Submited on: 09 Feb 2013 01:40:46 AM GMT
Published on: 09 Feb 2013 11:43:38 AM GMT
 

  • What are the main claims of the paper and how important are they?

    The author proposes a new theory of the epidemic of obesity in the USA. The claims are interesting and important as the final word about it is yet to be written. Once we know the exact reasons we will be in a position to overcome the problem.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    No.

    Contrary to the author’s argument, the incidence of caries and dentine sensitivity has increased with the consumption of sugar containing foods and beverages. Now if we look at India there is an ongoing epidemic of obesity and its complications like type 2 diabetes mellitus. The theory put forth by the author does not hold true. In India, caries is on the rise and preventive measures are a distant dream. But two factors are common in producing obesity: lots of food especially rich in fat and the rapidly assimilable carbohydrates.

    The classical case of the Pima Indians supports this. Those people got the proverbial train in the literal sense and with it the affluence and food. Within years these people had 100 percent obesity and 50% became diabetics. They did not have anything to do with the quality of teeth or the masticatory functions. It happened so fast. The role of genes was investigated and we got the famous "thrifty" gene.

    And then the poor H. pylori is the culprit. Although this time, for a change, it's eradication is an issue.


  • Are the claims properly placed in the context of the previous literature?

    The author's contention and conclusion drawn from some studies can be seen from the opposite angle. It was the rise in obesity and it's complications especially heart diseases which led to the formulation of the guidelines for cholesterol, proliferation of diet programs and fitness clubs.

    It is well known that the poor of the society have an increased tendency to obesity and the various complications. USA is a country of many different ethnic groups from all over the world. In a sense because the have-nots have flooded USA, it is they who are prone to obesity. This after generations of their kind suffered from starvation.

    Diarrhea seems to be the only factor contributing to nullify some of the weight gain. So prevention and prompt treatment must have had a contributory effect on the epidemic of obesity.

    Regarding caries, it is an effect of high carbohydrate diet. Therefore more obese people are expected to have it. More importantly, obese people believe in gluttony rather than chewing food. And studies show that chewing food properly as well as more use of masticatory muscles stimulates the satiety center and prevents obesity!


  • Do the results support the claims? If not, what other evidence is required?

    The epidemic of obesity might have leveled off in the USA but is gaining momentum in India. It is the sheer amount of food people take which is one important factor. After a decade or so we may expect the government to introduce some measures to prevent dental caries, supply fluoridated water, open up dental hospitals and clinics for the masses, and control the number one killer in children-diarrhea. By then obesity would be at it's peak and it surely would be oversimplification to attribute these changes as the cause of the obesity. 


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes. Basically it is an analysis of the data suited to the conclusions drawn.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    NA


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes. This will carry forward the discussion on obesity, the causes and possible remedies.


  • Other Comments:

    Despite not agreeing with the author on most of the points, I would none the less congratulate him on postulating a new theory.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    Khan SA. Doctors should be role models in the fight against obesity (Editorial). Physicians Academy. 2008; 2(2): http://www.physicians-academy.com/current_article_details.aspx?Id=129

  • Experience and credentials in the specific area of science:
    None
  • How to cite:  Khan S A.Obesity and the disorders of the Alimentary Canal: Is there a relationship?[Review of the article 'The Relationship between Obesity and Disorders of the Alimentary Canal ' by Zenian J].WebmedCentral 2013;4(2):WMCRW002531
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I appreciate Dr. Khan's review of my article. The data in tables 1,2 and 3 come from Federal agencies and nationwide organizations which produce only one set of data for each variable. Therefore, it is not possible for me to select data that suit my opinions and ignore those that don't. According to the NHANES (reference 18), the prevalence of dental caries declined in all socioeconomic groups between 1990 and 2000. The decrease in the DMFT scores of poorer Americans was smaller than the decrease in the DMFT scores of wealthier Americans, but this was mainly due to the fact that the baseline DMFT scores of wealthier Americans were higher than the baseline scores of poorer Americans. The proliferation of diet and exercise programs did not prevent the rise in the prevalence of obesity in the United States. The first survey that showed a jump in the prevalence of obesity, carried out between 1988 and 1994 (listed under the year 1990 in Illustration 1), also showed the first significant decline in fat consumption. Therefore, the decline in fat consumption could not have been a response to the obesity epidemic because it began simultaneously with the first increase in the prevalence of obesity. The association between obesity and socioeconomic status in the United States is complex and depends on racial/ethnic differences. Nevertheless, the prevalence of obesity increased in all socioeconomic groups during the obesity epidemic (reference 3). The rate of poverty in the United States declined after 1960 and despite some fluctuations remained at the same level in 2010 as it did in the mid 1960s. Thus, it is unlikely that poverty played a role in the United States obesity epidemic. To my knowledge, the NHANES did not publish data about Native Americans. The problem of obesity among Pima Indians is important and deserves more attention. However, it is worth mentioning that Native Americans, of which the Pima Indians are part of, constitute only about 1% of the total U.S. population, and their inclusion would not have significantly changed the outcome of this study. I agree with the reviewer that local prevailing conditions should be taken into consideration when studying obesity in other countries.
Responded by Dr. John Zenian on 27 Feb 2013 05:18:20 PM

  • What are the main claims of the paper and how important are they?

