The Cleveland Clinic says the following factors make childhood obesity more likely:

• A genetic predisposition or family history of obesity.
• Not getting enough exercise.
• Eating unhealthy foods.
• Rarely, a health condition such as an endocrine disorder.

The Cleveland Clinic says the following factors make childhood obesity more likely:

• A genetic predisposition or family history of obesity.
• Not getting enough exercise.
• Eating unhealthy foods.
• Rarely, a health condition such as an endocrine disorder.

The finding builds on prior research that established that being obese raises the risk for developing colon cancer in the first place.

"Previous studies have shown that obesity does influence the risk of developing colon cancer, but this study takes it one step further," said study author Dr. Frank A. Sinicrope, a professor of medicine and oncology at the Mayo Clinic in Rochester, Minn. "Because now we know that if you're obese, you have a higher risk of cancer recurrence or death for patients who have established colon cancer."

Sinicrope and his colleagues, whose work was funded in part by the U.S. National Cancer Institute, report their findings in the March 15 issue of Clinical Cancer Research.

The American Cancer Society estimates that last year more than 106,000 Americans were newly diagnosed with colon cancer, while nearly 50,000 men and women died from the disease.

To explore a potential connection between obesity and colon cancer survival, the authors analyzed data concerning 4,381 men and women who had been diagnosed with either stage II or stage III colon cancer. All of the patients had undergone both surgical removal of their cancer and subsequent chemotherapy.

Based on body mass index (BMI), which is a measurement that takes into account weight and height, the researchers determined that approximately 20 percent of the patients were obese (above 30 on the BMI chart). Among that group, about seven in 10 patients were classified as "moderately obese" (BMI between 30 and 34.9), while slightly more than one-quarter were "very obese" (BMI of 35 and up).

About 37 percent of the patients were normal weight (BMI of 20 to 24.9), while a similar number were deemed overweight (BMI of 25 to 29.9). Six percent were classified as underweight (BMI under 20).

Tracking all the cancer survivors for an average of eight years, Sinicrope and his associates observed that 36 percent went on to experience cancer recurrence, while 42 percent ultimately died.

Furthermore, the researchers found that, taken as a group, being either moderately or very obese was associated on average with a 19 percent increase in the risk for death, when compared with normal-weight cancer patients.

Although the pool of underweight patients was considerably smaller, the researchers found that the underweight group also had a much poorer survival rate than normal-weight patients. And while overweight patients actually seemed to fare slightly better (by 6 percent) than normal-weight survivors, Sinicrope indicated that more sophisticated obesity measurements that take into account muscle-mass ratios (not revealed by BMI) could yield slightly different results.

Gender differences were also apparent.

With a patient pool that was more or less evenly divided between men and women, the authors found that taken on their own, the most severely obese men faced the highest risk for cancer recurrence and death -- tagged as a 35 percent increase, relative to normal-weight patients.

However, women on the lowest end of the obesity scale were linked to a 24 percent increased risk for death -- a risk that actually dropped down to 11 percent as obesity rose.

"For now, we don't really have a clear explanation for why the moderately obese women did worse than the very obese women," said Sinicrope. "Menopausal status and hormone replacement therapy -- which could be protective against colon cancer -- could both be factors. But we don't know which women were pre- or postmenopausal and which were taking this medication."

As for what general underlying cause accounts for the obesity-survival risk connection, Sinicrope said the question remains unanswered. But he speculated that the association might result from the presence of higher insulin and insulin-like growth-factor-1 hormone levels in obese patients.

"We know the obese patients have higher levels of both these hormones, which have been associated with both obesity and colon cancer risk in the past," he noted. "So we think that could be playing a role in this risk."

A number of variables could explain the findings, said Dr. Joseph Martz, chief of the division of colorectal surgery at Beth Israel Medical Center in New York City.

"Obesity is often associated with a higher likelihood for diabetes and other diseases, and overall secondary immune dysfunction. And since colon cancer is somewhat of an immune disease, that is going to be a driving factor," he noted.

"There is also a good deal of data already regarding the supportive benefit of exercise and activity after colon cancer treatment in terms of prognosis," Martz added. "So I think that goes along with the concept that obese individuals are less likely to be in shape. Also, there may be some inherent surgical limitations that could compromise the technical ability to achieve complete removal of the cancer and the potentially affected lymph node tissues when operating on an obese person. All of this may play a role."

