Journal of Obesity The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Lifestyle Intervention Involving Calorie Restriction with or without Aerobic Exercise Training Improves Liver Fat in Adults with Visceral Adiposity Thu, 17 Apr 2014 10:21:49 +0000 Objective. To evaluate the effect of calorie restriction-induced weight loss with or without aerobic exercise on liver fat. Methods. Thirty-three adults with visceral adiposity were divided into calorie restriction (CR; ) or CR and aerobic exercise (CR + Ex; ) groups. Target energy intake was 25 kcal/kg of ideal body weight. The CR + Ex group had a targeted exercise time of 300 min/wk or more at lactate threshold intensity for 12 weeks. Results. Reductions in body weight (CR,  kg; CR + Ex,  kg), fat mass (CR, kg; CR + Ex,  kg), and visceral fat (CR,  cm2; CR + Ex,  cm2) were not statistically different between groups. Liver fat decreased significantly in both groups, with no difference between groups. Change in maximal oxygen uptake was significantly greater in the CR + Ex group than in the CR group (CR,  mL/kg/min; CR + Ex,  mL/kg/min). Conclusion. Both CR and CR + Ex resulted in an improved reduction in liver fat; however, there was no additive effect of exercise training. Eiichi Yoshimura, Hideaki Kumahara, Takuro Tobina, Takuro Matsuda, Makoto Ayabe, Akira Kiyonaga, Keizo Anzai, Yasuki Higaki, and Hiroaki Tanaka Copyright © 2014 Eiichi Yoshimura et al. All rights reserved. Achieving Cultural Congruency in Weight Loss Interventions: Can a Spirituality-Based Program Attract and Retain an Inner-City Community Sample? Mon, 07 Apr 2014 06:36:42 +0000 Ethnic minorities continue to be disproportionately affected by obesity and are less likely to access healthcare than Caucasians. It is therefore imperative that researchers develop novel methods that will attract these difficult-to-reach groups. The purpose of the present study is to describe characteristics of an urban community sample attracted to a spiritually based, weight loss intervention. Methods. Thirteen participants enrolled in a pilot version of Spiritual Self-Schema Therapy (3S) applied to disordered eating behavior and obesity. Treatment consisted of 12 one-hour sessions in a group therapy format. At baseline, participants were measured for height and weight and completed a battery of self-report measures. Results. The sample was predominantly African-American and Hispanic and a large percentage of the sample was male. Mean baseline scores of the EDE-Q, YFAS, and the CES-D revealed clinically meaningful levels of eating disordered pathology and depression, respectively. The overall attrition rate was quite low for interventions targeting obesity. Discussion. This application of a spiritually centered intervention seemed to attract and retain a predominantly African-American and Hispanic sample. By incorporating a culturally congruent focus, this approach may have been acceptable to individuals who are traditionally more difficult to reach. Chad Davis, William Blake Dutton, Taryn Durant, Rachel A. Annunziato, and David Marcotte Copyright © 2014 Chad Davis et al. All rights reserved. Intrauterine Growth Restriction Increases TNFα and Activates the Unfolded Protein Response in Male Rat Pups Sun, 06 Apr 2014 12:28:50 +0000 Intrauterine growth restriction (IUGR) programs adult disease, including obesity and insulin resistance. Our group previously demonstrated that IUGR dysregulates adipose deposition in male, but not female, weanling rats. Dysregulated adipose deposition is often accompanied by the release of proinflammatory signaling molecules, such as tumor necrosis factor alpha (TNFα). TNFα contributes to adipocyte inflammation and impaired insulin signaling. TNFα has also been implicated in the activation of the unfolded protein response (UPR), which impairs insulin signaling. We hypothesized that, in male rat pups, IUGR would increase TNFα, TNFR1, and components of the UPR (Hspa5, ATF6, p-eIF2α, and Ddit3) prior to the onset of obesity. We further hypothesized that impaired glucose tolerance would occur after the onset of adipose dysfunction in male IUGR rats. To test this hypothesis, we used a well-characterized rat model of uteroplacental insufficiency-induced IUGR. Our primary findings are that, in male rats, IUGR (1) increased circulating and adipose TNFα, (2) increased mRNA levels of UPR components as well as p-eIF2a, and (3) impaired glucose tolerance after observed TNFα increased and after UPR activation. We speculate that programmed dysregulation of TNFα and UPR contributed to the development of glucose intolerance in male IUGR rats. Emily S. Riddle, Michael S. Campbell, Brook Y. Lang, Ryann Bierer, Yan Wang, Heidi N. Bagley, and Lisa A. Joss-Moore Copyright © 2014 Emily S. Riddle et al. All rights reserved. Periconception Weight Loss: Common Sense for Mothers, but What about for Babies? Wed, 02 Apr 2014 08:49:07 +0000 Obesity in the childbearing population is increasingly common. Obesity is associated with increased risk for a number of maternal and neonatal pregnancy complications. Some of these complications, such as gestational diabetes, are risk factors for long-term disease in both mother and baby. While clinical practice guidelines advocate for healthy weight prior to pregnancy, there is not a clear directive for achieving healthy weight before conception. There are known benefits to even moderate weight loss prior to pregnancy, but there are potential adverse effects of restricted nutrition during the periconceptional period. Epidemiological and animal studies point to differences in offspring conceived during a time of maternal nutritional restriction. These include changes in