    The main claims are very interesting propsing that prevention and treatment of oral and gastrointestinal disorders which reached a critical mass during a period of 1958 to 1970 prior to the onset og obesity epidemic  and decrease in prevalence of dental caries,peptic ulcer along with a decreasing mortality from diarrheal disease by time trend analysis ,while the prevalence of gastrooesophageal reflux disease increased prior to or concurrent with increase in prevalence of onesity .Furthermore the treatment measures and prevengtive measures for dental caries, dental malocclusion ,dentine sensitivity improved with a better masticatory apparatus which enabled people to consume morefood while dentine sensitivity treatment enabled people to consume more sugar containing foods and beverages.Effective suppression of gastric acid enabled people to eat more ,with better absorption of nutrients following tratment of diarrheal diseases and thus  an overa;ll improvement of health and efficiency of alimentary canal explaining to the contribution of US obesity epidemic supported by the data drom NHANES and CDE criteria in different decades. It seems important with the corroborating evidence and an innovative idea rather than just simply discuss various neuropeptides.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes they are novel in terms of demographic data for an epidemic in a particular country the way it has been presented although the articles of similar nature involving GIT and related to demographic data in mexico1)Bernal-Reyes-A,Monzalvo-Lopez A,Bernal-Serrano M.Prevalence of gastrointestinal symptoms in overweight and obese subjects:An epidemiologic study on a Mexican population.Rev Gastroenterol Mex 2013;Feb 6 Pii:S0375-0906(12)00140-1.ePUB AHEAD OF PRINT.2)Shillotoe E,Weinstock R,Kim T,Simon H,Planer j,Noonan S,Cooney R.The iral microflora in obesity and type 2-diabetes.J Oral Microbiol 2012;4:19013-19020.-where thet discuss effects of changes in endotoxin and tumour nacrosis factor alpha before and after Roux-en Y gastric bypass surgery suggesting importance of GIT flora in weight control following bariatric surgery.3)Liou AP.G protein coupled receptors in nutrient chemosensation and gastrointestinal hormone secretion. J anim Sci 2012;Dec 10-Epub ahead of print,4)Zhang JV,Huang Q,Ren PG.Obestatin receptor in energy homeostasis and obesity pathogenesis.Prog Mol Biol Trans Sci 2013;114:89-107.-discuss special role of obestatin-discovered by Zhang et al a new 23 aa hormone from rat dtomach extract encoded by ghrelin gene present not only in GIT,,BUT ALSO MAMMARY GLAND ,SPLEEN ,plasma and befreast milk with role in obesity.


  • Are the claims properly placed in the context of the previous literature?

    Yes but the authors have used data from NHANES website where it is mentioned it is constantly updated and subgrouped according to sexes and race,ethnicity although author has tried to genaralize.The incidence of peptic ulcer and gastooesophageal disease is not provided for 2000s .Although the novelty of idea impresses me it would have been nice if the author had tried to see if any coorelation with conventional gastric peptides invilves uin absorption could have been compared say ghrelin and leptin which a study compares for proton pump inhibitors-maybe data could have been drawn by personal communications if not available on NHANES site as addresses could be procured as populations jobprofiles have been considered,besides GLP-1,incretins etc to make it more complete.


  • Do the results support the claims? If not, what other evidence is required?

    It is not a randomozed control trial but author has used data from various decades from US NHANES/US BUREAU OF LABOUR STATISTICS/PER CAPITA INCOME FRON US DEPTT OF AGRICULTURE/tv viewing for sedentary habits from ref15-although for a demographic study fine but for completness sake a data on various gastric peptides would be interesting and not clear whether ethnicity etc has been considered or sex based differences  considered.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    Yes although the lacunae have been mentioned in the above section.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes giving additional data on various GIT peptides altered by the mentioned say proton pump therapy changes in ghrelin and leptin levels,study of GIT intestinal flora,study of incretins-although would not be easy to contact from the NHANESA population surveys but alleast from that data can try to analyze the effect on ethnicity basis,sex basis,job basis . .Another thing the author has not considered the effects of various addictive drugs on GIT motility &the percentafe of population using it as endorphin substitutes like heroin lead to marked constipation and could also be invreasing absorption directly and indirect affects of endorphins through CRF axis with so ptrevalent addiction on USA.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No as it is important from a demographic point of view but doesnt offer any clues to how to improne treatment of obesity.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Recently a new drug rimonabant a CB1 RECEPTOR ANTAGONIST WAS Introduced and banned in USA by rhe FDA because of depressive and suicidal tendencies while more trials are being carried out in EUROPE by RIO-Europe since very good effects on meta bolic profiles found in obese specially obese diabetics and suicidal tendencies found in american cohort was due to poor selection of patients.I feel the authoe should have mentioned the introduction of various antiopbesity drugs and there efficacy as well.


