Journal of Obesity The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Long-Term Weight Maintenance after a 17-Week Weight Loss Intervention with or without a One-Year Maintenance Program: A Randomized Controlled Trial Mon, 30 Mar 2015 13:00:36 +0000 Background. Weight lost by obese patients is almost always regained over time. Extended treatment may improve maintenance, but solid evidence is lacking. Purpose. We determined effectiveness of maintenance therapy after a weight loss program. Methods. Together 201 patients (mean age 47 years and BMI 42 kg/m2, 71% women) were randomly assigned to either a 17-week weight loss program followed by a one-year maintenance program or to a weight loss program without subsequent maintenance intervention. The weight loss program included behavior modification and a very-low-calorie diet, and maintenance program behavior modification. The primary outcome measure was percentage of patients with 5% or more weight loss at the end of maintenance (week 69) and one year later (week 121). Secondary outcomes were weight related changes in lifestyle and quality of life. Results. At week 69, 52% of the patients with and 44% of those without maintenance program had lost weight 5%, , and, at week 121, 33% and 34%, , respectively. At week 121 secondary outcomes did not differ between the groups among those successfully followed up. Conclusions. This one-year maintenance program was not effective in preventing weight regain in severely obese patients. Trial Registration. This trial is registered under Identifier: NCT00590655. Tuula Pekkarinen, Jarmo Kaukua, and Pertti Mustajoki Copyright © 2015 Tuula Pekkarinen et al. All rights reserved. Is Acculturation Related to Obesity in Hispanic/Latino Adults? Results from the Hispanic Community Health Study/Study of Latinos Sun, 29 Mar 2015 07:39:24 +0000 Background. The study examined the association of obesity with acculturation in a large and diverse sample of US Hispanic/Latino adults. Methods. The Hispanic Community Health Study (HCHS)/Study of Latinos (SOL) is a community-based cohort study of Hispanic/Latino adults aged 18–74 years () from four urban areas. Height and weight were directly measured using a standardized protocol. Acculturation was assessed by the Short Acculturation Scale for Hispanics (SASH). Other immigration related variables included place of birth, length of residency in the US, and age at immigration. Odds ratios were calculated to assess the association of overweight, moderate obesity, and extreme obesity ( kg/m2) with acculturation and sociodemographic variables. Results. The prevalence of obesity was 42.4% for women and 36.5% for men and varied by field center and Hispanic/Latino background. The strongest predictor of moderate and extreme obesity was length of residency in mainland US. This association was consistent across Hispanic/Latino backgrounds. Acculturation was not significantly associated with obesity. Discussion. The burden of obesity is high among Hispanic/Latino adults. The study findings suggest that prolonged exposure to the environments in these communities, rather than acculturation, is an important risk factor for obesity in this population. Carmen R. Isasi, Guadalupe X. Ayala, Daniela Sotres-Alvarez, Hala Madanat, Frank Penedo, Catherine M. Loria, John P. Elder, Martha L. Daviglus, Janice Barnhart, Anna Maria Siega-Riz, Linda Van Horn, and Neil Schneiderman Copyright © 2015 Carmen R. Isasi et al. All rights reserved. The Effect of Early Life Factors and Early Interventions on Childhood Overweight and Obesity Wed, 25 Mar 2015 13:55:01 +0000 Li Ming Wen, Chris Rissel, and Gengsheng He Copyright © 2015 Li Ming Wen et al. All rights reserved. Calorie Labeling in a Rural Middle School Influences Food Selection: Findings from Community-Based Participatory Research Sun, 22 Mar 2015 12:39:25 +0000 Background. Calorie labeling at the point-of-purchase in chain restaurants has been shown to reduce energy intake. Objective. To investigate the impact of point-of-purchase calorie information at one rural middle school. Methods. With a community-based participatory research framework a mixed method approach was used to evaluate the impact of point-of-purchase calorie information. Students in grades 6–8, dining at the school cafeteria January and February 2010, participated for 17 school days each month; in January a menu was offered in the usual manner without calorie labels; the same menu was prepared in February with the addition of calorie labels at point-of-purchase. Gross calories served per student were measured each day allowing for matched comparison by menu. In March/April of 2010, 32 students who ate in the cafeteria 3 or more times per week were interviewed regarding their views on menu labeling. Results. Calorie consumption decreased by an average of 47 calories/day; fat intake reduced by 2.1 grams/day. Five main themes were consistent throughout the interviews. Conclusion. Point-of-purchase calorie labels can play a role in reducing the number of calories consumed by middle school age children at the lunch. The majority of students interviewed found the calorie labels helped them choose healthier food. Monica Hunsberger, Paul McGinnis, Jamie Smith, Beth Ann Beamer, and Jean O’Malley Copyright © 2015 Monica Hunsberger et al. All rights reserved. Reducing Hispanic Children’s Obesity Risk Factors in the First 1000 Days of Life: A Qualitative Analysis Sun, 22 Mar 2015 09:52:22 +0000 Objectives. Modifiable behaviors during the first 1000 days (conception age 24 months) mediate Hispanic children’s obesity disparities. We aimed to examine underlying reasons for early life obesity risk factors and identify potential early life intervention strategies. Methods. We conducted 7 focus groups with 49 Hispanic women who were pregnant or had children < age 24 months. Domains included influences on childhood obesity