On a related front, a separate study published this week in the Journal of the National Cancer Institute provides fresh evidence that being obese does appear to be linked to a higher risk for colon cancer.

However, the research team -- led by Peter T. Campbell of the epidemiology research program at the American Cancer Society -- also found that the obesity-survival link does not seem to hold for all tumors, but only for those that are so-called "microsatellite stable." Obese patients who had this common type of tumor had lower five-year survival rates than obese patients with "microsatellite-high" tumors, suggesting that obesity has a varying impact on prognosis, depending on the kind of colon cancer at hand.

More information

For more information on colorectal cancer, visit the American Cancer Society.

The finding builds on prior research that established that being obese raises the risk for developing colon cancer in the first place.

"Previous studies have shown that obesity does influence the risk of developing colon cancer, but this study takes it one step further," said study author Dr. Frank A. Sinicrope, a professor of medicine and oncology at the Mayo Clinic in Rochester, Minn. "Because now we know that if you're obese, you have a higher risk of cancer recurrence or death for patients who have established colon cancer."

Sinicrope and his colleagues, whose work was funded in part by the U.S. National Cancer Institute, report their findings in the March 15 issue of Clinical Cancer Research.

The American Cancer Society estimates that last year more than 106,000 Americans were newly diagnosed with colon cancer, while nearly 50,000 men and women died from the disease.

To explore a potential connection between obesity and colon cancer survival, the authors analyzed data concerning 4,381 men and women who had been diagnosed with either stage II or stage III colon cancer. All of the patients had undergone both surgical removal of their cancer and subsequent chemotherapy.

Based on body mass index (BMI), which is a measurement that takes into account weight and height, the researchers determined that approximately 20 percent of the patients were obese (above 30 on the BMI chart). Among that group, about seven in 10 patients were classified as "moderately obese" (BMI between 30 and 34.9), while slightly more than one-quarter were "very obese" (BMI of 35 and up).

About 37 percent of the patients were normal weight (BMI of 20 to 24.9), while a similar number were deemed overweight (BMI of 25 to 29.9). Six percent were classified as underweight (BMI under 20).

Tracking all the cancer survivors for an average of eight years, Sinicrope and his associates observed that 36 percent went on to experience cancer recurrence, while 42 percent ultimately died.

Furthermore, the researchers found that, taken as a group, being either moderately or very obese was associated on average with a 19 percent increase in the risk for death, when compared with normal-weight cancer patients.

Although the pool of underweight patients was considerably smaller, the researchers found that the underweight group also had a much poorer survival rate than normal-weight patients. And while overweight patients actually seemed to fare slightly better (by 6 percent) than normal-weight survivors, Sinicrope indicated that more sophisticated obesity measurements that take into account muscle-mass ratios (not revealed by BMI) could yield slightly different results.

Gender differences were also apparent.

With a patient pool that was more or less evenly divided between men and women, the authors found that taken on their own, the most severely obese men faced the highest risk for cancer recurrence and death -- tagged as a 35 percent increase, relative to normal-weight patients.

However, women on the lowest end of the obesity scale were linked to a 24 percent increased risk for death -- a risk that actually dropped down to 11 percent as obesity rose.

"For now, we don't really have a clear explanation for why the moderately obese women did worse than the very obese women," said Sinicrope. "Menopausal status and hormone replacement therapy -- which could be protective against colon cancer -- could both be factors. But we don't know which women were pre- or postmenopausal and which were taking this medication."

As for what general underlying cause accounts for the obesity-survival risk connection, Sinicrope said the question remains unanswered. But he speculated that the association might result from the presence of higher insulin and insulin-like growth-factor-1 hormone levels in obese patients.

"We know the obese patients have higher levels of both these hormones, which have been associated with both obesity and colon cancer risk in the past," he noted. "So we think that could be playing a role in this risk."

A number of variables could explain the findings, said Dr. Joseph Martz, chief of the division of colorectal surgery at Beth Israel Medical Center in New York City.

"Obesity is often associated with a higher likelihood for diabetes and other diseases, and overall secondary immune dysfunction. And since colon cancer is somewhat of an immune disease, that is going to be a driving factor," he noted.