  • Other Comments:

    NA

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    Confused HYPOTHALAMUS-A CAUSE OF WORLDWIDE OBESITY presented in the 12th world Congress of Gynaecological Endocrinology held in Florence Italy in MAR 2006-1STAUTHOR2)Topiramate iovulation induction in obese infertile couples-presented in world congress of ovulation induction in rome italy in 2007,3)oworld congress of neurology in 2007 regarding altered autonoimic profile in australia,5)management of obese Indertile couple-published by gautam allahbadia editors for reproductive challenges in the future 2013.

  • Experience and credentials in the specific area of science:
    None
  • How to cite:  Kaur K K.Review on The Relationship between Obesity and Disorders of the Alimentary Canal[Review of the article 'The Relationship between Obesity and Disorders of the Alimentary Canal ' by Zenian J].WebmedCentral 2013;4(2):WMCRW002519
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I appreciate Prof. Kaur's review of my article. Being a theoretical scientist I rely on published data to formulate and test my theories. Sometimes, the data do not emerge in the same uniform fashion as one would prefer. However, I always make sure that I have enough data to support my claims. I have not included anti-obesity drugs, but I also have not included other drugs such as corticosteroids and anti-depressants which might also affect body weight. The cumulative effect of such drugs and other substances such as GIT peptides on the overall prevalence of obesity in the United States would be worth studying. The use of antacid drugs, and proton pump inhibitors in particular, continue to rise in the United States despite any setbacks in introducing new drugs. I believe that dentine sensitivity and reflux disease could provide the framework for an alternative weight loss strategy in which toothache and heartburn are used as negative reinforcements in order to achieve a low fat low carbohydrate diet. such a program would be best performed in the context of a dentist-patient or a doctor-patient relationship. The present article is a preliminary report. I hope that other scientists would extend and improve my findings by doing further research in this area.
Responded by Dr. John Zenian on 21 Feb 2013 12:07:34 PM

  • What are the main claims of the paper and how important are they?

    This article/communication discusses the environmental theory of obesity and development of obesity that is linked to efficiency of alimentary canal in United States obesity epidemic. The attributes of sedentary lifestyle, consumption of cheap calorie dense processed food, television watching among the children and alimentary canal disorders can/cannot cause obesity has been discussed in depth. The improvement in the over all health and effective alimentary canal need to be considered as a possible alternative explanation for this.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    This article shows less/no influence of sedentary lifestyle, type of food consumption to obesity pandemic in USA. In contrast, the eradication and treatment of the diseases of the alimentary canal are likely to have a more profound effect on body weight that can result in obesity. Though this result was observed in that study period selected, it cannot be the principle cause for its development now a day. Earlier mentioned factors have a predominant role in obesity and other metabolic disoders. Excess energy does cause weight gain.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes. Time trend of comparison of the prevalence of obesity with determinants of energy balance, comparison of the prevalence of obesity with selected disorders of the alimentary canal, analysis of preventive and therapeutic procedures of possible relevance to weight gain, advances in the prevention and treatment of oral and gastrointestinal disorders with relevance to weight gain across different years has been discussed.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    NA


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    NA


  • Other Comments:

    Author has extensively studied all the previous modalities linking obesity pandemic of USA and has concluded to alimentary canal efficiency in causation of obesity with relevant data substantiated by results and discussion.

     

    Abstract is not structured. It does not include clear objectives, methodology, results and discussion part. Should have cut short the lengthy Results section. Too many references.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Has worked in the fields of Cardio metabolic, Nutrition and Obesity. Presented papers, Published articles in National and International Journals in these fields.

  • How to cite:  Dutt. R A .A Review of - The Relationship between Obesity and Disorders of the Alimentary Canal.[Review of the article 'The Relationship between Obesity and Disorders of the Alimentary Canal ' by Zenian J].WebmedCentral 2013;4(2):WMCRW002503
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I appreciate Dr. Aswini Dutt's insightful review of my article. His comment on the role of excess energy in weight gain is particularly relevant. My article does not in any way contradict such a notion, nor does it minimize the role of energy dense foods in weight gain. Rather, it refutes the idea that the relative affordability of such foods is behind the United States obesity epidemic. I agree with his assessment of the relevance of my findings to the present day only to a certain extent. While it is true that the role of some of the advances in the prevention and treatment of alimentary disorders such as peptic ulcer and diarrhea are of historical significance, the role of advances affecting other disorders are still relevant today. A case in point is gastroesophageal reflux disease, the prevalence and treatment of which are not expected to decline, because antacid drugs neither cure nor eradicate reflux disease.
Responded by Dr. John Zenian on 14 Feb 2013 03:39:24 PM