risk factors and future intervention ideas. We analyzed data with immersion-crystallization methods until no new themes emerged. Results. Themes included coping with pregnancy may trump healthy eating and physical activity; early life weight gain is unrelated to later life obesity; fear of infant hunger drives bottle and early solids introduction; beliefs about infant taste promote early solids and sugary beverage introduction; and belief that screen time promotes infant development. Mothers identified physicians, nutritionists, and relatives as important health information sources and expressed interest in mobile technology and group or home visits for interventions. Conclusion. Opportunities exist in the first 1000 days to improve Hispanic mothers’ understanding of the role of early life weight gain in childhood obesity and other obesity risk factors. Interventions that link health care and public health systems and include extended family may prevent obesity among Hispanic children. Jennifer A. Woo Baidal, Shaniece Criss, Roberta E. Goldman, Meghan Perkins, Courtney Cunningham, and Elsie M. Taveras Copyright © 2015 Jennifer A. Woo Baidal et al. All rights reserved. Blending Better Beverage Options: A Nutrition Education and Experiential Workshop for Youths Sun, 22 Mar 2015 09:38:27 +0000 Objective. To reduce intake of sugar-sweetened beverages (SSBs) in youths as a means to reduce obesity risk. Methods. Youths 5–14 years old attending a summer program were given a two-hour workshop addressing the sugar content in SSBs, the health risks from drinking SSBs, and hands-on preparation as well as tastings of low-sugar beverage alternatives. Data on usual intake of SSBs was obtained at baseline, and pre- and postprogram surveys were conducted to gauge change in knowledge and/or attitudes regarding SSBs. Results. There were 128 participants (63% male) in the program. SSBs were commonly consumed with over 80% reporting regular consumption (mean daily intake 17.9 ounces). Significant increase in knowledge regarding the sugar content of commonly consumed SSBs was achieved; however change in attitudes was not significant. The large majority of youths reported enjoying the workshop and intention to reduce intake of SSBs following program participation. Conclusion. SSBs are commonly consumed by youths. Knowledge regarding the sugar content of SSBs is easier to impart to youths than influencing attitudes held about these beverages. Long-term interventions that reach out to parents and address the widespread availability of SSBs are needed to influence resistant attitudes and beverage choosing behaviors in youths. Kathy K. Isoldi and Veronika Dolar Copyright © 2015 Kathy K. Isoldi and Veronika Dolar. All rights reserved. The Intrauterine and Nursing Period Is a Window of Susceptibility for Development of Obesity and Intestinal Tumorigenesis by a High Fat Diet in Min/+ Mice as Adults Thu, 19 Mar 2015 14:14:19 +0000 We studied how obesogenic conditions during various life periods affected obesity and intestinal tumorigenesis in adult C57BL/6J-Min (multiple intestinal neoplasia)/+ mice. The mice were given a 10% fat diet throughout life (negative control) or a 45% fat diet in utero, during nursing, during both in utero and nursing, during adult life, or during their whole life-span, and terminated at 11 weeks for tumorigenesis (Min/+) or 23 weeks for obesogenic effect (wild-type). Body weight at 11 weeks was increased after a 45% fat diet during nursing, during both in utero and nursing, and throughout life, but had normalized at 23 weeks. In the glucose tolerance test, the early exposure to a 45% fat diet in utero, during nursing, or during both in utero and nursing, did not affect blood glucose, whereas a 45% fat diet given to adults or throughout life did. However, a 45% fat diet during nursing or during in utero and nursing increased the number of small intestinal tumors. So did exposures to a 45% fat diet in adult life or throughout life, but without increasing the tumor numbers further. The intrauterine and nursing period is a window of susceptibility for dietary fat-induced obesity and intestinal tumor development. Ha Thi Ngo, Ragna Bogen Hetland, and Inger-Lise Steffensen Copyright © 2015 Ha Thi Ngo et al. All rights reserved. Associations of Parental Influences with Physical Activity and Screen Time among Young Children: A Systematic Review Thu, 19 Mar 2015 11:51:19 +0000 Parents play a critical role in developing and shaping their children’s physical activity (PA) and sedentary behaviours, particularly in the early years of life. The aim of this systematic review is to identify current literature investigating associations of parental influences with both PA and screen time in young children. This systematic review was conducted in November 2013 using 6 electronic databases covering research literature from January 1998 to November 2013. Thirty articles that met inclusion criteria were identified. These studies covered five important aspects of parenting: (1) parenting practices; (2) parents’ role modelling; (3) parental perceptions of children’s PA and screen viewing behaviours; (4) parental self-efficacy; and (5) general parenting style. Findings suggest that parents’ encouragement and support can increase children’s PA, and reducing parents’ own screen time can lead to decreased child screen time. Improving parenting practices, parental self-efficacy or changing parenting style may also be promising approaches to increasing PA time and decreasing screen time of young children. Huilan Xu, Li Ming Wen, and Chris Rissel Copyright © 2015 Huilan Xu et al. All rights reserved. Latino Family Childcare Providers’ Beliefs, Attitudes, and Practices Related to Promotion of Healthy Behaviors among Preschool Children: A Qualitative Study Thu, 19 Mar 2015 11:10:28 +0000 Background. The continuing rise of obesity among Latinos is a public