"There is also a good deal of data already regarding the supportive benefit of exercise and activity after colon cancer treatment in terms of prognosis," Martz added. "So I think that goes along with the concept that obese individuals are less likely to be in shape. Also, there may be some inherent surgical limitations that could compromise the technical ability to achieve complete removal of the cancer and the potentially affected lymph node tissues when operating on an obese person. All of this may play a role."

On a related front, a separate study published this week in the Journal of the National Cancer Institute provides fresh evidence that being obese does appear to be linked to a higher risk for colon cancer.

However, the research team -- led by Peter T. Campbell of the epidemiology research program at the American Cancer Society -- also found that the obesity-survival link does not seem to hold for all tumors, but only for those that are so-called "microsatellite stable." Obese patients who had this common type of tumor had lower five-year survival rates than obese patients with "microsatellite-high" tumors, suggesting that obesity has a varying impact on prognosis, depending on the kind of colon cancer at hand.

More information

For more information on colorectal cancer, visit the American Cancer Society.

State Health Commissioner Richard Daines took up the issue Monday, speaking of a "golden opportunity" to create the tax.

"The dramatic underpricing of sugar-sweetened beverages, their widespread availability, and the ceaseless marketing of these products constitute a stumbling block to good health and are a clear and present danger to the future of our children," Daines said.

He called obesity "the biggest public health challenge of this and the next few decades."

Public officials in New York and other states are echoing that call, eyeing the tax as a chance both to influence diets and to replenish tax coffers depleted by the recession.

New York Mayor Michael Bloomberg, well known for his anti-smoking crusade in the city, also touted the idea in his weekly radio address Sunday.

"In these tough economic times, easy fixes to our problems are hard to come by," he said. "But the soda tax is a fix that just makes sense. It would save lives, it would cut rising health costs."

Nearly 20 percent of US children between the ages of six and 19 are estimated to suffer from obesity, which can encourage diabetes, heart disease and other grave problems.

Health experts blame insufficient exercise, but also the habit, particularly among the poor, of washing down fast food with extra-sugary soda.

The crisis has fed ballooning public costs -- 7.6 billion dollars in annual obesity-related medical bills in New York state alone -- much of which are covered by taxpayers.

Tax proponents say that soft drinks should be treated like tobacco so that the government can effectively price people away from their bad habits.

The soda industry dismisses the cigarettes parallel and has lobbied hard -- successfully so far -- against the levy.

J. Justin Wilson, senior research analyst at the soft drinks industry-connected Center for Consumer Freedom accused the government of using spurious health arguments to sneak in a new tax on businesses.

"If the city or state is out of money, then they should own up to it, rather than trying to hide taxes in a whole slew of new fees," he told AFP.

"They should own up to their financial mismanagement and raise income taxes."

The industry scored a rare piece of positive publicity Monday when it announced huge voluntary reductions in the amount of high-sugar drinks sold to schools across the country.

Leading companies, including Coca-cola and PepsiCo, joined former president Bill Clinton in announcing the initiative, saying that 88 percent less calories were now sold in drinks compared to 2004.

"It's a brand new day in America's schools when it comes to beverages," the head of the American Beverage Association, Susan Neely.

"Our beverage companies have slashed calories in schools as full-calorie soft drinks have been removed. The beverages available to students are now lower-calorie, nutritious, smaller-portion choices."

Wilson, at the Center for Consumer Freedom, accused the government of denying people their guilty pleasures, or, as he put it, deciding their own "balance of enjoying life and life extension."

"They're punishing people for enjoying a little life once in a while," he said.

Many health experts say non-diet soft drinks are a key source of excess calories in the U.S. diet and likely helping to fuel the obesity epidemic. Two-thirds of Americans, including one in three children, are overweight or obese.

An initiative by The American Beverage Association --including The Coca-Cola Co, Dr Pepper Snapple Group and PepsiCo -- the Clinton Foundation and the American Heart Association has helped cut shipments of full-sugar soft drinks to schools by 95 percent compared with 2004, Clinton said.

"There's been a dramatic shift toward lower calorie and more nutritious beverages in schools," Clinton told a news conference. "It could lay the foundation for broader changes in our society."

