Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Virus?
- Daniel R Hicks (14 August 2008)
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A personal experience...
- David Wilson (15 August 2008)
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Classification of obesity into few sub groups may help to find the processes associated with poorer neurological or cognitive functions with obesity and type2 diabetes in obese adults.
- Arya K Kumarasena (16 August 2008)
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Developmental Coordination Disorder
- Gydhia Zuhair AL-CHALABY (24 August 2008)
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Physical control and coordination in childhood and adult obesity
- Scott M Montgomery, Walter Osika (27 August 2008)
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Daniel R Hicks, Computer programmer Rochester MN USA 55901
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While the associations described by Osika and Montgomery are very likely due to innate factors, I'd humbly suggest that this not be assumed without considering the possibility that a virus may be at work. In particular, enteroviri such as coxsackie are capable of producing CNS injury that may not be recognized in an infant, but which may lead to lack of coordination early in life and symptoms resembling metabolic syndrome later. You see this particularly in former polio patients, who very commonly suffer from obesity and other metabolic syndrome symptoms far out of proportion with their activity levels. Competing interests: None declared |
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David Wilson, Psychiatry Registrar Tauranga Hospital, 3001, NZ
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When I read the title of this article, I was interested to see what conclusions the authors would come to. Although I agree that there could be many causes of a link between coordination problems and obesity and the authors mention some of these, the comment that most stands out to me is that “people with lower motor competence may be less likely to exercise.” From personal experience, this would seem to be an important association. I am in my late twenties and was born in the UK. I went to school in the UK and have been brought up on the National Curriculum. I have always been clumsy and although it was mentioned when I was younger, it was only relatively recently that I actually got properly tested for and got told that I have dyspraxia. I found that in most school subjects having poor coordination can be overcome to an extent as there is usually another way of addressing a problem; for example, typing instead of handwriting. The main subject area where it could be a big problem though was in physical education (PE) and games lessons. Most of the things we did in these lessons involved climbing, throwing and catching, using bats, kicking balls etc. Although I would agree that these sorts of things weren’t impossible, I definitely did find them to be difficult. Compared to my peer group I was always the worst at them and would usually be the last to get picked for any sort of team game. Even individual, athletic type sports had their problems. I remember one PE lesson when one particular teacher spent 20 minutes berating me in front of a class of 30 for not being able to get the component parts of the triple jump in the right order. At the time these things really put me off sports. At school, I invariably found them to be difficult and I usually felt quite awkward and embarrassed. Because of this I didn’t really feel that motivated to engage in any sporting or exercise type activity outside of school either. I started to do less and less exercise. Consequently I put on more and more weight… Although I received advice on the intake side of the diet equation, nobody ever thought to ask about the exercise side. Only after leaving school and going to university did I actually start to enjoy playing sport and exercising. The focus was more on playing for a laugh rather than on ability and competition and it was a lot more relaxed. I had freedom in what I played and I also discovered and started to indulge in other sports where coordination isn’t such a big issue or that I could do on my own. Although it might be confounded by turning vegetarian at around this point, my weight started to go down and ultimately return to the normal range… I left school nearly 10 years ago and things may well also have changed in that time with regard to physical and games education in schools. It might be that my experience is an atypical one or it might be that those reading this without coordination problems can also relate to this too. Although lack of exercise is not the only factor involved in obesity, it is none the less a significant factor. Encouraging participation in sports and exercise is important and the primary aim of PE and games lessons should be to encourage widespread enjoyment in physical activity amongst young people with the aim of this extending into adulthood. With certain groups of young people, such as those with coordination problems, this might require a different approach but none the less the ultimate aim should still be the same. Competing interests: None declared |
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Arya K Kumarasena, Consultant/Director 85,Braybrooke Place,Colombo2,Sri Lanka
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Authors have combined the data available from past records in a structured manner to enhance the knowledge on correlations between the childhood defects and problems appearing in obese adults [1]. It is quite common in medical research to apply corrections based on statistical techniques to highlight the correlation between two factors by eliminating various types of biases, which cannot be eliminated at the sample selection stage. In fact this process is essential to find the actual level of correlation in spite of natural restrictions placed due to differences in age, ethnicity and many other factors. How ever if the sample consists two or more different categories of people this approach may dilute the expected result. As an example before diabetic patients were classified as type 1 and type 2 , correlation between insulin concentration and blood sugar level in a patient sample having both type of patients should have painted a some what blurred picture, although it would have been useful to a reasonable extent. Once the two groups are separated better analysis and treatment became possible. As time goes on process is further evolving and the picture becomes clearer with some more subgroups getting introduced. Similarly obesity seems to be a physical property that can arise due to various conditions. As an example having smaller number of large cells and large number of small cells can cause virtually same weight, volume and BMI (body mass index) .As the number of beta cells does not increase after some time (after birth) insulin secretion capacity of increased beta cell mass represents the result that has caused due to cell size increase (without cell number increase). It is anticipated that obesity associated with smaller