health concern with an immediate need for early prevention. Changes in family structures have increased demand and reliance for child care for young children. Latino children are the fastest-growing segment of the child population in the United States, and research shows that Latino families use preschools and day care centers much less than those of other ethnic groups, apparently because of cultural preferences for family-like care. Objectives. Given that many low income Latino children attend family child care homes (FCCHs), there is a need to explore the role that FCCH providers may play in establishing and reinforcing children’s early healthful eating and physical activity behaviors and consequently in the prevention of childhood obesity. Design. Using purposive sampling, six focus groups were conducted in Spanish with licensed Latino FCCH providers . Data was analyzed to identify recurrent themes. Results. Latino FCCH providers described how they play an influential role in promoting healthful eating and physical activity behaviors of preschool children in their care. They also identified many barriers and challenges in establishing and maintaining healthful nutrition and physical activity behaviors, including high cost of healthy foods, cold weather, and physical environment of FCCH. Conclusions. Latino FCCH providers can have a strong impact in promoting healthful behaviors in low-income, Latino communities. They may be able to effectively deliver interventions targeting low-income, minority families to promote healthful eating and physical activity behaviors and prevent child obesity. Ana C. Lindsay, Judith A. Salkeld, Mary L. Greaney, and Faith D. Sands Copyright © 2015 Ana C. Lindsay et al. All rights reserved. Birth Weight, Current Anthropometric Markers, and High Sensitivity C-Reactive Protein in Brazilian School Children Thu, 19 Mar 2015 09:59:55 +0000 Studies have shown associations of birth weight with increased concentrations of high sensitivity C-reactive protein. This study assessed the relationship between birth weight, anthropometric and metabolic parameters during childhood, and high sensitivity C-reactive protein. A total of 612 Brazilian school children aged 5–13 years were included in the study. High sensitivity C-reactive protein was measured by particle-enhanced immunonephelometry. Nutritional status was assessed by body mass index, waist circumference, and skinfolds. Total cholesterol and fractions, triglycerides, and glucose were measured by enzymatic methods. Insulin sensitivity was determined by the homeostasis model assessment method. Statistical analysis included chi-square test, General Linear Model, and General Linear Model for Gamma Distribution. Body mass index, waist circumference, and skinfolds were directly associated with birth weight (, , and , resp.). Large for gestational age children showed higher high sensitivity C-reactive protein levels than small for gestational age. High birth weight is associated with higher levels of high sensitivity C-reactive protein, body mass index, waist circumference, and skinfolds. Large for gestational age altered high sensitivity C-reactive protein and promoted additional risk factor for atherosclerosis in these school children, independent of current nutritional status. Camile Boscaini and Lucia Campos Pellanda Copyright © 2015 Camile Boscaini and Lucia Campos Pellanda. All rights reserved. Prenatal Stress due to a Natural Disaster Predicts Adiposity in Childhood: The Iowa Flood Study Thu, 19 Mar 2015 09:58:45 +0000 Prenatal stress can affect lifelong physical growth, including increased obesity risk. However, human studies remain limited. Natural disasters provide models of independent stressors unrelated to confounding maternal characteristics. We assessed degree of objective hardship and subjective distress in women pregnant during severe flooding. At ages 2.5 and 4 years we assessed body mass index (BMI), subscapular plus triceps skinfolds (SS + TR, an index of total adiposity), and SS : TR ratio (an index of central adiposity) in their children (). Hierarchical regressions controlled first for several potential confounds. Controlling for these, flood exposure during early gestation predicted greater BMI increase from age 2.5 to 4, as well as total adiposity at 2.5. Greater maternal hardship and distress due to the floods, as well as other nonflood life events during pregnancy, independently predicted greater increase in total adiposity between 2.5 and 4 years. These results support the hypothesis that prenatal stress increases adiposity beginning in childhood and suggest that early gestation is a sensitive period. Results further highlight the additive effects of maternal objective and subjective stress, life events, and depression, emphasizing the importance of continued studies on multiple, detailed measures of maternal mental health and experience in pregnancy and child growth. Kelsey N. Dancause, David P. Laplante, Kimberly J. Hart, Michael W. O’Hara, Guillaume Elgbeili, Alain Brunet, and Suzanne King Copyright © 2015 Kelsey N. Dancause et al. All rights reserved. Early Life Cognitive Abilities and Body Weight: Cross-Sectional Study of the Association of Inhibitory Control, Cognitive Flexibility, and Sustained Attention with BMI Percentiles in Primary School Children Thu, 19 Mar 2015 09:45:15 +0000 The objective of this study was to investigate the association of different cognitive abilities with children’s body weight adjusted for further weight influencing sociodemographic, family, and lifestyle factors. Cross-sectional data of 498 primary school children (7.0 ± 0.6 years; 49.8% boys) participating in a health promotion programme in southwest Germany were used. Children performed a computer-based test battery (KiTAP) including an inhibitory control task (Go-Nogo paradigm), a cognitive flexibility task, and a sustained attention