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The Connection Between Ultra-Processed Foods and Endocrine Disruptors
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In this month's newsletter, we examine the relationship between ultra-processed foods and endocrine disrupting chemicals and explore how they may contribute to obesity.


Ultra-processed Foods and Obesity

NOVA – a food classification that categorizes foods according to the extent and purpose of processing – defines ultra-processed foods (UPFs) as “formulations made mostly or entirely from substances derived from foods and additives.” Examples of UPFs include soft drinks, sweet or savory packaged snacks and baked goods, pre-prepared and “instant” dishes, and reconstituted meat products. These foods contain ingredients processed industrially – such as high-fructose corn syrup, hydrogenated oils, hydrolyzed proteins, and cosmetic additives. UPFs make up over half (58.5%) of the total dietary energy consumed in the United States; in 2018 the estimated percentage of total energy consumed from UPFs among US youths aged 2-19 years was approximately 67.0%.

The upward trends in UPF sales and consumption does not bode well for the obesity epidemic. Among adults, diets high in ultra-processed foods are associated with excess calorie intake and weight gain. A large cohort study of participants aged 40-69 years found that higher UPF consumption is associated with a ≥ 5% increase in BMI from baseline to follow-up after 5.8 years and a significantly higher risk of developing overweight and obesity. Globally, increases in ultra-processed food and drink volume sales per capita are positively associated with mean population BMI. Findings from a recent cohort study suggest that higher consumption of UPFs in childhood is associated with more rapid increase of weight, waist circumference, and BMI into adolescence and early adulthood.


                       Source: Rauber et al., 2020

Endocrine Disrupting Chemicals and Obesity
An endocrine-disrupting chemical, or EDC, is defined as “an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects” to an organism. Substantial literature suggests that two classes of EDCs used in the production of plastic products – phthalates and bisphenols – penetrate food and the environment. Nearly 100% of the US population is exposed to phthalates on a daily basis, and bisphenol metabolites were found in over 90% of participants in a nationally-representative sample of individuals ≥6 years of age. EDCs have been associated with weight gain, stimulation of fat cells, and predisposition to metabolic disorders such as type 2 diabetes. A large body of cross-sectional research has demonstrated a relationship between BPA exposure and increased risk of diabetes, general/abdominal obesity, and hypertension. Systematic reviews have also linked phthalate exposure to diabetes and insulin resistance.
Endocrine Disrupting Chemicals in Ultra-processed Foods
UPFs are often packaged in materials that are a source of EDCs. For example, bisphenol A (BPA) is found in food packaging such as water bottles and coatings on food and beverage cans. Phthalates are also found in food packaging such as cling film, and they are soluble in oil and are therefore commonly found in foods high in fat. A preliminary analysis of items from U.S. fast food chains found detectable levels of phthalates and other plasticizers in food items and food handling gloves, which may be a source of contamination. Because UPFs are generally packaged, and food packaging often contains EDCs, UPFs are likely to contribute to concentrations of EDCs that people ingest.
The increased production and consumption of UPFs, combined with the increased production and use of various EDC-containing products like food packaging, may have a synergistic effect that further contributes to the development and persistence of obesity globally. While further research is needed to better understand the effects of this synergy on obesity, these observations demonstrate yet another reason to eat less processed foods.


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Upcoming Events

Jan 19: COPE Culinary Nutrition Module 3
Jan. 25: Obesity Canada Webinar 
Jan. 28: ASN Nomination Deadline
Feb. 14: ASN Abstract Deadline
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AAPA Certificate Program
MD BriefCase Advancing Obesity Management Program
ASN Call for Nominations and Abstracts
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New Publications in Obesity and NAM
AAPA Obesity Management in Primary Care Certificate Program
At the end of December, the American Academy of PAs along with its educational partners The Obesity Society and Integrated Learning Partners graduated 100 PAs and NPs from its Obesity Management in Primary Care Certificate Program. Participants engaged in 10 clinical modules covering the principles of medical obesity management over the course of a year.  Each module was followed by an interactive coaching session designed to help learners to assimilate the information and discuss implementation. 

