ISRN Obesity The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. The Relationship between High Risk for Obstructive Sleep Apnea and General and Central Obesity: Findings from a Sample of Chilean College Students Mon, 14 Apr 2014 06:25:15 +0000 This cross-sectional study evaluates the prevalence and extent to which high risk for obstructive sleep apnea (OSA) is associated with general obesity and central obesity among college students in Punta Arenas, Chile. Risk for OSA was assessed using the Berlin Questionnaire and trained research nurses measured anthropometric indices. Overweight was defined as body mass index (BMI) of 25–29.9 kg/m2 and general obesity was defined as  kg/m2. Central obesity was defined as waist circumference centimeters (cm) for males and  cm for females. Multivariate logistic regression models were fit to obtain adjusted odds ratios (OR) and 95% confidence intervals (CI). Prevalence of high risk for OSA, general obesity, and central obesity were 7.8%, 12.8%, and 42.7%, respectively. Students at high risk for OSA had greater odds of general obesity (OR 9.96; 95% CI: 4.42–22.45) and central obesity (OR 2.78; 95% CI 1.43–5.40). Findings support a strong positive association of high risk for OSA with obesity. Adaeze C. Wosu, Juan Carlos Vélez, Clarita Barbosa, Asterio Andrade, Megan Frye, Xiaoli Chen, Bizu Gelaye, and Michelle A. Williams Copyright © 2014 Adaeze C. Wosu et al. All rights reserved. Appetite Sensations, Appetite Signaling Proteins, and Glucose in Obese Adolescents with Subclinical Binge Eating Disorder Tue, 11 Mar 2014 09:01:16 +0000 Objective. This study aimed to investigate potential differences in appetite sensations, ghrelin, peptide YY, and glucose and their relationship with energy and macronutrient intake in obese adolescents with subclinical binge eating disorder. Methods. Fifteen obese adolescents (six and nine individuals with and without subclinical binge eating disorder, resp.) qualified for this study. Visual analog scales and Three-Factor Eating Questionnaires were used to assess eating behaviours. Circulating ghrelin, peptide YY, and glucose were measured after fasting and at multiple time points postprandially following a standardized breakfast meal. Energy and macronutrient intake were measured with an ad libitum lunch buffet. Results. Emotional eating scores were significantly higher in obese adolescents with subclinical binge eating disorder. Hunger levels rose and satiety levels fell significantly over the course of the monitoring period but there was no difference between the two groups. Obese adolescents with subclinical binge eating disorder did not have significantly different levels of appetite signaling proteins or glucose. Obese adolescents with subclinical binge eating disorder had a nonsignificantly higher energy and macronutrient intake. Conclusions. A significant difference between the two groups in terms of their emotional eating scores highlights the important role that psychological factors play in relation to eating behaviours. Kristi B. Adamo, Shanna L. Wilson, Zachary M. Ferraro, Stasia Hadjiyannakis, Éric Doucet, and Gary S. Goldfield Copyright © 2014 Kristi B. Adamo et al. All rights reserved. Concurrent Associations between Physical Activity, Screen Time, and Sleep Duration with Childhood Obesity Sun, 09 Mar 2014 08:28:32 +0000 Aim. To examine the simultaneous influence of physical activity, screen time, and sleep duration recommendations on the odds of childhood obesity (including overweight). Methods. Physical activity was assessed via pedometer and screen time, and sleep duration were assessed via survey in a cross sectional sample of 674 children (aged 7–12 years) from two Midwestern communities in the fall of 2005. Participants were cross tabulated into four groups depending on how many recommendations were being met (0, 1, 2, or all 3). Linear and logistic regression were used to examine the influence of physical activity, screen time and sleep duration on obesity and interactions among the three variables. Results. Children achieving all three recommendations simultaneously (9.2% of total sample) were the least likely to be obese. Approximately 16% of boys and 9% of girls achieving all recommendations were overweight or obese compared to 53% of boys and 42.5% of girls not achieving any. Conclusions. The odds of obesity increased in a graded manner for each recommendation which was not met. Meeting all three recommendations appears to have a protective effect against obesity. Continued efforts are warranted to promote healthy lifestyle behaviors that include meeting physical activity, screen time, and sleep duration recommendations concurrently. Kelly R. Laurson, Joey A. Lee, Douglas A. Gentile, David A. Walsh, and Joey C. Eisenmann Copyright © 2014 Kelly R. Laurson et al. All rights reserved. Obesity as a Consequence of Gut Bacteria and Diet Interactions Thu, 06 Mar 2014 10:40:59 +0000 Obesity is a major public health concern, caused by a combination of increased consumption of energy-dense foods and reduced physical activity, with contributions from host genetics, environment, and adipose tissue inflammation. In recent years, the gut microbiome has also been found to be implicated and augmented research in mice and humans have attributed to it both the manifestation and/or exacerbation of this major epidemic and vice versa. At the experimental level, analysis of fecal samples revealed a potential link between obesity and alterations in the gut flora (drop in Bacteroidetes and increase in Firmicutes), the specific gut microbiome being associated with the obese phenotype. Conventionally raised mice were found to have over 40% more total body fat compared with those raised under germ-free conditions, while conventionalization of germ-free mice resulted in a significant increase in total body fat. Similarly, the sparse data in humans supports the fact that fat storage is favoured by the presence of the gut microbiota, through a