Although the American Beverage Association said school drink sales make up less than one percent of the total market, Clinton said companies were not asked to forgo revenue, instead "we asked them to make money in a different way."

The guidelines allow 100 percent juice drinks, low-fat milk and bottled water in elementary and middle schools, and diet beverages and calorie-capped sports drinks, flavored waters and teas in high schools.

A report prepared by Keybridge Research LLC said that while the agreement had only been in place since 2006, its progress had been measured against figures from 2004 because that was the most recent data available for comparison.

Keybridge Research president Dr. Robert Wescott said in a statement: "The reduction of calories in schools is real and meaningful. The data truly speaks for itself."

OBESITY PLAGUE

To tackle broader consumption of soft drinks, California and Philadelphia have introduced legislation to tax soda and now New York Governor David Paterson and New York City Mayor Michael Bloomberg are urging state lawmakers to do the same.

Referring to the large numbers of obese and overweight Americans, Paterson told reporters on Monday: "It's not going to be on my conscience, I think we need a sugar tax."

Bloomberg said in a radio address on Sunday that taxing soda would raise nearly $1 billion to help plug the state's shortfalls in health care and education funding.

"And, at the same time, it would help us fight a major problem plaguing our children: obesity," he said.

The U.S. Institute of Medicine says local governments should consider zoning laws to limit access to junk food near schools, and CDC director Dr. Thomas Frieden supports taxes on soft drinks, as does the American Heart Association.

Speaking at Clinton's news conference on Monday, Susan Neely, American Beverage Association chief executive, said a soda tax would not solve "a complex problem like obesity."

Clinton declined to comment, saying: "It's dumb for me to get involved in (the tax) debate when I can save God knows how many kids lives by making other agreements."

The report on the initiative to cut the amount of sugary drinks sold in schools was unable to show if the changes meant children actually consumed fewer calories from the drinks available to them. But it suggested they bought fewer drinks.

And it echoes findings from the U.S. Centers for Disease Control and Prevention, which reported in October that a median of 63 percent of schools limited carbonated soft drinks in 2008, compared to 38 percent in 2006.

The Robert Wood Johnson Foundation and the Center for Science in the Public Interest both praised the results of the initiative, which is part of the Alliance for a Healthier Generation, but said more needed to be done.

"Children drink and eat an estimated 35 percent to 50 percent of their daily calories during school hours," said the foundation's chief executive Risa Lavizzo-Mourey. "Given the central role school plays in our children's lives, we must strive to make every school in the country a healthy school."

(Additional reporting by Maggie Fox, Phil Wahba and Basil Katz; editing by Todd Eastham)

The researchers, writing in the journal Archives of Internal Medicine on Monday, suggested taxing could be used as a weapon in the fight against obesity, which costs the United States an estimated $147 billion a year in health costs.

"While such policies will not solve the obesity epidemic in its entirety and may face considerable opposition from food manufacturers and sellers, they could prove an important strategy to address overconsumption, help reduce energy intake and potentially aid in weight loss and reduced rates of diabetes among U.S. adults," wrote the team led by Kiyah Duffey of the University of North Carolina at Chapel Hill.

With two-thirds of Americans either overweight or obese, policymakers are increasingly looking at taxing as a way to address obesity on a population level.

California and Philadelphia have introduced legislation to tax soft drinks to try to limit consumption.

CDC director Dr. Thomas Frieden supports taxes on soft drinks, as does the American Heart Association.

There are early signs that such a policy works.

Duffey's team analyzed the diets and health of 5,115 young adults aged age 18 to 30 from 1985 to 2006.

They compared data on food prices during the same time. Over a 20-year period, a 10 percent increase in cost was linked with a 7 percent decrease in the amount of calories consumed from soda and a 12 percent decrease in calories consumed from pizza.

The team estimates that an 18 percent tax on these foods could cut daily intake by 56 calories per person, resulting in a weight loss of 5 pounds (2 kg) per person per year.

"Our findings suggest that national, state or local policies to alter the price of less healthful foods and beverages may be one possible mechanism for steering U.S. adults toward a more healthful diet," Duffey and colleagues wrote.

In a commentary, Drs. Mitchell Katz and Rajiv Bhatia of the San Francisco Department of Public Health said taxes are an appropriate way to correct a market that favors unhealthy food choices over healthier options.

