5–10% of your total body weight is likely to produce health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars.”

Also, a review of existing literature in the BMJ concludes that weight loss interventions “may reduce premature all-cause mortality in adults with obesity.”

Obesity is highly prevalent. Currently, the stigma surrounding the condition is unhelpful and can be damaging. We need to address it whenever we encounter it.

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Two studies involving postmenopausal females found that sedentary behavior increased their risk of developing heart failure and that walking lowered their risk of high blood pressure.

For people spending more time at home as a result of the COVID-19 pandemic, the new research provides an impetus to go for more walks and avoid sitting too long in front of computer or television screens.

In the two studies, which the University at Buffalo (UB), NY, led, researchers found that postmenopausal females who went for brisk walks and spent less time sitting or lying down during their waking hours had a lower risk of hypertension and heart failure, respectively.

“Walking and moving are simple activities that can be easily integrated into our daily lives,” says Jean Wactawksi-Wende, Ph.D., dean of UB’s School of Public Health and Health Professions (SPHHP) and a co-author of both studies.

The research drew upon data collected over several years from females who took part in the Women’s Health Initiative. The participants were 50–79 years of age at the start of the studies.

The results suggest that regardless of overall levels of physical activity, walking more and being less sedentary can benefit cardiovascular health.

“Sit less, walk more for heart health,” advises Michael LaMonte, Ph.D., research associate professor of epidemiology at the SPHHP.

LaMonte was the senior author on the paper that linked walking to a reduced risk of hypertension and first author on the paper that found an association between sedentary behavior and an increased risk of heart failure.

Walking and hypertension

The walking research followed 83,435 females who did not have a diagnosis of hypertension, heart failure, coronary heart disease, or stroke at the start of the study.

All of the participants reported that they could walk at least one block without assistance.

During the average follow-up period of 11 years, 38,230 participants received a diagnosis of hypertension.

After adjusting for other possible contributing factors, including other types of physical exercise, the participants who walked the most were 11% less likely to develop hypertension than those who walked the least.

Participants who were among the fastest walkers had a 21% lower risk of hypertension compared with those who walked the slowest.

Even after adjusting the figures to account for the overall amount of time that each participant spent walking and the distance they covered, a walking speed of at least 2 miles per hour was associated with a significant reduction in the risk of hypertension.

The study suggests that walking briskly has a more significant effect on hypertension risk than either the total distance or the duration of walks.

“To put it simply, get your steps in, and try to make them quick,” says Connor Miller, who was the lead researcher on the study, which he worked on while obtaining his master’s in epidemiology at UB. He is now an epidemiologist at Roswell Park Comprehensive Cancer Center in Buffalo.

“Our work adds to growing evidence that you don’t necessarily have to be an avid jogger or cyclist to gain health benefits from physical activity,” he adds.

The findings of this study appear in the journal Hypertension.

Sedentary behavior and heart failure

The study of sedentary behavior followed 80,982 females who had not received a diagnosis of heart failure at the start of the study and were able to walk at least one block unassisted.

The participants regularly filled out questionnaires that included questions about the amount of time they spent sitting or lying down in their waking hours.

During the average follow-up period of 9 years, there were 1,402 cases of hospitalization for heart failure.

In their analysis, the researchers adjusted the figures to account for a wide range of other possible confounding factors, including the participants’ age, race/ethnicity, smoking status, alcohol consumption, and use of hormone replacement therapy.

Compared with the participants who reported sitting for no more than 4.5 hours a day, sitting for 4.6–8.5 hours a day was associated with a 14% increased risk of heart failure.

Sitting for more than 8.5 hours per day was associated with a 54% increased risk of heart failure.

Even among females with the highest levels of recreational physical activity, the risk of heart failure was significantly raised if they spent more than 9.5 hours per day sitting or lying down.

“This latter finding points to the need to not only promote more physical activity for heart failure prevention but to also promote interruption of sedentary time throughout the day,” says LaMonte.

In their paper, the researchers say that the risks of heart failure associated with prolonged sedentary behavior are on a par with those for obesity and diabetes.