multifaceted mechanism. Efforts to identify new therapeutic strategies to modulate gut microbiota would be of high priority for public health, and to date, probiotics and/or prebiotics seem to be the most effective tools. Katerina Kotzampassi, Evangelos J. Giamarellos-Bourboulis, and George Stavrou Copyright © 2014 Katerina Kotzampassi et al. All rights reserved. Obesity and Surgical Wound Healing: A Current Review Thu, 20 Feb 2014 15:55:28 +0000 Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional deficiencies. Most recently, advances made in the field of gene array have allowed researchers to determine a few plausible alterations and deficiencies in obese individuals that contribute to their increased risk of morbidity and mortality, especially wound complications. Conclusion. While the literature discusses how obesity may negatively affect health on various of medical fronts, there is yet to be a comprehensive study detailing all the mechanisms involved in obesity-related morbidities in their entirety. Improved knowledge and understanding of obesity-induced physiological, cellular, molecular, and chemical changes will facilitate better assessments of surgical risks and outcomes and create efficient treatment protocols for improved patient care of the obese patient population. Yvonne N. Pierpont, Trish Phuong Dinh, R. Emerick Salas, Erika L. Johnson, Terry G. Wright, Martin C. Robson, and Wyatt G. Payne Copyright © 2014 Yvonne N. Pierpont et al. All rights reserved. A Single Institution’s Overweight Pediatric Population and Their Associated Comorbid Conditions Thu, 13 Feb 2014 11:52:41 +0000 Background. Obesity studies are often performed on population data. We sought to examine the incidence of obesity and its associated comorbidities in a single freestanding children’s hospital. Methods. We performed a retrospective analysis of all visits to Boston Children’s Hospital from 2000 to 2012. This was conducted to determine the incidence of obesity, morbid obesity, and associated comorbidities. Each comorbidity was modeled independently. Incidence rate ratios were calculated, as well as odds ratios. Results. A retrospective review of 3,185,658 person-years in nonobese, 26,404 person-years in obese, and 25,819 person-years in the morbidly obese was conducted. Annual rates of all major comorbidities were increased in all patients, as well as in our obese and morbidly obese counterparts. Incidence rate ratios (IRR) and odds ratios (OR) were also significantly increased across all conditions for both our obese and morbidly obese patients. Conclusions. These data illustrate the substantial increases in obesity and associated comorbid conditions. Study limitations include (1) single institution data, (2) retrospective design, and (3) administrative undercoding. Future treatment options need to address these threats to longevity and quality of life. Sigrid Bairdain, Chueh Lien, Alexander P. Stoffan, Michael Troy, Donald C. Simonson, and Bradley C. Linden Copyright © 2014 Sigrid Bairdain et al. All rights reserved. Health Communication Cards as a Tool for Behaviour Change Thu, 06 Feb 2014 06:23:03 +0000 Individuals seeking healthcare treatment in the context of obesity often experience difficulty engaging in discussions around their health and face challenges finding consensus with practitioners on care plans that best suit their lives. The complex set of biological, social, and environmental variables that have contributed to the higher prevalence of obesity are well illustrated in the foresight obesity system map. Effectively understanding and addressing key variables for each individual has proven to be difficult, with clinicians facing barriers and limited resources to help address patients’ unique needs. However, productive discussions inspired by patient centered care may be particularly effective in promoting behaviour change. Tools based on systems science that facilitate patient centered care and help identify behaviour change priorities have not been developed to help treat adult obesity. This project created and pilot tested a card based clinical communication tool designed to help facilitate conversations with individuals engaged in health behaviour change. The health communication cards were designed to help direct conversation between patients and healthcare providers toward issues relevant to the individual. Use of the cards to facilitate patient driven conversations in clinical care may help to streamline conversations, set realistic care plan goals, and improve long term rates of compliance. Carrie L. Matteson, Thomas D. N. Merth, and Diane T. Finegood Copyright © 2014 Carrie L. Matteson et al. All rights reserved. Lifestyle Risk Factors of General and Abdominal Obesity in Students of the School of Medicine and Health Science of the University of Development Studies, Tamale, Ghana Tue, 04 Feb 2014 09:03:29 +0000 This study evaluated the prevalence of general and abdominal obesity among students of the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS), Tamale, Ghana. Also, lifestyle risk factors for the two obesity indices were investigated. This study was conducted among a sample of 646 students. Anthropometric measures of weight, height, and waist circumference were appropriately assessed. The prevalence of general and abdominal obesity was 1.9% and 4.2%, respectively. Risk factors of general obesity were being female (crude OR = 6.9, 95% CI = 1.85–25.80, ), engaging in light PA (OR = 12.45, 95% CI = 2.96–52.41, ), being aged 28–37 years (OR = 5.37, 95% CI = 1.39–20.68, ), nonintake of coffee (OR = 4.1, 95% CI = 1.10–15.28, ), being married (OR = 5.7, 95% CI = 1.48–22.02, ), and being abdominally obese (OR = 02.7, 95% CI = 25.61–11.60, ). Risk factors for abdominal obesity were being female, being married, having general obesity, and nonintake of coffee. Abdominal obesity was more prevalent than general obesity. Risk factors included being female, married, and generally obese and nonintake of coffee. Victor