task. Height and weight were measured in a standardized manner and converted to BMI percentiles based on national standards. Sociodemographic features (migration background and parental education), family characteristics (parental body weight), and children’s lifestyle (TV consumption, physical activity, consumption of sugar-sweetened beverages and breakfast habits) were assessed via parental questionnaire. A hierarchical regression analysis revealed inhibitory control and cognitive flexibility to be significant cognitive predictors for children’s body weight. There was no association concerning sustained attention. The findings suggest that especially cognitive abilities known as executive functions (inhibitory control and cognitive flexibility) are associated with children’s body weight. Future longitudinal and intervention studies are necessary to investigate the directionality of the association and the potential of integrating cognitive training in obesity prevention strategies. This trial is registered with DRKS00000494. Tamara Wirt, Anja Schreiber, Dorothea Kesztyüs, and Jürgen M. Steinacker Copyright © 2015 Tamara Wirt et al. All rights reserved. The Impact of Incarceration on Obesity: Are Prisoners with Chronic Diseases Becoming Overweight and Obese during Their Confinement? Wed, 18 Mar 2015 12:53:37 +0000 Introduction. The association between incarceration and weight gain, along with the public health impact of former prisoners who are overweight or obese, warrants more investigation to understand the impact of prison life. Studies regarding incarceration’s impact on obesity are too few to support assertions that prisons contribute to obesity and comorbid conditions. This study examined a statewide prison population over several years to determine weight gain. Methods. Objective data for weight, height, and chronic diseases, along with demographics, were extracted from an electronic health record. These data were analyzed statistically to determine changes over time and between groups. Results. As a total population, prisoners not only gained weight, but also reflected the distribution of BMIs for the state. There were differences within the population. Male prisoners gained significantly less weight than females. The population with chronic diseases gained less weight than the population without comorbid conditions. Prisoners with diabetes lost weight while hypertension’s impact was negligible. Conclusion. This study found that weight gain was a problem specifically to females. However, this prison system appears to be providing effective chronic disease management, particularly for prisoners with diabetes and hypertension. Additional research is needed to understand the impact incarceration has on the female population. Madison L. Gates and Robert K. Bradford Copyright © 2015 Madison L. Gates and Robert K. Bradford. All rights reserved. The Impact of Parents’ Categorization of Their Own Weight and Their Child’s Weight on Healthy Lifestyle Promoting Beliefs and Practices Mon, 16 Mar 2015 16:22:01 +0000 Objective. To evaluate parents’ beliefs and practices related to childhood obesity and determine if these are influenced by parent’s perception of their own weight or their child’s weight. Methods. Parents of obese () or normal weight () children 4–15 years in Georgia, USA, were randomly selected to complete a telephone survey. Frequency of child obesity-related perceptions, beliefs, and practices were assessed, stratified by parent-perceived self-weight and child weight status, and compared using Chi-squared tests and multivariate logistic regression. Results. Most parents, regardless of perceived child weight, agreed that child overweight/obesity can cause serious illness (95%) but only one-half believed it was a problem in Georgia. Many (42.4%) failed to recognize obesity in their own children. More parents who perceived their child as overweight versus normal weight reported concern about their child’s diet and activity and indicated readiness for lifestyle change. Parents’ perception of their own weight had little additional impact. Conclusions. While awareness of child overweight as a modifiable health risk is high, many parents fail to recognize it in their own families and communities, reducing the likelihood of positive lifestyle change. Additional efforts to help parents understand their role in facilitating behavior change and to assist them in identifying at-risk children are required. Allison C. Sylvetsky-Meni, Scott E. Gillepsie, Trisha Hardy, and Jean A. Welsh Copyright © 2015 Allison C. Sylvetsky-Meni et al. All rights reserved. Tissue Factor Expression in Obese Type 2 Diabetic Subjects and Its Regulation by Antidiabetic Agents Sun, 15 Mar 2015 12:30:29 +0000 Objective. Increased coagulation activation may contribute to the high incidence of cardiovascular complications observed in obese and type 2 diabetes (T2D) subjects. Although tissue factor (TF), the primary initiator of coagulation is increased in obesity, its expression in adipose tissues and its association with metabolic parameters are unclear. We sought to compare TF expression in plasma and adipose tissues of obese subjects with and without T2D, its correlation with metabolic parameters, and regulation in response to antidiabetic drugs. Methods Subjects were recruited from diabetes clinics and adipose tissue was obtained by needle biopsy of lower subcutaneous abdominal depot. For the intervention study, subjects were randomized into treatment groups with rosiglitazone or metformin for 4 months. Results. Plasma TF antigen, activity, and adipose TF mRNA were greater in obese T2D subjects compared with obese nondiabetics. Plasma TF activity correlated with fasting insulin, glucose, and free fatty acids, (FFAs), and adipose TF mRNA correlated with plasma FFA. Plasma TF activity was reduced by metformin and increased with rosiglitazone