Other studies suggest that sedentary behavior promotes the development of atherosclerosis (narrowing of the arteries supplying the heart muscle), the authors write, which, in turn, increases a person’s risk of heart failure.

They report their findings in the journal Circulation: Heart Failure.

Medical News Today have reported a range of other possible negative health effects of sedentary behavior, including obesity, type 2 diabetes, and cancer.

Limitations of the research

Both studies had some limitations in common.

The researchers could not rule out the possibility that some participants had undiagnosed underlying health conditions at the start of the study. These could have affected their walking and sedentary behavior.

Also, both studies relied upon the participants’ estimates of how far and fast they walked or the amount of time they spent sitting or lying down.

Finally, the study of sedentary behavior only gauged the total time that people spent sitting or lying down. Other research, using accelerometers to record participants’ movements, suggests that the length of each uninterrupted bout of sedentary behavior is also an important factor.

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Encouraging people to eat more dried fruit — without added sugar — could be an effective way to boost their intake of vital nutrients, researchers have concluded.

Low consumption of fruit in the United States and other countries is a major contributor to diet-related disease and disability, according to a recent analysis.

Fruit is a good source of nutrients, such as fiber and potassium, that many people lack in their diet. It also contains bioactive nutrients that provide extra health benefits, including polyphenols and carotenoids.

Research suggests that eating fruit is associated with a lower risk of cardiovascular disease, cancer, and type 2 diabetes.

However, only about 24% of females and 14% of males in the U.S. eat the recommended daily amount of fruit, according to the National Cancer Institute.

Several factors might contribute to people’s low intake of fresh fruit, including limited availability, high cost, and perishability.

Recommending that people eat more dried fruit could be one solution.

Healthful snack?

Dried fruit offers several advantages over fresh fruit in terms of cost, availability, and ease of storage and transport. It could also replace more unhealthful snack food that is high in sugar, salt, and saturated fat.

At the same time, however, there are concerns about overconsumption leading to excess calorie intake because dried fruit is such an “energy dense” form of fruit.

Previous observational studies have found that eating dried fruit is associated with health benefits. However, the evidence is inconclusive because people who eat more dried fruit may tend to have a more healthful diet and lifestyle overall.

The new study by researchers at Pennsylvania (Penn) State University in University Park aimed to get around this difficulty by comparing days when particular participants reported eating dried fruit with days when they ate none.

They found that people tended to consume more key nutrients on the days they ate dried fruit, including dietary fiber and potassium. However, they also consumed more calories.

“Dried fruit can be a great choice for a nutritious snack, but consumers might want to be sure they’re choosing unsweetened versions without added sugar,” says Valerie Sullivan of Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, who was a grad student at Penn State when she led the study.

“Portion sizes can also be tricky because a serving of dried fruit is smaller than a serving of fresh since the water has been taken out. But the positive is that dried fruit can help people potentially consume more fruit because it’s portable, it’s shelf-stable, and can even be cheaper.”

The research appears in the Journal of the Academy of Nutrition and Dietetics.

Health and nutrition survey

For their analysis, the scientists drew on survey responses from 25,590 individuals who took part in the National Health and Nutrition Examination Survey (NHANES) 2007–2016.

The respondents provided information about the food they had consumed in the past 24 hours (called “dietary recalls”).

Dried fruit accounted for only 3.7% of all the fruit consumed. However, a total of 1,233 participants reported consuming dried fruit on one out of two dietary recalls, allowing the scientists to compare their intake on these days.

Data were also available on the participants’ health, including their body mass index (BMI), waist circumference, and seated resting blood pressure.

Even after adjusting for demographic and lifestyle factors, the participants who ate significant amounts of dried fruit tended to have better diets, a lower BMI, a smaller waist circumference, and lower systolic blood pressure compared with those who did not.

When the researchers compared the days when a participant ate dried fruit with those when they did not, they found that the average intake of total carbohydrate, dietary fiber, potassium, and polyunsaturated fat was greater on the days they ate dried fruit.

Active lifestyle

Taken together, the findings suggest that people who ate dried fruit expended more energy, compensating for the extra calories.