hypothalamic-pituitary-adrenal axis function, body composition, glucose metabolism, and cardiovascular function. The periconceptional period is therefore believed to play an important role in programming offspring physiological function and is sensitive to nutritional insult. This review summarizes the evidence to date for offspring programming as a result of maternal periconception weight loss. Further research is needed in humans to clearly identify benefits and potential risks of losing weight in the months before conceiving. This may then inform us of clinical practice guidelines for optimal approaches to achieving a healthy weight before pregnancy. Kristine Matusiak, Helen L. Barrett, Leonie K. Callaway, and Marloes Dekker Nitert Copyright © 2014 Kristine Matusiak et al. All rights reserved. The Influence of Gender and Self-Efficacy on Healthy Eating in a Low-Income Urban Population Affected by Structural Changes to the Food Environment Thu, 27 Mar 2014 09:09:05 +0000 Although US obesity prevention efforts have begun to implement a variety of system and environmental change strategies to address the underlying socioecological barriers to healthy eating, factors which can impede or facilitate community acceptance of such interventions are often poorly understood. This is due, in part, to the paucity of subpopulation health data that are available to help guide local planning and decision-making. We contribute to this gap in practice by examining area-specific health data for a population targeted by federally funded nutrition interventions in Los Angeles County. Using data from a local health assessment that collected information on sociodemographics, self-reported health behaviors, and objectively measured height, weight, and blood pressure for a subset of low-income adults (n = 720), we compared health risks and predictors of healthy eating across at-risk groups using multivariable modeling analyses. Our main findings indicate being a woman and having high self-efficacy in reading Nutrition Facts labels were strong predictors of healthy eating (). These findings suggest that intervening with women may help increase the reach of these nutrition interventions, and that improving self-efficacy in healthy eating through public education and/or by other means can help prime at-risk groups to accept and take advantage of these food environment changes. Brenda Robles, Lisa V. Smith, Mirna Ponce, Jennifer Piron, and Tony Kuo Copyright © 2014 Brenda Robles et al. All rights reserved. Complement Receptors C5aR and C5L2 Are Associated with Metabolic Profile, Sex Hormones, and Liver Enzymes in Obese Women Pre- and Postbariatric Surgery Wed, 26 Mar 2014 07:14:47 +0000 Objective. Obesity is associated with metabolic dysfunction with sex differences and chronic, low-grade inflammation. We proposed that hepatic expression of immune complement C3 related receptors (C3aR, C5aR, and C5L2) would be associated with pre- or postmenopausal status and metabolic profile in severely obese women. We hypothesized that C5L2/C5aR ratio, potentially influencing the ASP/C5L2 metabolic versus C5a/C5aR immune response, would predict metabolic profiles after weight loss surgery. Materials and Methods. Fasting plasma (hormone, lipid, and enzyme analysis) and liver biopsies (RT-PCR gene expression) were obtained from 91 women during surgery. Results. Hepatic C5L2 mRNA expression was elevated in pre- versus postmenopausal women () and correlated positively with circulating estradiol, estrone, ApoB, ApoA1, ApoA1/B, waist circumference, age, and LDL-C (all ). While plasma ASP was lower in pre- versus postmenopausal women (), the hepatic C5L2/C5aR mRNA ratio was increased () and correlated positively with estrone () and estradiol () and negatively with circulating ApoB and liver enzymes ALT, AST, and GGT (all ). Over 12 months postoperatively, liver enzymes in low C5L2/C5aR mRNA ratio group remained higher (ALP and ALT, , AST and GGT, 2-way-ANOVA). Conclusion. C5L2-C5aR association with other mediators including estrogens may contribute to hepatic metabolic and inflammatory function. Reza Rezvani, Jessica Smith, Marc Lapointe, Picard Marceau, Andre Tchernof, and Katherine Cianflone Copyright © 2014 Reza Rezvani et al. All rights reserved. The Contribution of Applied Social Sciences to Obesity Stigma-Related Public Health Approaches Mon, 24 Mar 2014 13:20:07 +0000 Obesity is viewed as a major public health concern, and obesity stigma is pervasive. Such marginalization renders obese persons a “special population.” Weight bias arises in part due to popular sources’ attribution of obesity causation to individual lifestyle factors. This may not accurately reflect the experiences of obese individuals or their perspectives on health and quality of life. A powerful role may exist for applied social scientists, such as anthropologists or sociologists, in exploring the lived and embodied experiences of this largely discredited population. This novel research may aid in public health intervention planning. Through these studies, applied social scientists could help develop a nonstigmatizing, salutogenic approach to public health that accurately reflects the health priorities of all individuals. Such an approach would call upon applied social science’s strengths in investigating the mundane, problematizing the “taken for granted” and developing emic (insiders’) understandings of marginalized populations. Andrea E. Bombak Copyright © 2014 Andrea E. Bombak. All rights reserved. The Cut-Off Values of Anthropometric Indices for Identifying Subjects at Risk for Metabolic Syndrome in Iranian Elderly Men Sun, 23 Mar 2014 11:26:27 +0000 Aim. This study aimed to investigate which anthropometric