Mogre, Rauf Nyaba, and Samuel Aleyira Copyright © 2014 Victor Mogre et al. All rights reserved. Role of Suppressor Variables in Primary Prevention Obesity Research: Examples from Two Predictive Models Thu, 30 Jan 2014 10:04:45 +0000 Pediatric obesity is a pertinent public health challenge. Child physical activity and screen time behaviors enacted within the context of the family and home environment are important determinants of pediatric obesity. The purpose of this study was to operationalize five, maternal-facilitated, social cognitive theory constructs for predicting physical activity and screen time behaviors in children. A secondary purpose was to elucidate the function of suppressor variables in the design and implementation of family- and home-based interventions seeking to prevent pediatric obesity. Instrumentation included face and content validity of the measurement tool by a panel of experts, test-retest reliability of the theoretical constructs, and predictive validity of the constructs through structural equation modeling. Physical activity and screen time were modeled separately according to the five selected social cognitive theory constructs. Data were collected from 224 mothers with children between four and six years of age. Specification indices indicated satisfactory fit for the final physical activity and screen time models. Through a series of four procedures, the structural models identified emotional coping and expectations as suppressor variables for self-efficacy. Suppressor variables can complement program design recommendations by providing a suggested ordering to construct integration within an intervention. Adam P. Knowlden Copyright © 2014 Adam P. Knowlden. All rights reserved. Accuracy of Neck Circumference in Classifying Overweight and Obese US Children Thu, 30 Jan 2014 08:33:16 +0000 Objective. To evaluate classification accuracy of NC and compare it with body mass index (BMI) in identifying overweight/obese US children. Methods. Data were collected from 92 children (boys: 61) aged 7 to 13 over a 2-year period. NC, BMI, and percent of body fat (BF%) were measured in each child and their corresponding cut-off values were applied to classify the children as being overweight/obese. Classification accuracy of NC and BMI was systematically investigated for boys and girls in relation to true overweight/obesity categorization as assessed with a criterion measure of BF% (i.e., Bod Pod). Results. For boys, Cohen’s (0.25), sensitivity (38.1%), and specificity (85.0%) of NC were smaller in comparison with Cohen’s (0.57), sensitivity (57.1%), and specificity (95.0%) of BMI in relation to BF% categorization. For girls, Cohen’s (0.45), sensitivity (50.0%), and specificity (91.3%) of NC were smaller in comparison with Cohen’s (0.52), sensitivity (50.0%), and specificity (95.7%) of BMI. Conclusion. NC measurement was not better than BMI in classifying childhood overweight/obesity and, for boys, NC was inferior to BMI. Pediatricians and/or pediatric researchers should be cautious or wary about incorporating NC measurements in their pediatric care and/or research. Youngwon Kim, Jung-Min Lee, Kelly Laurson, Yang Bai, Glenn A. Gaesser, and Gregory J. Welk Copyright © 2014 Youngwon Kim et al. All rights reserved. Carotid Intima Media Thickness Is Independently Associated with Male Gender, Middle Age, and IGF-1 in Metabolically Healthy Obese Individuals Tue, 28 Jan 2014 08:38:12 +0000 Background/Aims. The effect of benign obesity on subclinical cardiovascular disease is still questionable. The purpose of this study was to assess carotid intima media thickness (CIMT), as a marker of subclinical atherosclerosis, and to evaluate its relation to age, sex, and IGF-1 in metabolically healthy obese (MHO) subjects. Methods. A total of 75 MHO subjects and 80 age, and sex matched healthy nonobese control subjects were included in the study. Body mass index (BMI), waist circumference (WC), blood pressure, fasting plasma glucose, fasting insulin, HOMA-IR, lipid profile, insulin like growth factor-1 (IGF-1), and CIMT were assessed in all subjects. Results. MHO subjects had significantly higher CIMT and lower IGF-1 than healthy nonobese controls. Mean CIMT was significantly higher in MHO men age subgroup range from 30 to 50 years than in their age range matched (premenopausal) MHO women subgroup. In MHO subjects, CIMT was positively correlated with age, BMI, WC, SBP, HOMA-IR, TG, and LDL-C, and negatively correlated with IGF-1. Regression analysis revealed that middle age, male sex and IGF-1 remained independently associated with CIMT in MHO subjects. Conclusion. CIMT is elevated and IGF-1 is reduced in MHO subjects, and CIMT is independently associated with male gender, middle age, and IGF-1. Definition of healthy obesity may be broadened to include IMT measurement. Hala Abd El-Hafez, Mohamed M. Elrakhawy, Azza A. El-Baiomy, and Mervat M. El-Eshmawy Copyright © 2014 Hala Abd El-Hafez et al. All rights reserved. Downregulation of RelA (p65) by Rapamycin Inhibits Murine Adipocyte Differentiation and Reduces Fat Mass of C57BL/6J Mice despite High Fat Diet Thu, 23 Jan 2014 12:17:06 +0000 Rapamycin (RAPA) is a clinical immunosuppressive agent first reported in the literature in 1975 after its discovery in a soil sample from the island of Rapa Nui. Aside from the well-documented effects of RAPA on cell division and immunologic response, the literature reveals it to have negative effects on adipocyte and osteocyte differentiation as well. Understanding of the molecular effects of RAPA on cell differentiation is fragmentary in regard to these cell lineages. In this paper, we examined a potential mechanism for RAPA’s effects on adipocyte differentiation in vitro and in vivo. The data point to a unique role of Rel A (p65)—a component of the NF-B system—in mediating this event. In murine adipose derived stem cell cultures (muADSCs) from C57BL/6J mice, RAPA was found to selectively downregulate RelA/p65, mammalian target