They argued that the U.S. government should carefully consider food subsidies that contribute to the problem.

"Sadly, we are currently subsidizing the wrong things including the product of corn, which makes the corn syrup in sweetened beverages so inexpensive," they wrote.

Instead, they argued that agricultural subsidies should be used to make healthful foods such as locally grown vegetables, fruits and whole grains less expensive.

(Editing by Mohammad Zargham)

Researchers at Brigham and Women?s Hospital in Boston asked more than 19,000, normal-weight US women aged 39 or older how many alcoholic beverages they typically drank in a day, and then tracked the women for around 13 years.

The largest single group -- 7,346 women or just over 38 percent -- said they didn't drink a drop, according to the study published in the Archives of Internal Medicine, a publication of the American Medical Association.

The second biggest group -- 6,312 women or nearly a third of those surveyed -- reported drinking the equivalent of around a third of a five-ounce glass of wine or a third of a 12-ounce beer. They did not explain how they managed to do so.

Twenty percent of the women said they drank the equivalent of up to a glass of wine, a 12-ounce beer, or a single-shot drink made with 80-proof spirits, while six percent said they had up to two drinks a day and three percent had more than two.

Over the 13-year follow-up period, the women who did not drink at all gained the most weight, and the women who had the equivalent of two drinks a day were the least likely to pack on pounds.

The best drink for keeping the pounds off was red wine, but all four types of tipple included in the study -- red or white wine, beer and spirits -- showed the same "inverse association between alcohol intake and risk of becoming overweight or obese," the study found.

The authors cautioned, however, against making recommendations on alcohol use as a tool against obesity, given the potential medical and psycho-social problems associated with drinking.

The women's alcohol intake was recorded in grams of alcohol.

A five-ounce (150 ml) glass of wine, 12-ounce beer or one mixed drink made with a single, 1.5-ounce shot of 80-proof alcohol all contain around 14 grams of pure alcohol and are considered "standard drink sizes" in the United States, according to the National Institutes of Health (NIH).

Obesity is everywhere in our society today -- and this is how it is met by a remarkable number of people.

People who would find slurs against other groups unthinkable still seem to think nothing of correcting, lecturing, and even humiliating complete strangers who are overweight.

Not only is such casual obesity-bashing considered harmless, some people actually seem to believe they are "helping" the overweight person by "giving advice."

And the more overweight the person, the more many people seem to feel entitled either to preach or scorn.

This is not a small issue.

Obesity is fast becoming a worldwide epidemic. More than 25 percent of Americans are obese.

The implications -- higher mortality, greater preventable disease, billions of dollars in often unsuccessful remedies -- are enormous.

Michelle Obama has waged war on it.

Airlines wrestle with it.

Employers prefer to avoid it wherever possible.

And yet feelings of superiority continue to lace the public discourse on this issue.

My question is, while the obesity wars are being waged, can't we remain compassionate? Wherever we fall on the scale, we all are obliged to give some thought to this matter.

Good manners are based on kindness, respect, and consideration for every human being. They often depend on our ability to put ourselves in the other person's shoes and, always, on our belief in the dignity of individuals.

Why are these attitudes so often cast aside when the issue at hand is weight?

I've consulted with physicians who care for obese individuals and surgeons who perform weight-loss surgery, as well as remarkable, thoughtful patients who courageously shared their painful experiences.

Their days are filled with pressure and embarrassment:

- They are shamed by the disgust and judgment they see in the eyes of others-even from complete strangers

- They live in constant fear of getting trapped in turnstiles, of breaking chairs and toilets, and of not being able to get up should they fall.

- They can well imagine - if not hear outright - the criticism of passengers seated next to them on airplanes, buses, and trains

- They can spot the disapproval and immediate dismissal of those who interview them for jobs (assuming they have the temerity to show up for an interview)

- Above all, they are keenly aware that just about everyone out there believes that they could lose all that weight if they just exerted a little willpower, if they weren't so lazy, if they didn't eat this, or do that.

The fact is, most obese people are fundamentally just average-sized folks who have become trapped under layers of fat and can't seem to find a way out. Most have spent countless hours and dollars trying to do something about their weight.