“In our study, people who consumed dried fruits had a higher calorie intake but a lower BMI and waist circumference, which suggests they were more physically active,” says co-author Penny Kris-Etherton, Evan Pugh University Professor of Nutritional Sciences at Penn State.

“So, when incorporating dried fruits, pay attention to calories and be sure to substitute out calories from low nutrient foods for dried fruits to get the greatest benefit of eating dried fruits,” she adds.

The researchers write that eating dried fruit tended to increase total fruit consumption, rather than replacing other forms of fruit. “Thus, increasing dried fruit consumption might help Americans achieve greater fruit intakes.”

The authors acknowledge that their study did not prove that eating dried fruit improves health, only that there seems to be an association. People who are likely to eat dried fruit may have better health for other reasons, such as taking more exercise or leading less stressful lives.

In addition, they note that the survey relied on the participants’ recollection of what they had eaten over the past 24 hours and their ability to estimate quantities accurately.

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A newly released study found that people with heart failure who received the diabetes drug empagliflozin showed significant improvements in heart structure and function, with many experiencing a reversal of the disease.

Approximately 6.2 million adults in the United States have heart failure. As a result of its high prevalence, the national cost of healthcare services, medicines, and missed workdays related to this disorder reached an estimated $30.7 billion in 2012.

Globally, the disease affects approximately 23 million people.

What is heart failure?

Heart failure occurs when the heart cannot pump blood effectively to other parts of the body, causing symptoms that include shortness of breath, difficulty breathing, weakness and tiredness, and weight gain and swelling in the legs, ankles, feet, or stomach.

It may progress to congestive heart failure due to the buildup of fluids in the lungs, liver, and lower extremities.

Underlying causes of heart failure include coronary artery disease, high blood pressure, obesity, heart valve disease, and diabetes. Over time, these diseases may result in “adverse modeling,” which is the heart’s attempt to compensate for its added workload by getting larger, developing thicker walls, and pumping more frequently.

Among people with heart failure, about 50% present with heart failure with reduced ejection fraction (HFrEF). The lowered ejection fraction occurs when the heart’s left ventricle cannot pump blood effectively, decreasing the amount of blood that leaves the ventricle to circulate the body after each contraction.

Treatment options for heart failure include taking prescription drugs, reducing the amount of sodium in the diet, consuming a lower volume of liquids, and making any necessary lifestyle changes, such as reaching a moderate weight, quitting smoking, and eating a heart-healthy diet.

New study shows promising results

With limited heart failure treatment options available, researchers from the Icahn School of Medicine at Mount Sinai set up a clinical trial called EMPATROPISM to investigate the use of empagliflozin, a diabetes drug, for treating HFrEF in people without diabetes.

The researchers presented the trial results on November 13 at the American Heart Association (AHA) Scientific Sessions 2020, with a pre-proof appearing in the Journal of the American College of Cardiology.

In the double-blind, placebo-controlled, randomized study, the scientists divided the 84 participants, who were 18–85 years of age, into two groups. One group received 10 milligrams (mg) of empagliflozin daily, and the other took a placebo.

At the trial’s onset, all of the participants underwent baseline evaluations, which included cardiac MRI, a 6-minute walk test, and a cardiopulmonary exercise test to determine their oxygen levels. They also completed questionnaires regarding their quality of life.

After 6 months of receiving either the placebo or empagliflozin, the participants completed the same tests again.

The researchers found that approximately 80% of those who received the medication showed significant improvement in their condition, with a 16.6% improvement in left ventricle ejection fraction.

They also experienced a reduction in heart size and thickness and had less congestion, indicating that their heart failure had become less severe.

Remarkably, the investigators note that the heart returned to near normal in this group of participants.

Additionally, those who received empagliflozin experienced no severe side effects and saw improvements in their exercise levels and quality of life, which occurred relatively quickly after beginning the medication.

Although empagliflozin is an antidiabetes drug, the investigators noted no adverse blood sugar-related side effects, such as hypoglycemia, in the study participants, despite them not having diabetes.

