September 19, 2019

expert reaction to conference abstract/poster looking at probiotic supplements and weight loss in obese children

A conference abstract/poster, being presented at the European Society for Paediatric Endocrinology meeting (ESPE 2019), reports that probiotic supplements may enhance weight loss and improve the metabolic health of obese children following a diet and exercise plan.

Prof Kim Barrett, Distinguished Professor of Medicine, University of California San Diego, and Editor-in-Chief of The Journal of Physiology, said:

“Improved approaches are urgently needed to counter the epidemic of obesity, including in children.  The study to be presented by Chen and colleagues suggests that a cocktail of probiotics may be a useful addition to diet and exercise.  Although the study was small and effect sizes are not stated, the treatment and control groups were well-matched and the intriguing effects of the probiotics on weight loss were accompanied by beneficial effects on markers of inflammation and metabolic dysfunction.  But statistical significance doesn’t necessarily mean biologically significant, so we need to see the numbers before we can know how exciting this is.

“The authors propose that the length of treatment may account for the fact that they saw a beneficial effect when other such trials have failed, but again we need to know what the size of the effect is, which isn’t given in the abstract.  I look forward to seeing the results of this work in the peer-reviewed literature as well as attempts to replicate it in larger cohorts of children and in other settings.”

Prof Glenn Gibson, Professor of Food & Nutritional Sciences, University of Reading, said:

“Obesity is arguably the 21st Century’s biggest health worry particularly in children.  The information here is not especially novel however, as both probiotics and prebiotics have been well researched in this regard.  There are some caveats in the present trial however.  Firstly, is an abstract not a refereed paper so difficult to make a scientific judgement on its quality (owing to the lack of detail).

“The following issues spring to my mind:

“It is a small study, but this is normal in the field.  It is not a crossover trial so the participants are not acting as their own controls, this approach also ‘doubles’ the data.

“The probiotics used are not well described.  Only species designations are given.  The authors ought to provide strain information and culture collection access (otherwise other scientists are unable to repeat the study and test its robustness).

“Probiotic dose is not given.  The placebo used is not given.  Actually, 2 of the 3 bacteria used are not usually considered to be probiotics (S. thermopilus and L. bulgaricus are yoghurt starter cultures).  If there is any probiotic effect then it must be due to B. longum.

“No faecal microbiology seems to have been done, this is essential if the authors wish to claim probiotic effects.

“The size of any effects seen is not quantified.

“Why reduce calories and increase exercise- these must surely have affected outcome?

“Presumably when the full trial is reported these and other considerations will be covered in the peer review process.  Assuming that to be the case, the study would add to the large body of data on health effects of probiotics.  The gut microbiota is known to be involved in satiety, appetite regulation and calorie regulation.  So there are plausible mechanisms behind these findings.

“One wonders, however, whether legislation to allow these important health messages on the gut microbiome will ever be unravelled to the extent that consumers can actually be made aware of realistic benefits?  This is the main conundrum in the field – the science is progressing extremely well but communication paths to the people who can benefit from good science is poor and needs addressing.”

Dr Harriët Schellekens, a molecular and behavioural pharmacologist investigating the diet-microbiota-gut-brain axis, particular focussing on appetite, eating behaviour and mood, University College Cork, said:

“This study delivers important evidence that probiotic supplementation can indeed be useful in the fight against obesity.  It is very promising that only 12 weeks of supplementation of the probiotic cocktail was able to reduce Body Mass Index (BMI) and also led to the improvement of other metabolic markers of obesity, including a reduction in fasting glucose levels.

“This reinforces the concept of the link between the gut microbiome and metabolic disease, which is a growing area of obesity research.

“The fact that this was shown in obese children is exciting, as childhood obesity is a serious concern which needs early intervention to prevent long-term health problems.

“A limitation of the study is that it does not investigate if the probiotic on its own has any benefits.  It is likely only enhancing the effect of caloric restriction and increased exercise (thus the probiotic helps but does not cure obesity).  It will also be interesting to see if the probiotic effect size is independent of the amount of caloric restriction and/or amount of exercise.

“More and more evidence shows that the gut microbiome contributes to obesity, but obesity is very complex, and everyone has a different microbiome (its own microbiome signature), which means that a probiotic that works for one person may not work for another.

“Obesity and metabolic disease are driven by a combination of diet, environment, genetics and lifestyle.  The full microbiota-driven mechanism of metabolism and appetite regulation still need to be elucidated.

“Probiotics for weight management and metabolic control are likely to be developed in the near future, but more research is needed to separate hope from hype.”

Abstract/poster title: ‘Effect of Probiotics intake on obese children’ by Ruimin Chen et al.

This is a conference abstract from the European Society for Paediatric Endocrinology meeting (ESPE 2019) in Vienna, and is under embargo until 23:01 UK time on Thursday 19 September 2019.

There is no paper as this is not published work.

Declared interests

Prof Kim Barrett: “I have no conflicts of interest.”

Prof Glenn Gibson: “No declarations.”

Dr Harriët Schellekens: “No conflict of interest.”