treatment. Conclusions. Specific diabetes-related metabolic parameters, but not obesity per se, are correlated with TF expression. Regulation of TF activity by different classes of antidiabetic drugs may relate to protective or adverse cardiovascular outcomes. Jing Wang, Theodore P. Ciaraldi, and Fahumiya Samad Copyright © 2015 Jing Wang et al. All rights reserved. Obesity and Metabolic Phenotypes (Metabolically Healthy and Unhealthy Variants) Are Significantly Associated with Prevalence of Elevated C-Reactive Protein and Hepatic Steatosis in a Large Healthy Brazilian Population Mon, 09 Mar 2015 12:33:40 +0000 Background. Among the obese, the so-called metabolically healthy obese (MHO) phenotype is thought to confer a lower CVD risk as compared to obesity with typical associated metabolic changes. The present study aims to determine the relationship of different subtypes of obesity with inflammatory-cardiometabolic abnormalities. Methods. We evaluated 5,519 healthy, Brazilian subjects ( years, 78% males), free of known cardiovascular disease. Those with <2 metabolic risk factors (MRF) were considered metabolically healthy, and those with BMI ≥ 25 kg/m2 and/or waist circumference meeting NCEP criteria for metabolic syndrome as overweight/obese (OW). High sensitivity C reactive protein (hsCRP) was measured to assess underlying inflammation and hepatic steatosis (HS) was determined via abdominal ultrasound. Results. Overall, 40% of OW individuals were metabolically healthy, and 12% normal-weight had ≥2 MRF. The prevalence of elevated CRP (≥3 mg/dL) and HS in MHO versus normal weight metabolically healthy group was 22% versus 12%, and 40% versus 8% respectively (). Both MHO individuals and metabolically unhealthy normal weight (MUNW) phenotypes were associated with elevated hsCRP and HS. Conclusion. Our study suggests that MHO and MUNW phenotypes may not be benign and physicians should strive to treat individuals in these subgroups to reverse these conditions. Sameer Shaharyar, Lara L. Roberson, Omar Jamal, Adnan Younus, Michael J. Blaha, Shozab S. Ali, Kenneth Zide, Arthur A. Agatston, Roger S. Blumenthal, Raquel D. Conceição, Raul D. Santos, and Khurram Nasir Copyright © 2015 Sameer Shaharyar et al. All rights reserved. A Study of the Relationship between Food Group Recommendations and Perceived Stress: Findings from Black Women in the Deep South Wed, 04 Mar 2015 09:43:47 +0000 Black women in the Deep South experience excess morbidity/mortality from obesity-related diseases, which may be partially attributable to poor diet. One reason for poor dietary intake may be high stress, which has been associated with unhealthy diets in other groups. Limited data are available regarding dietary patterns of black women in the Deep South and to our knowledge no studies have been published exploring relationships between stress and dietary patterns among this group. This cross-sectional study explored the relationship between stress and adherence to food group recommendations among black women in the Deep South. Participants () provided demographic, anthropometric, stress (PSS-10), and dietary (NCI ASA-24 hour recall) data. Participants were obese (BMI = 36.5 kg/m2) and reported moderate stress (PSS-10 score = 16) and minimal adherence to Dietary Guidelines for Americans food group recommendations (1/3 did not meet recommendations for any food group). Participants reporting higher stress had higher BMIs than those reporting lower stress. There was no observed relationship between stress and dietary intake in this sample. Based on these study findings, which are limited by potential misreporting of dietary intake and limited variability in stress measure outcomes, there is insufficient evidence to support a relationship between stress and dietary intake. Tiffany L. Carson, Renee Desmond, Sharonda Hardy, Sh’Nese Townsend, Jamy D. Ard, Karen Meneses, Edward E. Partridge, and Monica L. Baskin Copyright © 2015 Tiffany L. Carson et al. All rights reserved. Young Adults, Technology, and Weight Loss: A Focus Group Study Wed, 18 Feb 2015 13:16:54 +0000 Overweight and obesity are a major concern in young adults. Technology has been integrated into many weight loss interventions; however little is known about the use of this technology in young adults. The purpose of this study was to explore through focus group sessions the opinions of young adults on the use of technology for weight loss. A total of 17 young adults, between 18 and 25 years of age, participated in three focus group sessions. Major results indicated that young adults have very little knowledge on the use of Smartphone technology for weight loss but would like to use this type of technology to help them lose weight. Results also indicated that young adults struggle to make healthy food choices and have priorities that outweigh exercise and they need support and guidance to make better decisions. In conclusion, young adults would be open to using Smartphone technology for weight loss but also need feedback and guidance to help make healthy decisions. Janna Stephens, Gyasi Moscou-Jackson, and Jerilyn K. Allen Copyright © 2015 Janna Stephens et al. All rights reserved. Obesity Is Associated with an Increase in Pharmaceutical Expenses among University Employees Sun, 08 Feb 2015 14:34:06 +0000 Objective. To examine costs associated with obesity in an employee population and factors associated with increased costs. Methods. We used data from the Physical Activity and Life Style (PALS) study, a randomized prospective design evaluating three interventions to increase physical activity among physically inactive nonfaculty university employees (). The primary exposure variable, obesity (measured by body mass index), was obtained from the in-person baseline survey. Covariates were obtained from the baseline survey and included demographic characteristics and health status. Data from the