of rapamycin (mTOR), and do so in a dose-dependent manner. This implies a novel role for RelA in adipocyte biology. Intracellular lipid accumulation—as subjectively observed—was also decreased in muADSCs treated with RAPA. Mice treated with RAPA had reduced overall body weight and reduced size of both intraabdominal and subcutaneous fat pads. When treated with RAPA, mice fed a high fat diet did not develop obesity and were not different from their regular diet controls in terms of body weight. These results suggested that RAPA inhibits adipogenesis and lipogenesis of muADSCs resulting in a prevention of obesity in C57BL/6J mice. This inhibition is strong enough to negate the effects of a high fat diet and seems to act by downregulating the RelA/p65 mTOR signaling pathway—a key component of the NF-B family. Peter D. Ray, Reid A. Maclellan, Jin He, Zhigang Liu, and Jianguo Wu Copyright © 2014 Peter D. Ray et al. All rights reserved. Body Adiposity Index: Its Relevance and Validity in Assessing Body Fatness of Adults Wed, 22 Jan 2014 13:25:13 +0000 Background. One of the limitations of body mass index is its accuracy to assess body fatness. To address this limitation, a new index, body adiposity index, has been developed. However its validity needs to ascertained. Objective. Our aim was to investigate sex-specific relationship between BAI, BMI, and percent body fat in an endogamous population of Delhi, India. Method. Data was collected from 578 adults on bodyweight, height, skinfold thicknesses, hip circumference, waist circumference, and systolic and diastolic blood pressure. Pearson’s correlations were calculated for BAI and BMI with PBF. Differences in the correlation coefficients were examined using Fisher’s tests. Receiver operating characteristic analysis was used to compare the predictive validity and to determine optimal cut-off values. Odds ratios were calculated to assess the risk of having hypertension using the proposed cut-off points. Results. The correlations of PBF with BMI (men: ; women: ) were stronger than those with BAI (men: ; women: ). In men, the sensitivity and specificity of BAI to predict hypertension were higher than other anthropometric markers but lower than BMI. In women, the sensitivity of BAI was higher than BMI and WC. Conclusions. BAI can be used as an additional marker for screening population; however its validity needs to be demonstrated on other populations too. Shilpi Gupta and Satwanti Kapoor Copyright © 2014 Shilpi Gupta and Satwanti Kapoor. All rights reserved. Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox Sun, 12 Jan 2014 11:37:57 +0000 Obesity paradox has been described in various populations of coronary artery disease, mainly asymptomatic subjects. However, relationship between obesity and coronary artery calcification detected by cardiac CT in symptomatic patients has rarely been demonstrated. This study seeks to investigate whether the paradoxical relationship between obesity and coronary artery calcification exists in patients with acute chest pain. A final cohort of 1030 chest pain patients presenting at our emergency department who underwent coronary evaluation by multidetector cardiac CT were examined. With absent-to-mild coronary calcification (CAC score < 100) as a referent, multivariable analysis showed that presence of obesity (OR 0.564; 95% CI 0.395, 0.806; 0.002), body mass index (OR 0.945; 95% CI 0.920, 0.971; ), body weight (OR 0.987; 95% CI 0.979, 0.995; 0.001), and body surface area (OR 0.582; 95% CI 0.369, 0.920; 0.020) were inversely associated with moderate-to-severe coronary calcification (CAC score ≥ 100). This study extends the concept of obesity paradox to symptomatic patients undergoing coronary artery calcium score assessment. However, biological explanation(s) of this paradox remains unanswered. Kongkiat Chaikriangkrai, Mahwash Kassi, Sayf Khaleel bala, Faisal Nabi, and Su Min Chang Copyright © 2014 Kongkiat Chaikriangkrai et al. All rights reserved. The Work behind Weight-Loss Surgery: A Qualitative Analysis of Food Intake after the First Two Years Post-Op Thu, 09 Jan 2014 12:11:55 +0000 Purpose. Obesity has reached epidemic proportions in the U.S. and has nearly doubled worldwide since 1980. Bariatric surgery is on the rise, but little focus has been placed on the psychosocial impacts of surgery. The purpose of this study was to explore experiences of patients who have undergone bariatric surgery at least two years before to gain an understanding of the successes and challenges they have faced since surgery. Methods. This study used a phenomenological approach, to investigate the meaning and essence of bariatric patients with food after surgery. Semi-structured interviews were conducted on a sample of nine participants who had undergone surgery at least two years prior. Findings. Two main themes regarding food intake emerged from the data: (a) food after the first year post-surgery and (b) bariatric surgery is not a magic pill. Upon further analysis, food after the first year post-surgery had four subthemes emerge: diet adherence after the first year post-surgery, food intolerances, amount of food, and tendencies toward coping with food do not magically disappear. Conclusion. Findings revealed that post-operative diet and exercise adherence becomes increasingly difficult as weight loss slows. Many participants find that only after the first year after surgery the work really begins. Angela A. Geraci, Ardith Brunt, and Cindy Marihart Copyright © 2014 Angela A. Geraci et al. All rights reserved. Prevalence and Trends of Adult Obesity in the US, 1999–2012 Mon, 06 Jan 2014 11:38:07 +0000 Aim. To provide national estimates of obesity among US adults aged 20 years and older in 2011-2012 and track its trends from 1999 to 2012. Methods. Measured weight/height from National Health and Nutrition Examination Survey 1999–2012 waves was used to calculate body mass index (BMI) and prevalence measures. Piecewise logistic regressions were conducted to