indices could be a better predictor of metabolic syndrome (MetS) and the cut-off points for these surrogates to appropriately differentiate MetS in the Iranian elderly. Method. The present cross-sectional study was conducted on a sample of Isfahan Healthy Heart Program (IHHP). MetS was defined according to Third Adult Treatment Panel (ATPIII). In total, 206 elderly subjects with MetS criteria were selected. Anthropometric indices were measured and plotted using receiver operating characteristic (ROC) curves. Results. WC followed by WHtR yielded the highest area under the curve (AUC) (0.683; 95% CI 0.606–0.761 and 0.680; 95% CI 0.602–0.758, resp.) for MetS. WC at a cut of 94.5 cm resulted in the highest Youden index with sensitivity 64% and 68% specificity to predict the presence of ≥2 metabolic risk factors. BMI had the lowest sensitivity and specificity for MetS and MetS components. WC has the best ability to detect MetS which followed by WHtR and BMI had a lower discriminating value comparatively. Conclusion. WC is the best predictor for predicting the presence of ≥2 metabolic risk factors among Iranian elderly population and the best value of WC is 94.5 cm. This cut-off values of WC should be advocated and used in Iranian men until larger cross-sectional studies show different results. Mojgan Gharipour, Masoumeh Sadeghi, Minoo Dianatkhah, Shirin Bidmeshgi, Alireza Ahmadi, Marzieh Tahri, and Nizal Sarrafzadegan Copyright © 2014 Mojgan Gharipour et al. All rights reserved. Development of Automatic Visceral Fat Volume Calculation Software for CT Volume Data Thu, 20 Mar 2014 07:32:15 +0000 Objective. To develop automatic visceral fat volume calculation software for computed tomography (CT) volume data and to evaluate its feasibility. Methods. A total of 24 sets of whole-body CT volume data and anthropometric measurements were obtained, with three sets for each of four BMI categories (under 20, 20 to 25, 25 to 30, and over 30) in both sexes. True visceral fat volumes were defined on the basis of manual segmentation of the whole-body CT volume data by an experienced radiologist. Software to automatically calculate visceral fat volumes was developed using a region segmentation technique based on morphological analysis with CT value threshold. Automatically calculated visceral fat volumes were evaluated in terms of the correlation coefficient with the true volumes and the error relative to the true volume. Results. Automatic visceral fat volume calculation results of all 24 data sets were obtained successfully and the average calculation time was 252.7 seconds/case. The correlation coefficients between the true visceral fat volume and the automatically calculated visceral fat volume were over 0.999. Conclusions. The newly developed software is feasible for calculating visceral fat volumes in a reasonable time and was proved to have high accuracy. Mitsutaka Nemoto, Tusufuhan Yeernuer, Yoshitaka Masutani, Yukihiro Nomura, Shouhei Hanaoka, Soichiro Miki, Takeharu Yoshikawa, Naoto Hayashi, and Kuni Ohtomo Copyright © 2014 Mitsutaka Nemoto et al. All rights reserved. A Patient-Centered Electronic Tool for Weight Loss Outcomes after Roux-en-Y Gastric Bypass Thu, 20 Mar 2014 00:00:00 +0000 Background. Current patient education and informed consent regarding weight loss expectations for bariatric surgery candidates are largely based on averages from large patient cohorts. The variation in weight loss outcomes illustrates the need for establishing more realistic weight loss goals for individual patients. This study was designed to develop a simple web-based tool which provides patient-specific weight loss expectations. Methods. Postoperative weight measurements after Roux-en-Y gastric bypass (RYGB) were collected and analyzed with patient characteristics known to influence weight loss outcomes. Quantile regression was used to create expected weight loss curves (25th, 50th, and 75th %tile) for the 24 months after RYGB. The resulting equations were validated and used to develop web-based tool for predicting weight loss outcomes. Results. Weight loss data from 2986 patients (2608 in the primary cohort and 378 in the validation cohort) were included. Preoperative body mass index (BMI) and age were found to have a high correlation with weight loss accomplishment ( for each). An electronic tool was created that provides easy access to patient-specific, 24-month weight loss trajectories based on initial BMI and age. Conclusions. This validated, patient-centered electronic tool will assist patients and providers in patient teaching, informed consent, and postoperative weight loss management. G. Craig Wood, Peter Benotti, Glenn S. Gerhard, Elaina K. Miller, Yushan Zhang, Richard J. Zaccone, George A. Argyropoulos, Anthony T. Petrick, and Christopher D. Still Copyright © 2014 G. Craig Wood et al. All rights reserved. Prevalence and Trends of Obesity and Association with Socioeconomic Status in Thai Adults: National Health Examination Surveys, 1991–2009 Mon, 17 Mar 2014 12:28:40 +0000 We determined the prevalence of obesity in Thai adults aged 20 and over in 2009 and examined trends of body mass index (BMI) between 1991 and 2009. Data from Thai National Health Examination Survey for 19,181 adults in 2009 and 64,480 adults between 1991 and 2004 were used to calculate age-adjusted mean and prevalence. Logistic regression was used to examine the association of obesity with education level. In 2009, age-adjusted prevalence of obesity classes I (BMI 25–29.9 kg/m2) and II (BMI ≥30 kg/m2) in Thai adults aged ≥20 years were 26.0% and 9.0%, respectively. Compared with primary education, the odds of obesity class I were highest in men with university