baseline survey was linked with administrative data to determine pharmaceutical, inpatient, outpatient, and total health care costs for three years. Average monthly expenditures for obese and nonobese individuals were compared using t-tests and a two-part multivariate regression model adjusted for demographic and socioeconomic characteristics and health behaviors. Results. Although in-patient and outpatient expenses were not associated with obesity, pharmaceutical expenditures were $408 or 87.2% higher per year ($468 versus $876) for obese individuals than for nonobese individuals, which reflected poorer health behaviors and health status of obese adults. Conclusion. Awareness of the costs associated with obesity among employees can stimulate employers to make the investment in providing employer-sponsored wellness and health improvement programs to address obesity. Julie A. Gazmararian, David Frisvold, Kun Zhang, and Jeffrey P. Koplan Copyright © 2015 Julie A. Gazmararian et al. All rights reserved. Gastric Band Port Site Fixation: Which Method Is Best? Wed, 28 Jan 2015 07:42:09 +0000 Laparoscopic adjustable gastric banding is a popular and successful bariatric surgical technique. Although short-term complications are few in number, long-term complications are more common. One such complication is flippage of the gastric band port. This study compares three popular methods of port fixation and demonstrates that fixation with nonabsorbable mesh helps to prevent port flippage when compared to other techniques, reducing the need for repositioning operations. Corinne E. Owers, Sarah M. Barkley, and Roger Ackroyd Copyright © 2015 Corinne E. Owers et al. All rights reserved. Evaluating the Cause of Death in Obese Individuals: A Ten-Year Medical Autopsy Study Wed, 14 Jan 2015 12:06:55 +0000 Background. Obesity is a growing public health problem associated with increased morbidity and rate of death. Postmortem examination is imperative to determine the cause of death, to detect clinically unsuspected disease entities, and consequently to determine the actual impact of obesity on patient mortality. Methods. A total of 849 adult autopsies were retrospectively reviewed. Obese (BMI ≥ 30 kg/m2) and nonobese patients were separately studied. The primary cause of death in each group was categorized into malignancy, infection, stroke, ischemic and nonischemic heart disease, pulmonary embolism, hemorrhage, and primary nonneoplastic diseases of different organ systems. Results. Of 849 autopsies, 32.3% were obese. The leading causes of death in the obese population were malignancy (31.4%), infection (25.9%), ischemic heart disease (12.8%), and pulmonary embolism (6.2%). Obese individuals were statistically more likely to die from pulmonary embolism and liver disease and less likely to die from neurologic diseases and nonischemic heart disease. Conclusion. Autopsies on obese individuals constitute a third of all adult medical autopsies in our center. Increased death rates in the obese due to pulmonary embolism and liver disease should receive special clinical attention. Autopsy findings in the obese population should contribute to overall premortem disease detection, prevention, and management. Jad Saab and Steven P. Salvatore Copyright © 2015 Jad Saab and Steven P. Salvatore. All rights reserved. Physical Activity and Quality of Life in Severely Obese Adults during a Two-Year Lifestyle Intervention Programme Tue, 13 Jan 2015 13:29:28 +0000 It is unknown how changes in physical activity may affect changes in quality of life (QoL) outcomes during lifestyle interventions for severely obese adults. The purpose of this study was to examine associations in the patterns of change between objectively assessed physical activity as the independent variable and physical, mental, and obesity-specific QoL and life satisfaction as the dependent variables during a two-year lifestyle intervention. Forty-nine severely obese adults (37 women; years; body mass index  kg/m2) participated in the study. Assessments were conducted four times using Medical Outcomes Study Short-Form 36 Health Survey (SF-36), Obesity-Related Problems (OP) scale, a single item on life satisfaction, and accelerometers. The physical component summary (PCS) score and the mental component summary (MCS) score were used as SF-36 outcomes. Associations were determined using linear regression analyses and reported as standardized coefficients (stand. coeff.). Change in physical activity was independently associated with change in PCS (stand. coeff. = 0.35, ), MCS (stand. coeff. = 0.51, ), OP (stand. coeff. = −0.31,  ), and life satisfaction (stand. coeff. = 0.39, ) after adjustment for gender, age, and change in body mass index. Randi Jepsen, Eivind Aadland, Lesley Robertson, Ronette L. Kolotkin, John Roger Andersen, and Gerd Karin Natvig Copyright © 2015 Randi Jepsen et al. All rights reserved. Patient Perception of Ideal Body Weight and the Effect of Body Mass Index Mon, 29 Dec 2014 06:45:26 +0000 Objective. Despite much effort, obesity remains a significant public health problem. One of the main contributing factors is patients’ perception of their target ideal body weight. This study aimed to assess this perception. Methods. The study took place in an urban area, with the majority of participants in the study being Hispanic (65.7%) or African-American (28.0%). Patients presented to an outpatient clinic were surveyed regarding their ideal body weight and their ideal BMI calculated. Subsequently they were classified into different categories based on their actual measured BMI. Their responses for ideal BMI were compared. Results. In 254 surveys, mean measured BMI was 31.71 ± 8.01. Responses to ideal BMI had a range of 18.89–38.15 with a mean of 25.96 ± 3.25. Mean (±SD) ideal BMI for patients with a measured BMI of <18.5, 18.5–24.9, 25–29.9, and ≥30 was 20.14 ± 1.46, 23.11 ± 1.68, 