Conversely, the study participants who took the placebo showed no improvements. Their condition either stayed the same or worsened, with a further reduced ejection fraction, increased heart size and thickness, and an abnormal change in the heart’s overall shape.

According to the researchers, the study results also explain why this medication effectively treats heart failure. They explain that it essentially reverses the adverse modeling that occurs when the heart attempts to restructure itself to compensate for changes associated with other chronic conditions.

Supporting evidence

The EMPEROR-Reduced trial, a slightly earlier study that featured in the New England Journal of Medicine, saw similar results. In this double-blind trial, 3,730 people with HFrEF took either empagliflozin (10 mg once daily) or a placebo, in addition to recommended therapy.

The results concurred with the EMPATROPISM findings, showing that people both with and without diabetes in the empagliflozin group experienced a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group.

Researchers look to the future

The EMPATROPISM study’s first author, Carlos Santos-Gallego, a postdoctoral fellow at the Icahn School of Medicine, explains the implications of these findings.

He says, “Our clinical trial’s promising results show this diabetes drug can ameliorate lives of heart failure patients with reduced ejection fraction, enhance their exercise capacity, and improve their quality of life with little to no side effects.”

“We expect this work will help lead to U.S. Food and Drug Administration [FDA] approval of empagliflozin for this patient population in the coming months.”

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In today’s turbulent political climate, hostility is becoming an increasingly familiar part of everyday life. This negative environment not only makes it uncomfortable to socialize, but prolonged, cynical hostility may pose a serious health issue.

According to a Baylor University-led study that appeared in the September 2020 issue of Psychophysiology, cynical hostility may cause an increased risk of developing cardiovascular disease.

The findings resulted from data collected from 196 participants in a stress test conducted by the Laboratory for the Study of Stress, Immunity, and Disease at Carnegie Mellon University in Pittsburgh, PA.

Participants took part in two lab sessions, 7 weeks apart. Sessions consisted of establishing a 20-minute baseline and a 15-minute psychological stress test.

Researchers recorded each person’s heart rate and blood pressure, and the participants completed a standard psychological scale to determine their personality and temperament.

The sessions involved placing participants in reasonably stressful situations, for example, asking them to take 5 minutes to prepare and then deliver a speech defending themselves from traffic violations or shoplifting accusations. All participants knew that the researchers would record and evaluate them.

As Alexandra T. Tyra, a doctoral candidate in psychology and neuroscience and the lead study author, explains, “These methods of social and self-evaluation are designed to increase the experience of stress and have been validated in prior research.”

Tyra’s team looked at three types of hostility: cognitive, which includes cynical hostility; emotional hostility, which links to chronic anger; and behavioral hostility, which involves verbal and physical aggression.

The researchers found that stress responses had no relationship to emotional or behavioral hostility.

“This does not imply that emotional and behavioral hostility are not bad for you,” says Tyra, “just that they may affect your health or well-being in other ways.”

The prolonged harm of cynical hostility

Cognitive hostility’s impact on the cardiovascular system ultimately comes down to how a person deals with repeated exposure to stress triggers.

Tyra explains how a typical reaction to repeated stress normally plays out, “When you’re exposed to the same thing multiple times, the novelty of that situation wears off, and you don’t have as big of a response as you did the first time.” This is a healthy reaction to stress.

With cynical hostility, a person continues to react to stressful circumstances with a similar intensity level, no matter how much exposure they have to similarly stressful situations.

Consistent arousal of this nature causes a strain on the cardiovascular system over time.

The Baylor University study represents the latest of its kind linking cynicism with adverse health problems. A 2014 study appearing in Neurology found that those with higher levels of cynical distrust in later life might be more likely to develop dementia.

The study author, Anna-Maija Tolppanen, Ph.D., of the University of Eastern Finland in Kuopio, believed her team’s findings showed a person’s “view on life and personality may have an impact on their health.”

Although it is more common to probe the harm caused by cynicism and negative thinking, some researchers try to find a positive outcome for less positive mindsets.

One such study looked at pessimism in particular. The research suggested “defensive pessimism” might be useful for developing actionable strategies in the face of the worst possible outcome.