education. For women, the odds of obesity classes I and II were highest in those with primary education. BMI significantly increased from 21.6 kg/m2 in men and 22.8 kg/m2 in women in 1991 to 23.3 kg/m2 and 24.4 kg/m2 in 2009, respectively. The average BMI increases per decade were highest in men with secondary education (1.0 kg/m2, ) and in women with primary education with the same rate. There were increasing trends in BMI with slight variation by SES groups in Thai men and women during 1991–2009. Wichai Aekplakorn, Rungkarn Inthawong, Pattapong Kessomboon, Rassamee Sangthong, Suwat Chariyalertsak, Panwadee Putwatana, and Surasak Taneepanichskul Copyright © 2014 Wichai Aekplakorn et al. All rights reserved. Predictors of Weight Loss Maintenance following an Insurance-Sponsored Weight Management Program Tue, 11 Mar 2014 12:29:07 +0000 Intentional weight loss among overweight and obese adults (body mass index ≥ 25 kg/m2) is associated with numerous health benefits, but weight loss maintenance (WLM) following participation in weight management programming has proven to be elusive. Many individuals attempting to lose weight join formal programs, especially women, but these programs vary widely in focus, as do postprogram weight regain results. We surveyed 2,106 former participants in a community-based, insurance-sponsored weight management program in the United States to identify the pre, during, and post-intervention behavioral and psychosocial factors that lead to successful WLM. Of 835 survey respondents (39.6% response rate), 450 met criteria for inclusion in this study. Logistic regression analyses suggest that interventionists should assess and discuss weight loss and behavior change perceptions early in a program. However, in developing maintenance plans later in a program, attention should shift to behaviors, such as weekly weighing, limiting snacking in the evening, limiting portion sizes, and being physically active every day. Christiaan G. Abildso, Olivier Schmid, Megan Byrd, Sam Zizzi, Alessandro Quartiroli, and Sean J. Fitzpatrick Copyright © 2014 Christiaan G. Abildso et al. All rights reserved. Is Exergaming a Viable Tool in the Fight against Childhood Obesity? Tue, 11 Mar 2014 09:16:20 +0000 Gary S. Goldfield, Jameason D. Cameron, and Jean-Philippe Chaput Copyright © 2014 Gary S. Goldfield et al. All rights reserved. Extra Fructose in the Growth Medium Fuels Lipogenesis of Adipocytes Wed, 19 Feb 2014 11:38:11 +0000 Fructose in excessive amounts exerts negative effects on insulin sensitivity, blood pressure, and liver metabolism. These adverse outcomes were attributed to its disturbances of key metabolic pathways in the liver. Recently, possible consequences of high fructose levels directly on adipocytes in vivo have been considered. We have cultured adipocytes in growth media containing 1 g/L fructose additionally to glucose and monitored the cells fate. Cells developed lipid vesicles much earlier with fructose and showed altered kinetics of the expression of mRNAs involved in lipogenesis and hexose uptake. Adiponectin secretion, too, peaked earlier in fructose containing media than in media with glucose only. From these data it can be speculated that similar effects of fructose containing diets happen in vivo also. Apart from toxic action on liver cells, adipocytes might be stimulated to take up extra fructose and generate new lipid vesicles, further dysregulating energy homeostasis. Armin Robubi, Klaus R. Huber, and Walter Krugluger Copyright © 2014 Armin Robubi et al. All rights reserved. Obesity Does Not Increase Mortality after Emergency Surgery Sun, 16 Feb 2014 14:47:44 +0000 Objective. The aim of this study is to evaluate the impact of obesity on patient outcomes after emergency surgery. Methods. A list of all patients undergoing emergent general surgical procedures during the 12 months ending in July 2012 was obtained from the operating room log. A chart review was performed to obtain the following data: patient characteristics (age, gender, BMI, and preexisting comorbidities), indication for surgery, and outcomes (pulmonary embolus (PE), deep venous thrombosis (DVT), respiratory failure, ICU admission, wound infection, pneumonia, and mortality). Obesity was defined as a BMI over 25. Comparisons of outcomes between obese and nonobese patients were evaluated using Fischer’s exact test. Predictors of mortality were evaluated using logistic regression. Results. 341 patients were identified during the study period. 202 (59%) were obese. Both groups were similar in age (48 for obese versus 47 for nonobese, ). Obese patients had an increased incidence of diabetes, (27% versus 7%, ), hypertension (52% versus 34%, ), and sleep apnea (0% versus 5%, ). There was a statistically significant increased incidence of postoperative wound infection (obese 9.9% versus nonobese 4.3%, ) and ICU admission (obese 58% versus nonobese 42%, ) among the obese patients. Obesity alone was not shown to be a significant risk factor for mortality. Conclusions. A higher BMI is not an independent predictor of mortality after emergency surgery. Obese patients are at a higher risk of developing wound infections and requiring ICU admission after emergent general surgical procedure. Paula Ferrada, Rahul J. Anand, Ajai Malhotra, and Michel Aboutanos Copyright © 2014 Paula Ferrada et al. All rights reserved. Predictors of Quality of Life in Portuguese Obese Patients: A Structural Equation Modeling Application Sun, 16 Feb 2014 13:48:50 +0000 Living with obesity is an experience that may affect multiple aspects of an individual’s life. Obesity is considered a relevant public health problem in modern societies. To determine the comparative