25.69 ± 2.19, and 27.22 ± 3.31, respectively. These differences were highly significant (, ANOVA). Conclusions. Most patients had an inflated sense of their target ideal body weight. Patients with higher measured BMI had higher target numbers for their ideal BMI. Better education of patients is critical for obesity prevention programs. Rozhin Naghshizadian, Amir A. Rahnemai-Azar, Kruthi Kella, Michael M. Weber, Marius L. Calin, Shahida Bibi, and Daniel T. Farkas Copyright © 2014 Rozhin Naghshizadian et al. All rights reserved. Avoiding Weight Gain in Cardiometabolic Disease: A Systematic Review Sun, 28 Dec 2014 00:10:23 +0000 Patients with cardiometabolic disease are at higher risk for obesity-related adverse effects. Even without weight loss, weight maintenance may be beneficial. We performed a systematic review to identify the effect of nonweight loss-focused lifestyle interventions in adults with cardiometabolic disease. We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify comparative studies of lifestyle interventions (self-management, diet, exercise, or their combination) without a weight loss focus in adults with or at risk for diabetes and cardiovascular disease. Weight, BMI, and waist circumference at ≥12 months were the primary outcomes. Of 24,870 citations, we included 12 trials (self-management, ; diet, ; exercise, ; combination, ) studying 4,206 participants. Self-management plus physical activity ± diet versus minimal/no intervention avoided meaningful weight (−0.65 to −1.3 kg) and BMI (−0.4 to −0.7 kg/m2) increases. Self-management and/or physical activity prevented meaningful waist circumference increases versus control (−2 to −4 cm). In patients with cardiometabolic disease, self-management plus exercise may prevent weight and BMI increases and self-management and/or exercise may prevent waist circumference increases versus minimal/no intervention. Future studies should confirm these findings and evaluate additional risk factors and clinical outcomes. Nisa M. Maruthur, Kimberly Gudzune, Susan Hutfless, Oluwakemi A. Fawole, Renee F. Wilson, Brandyn D. Lau, Cheryl A. M. Anderson, Sara N. Bleich, and Jodi Segal Copyright © 2014 Nisa M. Maruthur et al. All rights reserved. Identification of Novel Clinical Factors Associated with Hepatic Fat Accumulation in Extreme Obesity Wed, 24 Dec 2014 00:10:08 +0000 Objectives. The accumulation of lipids stored as excess triglycerides in the liver (steatosis) is highly prevalent in obesity and has been associated with several clinical characteristics, but most studies have been based on relatively small sample sizes using a limited set of variables. We sought to identify clinical factors associated with liver fat accumulation in a large cohort of patients with extreme obesity. Methods. We analyzed 2929 patients undergoing intraoperative liver biopsy during a primary bariatric surgery. Univariate and multivariate regression modeling was used to identify associations with over 200 clinical variables with the presence of any fat in the liver and with moderate to severe versus mild fat accumulation. Results. A total of 19 data elements were associated with the presence of liver fat and 11 with severity of liver fat including ALT and AST, plasma lipid, glucose, and iron metabolism variables, several medications and laboratory measures, and sleep apnea. The accuracy of a multiple logistic regression model for presence of liver fat was 81% and for severity of liver fat accumulation was 77%. Conclusions. A limited set of clinical factors can be used to model hepatic fat accumulation with moderate accuracy and may provide potential mechanistic insights in the setting of extreme obesity. Glenn S. Gerhard, Peter Benotti, G. Craig Wood, Xin Chu, George Argyropoulos, Anthony Petrick, William E. Strodel, Jon D. Gabrielsen, Anna Ibele, Christopher D. Still, Christopher Kingsley, and Johanna DiStefano Copyright © 2014 Glenn S. Gerhard et al. All rights reserved. Abdominal Adiposity Distribution in Diabetic/Prediabetic and Nondiabetic Populations: A Meta-Analysis Wed, 26 Nov 2014 08:20:43 +0000 Excess fat in the abdomen can be classified generally as visceral and subcutaneous adiposity. Evidence suggests that visceral adiposity has greater implications for diabetes than other fat depots. The purpose of this study is to explore the disparities in the distribution of abdominal adiposity in diabetic/prediabetic and nondiabetic populations and to identify moderators that influence the pattern of central obesity via a meta-analysis technique. The Hedges’ was used as a measure of effect size and 95% confidence interval was computed. A total of 41 relevant studies with 101 effect sizes were retrieved. Pooled effect sizes for visceral and subcutaneous adiposity were 0.69 and 0.42, respectively. Diabetic/prediabetic populations exhibited greater visceral and subcutaneous adiposity compared to nondiabetic populations (, ). Significant moderator effects of gender () and assessment method of abdominal adiposity () were found for visceral fat (), but not for subcutaneous fat. Type of health condition influenced both visceral () and subcutaneous () abdominal adiposity volumes (). Abdominal adiposity distributions were significantly altered in the diabetic/prediabetic population compared to the nondiabetic population. Gender, assessment method of abdominal adiposity, and type of health conditions (diabetic/prediabetics) were identified as crucial moderators that influence the degree of abdominal adiposity. Jane J. Lee, S. Natasha Beretvas, and Jeanne H. Freeland-Graves Copyright © 2014 Jane J. Lee et al. All rights reserved. The Influence of Antiobesity Media Content on Intention to Eat Healthily and Exercise: A Test of the Ordered Protection Motivation Theory Wed, 19 Nov 2014 07:25:10 +0000 This study extended the ordered protection motivation framework to determine whether exposure and attention