test the differential trends before and after 2010. Results. In 2011-2012, the age-adjusted prevalence of overweight and obesity combined () was 71.1% (95% CI: 68.0%–74.2%) among men and 65.5% (61.8%–69.3%) among women, and the prevalence of obesity () was 33.3% (30.5%–36.2%) among men and 35.8% (32.3%–39.4%) among women. From 1990–2000 to 2009-2010, the prevalence of overweight and obesity combined, obesity, grades 2 and 3 obesity combined (), and grade 3 obesity () increased by 7.2%, 17.8%, 17.6%, and 33.0%, respectively. Compared to 2009-2010, most gender- and race/ethnicity-specific prevalence measures remained unchanged or slightly decreased in 2011-2012. No significant difference in trends among prevalence measures was found before and after 2010. Conclusions. Concurrent evidence on the leveling off of obesity in the US is thin. Given its high prevalence and profound socioeconomic consequences, close monitoring of the trend is warranted. Ruopeng An Copyright © 2014 Ruopeng An. All rights reserved. Youth, Caregiver, and Prescriber Experiences of Antipsychotic-Related Weight Gain Wed, 20 Nov 2013 08:37:52 +0000 Objectives. To explore the lived experience of youth, caregivers, and prescribers with antipsychotic medications. Design. We conducted a qualitative interpretive phenomenology study. Youth aged 11 to 25 with recent experience taking antipsychotics, the caregivers of youth taking antipsychotics, and the prescribers of antipsychotics were recruited. Subjects. Eighteen youth, 10 caregivers (parents), and 11 prescribers participated. Results. Eleven of 18 youth, six of ten parents, and all prescribers discussed antipsychotic-related weight gain. Participants were attuned to the numeric weight changes usually measured in pounds. Significant discussions occurred around weight changes in the context of body image, adherence and persistence, managing weight increases, and metabolic effects. These concepts were often inextricably linked but maintained the significance as separate issues. Participants discussed tradeoffs regarding the perceived benefits and risks of weight gain, often with uncertainty and inadequate information regarding the short- and long-term consequences. Conclusion. Antipsychotic-related weight gain in youth influences body image and weight management strategies and impacts treatment courses with respect to adherence and persistence. In our study, the experience of monitoring for weight and metabolic changes was primarily reactive in nature. Participants expressed ambiguity regarding the short- and long-term consequences of weight and metabolic changes. Andrea Lynn Murphy, David Martin Gardner, Steve Kisely, Charmaine Cooke, Stanley Paul Kutcher, and Jean Hughes Copyright © 2013 Andrea Lynn Murphy et al. All rights reserved. Dietary Adherence and Satisfaction with a Bean-Based High-Fiber Weight Loss Diet: A Pilot Study Tue, 29 Oct 2013 14:51:18 +0000 Objective. Dietary fiber can reduce hunger and enhance satiety, but fiber intake during hypocaloric weight loss diets typically falls short of recommended levels. We examined the nutritional effects and acceptability of two high-fiber hypocaloric diets differing in sources of fiber: (a) beans or (b) fruits, vegetables, and whole grains. Methods. Subjects were 2 men, 18 women, mean age = 46.9, and mean BMI = 30.6. Subjects completed 3-day food diaries in each of the two baseline weeks. Subjects were then randomized to four weeks on one of two 1400-calorie diets including 25–35 g fiber primarily from 1.5 cups beans/day or from fruits, vegetables, and whole grains. Recommended fiber-rich foods were provided. Subjects kept weekly 3-day food diaries and were assessed weekly. Results. Diet conditions did not differ on outcome measures. Both diets increased fiber intake from 16.6 g/day (SD = 7.1) at baseline to (treatment average) 28.4 g/day (SD = 6.5) (). Fiber intake was consistent over treatment. Caloric intake dropped from 1623.1 kcal/day (SD = 466.9) (baseline) to 1322.2 kcal/day (SD = 275.8) (). Mean weight loss was 1.4 kg (SD = 1.5; ). Energy density and self-reported hunger decreased (’s < 0.01) while self-reported fullness increased (). Both diets were rated as potentially acceptable as long as six months. Conclusions. Both diets significantly increased fiber intake by 75%, increased satiation, and reduced hunger. Results support increasing fiber in weight loss diets with a variety of fiber sources. Tonya F. Turner, Laura M. Nance, William D. Strickland, Robert J. Malcolm, Susan Pechon, and Patrick M. O'Neil Copyright © 2013 Tonya F. Turner et al. All rights reserved. Relationship between Birth Weight and Metabolic Status in Obese Adolescents Wed, 28 Aug 2013 09:09:22 +0000 Objective. To examine the relationships between birth weight and body mass index, percent body fat, blood lipids, glycemia, insulin resistance, adipokines, blood pressure, and endothelial function in a cohort of obese adolescents. Design and Methods. Ninety-five subjects aged 10–16 years (mean age 13.5 years) with a body mass index >95th centile (mean [±SEM] 33.0 ± 0.6) were utilized from two prospective studies for obesity prevention prior to any interventions. The mean term birth weight was 3527 ± 64 g (range 1899–4990 g;). Results. Body mass index z-score correlated positively with birth weight (, ), but not percent body fat. Insulin resistance negatively correlated with birth weight (, ), as did fasting plasma insulin (, ); both being significantly greater for subjects of small versus large birth weight (Δ Homeostasis Model Assessment = 2.5 and Δ insulin = 10 pmol/L for birth weight <2.5 kg versus >4.5 kg). Adiponectin, but not leptin, blood pressure z-scores or peripheral arterial tomography values positively correlated with birth weight (, ). Conclusions. Excess body mass index in obese adolescents was positively related to birth weight. Birth weight was not associated with cardiovascular risk factors but represented a significant determinant of insulin resistance. David J. Hill, Harry Prapavessis, J. Kevin Shoemaker, Michelle Jackman, Farid H. Mahmud, and Cheril Clarson Copyright © 2013 David J. Hill et al. All rights reserved. Early Outcomes of Roux-en-Y Gastric Bypass in a Publically Funded Obesity Program Wed, 21 Aug 2013 14:08:14 +0000 Background. There is limited literature assessing the outcomes of bariatric surgery in a publically funded, North American, multidisciplinary bariatric program. Our objective was to assess outcomes of roux-en-Y gastric bypass (RYGB) in a publically funded bariatric program through a retrospective review of patient records. Methods. 