efficacy of different treatments and to assess their impact on patients’ everyday life, it is important to identify factors that are relevant to the quality of life of obese patients. The present study aims to evaluate, in Portuguese obese patients, the simultaneous impact of several psychosocial factors on quality of life. This study also explores the mediating role of stigma in the relationship between positive/negative affect and quality of life. A sample of 215 obese patients selected from the main hospitals in Portugal completed self-report questionnaires to assess sociodemographic, clinical, psychosocial, and quality of life variables. Data were analysed using structural equation modeling. The model fitted the data reasonably well, CFI = 0.9, RMSEA = 0.06. More enthusiastic and more active patients had a better quality of life. Those who reflect lower perception of stigma had a better physical and mental health. Partial mediation effects of stigma between positive affect and mental health and between negative affect and physical health were found. The stigma is pervasive and causes consequences for psychological and physical health. Estela Vilhena, José Pais-Ribeiro, Isabel Silva, Helena Cardoso, and Denisa Mendonça Copyright © 2014 Estela Vilhena et al. All rights reserved. Joint Effects of Physical Activity and BMI on Risk of Hypertension in Women: A Longitudinal Study Thu, 23 Jan 2014 10:11:19 +0000 Introduction. There is debate as to whether physical activity counteracts the adverse effect of weight on health outcomes. We investigated how physical activity modifies the effect of body mass index (BMI) on hypertension risk. Methods. BMI, physical activity, and hypertension were measured at baseline and at three-year interval for 14 years (from 1996 to 2010), in 10,339 participants in the Australian Longitudinal Study on Women’s Health. Generalised estimating equation models for binary repeated measures were performed to determine the individual and joint effects of BMI and physical activity on incident hypertension. Results. At baseline (mean age  SD), 57% were healthy weight, 28% overweight, and 14% obese. Increasing BMI and decreasing physical activity were associated with increased risk of hypertension. Physical activity attenuated the positive association between weight and risk of hypertension, especially for obese women. Compared to healthy weight high active women, risk of hypertension in obese high active women was 3.4 times greater (OR 3.43, 95% CI 2.68, 4.39) and in obese inactive women 4.9 times greater (OR 4.91, 95% CI 3.92, 6.13). Conclusions. Both physical activity and maintenance of a healthy body weight are associated with lower risk of hypertension. Physical activity reduced but did not remove the effect of obesity on hypertension risk. Caroline Jackson, Gerrie-Cor Herber-Gast, and Wendy Brown Copyright © 2014 Caroline Jackson et al. All rights reserved. Predicting Increased Blood Pressure Using Machine Learning Thu, 23 Jan 2014 07:04:24 +0000 The present study investigates the prediction of increased blood pressure by body mass index (BMI), waist (WC) and hip circumference (HC), and waist hip ratio (WHR) using a machine learning technique named classification tree. Data were collected from 400 college students (56.3% women) from 16 to 63 years old. Fifteen trees were calculated in the training group for each sex, using different numbers and combinations of predictors. The result shows that for women BMI, WC, and WHR are the combination that produces the best prediction, since it has the lowest deviance (87.42), misclassification (.19), and the higher pseudo (.43). This model presented a sensitivity of 80.86% and specificity of 81.22% in the training set and, respectively, 45.65% and 65.15% in the test sample. For men BMI, WC, HC, and WHC showed the best prediction with the lowest deviance (57.25), misclassification (.16), and the higher pseudo (.46). This model had a sensitivity of 72% and specificity of 86.25% in the training set and, respectively, 58.38% and 69.70% in the test set. Finally, the result from the classification tree analysis was compared with traditional logistic regression, indicating that the former outperformed the latter in terms of predictive power. Hudson Fernandes Golino, Liliany Souza de Brito Amaral, Stenio Fernando Pimentel Duarte, Cristiano Mauro Assis Gomes, Telma de Jesus Soares, Luciana Araujo dos Reis, and Joselito Santos Copyright © 2014 Hudson Fernandes Golino et al. All rights reserved. Trajectories of Objectively Measured Physical Activity among Secondary Students in Canada in the Context of a Province-Wide Physical Education Policy: A Longitudinal Analysis Mon, 20 Jan 2014 09:20:41 +0000 Lower levels of physical activity are associated with childhood obesity. School physical education (PE) policies have been identified as critical to improve child and adolescent physical activity levels but there has been little evaluation of such policies. In the province of Manitoba, Canada, the government implemented a mandatory PE policy in secondary schools designed to increase the daily physical activity levels of adolescents. The objective of this study was to examine the longitudinal changes in and the factors associated with the physical activity trajectories of adolescents in Manitoba during their tenure as secondary school students in the context of this school PE policy. The results found, despite the PE policy, a grade-related decline in the physical activity trajectories of adolescents; however, the decline in physical activity was attenuated among adolescents with low and moderate baseline physical activity compared to adolescents with high baseline physical