Still, research has repeatedly linked suspicious thoughts and a hostile disposition with poor health.

Timely findings

Following the study, the Baylor University team believes the outcome of its research is very timely. It comes near the end of a year of extremes, dominated end-to-end by intense political debates and social commentary.

Some might find it natural to approach each adverse circumstance with excessive cynical hostility. However, these harsh stances might not be worth the added risk to a person’s cardiovascular health. With this in mind, the study authors offer a word of caution:

“Perhaps the next time someone thinks a negative thought about the motives, intentions or trustworthiness of their best friend, a co-worker or even a politician, they will think twice about actively engaging with that thought.”

Even as they weigh the immediate implications of their research, the study team hopes that future research will give more insight into how cynical hostility affects one’s health across an entire life span. What can we learn from following more cynically hostile test participants as they age?

For now, a crucial takeaway of this study, especially in such a tense political climate, is to keep an open mind and a cool head.

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A new survey identifies one LGB+ group that is more likely to start smoking cigarettes after coming out.

Previous research suggests that LGB+ individuals are more likely to smoke cigarettes. However, a new study from the School of Public Health at Boston University (BU), MA, looks more closely at sexual identity and smoking.

The research finds that the association applies only to bisexual people, primarily during the first 3 years after coming out.

People coming out as bisexual are twice as likely to start smoking after coming out when compared to heterosexual, lesbian, gay, or other non-heterosexual people.

According to Andrew Stokes, the study’s corresponding author, the new research “highlights the importance of moving beyond static measures of sexual identity towards more dynamic measures that capture critical periods of vulnerability.”

This shift in the researchers’ perspectives, says lead author and doctoral candidate Alyssa Harlow, “turned out to be really important because it revealed disparities that would have otherwise been missed if we measured identity at one time point, or grouped all LGB+ identities together.”

The research appears in the journal JAMA Pediatrics. Stokes and Harlow were joined in the study by BU’s Dielle Lundberg, Julia Raifman, Carl Streed, and Emelia Benjamin, as well as Andy S.L. Tan of the University of Pennsylvania in Philadelphia.

Three interviews, 3 years

The researchers followed 7,843 young people and young adults over 3 years by analyzing data from the nationwide Population Assessment of Tobacco and Health (PATH) study. The group, whose ages ranged between 14–29 years, was interviewed three times between 2013–2018.

“The PATH study is unique because it asks youth about their sexual orientation and gender identity. Most national surveys do not,” says Lundberg.

The researchers adjusted for a variety of factors, including individuals’ sex, age, education level for those over 18, their parents’ level of education, race, ethnicity, and where they lived.

One limitation of the study is that there were not enough transgender participants in the original survey to consider the group sufficiently represented, so the new research applies only to LGB+ individuals.

By the final round of interviews, 14% of the PATH participants reported having smoked cigarettes, while 6% were current smokers.

While initial analysis of the entire LGB+ group supports the doubled likelihood of being a smoker, breaking down the data by sexual identity revealed that it applied only to bisexual individuals. This association applied equally to those who had once smoked and to those who still did.

Individuals who had maintained the same LGB+ status throughout the 3 years were no more likely to smoke than people with a constant heterosexual identification.

The bisexual individuals who had just come out — moving from one identity to another during the 3-year survey period — were found to be the only group that was twice as likely to start smoking.

Being bisexual is unique in the LGBTQ+ community

“The findings point to a need for public health interventions specifically designed to address the unique needs, experiences, and stressors associated with coming out and identifying as bisexual,” according to Harlow, who notes that bisexual people “may experience stigma from heterosexual individuals as well as from within the LGB+ community.”

Harlow adds, “There’s also prior research showing that bisexual populations have worse mental health outcomes than LG+ populations.”

Providing much-needed support

To better address the needs of bisexual and LGBTQ+ individuals, people who are disproportionately affected by mental health and substance use issues, the authors say a more fine-grained approach to health surveys is necessary:

“We must advocate for better data. Whenever national surveys fail to ask about sexual orientation and gender identity, they are directly contributing to health inequities for LGBTQ+ populations.”

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