293 patients spent a median of 13 months attending a multidisciplinary obesity clinic prior to undergoing laparoscopic RYGB surgery. The hospital was a Canadian, publically funded, level 2 trauma center with university teaching services. Results. 79% of the patients were female and the average BMI at first visit to clinic was 55.3 kg/m2. The average decrease in BMI was  kg/m2. This was an average absolute weight loss of 56.1 kg or 35.5% of initial weight. The average excess weight loss was %. Improvement or resolution of obesity related comorbidities occurred in 65.9% of type 2 diabetics and in 50% of hypertensive patients. Conclusion. Despite this being an unconventional setting of a publically funded program in a large Canadian teaching hospital, early outcomes following RYGB were appropriate in severely obese patients. Ongoing work will identify areas of improvement for enhanced efficiencies within this system. Kevin A. Whitlock, Richdeep S. Gill, Talal Ali, Xinzhe Shi, Daniel W. Birch, and Shahzeer Karmali Copyright © 2013 Kevin A. Whitlock et al. All rights reserved. Obesity Affects Mitochondrial Citrate Synthase in Human Omental Adipose Tissue Sun, 28 Jul 2013 10:23:58 +0000 The activities of some key enzymes in mitochondria from 135 human omental adipose tissue samples of obese and nonobese patients were analyzed for potential association with the patients’ state of obesity. The activities of respiratory complexes I and II as well as citrate synthase in isolated mitochondria were measured using spectrophotometric enzyme assays. ATP generation of mitochondria was determined with a bioluminescence assay. Protein levels of citrate synthase were quantified by western blot. The rates of ATP generation and the enzymatic activities of complexes I and II did not display associations with age, gender, obesity, or diabetes. By contrast, the enzymatic activities of citrate synthase and its protein levels were significantly reduced in obesity as compared to controls. In diabetic patients, protein levels but not enzymatic activities of citrate synthase were elevated. Thus, this investigation based on enzymatic assay and determination of protein levels revealed that the development of obesity is associated with a significant impact on citrate synthase in mitochondria of human omental adipose tissue. The state of obesity appears to affect mitochondrial function in human omental adipose tissue by limiting this key enzyme of the tricarboxylic acid cycle rather than by limiting the activities of respiratory chain enzymes. Martine Christe, Estelle Hirzel, Andrea Lindinger, Beatrice Kern, Markus von Flüe, Ralph Peterli, Thomas Peters, Alex N. Eberle, and Peter W. Lindinger Copyright © 2013 Martine Christe et al. All rights reserved. Prevalence of Overweight and Obesity in Adolescents: A Systematic Review Thu, 27 Jun 2013 08:55:16 +0000 Objective. To review the extant literature on the prevalence of overweight and obesity in adolescents (10–19 years old) of both sexes. Design. The search was carried out using Medline and Scopus considering articles published from the establishment of the databanks until June 7, 2012. Data on the prevalence of children being overweight and obese from the International Obesity Task Force (IOTF) website was also reviewed. Only original articles and one National Health Report were considered. Forty studies met the inclusion criteria. Results. Twenty-five of these studies were nationally representative, and ten countries were represented only by regional data. Conclusions. The prevalence of overweight and obesity among adolescents worldwide is high, and obesity is higher among boys. The IOTF criterion is the most frequently used method to classify adolescents as overweighed or obese in public health research. Maria del Mar Bibiloni, Antoni Pons, and Josep A. Tur Copyright © 2013 Maria del Mar Bibiloni et al. All rights reserved. Age-Related Differences in Response to High-Fat Feeding on Adipose Tissue and Metabolic Profile in ZDSD Rats Mon, 20 May 2013 14:07:38 +0000 The recruitment of new fat cells through adipogenesis may prevent the development of obesity-related comorbidities. However, adipogenic capacity is markedly reduced in mature adults. This study examined how initiation of high-fat feeding at different phases of adulthood modified adipose tissue (AT) morphology and obesity phenotype in obese and diabetic Zucker Diabetic Sprague Dawley (ZDSD) rats. For this, rodents were provided high-fat diet (HFD) beginning at 63, 84, or 112 d after parturition until termination . At termination, ZDSD rats fed HFD beginning at 63 d after parturition (early adulthood) exhibited greater body fat and lower lean mass without significant changes to energy intake or body weight. Moreover, early high fat feeding increased adipocyte size and number, whereas these effects were absent at 84 or 112 d after parturition. At 126 d after parturition, there were no detectable transcript differences in PPARγ or C/EBPα. However, rodents provided HFD in early adolescence exhibited lower expression of canonical Wnt signaling intermediates. Corresponding with these changes was a marked reduction in AT-specific inflammation, as well as overall improvement in systemic glucose, lipid, and inflammatory homeostasis. Taken together, these data indicate that dietary regulation of adipocyte recruitment in adolescence may represent a