In addition, each participant completed two small quality improvement projects. The certificate program was designed to help PAs and NPs incorporate the treatment of obesity within the context of a primary care practice. There are currently over 500 individuals who have indicated an interest in in joining the next cohort of learners. The certificate program was funded in part by an independent medical education grant from Novo Nordisk.

Learn more about the program here.
COPE's Online Culinary Nutrition Series Continues

January 19, 5:30-7pm ET

There is still time to register for COPE's upcoming virtual Culinary Nutrition sessions! Join the upcoming webinar for a deep dive into the history of Latin American food traditions and watch Carlett Ramirez-Farias, RD prepare recipes that highlight the key concepts of this cultural foodway. Learn how to apply practical knowledge with clients to help them adjust their diets to allow them to continue to cook and consume their favorite foods while meeting their personal health needs. Continuing Education credit awarded for participation.

Learn more and register here.
Connected Conversations: Upcoming Free Webinars with Obesity Canada

January 25, 1-2pm ET
Have you ever made a New Years resolution that involved trying a new fad diet and it just didn’t work out? As we settle into the new year and everyone is making plans for a healthy 2022, join this exciting, interactive webinar with Registered Dietitian and Certified Bariatric Educator, Jennifer Brown! As one of the authors for the Canadian Obesity Clinical Practice Guidelines, Jennifer will join hosts Lisa Schaffer and Ian Patton for a discussion about the negative effects of diet culture and how sometimes our efforts to do something to get healthier can in fact get in the way of effective obesity management. Come learn about evidence-based nutrition and ways we can set ourselves up for success in 2022!

Learn more and register here.


February 22, 1-2pm ET
Join hosts Lisa Schaffer and Ian Patton as they sit down with internationally recognized patient advocate Amber Huett-Garcia for this interactive webinar. As a former Chairwoman of the Board of Directors for the Obesity Action Coalition, and founding member of the Global Obesity Patient Alliance, Amber brings a wealth of knowledge and experience in advocating for policy and things we can do better to support people living with obesity.  From how we speak about our bodies and others, to advocating for what you need from healthcare, Amber is a trailblazer that we all can learn from!

Learn more and register here.
Advancing Obesity Management Program
The Advancing Obesity Management Program (AOMP) is designed for all primary care and secondary clinicians who want to improve the obesity care they deliver in their practice. A collaboration between Obesity Canada (OC), the Canadian Society of Endocrinology and Metabolism (CSEM) and the European Association for the Study of Obesity (EASO), this evidence-based program demonstrates how healthcare professionals can integrate the 2020 Canadian Adult Obesity Clinical Practice Guidelines into practice. 

With an estimated 10+ hours of accredited online CME/CPD/CE, this comprehensive program allows participants to learn at their own pace. Patient cases are introduced throughout the program, offering healthcare professionals an opportunity to see the key learning applied immediately.  

Learn more here.
Obesity Care Week 2022
Obesity Care Week 2022 (OCW2022) is right around the corner and we need your support! Obesity Care Week is an annual public awareness effort that will take place from February 27th - March 5th. OCW2022 is dedicated to raising awareness, educating the public, and advocating for a better world for people living with obesity. The core issue areas for OCW2022 include recognizing obesity as a serious and complex disease, combatting weight bias and stigma, expanding access to care, treating obesity with science-based treatments, and enacting prevention and education programs.

Last year, over 100 groups from 80 countries were OCW Champion Organizations. As a Founding Champion of OCW, STOP Obesity Alliance knows the importance of this awareness week and what is at stake for people who struggle with barriers to obesity care and weight bias. Now is the time to turn your passion and expertise into action! There are many ways in which you can support OCW, but becoming an OCW Champion is the most powerful way to make an impact.

