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High use of antibiotics overlaps with obesity rates in the Midwest and South

Updated: 2013-11-25T03:40:33Z

By SCOTT CANON

The Kansas City Star

Want to shed the love handles? Put down the doughnut and go for a walk.

Or, perhaps, think twice about pressing your doctor for antibiotics.

Research now hints that the stout among us tend to hail from the same places — including chubbier-than-most Missouri and Kansas — where antibiotic drug use is highest. Whether the germ-fighting drugs make us fat or our obesity leads us to pop more antibacterial pharmaceuticals makes for difficult unraveling.

Chicken, meet egg.

Some research, for instance, finds that children exposed to antibiotics, particularly in the first six months of life, tend to develop larger body mass than those who aren’t exposed.

Other studies have found that because the immune systems of people with diabetes are weakened, they’re more prone to infections that would prompt the use of antibiotics. And obesity is often linked to Type 2 diabetes.

Research accepted for publication in the upcoming Annals of the American Thoracic Society notes that the same American states in the country’s midsection where obesity is most common happen also to snarf down more antibiotics than their slimmer counterparts on the coasts.

“When I lined up those two maps, they were almost identical,” said Martin Blaser, a physician and head of the human microbiome program at New York University.

That means the Midwest and the South could be facing twin health problems of obesity and antibiotic overuse.

Blaser has been exploring links between antibiotics and obesity for more than a decade. The connection is not fully understood, but he suspects it could stem from disrupting the balance of the human microbiome — the collection of microscopic organisms residing in every gut. The drugs, for example, might alter how calories are absorbed by the body.

At some level, Blaser said, the relationship has been known on the farm for generations. Livestock producers have long been using tiny doses of antibiotics in their herds to grow bigger animals faster.

“If that’s what’s going on on the farm,” he said, “then maybe we’re doing something similar with people.”

The spread of obesity in America has often been described as epidemic, worrisome for the attendant health concerns that include diabetes, heart disease and some forms of cancer. Nearly a third of young adults in the country are so overweight they don’t qualify for military service.

Antibiotic resistance, when drugs lose their power to kill bacteria, draws less attention. But it threatens to transform one of modern medicine’s most potent weapons against infections and infectious diseases into a dud. Some 23,000 Americans die each year from diseases that are resistant to antibiotics. Hospitals can be particular breeding grounds for resistance that leaves 2 million people a year in the U.S. with infections not easily treated with drugs.

Antibiotic resistance comes from a number of things, but overuse of the drugs is a chief culprit. The drugs kill bacteria, but they can leave behind the hardiest strains that are impervious to a particular antibiotic. And those organisms can pass along DNA to other bacteria, creating super bugs.

That’s why the Centers for Disease Control and Prevention urges patient and physician alike to use antibiotics prudently. But doctors still prescribe antibiotics for people with colds or the flu — although the drugs are toothless against viruses — to appease insistent patients.

Disbursed into the wild, antibiotic prescriptions can go half-used. Bacteria are only temporarily weakened and can bounce back with new invincibility. Or prescriptions get shared, another watered-down deployment into battle with bacteria that emerge stronger for the next fight.

“We need to think about antibiotics as a shared precious resource that shouldn’t be given out like candy,” said Lauri Hicks, an epidemiologist and infectious disease specialist at the CDC.

She leads a “Get Smart” program at the agency aimed at reining in antibiotic overuse. The CDC wanted to see where antibiotic use was greatest to better direct education efforts. The resulting research — Blaser called it “pioneering” — found little difference between urban and rural areas. But it discovered that doses were passed out most in the middle and southern sections of the country.

“There are probably many explanations,” Hicks said.

It could be cultural. It could be the overall health of the population in those regions.

Or it could be your family.

People who live in a household that uses lots of antibiotics tend to carry higher levels of resistance to the bacteria killers. That may lead them to use more or stronger antibiotics to wage war with infections. Whether those people are necessarily heftier than others remains untested.

However complicated the correlation between antibiotics and obesity, Hicks said the relationship is more than coincidence. At least one side of the equation seems clear.

“There’s very little doubt that obesity leads to more antibiotic use,” she said. “That’s probably without question.”

A potential path to obesity is only one of the downsides of misusing antibiotics. Guidelines published this month give pediatricians the clearest advice yet about when to use the drugs and when to pass. They include a cheat sheet to better diagnose maladies and to better match the right antibiotic with a particular form of infection.

Mary Anne Jackson, the director of the infectious diseases division at Children’s Mercy Hospital, helped craft the guidance for dealing with upper respiratory tract infections. She thinks doctors will embrace them to avoid the multitude of possible side effects of antibiotics on their patients and to keep the drugs effective more broadly.

“It’s an easy sell,” she said. “Pediatric physicians are very aware that antibiotic resistance is a real danger.”

Perhaps the strongest correlation with antibiotic overuse is poverty, said Eric Wombwell, an assistant clinical professor in the University of Missouri-Kansas City School of Pharmacy. And increasingly, poverty is tied to obesity.

Wombwell said both can come from poor diets — antibiotics can offer an ad hoc answer to weakened immune systems that come from poor nutrition and empty calories offer a clear path to weight problems.

“We have far more evidence,” he said, “to say poor diets and lack of exercise are the main contributors to obesity.”

So nix the pastries. Go for a stroll.

To reach Scott Canon, call 816-234-4754 or send email to scanon@kcstar.com.

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