major determinant of obesity phenotype. Jeremy E. Davis, James Cain, William J. Banz, and Richard G. Peterson Copyright © 2013 Jeremy E. Davis et al. All rights reserved. From Passive Overeating to “Food Addiction”: A Spectrum of Compulsion and Severity Wed, 15 May 2013 13:53:38 +0000 A psychobiological dimension of eating behaviour is proposed, which is anchored at the low end by energy intake that is relatively well matched to energy output and is reflected by a stable body mass index (BMI) in the healthy range. Further along the continuum are increasing degrees of overeating (and BMI) characterized by more severe and more compulsive ingestive behaviours. In light of the many similarities between chronic binge eating and drug abuse, several authorities have adopted the perspective that an apparent dependence on highly palatable food—accompanied by emotional and social distress—can be best conceptualized as an addiction disorder. Therefore, this review also considers the overlapping symptoms and characteristics of binge eating disorder (BED) and models of food addiction, both in preclinical animal studies and in human research. It also presents this work in the context of the modern and “toxic” food environment and therein the ubiquitous triggers for over-consumption. We complete the review by providing evidence that what we have come to call “food addiction” may simply be a more acute and pathologically dense form of BED. Caroline Davis Copyright © 2013 Caroline Davis. All rights reserved. Biomarker Profile Does Not Predict Weight Loss Success in Successful and Unsuccessful Diet-Reduced Obese Individuals: A Prospective Study Tue, 14 May 2013 11:26:58 +0000 Background. Individuals attempting weight reduction have varying success when participating in the same intervention. Identifying physiological factors associated with greater weight loss could improve outcomes. Methods. Sixty-one adults (BMI 27–30 kg/m2) participated in a 16-week group-based, cognitive-behavioral control weight loss program. Concentrations of 12 fasting hormones and cytokines related to adiposity, satiety/hunger, and inflammation were measured using the Milliplex human metabolic human panel before and after weight loss. Participants were grouped based on ≥8% (successful group, SG) or <8% weight loss (less successful group, LSG). Results. The SG had 46 subjects (75.4%), while the LSG had 15 (24.6%). There were no differences in baseline sex distribution, age, weight, BMI, and body composition between groups. In the SG, baseline to the 16-week levels decreased significantly for c-peptide (1,030 versus 891 pg/mL, ), insulin (665 versus 541 pg/mL, ), and leptin (0.83 versus 0.58 ng/mL/kg fat, ). None of the baseline analytes predicted greater weight loss. Conclusions. Successful weight loss was associated with changes in adiposity (less fat mass) and unfavorable hunger signals. No baseline biomarker profile was associated with weight loss success. Behavioral factors may have outweighed physiological signals for determining successful weight loss. This trial is registered with NCT00429650. Sarit Polsky, Lorraine Garratt Ogden, Paul Scown MacLean, Erin Danielle Giles, Carrie Brill, and Holly Roxanna Wyatt Copyright © 2013 Sarit Polsky et al. All rights reserved. Effects of Visceral Fat Accumulation Awareness on a Web-Based Weight-Loss Program: Japanese Study of Visceral Adiposity and Lifestyle Information—Utilization and Evaluation (J-VALUE) Wed, 24 Apr 2013 15:38:53 +0000 A reduction of visceral fat is important for improvement of metabolic risk. This study was designed to compare the effects of a web-based program alone or together with measurement and self-awareness of accumulated visceral fat in Japanese workers. A new noninvasive device to measure visceral fat accumulation was introduced, and efficacy on weight-loss and improvement of healthy behaviors were examined. This study was conducted according to Helsinki declaration and approved by the ethical committee of Japan Hospital Organization, National Kyoto Hospital. Two-hundred and sixteen overweight and obese males with BMI of more than 23 participated from 8 healthcare offices of 3 Japanese private companies. Subjects were randomly allocated into control group, Web-based weight-loss program (Web), or Web + Visceral fat measurement group (Web + VFA). Eighty-one percent of participants completed the study. Reductions of body weight, waist circumference, and BMI were the largest in Web + VFA group, and the differences between groups were significant by ANOVA. Improvements of healthy behaviors were the largest in Web + VFA group, and the differences of healthy eating improvement scores between Web + VFA and control groups were significant. Our findings suggest that measurement and awareness of visceral fat are effective in weight reduction in overweight and obese males in the workplace. Naoki Sakane, Seitaro Dohi, Koichi Sakata, Shin-ichi Hagiwara, Toshihisa Morimoto, Takanobu Uchida, Mitsuhiro Katashima, Yoshiko Yanagisawa, Takeshi Yasumasu, and J-VALUE Study Group Copyright © 2013 Naoki Sakane et al. All rights reserved. Mechanisms of Weight Regain following Weight Loss Tue, 16 Apr 2013 18:29:20 +0000 Obesity is a world-wide pandemic and its incidence is on the rise along with associated comorbidities. Currently, there are few effective therapies to combat obesity. The use of lifestyle modification therapy, namely, improvements in diet and exercise, is preferable over bariatric surgery or pharmacotherapy due to surgical risks and issues with drug efficacy and safety. Although they are initially successful in producing weight loss, such lifestyle intervention strategies are generally unsuccessful in achieving long-term weight maintenance, with the vast majority of obese patients regaining their lost weight during followup. Recently, various compensatory mechanisms have been elucidated by which the body may oppose new weight loss, and this compensation may result in weight regain back to the