activity and among adolescents who attended schools in neighbourhoods of low compared to high socioeconomic status. There are several possible explanations for these findings, including the influence of the PE policy on the PA patterns of adolescent subpopulations that tend to be at higher risk for inactivity in both childhood and adult life. Erin Hobin, Jannice So, Laura Rosella, Melisa Comte, Steve Manske, and Jonathan McGavock Copyright © 2014 Erin Hobin et al. All rights reserved. Continuous Exercise but Not High Intensity Interval Training Improves Fat Distribution in Overweight Adults Thu, 16 Jan 2014 15:31:48 +0000 Objective. The purpose of this study was to assess the effect of high intensity interval training (HIIT) versus continuous aerobic exercise training (CONT) or placebo (PLA) on body composition by randomized controlled design. Methods. Work capacity and body composition (dual-energy X-ray absorptiometry) were measured before and after 12 weeks of intervention in 38 previously inactive overweight adults. Results. There was a significant group × time interaction for change in work capacity (), which increased significantly in CONT (%) and HIIT (%) but not PLA (%). There was a near-significant main effect for percentage trunk fat, with trunk fat reducing in CONT by % and in PLA by %, but not in HIIT (increase of %) (). There was a significant reduction in android fat percentage in CONT (%) and PLA (%) but not HIIT (increase of %) (). Conclusion. These data suggest that HIIT may be advocated as a time-efficient strategy for eliciting comparable fitness benefits to traditional continuous exercise in inactive, overweight adults. However, in this population HIIT does not confer the same benefit to body fat levels as continuous exercise training. Shelley E. Keating, Elizabeth A. Machan, Helen T. O'Connor, James A. Gerofi, Amanda Sainsbury, Ian D. Caterson, and Nathan A. Johnson Copyright © 2014 Shelley E. Keating et al. All rights reserved. Outcomes and Utilization of a Low Intensity Workplace Weight Loss Program Thu, 02 Jan 2014 15:03:57 +0000 Obesity is related to high health care costs and lost productivity in the workplace. Employers are increasingly sponsoring weight loss and wellness programs to ameliorate these costs. We evaluated weight loss outcomes, treatment utilization, and health behavior change in a low intensity phone- and web-based, employer-sponsored weight loss program. The intervention included three proactive counseling phone calls with a registered dietician and a behavioral health coach as well as a comprehensive website. At six months, one third of those who responded to the follow-up survey had lost a clinically significant amount of weight (≥5% of body weight). Clinically significant weight loss was predicted by the use of both the counseling calls and the website. When examining specific features of the web site, the weight tracking tool was the most predictive of weight loss. Health behavior changes such as eating more fruits and vegetables, increasing physical activity, and reducing stress were all predictive of clinically significant weight loss. Although limited by the low follow-up rate, this evaluation suggests that even low intensity weight loss programs can lead to clinical weight loss for a significant number of participants. Kelly M. Carpenter, Jennifer C. Lovejoy, Jane M. Lange, Jenny E. Hapgood, and Susan M. Zbikowski Copyright © 2014 Kelly M. Carpenter et al. All rights reserved. Safety and Efficacy of Glucomannan for Weight Loss in Overweight and Moderately Obese Adults Mon, 30 Dec 2013 14:04:07 +0000 Background. Few safe and effective dietary supplements are available to promote weight loss. We evaluated the safety and efficacy of glucomannan, a water-soluble fiber supplement, for achieving weight loss in overweight and moderately obese individuals consuming self-selected diets. Methods. Participants were randomly assigned to take 1.33 grams of glucomannan or identically looking placebo capsules with 236.6 mL (8 ounces) of water one hour before breakfast, lunch, and dinner for 8 weeks. The primary efficacy outcome was change in body weight after 8 weeks. Other efficacy outcomes were changes in body composition, hunger/fullness, and lipid and glucose concentrations. Safety outcomes included gastrointestinal symptoms/tolerance and serum liver enzymes and creatinine levels. Results. A total of 53 participants (18–65 years of age; BMI 25–35 kg/m2) were enrolled and randomized. The two groups did not differ with respect to baseline characteristics and compliance with the study supplement. At 8 weeks, there was no significant difference between the glucomannan and placebo groups in amount of weight loss ( and , resp.) or other efficacy outcomes or in any of the safety outcomes. Conclusions. Glucomannan supplements administered over 8 weeks were well tolerated but did not promote weight loss or significantly alter body composition, hunger/fullness, or lipid and glucose parameters. This trial is registered with NCT00613600. Joyce K. Keithley, Barbara Swanson, Susan L. Mikolaitis, Mark DeMeo, Janice M. Zeller, Lou Fogg, and Jehan Adamji Copyright © 2013 Joyce K. Keithley et al. All rights reserved. Effects of Exercise in the Treatment of Overweight and Obese Children and Adolescents: A Systematic Review of Meta-Analyses Tue, 24 Dec 2013 14:13:24 +0000 Purpose. Conduct a systematic review of previous meta-analyses addressing the effects of exercise in the treatment of overweight and obese children and adolescents. Methods. Previous meta-analyses of randomized controlled exercise trials that assessed adiposity in overweight and obese children and adolescents were included by searching nine electronic databases and cross-referencing from retrieved studies. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) Instrument. The alpha level for statistical significance was set at . Results. Of the 308 studies reviewed, two aggregate data meta-analyses representing 14 and 17 studies and 481 and 701 boys and girls met all eligibility criteria. Methodological quality was 64% and 73%. For both studies, statistically significant reductions in percent body fat were observed ( and ). The number-needed-to treat (NNT) was 4 and 3 with an estimated 24.5 and 31.5 million overweight and obese children in the world potentially benefitting, 2.8 and 3.6 million in the US. No other measures of adiposity (BMI-related measures, body weight, and central obesity) were statistically significant. Conclusions. Exercise is efficacious for reducing percent body fat in overweight and obese children and adolescents. Insufficient evidence exists to suggest that exercise reduces other measures of adiposity. George A. Kelley and Kristi S. Kelley Copyright © 2013 George A. Kelley and Kristi S. Kelley. All rights reserved. BMI and an Anthropometry-Based Estimate of Fat Mass Percentage Are Both Valid Discriminators of Cardiometabolic Risk: A Comparison with DXA and Bioimpedance Tue, 24 Dec 2013 12:11:46 +0000 Objective. To determine whether categories of obesity based on BMI and an anthropometry-based estimate of fat mass percentage (FM% equation) have similar discriminative ability for markers of cardiometabolic risk as measurements of FM% by dual-energy X-ray absorptiometry (DXA) or bioimpedance analysis (BIA). Design and Methods. A study of 40–79-year-old male () and female () Finns. Weight, height, blood pressure, triacylglycerols, HDL cholesterol, and fasting blood glucose were measured. Body composition was assessed by DXA and BIA and a FM%-equation. Results. For grade 1 hypertension, dyslipidaemia, and impaired fasting glucose >6.1 mmol/L, the categories of obesity as defined by BMI and the FM% equation had 1.9% to 3.7% () higher discriminative power compared to DXA. For grade 2 hypertension the FM% equation discriminated 1.2% () lower than DXA and 2.8% () lower than BIA. Receiver operation characteristics confirmed BIA as best predictor of grade 2 hypertension and the FM% equation as best predictor of grade 1 hypertension. All other differences in area under curve were small (≤0.04) and 95% confidence intervals included 0. Conclusions. Both BMI and FM% equations may predict cardiometabolic risk with similar discriminative ability as FM% measured by DXA or BIA. Benno Krachler, Eszter Völgyi, Kai Savonen, Frances A. Tylavsky, Markku Alén, and Sulin Cheng Copyright © 2013 Benno Krachler et al. All rights reserved. Association of Obesity with Proteasomal Gene Polymorphisms in Children Sat, 21 Dec 2013 18:28:41 +0000 The aim of this study was to ascertain possible associations between childhood obesity, its anthropometric and clinical parameters, and three loci of proteasomal genes rs2277460 (PSMA6 c.-110C>A), rs1048990 (PSMA6 c.-8C>G), and rs2348071 (PSMA3 c. 543+138G>A) implicated in obesity-related diseases. Obese subjects included 94 otherwise healthy children in Latvia. Loci were genotyped and then analyzed using polymerase chain reactions, with results compared to those of 191 nonobese controls. PSMA3 SNP frequency differences between obese children and controls, while not reaching significance, suggested a trend. These differences, however, proved highly significant () in the subset of children reporting a family history of obesity. Among obese children denying such history, PSMA6 c.-8C>G SNP differences, while being nonsignificant, likewise suggested a trend in comparison to the nonobese controls. No PSMA6 c.-110C>A SNP differences were detected in the obese group or its subsets. Finally, PSMA3 SNP differences were significantly associated () with circulating low-density lipoprotein cholesterol (LDL) levels. Our results clearly implicate the PSMA3 gene locus as an obesity risk factor in those Latvian children with a family history of obesity. While being speculative, the clinical results are suggestive of altered circulatory LDL levels playing a possible role in the etiology of obesity in the young. Sarmite Kupca, Tatjana Sjakste, Natalija Paramonova, Olga Sugoka, Irena Rinkuza, Ilva Trapina, Ilva Daugule, Alfred J. Sipols, and Ingrida Rumba-Rozenfelde Copyright © 2013 Sarmite Kupca et al. All rights reserved. The Impact of Rapid Weight Loss on Oxidative Stress Markers and the Expression of the Metabolic Syndrome in Obese Individuals Thu, 19 Dec 2013 13:11:00 +0000 Objective. Obesity is linked with a state of increased oxidative stress, which plays an important role in the etiology of atherosclerosis and type 2 diabetes mellitus. The aim of our study was to evaluate the effect of rapid weight loss on oxidative stress markers in obese individuals with metabolic syndrome (MetS). Design and Methods. We measured oxidative stress markers in 40 obese subjects with metabolic syndrome (MetS+), 40 obese subjects without metabolic syndrome (MetS−), and 20 lean controls (LC) at baseline and after three months of very low caloric diet. Results. Oxidized low density lipoprotein (ox-LDL) levels decreased by 12% in MetS+ subjects, associated with a reduction in total cholesterol (TC), even after adjustment for age and sex. Lipoprotein associated phospholipase A2 (Lp-PLA2) activity decreased by 4.7% in MetS+ subjects, associated with a drop in LDL-cholesterol (LDL-C), TC, and insulin levels. Multivariate logistic regression analysis showed that a model including ox-LDL, LpPLA2 activity, and myeloperoxidase (MPO) improved prediction