“Healthy” obesity: is it a myth?
A Swedish study published in Cell Reports provides further evidence against the notion of a healthy obese state, revealing that white fat tissue samples from individuals with obesity, classified as either metabolically healthy or unhealthy, actually show nearly identical, abnormal changes in gene expression in response to insulin stimulation. Recent estimates suggest that up to 30% of individuals with obesity are metabolically healthy and, therefore, may need less vigorous interventions to prevent obesity-related complications. A hallmark of metabolically healthy obesity is high sensitivity to insulin. However, there are currently no accepted criteria for identifying metabolically healthy obesity, and whether or not such a thing exists is now up for debate. The Swedish researchers assessed responses to insulin in 15 healthy, never-obese participants and 50 subjects with obesity enrolled in a clinical study of gastric bypass surgery. The researchers took biopsies of abdominal white fat tissue before and at the end of a 2-hour period of intravenous infusion of insulin and glucose. Based on the glucose uptake rate, the researchers classified 21 subjects with obesity as insulin sensitive and 29 as insulin resistant. Surprisingly, mRNA sequencing of white fat tissue samples revealed a clear distinction between never-obese participants and both groups of individuals with obesity. White fat tissue from insulin-sensitive and insulin-resistant individuals with obesity showed nearly identical patterns of gene expression in response to insulin stimulation. These abnormal gene expression patterns were not influenced by cardiovascular or metabolic risk factors such as waist-to-hip ratio, heart rate, or blood pressure. In future research, Rydén and his collaborators will track the study participants after bariatric surgery to determine whether weight loss normalizes gene expression responses to insulin.
Overlap between homelessness, drug and alcohol misuse
A new report from the Australian Institute of Health and Welfare showed that almost 40 000 Australians received both alcohol and drug treatment as well as specialist homelessness services over a 3-year period. This equates to more than one in every five alcohol and drug treatment clients also accessing homelessness assistance, while conversely about one in 12 of all homeless clients also received alcohol and drug treatment. The analysis reveals that 77% of the group accessing both services, in addition to their housing and drug and alcohol issues, experienced an additional vulnerability, including mental health problems or domestic and family violence. For example, of the 40 000, about half had a current mental health problem. Overall, 59% of the study population were male; however, in instances where a client was also experiencing domestic and family violence, 73% were female. People accessing both services were also three times more likely to have sought treatment for multiple drugs, and the rate of treatment for heroin and pharmaceutical misuse was double than that of clients who only received drug treatment. The analysis also showed that clients in the group accessing both services were less consistently engaged with homelessness services, generally having more frequent periods of homelessness support, but fewer nights of accommodation, probably as a consequence of seeking help only at times of crisis.
Pilot program for palliative care at home
St Vincent’s Private Hospital in Brisbane will run a 2-year pilot program to provide patients with the choice to receive intensive, specialist palliative care services at home. Managed by the hospital’s specialist palliative care team, the program started in August and is available for Bupa members in Brisbane who have complex symptoms or are in the final days of their life and want care at home. Research by the Grattan Institute suggests that there is an unmet need for at-home palliative care services – 70% of Australians would prefer to die at home, but only 14% do so. The individualised program includes: specialist palliative care multidisciplinary assessment and advanced care planning; at-home specialist palliative care, as required from physicians; palliative care nurses and allied health professionals, such as occupational therapists, physiotherapists and counsellors; intensive specialist palliative care, which may include physician and nurse visits as well as additional at-home nursing support; 24/7 telephone support access for patients, carers and family; and direct access to the hospital’s Palliative Care inpatient unit if required, avoiding any need to present at the emergency department. According to a Bupa spokesperson, the pilot aims to “explore a model of care that will provide people with dignity, respect and the choice to receive palliative care where they want”.
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