obese baseline. The present review summarizes the available evidence on these compensatory mechanisms, with a focus on weight loss-induced changes in energy expenditure, neuroendocrine pathways, nutrient metabolism, and gut physiology. These findings have added a major focus to the field of antiobesity research. In addition to investigating pathways that induce weight loss, the present work also focuses on pathways that may instead prevent weight regain. Such strategies will be necessary for improving long-term weight loss maintenance and outcomes for patients who struggle with obesity. Erik Scott Blomain, Dara Anne Dirhan, Michael Anthony Valentino, Gilbert Won Kim, and Scott Arthur Waldman Copyright © 2013 Erik Scott Blomain et al. All rights reserved. Urban, Suburban, and Rural: Adolescents’ Use and Preferences for Fitness Promotion Technologies across Communities Wed, 10 Apr 2013 15:43:32 +0000 Introduction. An understanding of adolescents’ use of technology across ages and communities could allow for future targeted obesity intervention strategies. Methods. Focus groups of adolescents from rural, suburban, and urban cities in three states were conducted. Focus groups were led by a trained facilitator to explore how participants used technologies and whether they applied them for fitness purposes. All focus groups were audio recorded and manually transcribed. Analysis was conducted by three investigators using an iterative process. Results. Five focus groups included adolescents between the ages of 12 and 18 years (20 females and 8 males.) Three themes were derived from our data. First, we found age differences regarding technology applied to fitness. Younger participants described technology as a complement to fitness; older participants viewed technology as a motivator for fitness. Second, differences in fitness approaches existed between rural and urban adolescents. Adolescents in rural communities reported focusing on the outdoors for fitness, while urban adolescents relied on fitness-oriented video games. Both rural and urban teens related having a lack of fitness-focused resources in their communities. Conclusions. Our findings indicate differences in adolescents’ application of technology for fitness. Despite adolescents’ differing uses of technology across communities, a common need exists to expand their resources. Erika Mikulec, Natalie Goniu, and Megan Moreno Copyright © 2013 Erika Mikulec et al. All rights reserved. Dysregulated Alternative Splicing Pattern of PKC during Differentiation of Human Preadipocytes Represents Distinct Differences between Lean and Obese Adipocytes Wed, 10 Apr 2013 13:29:45 +0000 Obesity and its comorbidities affect millions of people. Here, we demonstrate that human preadipocytes are susceptible to programmed cell death (apoptosis) while mature adipocytes are resistant to apoptosis. The molecular mechanisms underlying the phenotype of apoptosis-resistant adipocytes are lesser known. To study the role of apoptosis and define molecular differences in the developmental process of adipogenesis, human preadipocytes were differentiated in vitro to mature adipocytes. Many genes in the apoptosis pathway are alternatively spliced. Our data demonstrates that during differentiation PKCδ, Bclx, and Caspase9 switch to their prosurvival splice variants along with an increase in Bcl2 expression when the cells terminally differentiate into mature adipocytes. Next we determined the expression pattern of these genes in obesity. Our data indicated high expression of PKCδVIII in adipose tissue of obese patient in different depots. We demonstrate a shift in the in vitro expression of these splice variants in differentiating preadipocytes derived from obese patients along with a decrease in adipogenesis markers. Hence, the programmed splicing of antiapoptotic proteins is a pivotal switch in differentiation that commits adipocytes to a prosurvival pathway. The expression pattern of these genes is dysregulated in obesity and may contribute to adipose tissue dysfunction. Gay Carter, André Apostolatos, Rekha Patel, Abhishek Mathur, Denise Cooper, Michel Murr, and Niketa A. Patel Copyright © 2013 Gay Carter et al. All rights reserved. Changes in Primary School Children's Behaviour, Knowledge, Attitudes, and Environments Related to Nutrition and Physical Activity Tue, 19 Mar 2013 11:30:47 +0000 Rigorous evaluation of large-scale community-based obesity interventions can provide important guidance to policy and decision makers. The eat well be active (ewba) Community Programs, a five-year multilevel, multistrategy community-based obesity intervention targeting children in a range of settings, was delivered in two communities. A comprehensive mixed-methods evaluation using a quasiexperimental design with nonmatched comparison communities was undertaken. This paper describes the changes in primary school children's attitudes, behaviours, knowledge, and environments associated with healthy eating and physical activity, based on data from six questionnaires completed pre- and postintervention by students, parents, and school representatives. As self-reported by students in years from five to seven there were few significant improvements over time in healthy eating and physical activity behaviours, attitudes, knowledge, and perceived environments, and there were few changes in the home environment (parent report). Overall there were considerably more improvements in intervention compared with comparison schools affecting all environmental areas, namely, policy, physical, financial, and sociocultural, in addition to improvements in teacher skill and knowledge. These improvements in children's learning environments are important and likely to be sustainable as they reflect a change of school culture. More sensitive evaluation tools may detect behaviour changes. Anthea Margaret Magarey, Tahna Lee Pettman, Annabelle Wilson, and Nadia Mastersson Copyright © 2013 Anthea Margaret Magarey et al. All rights reserved.