The remarks they endure on a regular basis run from the borderline illegal, to the openly condescending, to the clueless and patronizing.

"When is your baby due?" "You would be so beautiful if you just lost weight." "Why can't you control yourself?" "I don't think of you as overweight."

Words aren't necessary to wound. Stares, snickers, sneers, and smirks cut just as sharply.

Discussing another person's weight without his or her permission is rude and inappropriate. If you are working with, or entertaining, an obese individual, know that they are very concerned about personal space and furniture that won't accommodate them. This understanding will help you meet their needs.

- When extending invitations, avoid situations where there are only folding chairs. Chairs without arms are easier to get on and off. Couches can be scary.

- Check that restaurants have chairs without arms, and tables rather than booths.

- Be wary of activities that require a lot of walking or standing. You would do the same for anyone with a walker or wheelchair.

- Suggest that you are the one who needs to stop for a rest, if you're walking with an obese person. It doesn't have to be obvious.

- Be as matter-of-fact as possible in asking, "Is there any way I can help?" Or, "Will you need some accommodations for you to be comfortable?"

As one obese individual said: "I think most people want to cover their eyes or look away. I would rather have my size acknowledged than ignored while I continue to struggle."

Ideally, obese individuals should be encouraged to take responsibility to ensure that their needs are met, their rights protected, and their lives led as fully as they want them to be. However, this does not relieve the rest of us of the need to be more compassionate.

Think about it. If, as we battle to eliminate obesity, we deny ourselves the friendship, the collegiality, the creativity, and the intelligence of one in every four people in the process, who is really the biggest loser?

(Editing by Belinda Goldsmith)

(Mary Mitchell has written several books on the subject of etiquette, including The Complete Idiot's Guide to Etiquette and Class Acts. She is also the founder of executive training consultancy The Mitchell Organization with the website http://www.themitchell.org. The opinions expressed are her own.)

That is because if the wrong kinds of bacteria take over they can cause a low-level inflammation that leads to a pre-diabetic condition and an elevated appetite, the study published Thursday in the journal Science found.

"It has been assumed that the obesity epidemic in the developed world is driven by an increasingly sedentary lifestyle and the abundance of low-cost, high-calorie foods," said senior author Andrew Gewirtz of Emory University School of Medicine.

"However, our results suggest that excess caloric consumption is not only a result of undisciplined eating but that intestinal bacteria contribute to changes in appetite and metabolism."

Gewirtz and his colleagues studied mice that were genetically engineered to be deficient in a key immune system protein - TLR5 - which helps cells sense the presence of bacteria.

"This protein serves as the neighborhood cop of the intestinal community," Gewirtz told AFP.

"It knows which bacteria it has to keep in check and it knows not to apply too much force and doesn't harm the good bacteria."

The immune system can continue to regulate bacteria without TLR5, but it does a poorer job. The bacterial composition changes, a low level inflammation sets in and insulin receptors are desensitized.

The protein-deficient mice ate about 10 percent more food and ended up about 20 percent heavier than normal mice.

They also developed metabolic syndrome, a cluster of disorders that in humans increases the risk of developing heart disease and diabetes.

While it was possible to get the mice to keep the weight off by restricting their food intake, they continued to show a decreased sensitivity to insulin.

That suggests that "at least some portion of obesity may result from insulin resistance rather than the commonly held view that type 2 diabetes and insulin resistance is a consequence of obesity," Gewirtz said.

Another key discovery was that if these bacteria were transferred to the intestines of mice which were not deficient in the protein, they would also develop metabolic syndrome.

This only worked, however, in mice whose intestines had been cleared of all other bacteria.

Humans have relatively stable intestinal bacterial populations which are acquired at birth but can be influenced by diet and antibiotics.

However, other studies have found that this baseline bacterial population is changing as a result of improvements in sanitation and the widespread use of antibiotics.

"It suggests that a portion of the epidemic of obesity and metabolic symptoms may be resulting from early environmental conditions that affect one's gut microbiota," Gewirtz said in a telephone interview.

While the study suggests a possible genetic predisposition to obesity, a deficiency in the TLR5 only affects a small percentage of the population, he said.

Changes in intestinal bacterial compositions could be significantly more widespread and could potentially one day be resolved by giving babies the right kind of bacteria before the wrong kind settles in, he added.