of MetS status among obese individuals compared to each oxidative stress marker alone. Conclusions. Oxidative stress markers were predictive of MetS in obese subjects, suggesting a higher oxidative stress. Rapid weight loss resulted in a decline in oxidative stress markers, especially in MetS+ patients. Eva Tumova, Wensheng Sun, Peter H. Jones, Michal Vrablik, Christie M. Ballantyne, and Ron C. Hoogeveen Copyright © 2013 Eva Tumova et al. All rights reserved. A Review of Adult Obesity Prevalence, Trends, Risk Factors, and Epidemiologic Methods in Kuwait Tue, 17 Dec 2013 11:42:49 +0000 Objective. Kuwait is among the countries with the highest obesity rates worldwide; however, little is known about the state of obesity epidemiology research in Kuwait. In this paper, we therefore review the findings and methodology of studies on the prevalence, trends and risk factors of obesity in Kuwait. Methods. The PubMed database was searched using the keyword combination: obesity and adults and Kuwait. Out of 111 articles, 39 remained after abstract review, and 18 were selected after full-text review. Results. The studies were all cross-sectional and published in the last fifteen years (1997–2012). The sample size ranged from 177 to 38,611 individuals. Only 30% of studies used random sampling. The prevalence (BMI ≥ 30) in studies with a nationally representative sample ranged from 24% to 48% overall and in adults 50 years was greater than 52%. Rates were significantly higher in women than those in men. Studies that examined trends showed an increase in obesity prevalence between 1980 and 2009. Multiple risk factors including sociocultural factors were investigated in the studies; however, factors were only crudely assessed. Conclusion. There is a need for future studies, particularly surveillance surveys and prospective cohort studies utilizing advanced methods, to monitor trends and to comprehensively assess the factors contributing to the obesity epidemic in Kuwait. Stalo Karageorgi, Osama Alsmadi, and Kazem Behbehani Copyright © 2013 Stalo Karageorgi et al. All rights reserved. Randomized Controlled Pilot Study Testing Use of Smartphone Technology for Obesity Treatment Tue, 10 Dec 2013 12:17:08 +0000 Background. The established interventions for weight loss are resource intensive which can create barriers for full participation and ultimate translation. The major goal of this pilot study was to evaluate the feasibility, acceptability, and preliminary efficacy of theoretically based behavioral interventions delivered by smartphone technology. Methods. The study randomized 68 obese adults to receive one of four interventions for six months: (1) intensive counseling intervention, (2) intensive counseling plus smartphone intervention, (3) a less intensive counseling plus smartphone intervention, and (4) smartphone intervention only. The outcome measures of weight, BMI, waist circumference, and self-reported dietary intake and physical activity were assessed at baseline and six months. Results. The sample was 78% female and 49% African American, with an average age of 45 years, and average BMI of 34.3 kg/m2. There were trends for differences in weight loss among the four intervention groups. Participants in the intensive counseling plus self-monitoring smartphone group and less intensive counseling plus self-monitoring smartphone group tended to lose more weight than other groups (5.4 kg and 3.3 kg, resp.). Conclusions. The results of this pilot trial of a weight loss intervention provide preliminary support for using a smartphone application for self-monitoring as an adjunct to behavioral counseling. Jerilyn K. Allen, Janna Stephens, Cheryl R. Dennison Himmelfarb, Kerry J. Stewart, and Sara Hauck Copyright © 2013 Jerilyn K. Allen et al. All rights reserved. Preliminary Blood Pressure Screening in a Representative Sample of Extremely Obese Kuwaiti Adolescents Mon, 18 Nov 2013 08:58:07 +0000 A relationship between blood pressure (BP) and obesity has been found in young adults, but no data are available for adolescents in Kuwait. 257 adolescent (11–19 years) participants were categorized into two groups according to their BMI; 48 nonobese (21 males: 43.7% and 27 females: 56.3%) with mean age of years and 209 obese (128 males: 61.25% and 81 females: 38.75%) with mean age of years. The mean BMI was  kg/m2 for the nonobese group and  kg/m3 for the obese group. Most BP measures based on a single screening were significantly higher in the obese group. The prevalence of elevated BP was significantly higher in the obese subjects (nonobese: 13%; obese: 63%; ). In the obese group, there was a significant positive correlation between total sample BMI and all BP measures except the pulse pressure. There was a similar rate of elevated blood pressure between males and females (64% versus 60%; ). For both isolated systolic elevated BP and isolated diastolic elevated BP, the prevalences were comparable between the males (systolic: 42%; diastolic: 5%) and females (systolic: 34%; diastolic: 14%). Only systolic BP was positively correlated with BMI in obese adolescent males (Spearman ; ), with a significant correlation between BMI with diastolic (Spearman ; ) and mean BP (Spearman ; ) in females. Rima Abdul Razzak, Asma Elmteri, Taiba Elkanderi, Fareedah Ishaq, Munera Eljasem, Saja AlDuraie, Jenan Al-Boloushi, Fatma Elbanay, and Latifa Eldabos Copyright © 2013 Rima Abdul Razzak et al. All rights reserved. Childhood Obesity: Today and Tomorrow’s Health Challenge Tue, 12 Nov 2013 14:24:40 +0000 Roya Kelishadi, Sarah D. de Ferranti, Reza Majdzadeh, Jennifer A. O’Dea, Ajay K. Gupta, and Khosrow Adeli Copyright © 2013 Roya Kelishadi et al. All rights reserved.