number of beta cells is likely to have several problems [2]. Therefore it may be of interest to analyze the same data by dividing the sample in to different sub groups (as an example based on gestational age or/and birth weight)[3]. In fact differential analysis on different criteria is likely to show stronger correlation between the identified factors in certain categories and no correlation in some other categories. Actually a notable deduction that can be made from direct observation of the data provided is that over 70% of the obese people seem to be quite normal. Classification of obesity according to average cell size seems to have a deeper meaning. When the particle transportation across the cell surface is limited by some factor (this can happen due to various reasons) rate of particle transportation is determined by the cell surface area. On the other hand same particle type consumption (when it is transported in side) or production (when the cell produces these particles) is determined by the cell volume. If the cells were spheres, then their volume would have been related to the cube of the radius while their surface area would have been related to the square of the radius. Obviously under those circumstance particle transportation across smaller cells becomes much faster. Although the cells are not perfect spheres, same property is more or less applicable for other similar topologies. Therefore obese persons with larger cells are likely to have a relatively higher probability of particle transport problems. Although the current study does not identify the specific biological processes linking poorer physical control and coordination with later obesity, it has provided a direction to future research. References 1] Physical control and coordination in childhood and adult obesity: longitudinal birth cohort study Walter Osika, Scott M Montgomery BMJ 2008;337:a699, doi: 10.1136/bmj.a699 (Published 12 August 2008) 2] Arya K Kumarasena Problems may not get fully corrected by just adjusting the hormone levels to normal range http://bmj.com/cgi/eletters/337/jul28_1/a801#199825, 1 Aug 2008 3] Association between psychological symptoms in adults and growth in early life: longitudinal follow up study Y B Cheung, , K S Khoo, J Karlberg, , D Machin, BMJ 2002;325:749 ( 5 October ) Competing interests: None declared |
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Gydhia Zuhair AL-CHALABY, F1 doctor pre-registration doctor
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It is a recognizable fact that obesity is rising fast in the west with inevitable consequences for heart diseas, cancer and type 2 DM. I agree with the author that many risk factors for adult health problems can begin to cluster in "normal" children. At the same time, I would like to address an important issue regarding other possible cause of poor motor coordination in childhood in that specific age group of the study know as "Developmental Coordination Disorder" which, in my opinion, should be excluded first to make more solid base for their conclusion. To start with, children with developmental coordination disorder have difficulties with motor coordination as compared to other children of the same age. Their performance in daily activities that require motor coordination is substantially below that expected given the person's chronological age and measured intelligence. This may be manifested by marked delayes in achieving motor milestones(e.g., walking, crawling, sitting), drooping things,"clumsiness,"poor performance in sports, or poor handwriting. The disturbance in these activities significantly interferes with academic achievement or activites of daily living. In addition, the prevalence of Developmental Coordination Disorder has been estimated to be as high as 6% for children in the age range of 5- 11 years-almost the same age group that has been included in the study(i.e.,7-11 years). Course Recognition of the Developmental Coordination Disorder usually occurs when the child first attempts such as running, holding a knife and fork, buttoning clothes, or playing ball games. The course is variable. In some cases, lack of coordination continues through adolescence and adulthood. The etiology is unknown but several lines of evidence suggest that it rises as a result of some form central nervous system pathology. There is no known cure for this disorder but some children benefit from occupational therapy, physiotherapy and specialized classrooms with additional assistance to help the child to cope. To sum-up, Developmental Coordination Disorder has to be ruled out in those children who were involved in the study and further information should be given a bout other differential diagnosis which can lead to some form of poor motor function in those children such as decreased visual acuity, orthopedic abnormality, mild cerebral palsy and congenital chorea. Dr.Gydhia Zuhair Al-chalaby.
Competing interests: None declared |
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Scott M Montgomery, Professor Dep of Primary Care and Social Medicine, Charing Cross Hospital, Imperial College, London,W6 8RP, Walter Osika
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The variety of suggestions among Rapid Responses to explain why some obese adults have poorer motor competence as children is consistent with the existence of several underlying mechanisms. Gydhia Zuhair Al-Chalaby says that ‘developmental coordination disorder has to be ruled out’. Rather than ruling out such explanations, we would prefer to consider them as potential explanatory mechanisms: do some early life exposures impair development of coordination as well as increasing later obesity risk? It is unlikely that gross impairment of coordination or motor function among a minority of children explains the association entirely, as this would probably have been identified during the medical examination. Also, the test scores show a dose-dependent relationship with obesity risk, indicating relatively poorer function across the spectrum is associated with later obesity, rather than being limited to those at the extreme. David Wilson wonders if poorer motor competence discourages individuals from participating in organised sport. We think that this could certainly be a contributory factor. However, it should be stressed that many childhood activities including play result in exercise, which is not solely the consequence of organised sport. Many types of physical activity may potentially influence development of motor competence, as well as helping to establish life-long patterns of exercise relevant to obesity risk. We agree with Arya K Kumarasena who emphasises the multiplicity of process that can result in obesity. To progress we should certainly try to identify which specific exposures are relevant at different times in life. This research suggests that we should look for early-life exposures in the subset of obese individuals with poorer physical control and coordination in childhood. In short, it is essential to adopt a life-course approach to understand fully the causes of obesity. Competing interests: None declared |
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