To learn more about becoming an OCW Champion, please email Chrystal Jones:
American Society for Nutrition Announcements

Mark your calendars for NUTRITION 2022 LIVE ONLINE – June 14-16, 2022 – the American Society for Nutrition’s flexible, convenient flagship meeting which will gather the global nutrition community virtually to explore the latest developments in nutrition science, clinical topics, and the most pressing policy issues. New, original research abstracts, case studies, and methods and protocols will be accepted for presentation to the global nutrition community. NUTRITION 2022 LIVE ONLINE will be part of NUTRITION 2022 – ASN’s year-round opportunities for learning through new standalone events, professional development workshops, and more.

Deadline for abstract submissions: February 14, 2022.
Learn more here.

The George Bray Outstanding Scientific Achievements Award in Obesity Research will be presented to a physician, clinician or investigator who has made a significant lifetime contribution to the field of obesity research. This award is designed to recognize an individual whose lifetime body of work includes meaningful contributions and/or demonstration of highly original, sustained, and reproducible scholarship that has made major contributions to the understanding of the causes, treatment and/or prevention of obesity. The recipient of this award will give an award lecture during NUTRITION 2022 LIVE ONLINE, ASN’s flagship meeting which will be held June 14-16, 2022

Deadline for nominations: January 28, 2022.
Learn more here.


George Bray Obesity Research Student Awards recognizes the two students with the highest-scoring abstracts in a topical area related to the causes, treatment or prevention of obesity presenting outstanding research during NUTRITION 2022 LIVE ONLINE.

Deadline for abstract submissions: February 14, 2022.
Learn more here.
Request for Public Comment: New Measures for Obesity Management
Minnesota Community Measurement (MNCM) and the Endocrine Society (ES) are pleased to announce the completion of measure specifications for a suite of new measures aimed at improving the health outcomes and reducing modifiable risks for patients with obesity. This measure development project included conducting a measure landscape and evaluation of measures used previously in the Obesity Care Model Collaborative. MNCM and the Society are seeking public comment on the measures.

Comments may be submitted at no later than Friday, January 14, 2022.

View the draft measures here.
Start Treating Obesity More Effectively in 2022
Do you feel equipped to properly advise your patients with obesity about available treatment options? As the disease of obesity continues to rise throughout the United States, more patients are turning to their healthcare providers for obesity treatment solutions. To help reverse this trend, attend the Fundamentals of Obesity Treatment Virtual Course from Feb. 18-19, 2022 to learn how you can start addressing obesity with your patients.

Learn more and register here.

STOP Obesity Alliance Director and Redstone Center Chair Dr. William Dietz co-authored a recent paper in the journal Obesity titled "Physical activity may mitigate COVID‐19 infections in people with obesity: A call to action." The paper calls out the research that moderate-intensity activities "could have immediate beneficial impacts on immune function, inflammatory responses, mental health, and vaccine responsiveness, all of which could reduce the severity of COVID-19 in people with obesity." Read the full paper here.

Dr. Dietz also co-authored a new discussion paper in the National Academy of Medicine's NAM Perspectives journal titled "Lessons Learned for Obesity Prevention and Care from Five Integrated Programs." The paper identifies gaps and challenges for obesity-focused integrated programs. Considering five examples of integrated health programs, the authors propose a new framework for establishing effective, equitable programs to improve obesity prevention and care by considering community-specific factors. Read the full paper here.

In addition, in the December issue of Obesity, Dr. Dietz authored two perspectives:

In "'Relapse' is the word we should use to describe weight regain after weight loss," Dr. Dietz suggests that we use the term "relapse" rather than "recidivism" to describe weight regain after weight loss. He explains, "Recidivism describes a behavior, whereas relapse describes a phenomenon," and therefore "relapse is a more appropriate and neutral term" with respect to chronic relapsing conditions or diseases like obesity. Read the full letter to the editor here.

In "What can regional estimates of the prevalence of obesity tell us about what risk factors we should target?", Dr. Dietz reviews the findings from the study by Bekelman et al. in Obesity that examined regional differences in BMI z scores among children in the US. He summarizes the study's findings and its limitations, and analyzes it in comparison with two studies that examined regional differences in adult obesity. Finally, he provides recommendations on how to better approach the issue of obesity. Read the full commentary here.
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