to antiobesity media content increases people’s appraisals of threat and their ability to cope with it. It also assesses whether these cognitive processes, in turn, affected people’s intention to abide by the practices recommended to prevent obesity. The results of a national online survey using a nonprobability sample indicate that attention to mediated obesity and related information significantly increased people’s intention to exercise as well as their overall coping appraisals (the perceived effectiveness of the recommended behaviors and their ability to perform them). Likewise, increased threat and coping appraisals were both found to significantly influence people’s intention to exercise and diet. Coping (rather than threat) appraisals more strongly predicted behavioral intent. Following the attitude-behavior literature, behavioral intention was used as the most proximate predictor of actual behavior (i.e., stronger intentions increase the likelihood of behavior change). Raeann Ritland and Lulu Rodriguez Copyright © 2014 Raeann Ritland and Lulu Rodriguez. All rights reserved. Relationship between Body Mass Index Reference and All-Cause Mortality: Evidence from a Large Cohort of Thai Adults Mon, 17 Nov 2014 11:49:37 +0000 We investigate variation in body mass index (BMI) reference and 5-year all-cause mortality using data from 87151 adult Open University students nationwide. Analyses focused on BMI reference bands: “normal” (≥18.5 to <23), “lower normal” (≥18.5 to <20.75), “upper normal” (≥20.75 to <23), and “narrow Western normal” (≥23 to <25). We report hazard ratios (HR) and 95% Confidence Intervals adjusting for covariates. Compared to lower normal, adults aged 35–65 years who were obese (BMI ≥ 30) were twice as likely to die during the follow-up (HR 2.37; 1.01–5.70). For the same group, when using narrow Western normal as the reference, the results were similar (HR 3.02; 1.26–7.22). However, different combinations of BMI exposure and reference band produce quite different results. Older age persons belonging to Asian overweight BMI category (≥23 to <25) were relatively protected from mortality (HR 0.57; 0.34–0.96 and HR 0.49; 0.28–0.84) when assessed using normal (≥18.5 to <23) and upper normal (≥20.75 to <23) as reference bands. Use of different “normal” reference produced varying mortality relationships in a large cohort of Thai adults. Caution is needed when interpreting BMI-mortality data. Vasoontara Yiengprugsawan, Cathy Banwell, Jiaying Zhao, Sam-ang Seubsman, and Adrian C. Sleigh Copyright © 2014 Vasoontara Yiengprugsawan et al. All rights reserved. Feasibility and Acceptability of an Early Childhood Obesity Prevention Intervention: Results from the Healthy Homes, Healthy Families Pilot Study Mon, 27 Oct 2014 13:13:06 +0000 Background. This study examined the feasibility and acceptability of a home-based early childhood obesity prevention intervention designed to empower low-income racially/ethnically diverse parents to modify their children’s health behaviors. Methods. We used a prospective design with pre-/posttest evaluation of 50 parent-child pairs (children aged 2 to 5 years) to examine potential changes in dietary, physical activity, and sedentary behaviors among children at baseline and four-month follow-up. Results. 39 (78%) parent-child pairs completed evaluation data at 4-month follow-up. Vegetable intake among children significantly increased at follow-up (0.54 cups at 4 months compared to 0.28 cups at baseline, ) and ounces of fruit juice decreased at follow-up (11.9 ounces at 4 months compared to 16.0 ounces at baseline, ). Sedentary behaviors also improved. Children significantly decreased time spent watching TV on weekdays () and also reduced weekend TV time. In addition, the number of homes with TV sets in the child’s bedroom also decreased (). Conclusions. The findings indicate that a home-based early childhood obesity prevention intervention is feasible, acceptable and demonstrates short-term effects on dietary and sedentary behaviors of low-income racially/ethnically diverse children. Akilah Dulin Keita, Patricia M. Risica, Kelli L. Drenner, Ingrid Adams, Gemma Gorham, and Kim M. Gans Copyright © 2014 Akilah Dulin Keita et al. All rights reserved. Maternal Characteristics Influencing the Development of Gestational Diabetes in Obese Women Receiving 17-alpha-Hydroxyprogesterone Caproate Mon, 27 Oct 2014 12:31:49 +0000 Objective. Gestational diabetes (GDM) and obesity portend a high risk for subsequent type 2 diabetes. We examined maternal factors influencing the development of gestational diabetes (GDM) in obese women receiving 17-alpha-hydroxyprogesterone caproate (17OHPC) for preterm delivery prevention. Materials and Methods. Retrospectively identified were 899 singleton pregnancies with maternal prepregnancy body mass indices of ≥30 kg/m2 enrolled for either 17OHPC weekly administration (study group) or daily uterine monitoring and nursing assessment (control group). Patients with history of diabetes type 1, 2, or GDM were excluded. Maternal characteristics were compared between groups and for women with and without development of GDM. A logistic regression model was performed on incidence of GDM, controlling for significant univariate factors. Results. The overall incidence of GDM in the 899 obese women studied was 11.9%. The incidence of GDM in the study group () was 13.8% versus 9.6% in the control group () (). Aside from earlier initiation of 17OHP and advanced maternal age, other factors including African American race, differing degrees of obesity, and use of tocolysis were not significant risks for the development of GDM. Conclusion. In obese women with age greater than 35 years, earlier initiation of 17OHPC may increase the risk for GDM. Robert Egerman, Risa Ramsey, Niki Istwan, Debbie Rhea, and Gary Stanziano Copyright © 2014 Robert Egerman et al. All rights reserved.