Journal of Obesity The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Preliminary Efficacy of Group Medical Nutrition Therapy and Motivational Interviewing among Obese African American Women with Type 2 Diabetes: A Pilot Study Thu, 28 Aug 2014 00:00:00 +0000 Objective. To assess the efficacy and acceptability of a group medical nutritional therapy (MNT) intervention, using motivational interviewing (MI). Research Design & Method. African American (AA) women with type 2 diabetes (T2D) participated in five, certified diabetes educator/dietitian-facilitated intervention sessions targeting carbohydrate, fat, and fruit/vegetable intake and management. Motivation-based activities centered on exploration of dietary ambivalence and the relationships between diet and personal strengths. Repeated pre- and post-intervention, psychosocial, dietary self-care, and clinical outcomes were collected and analyzed using generalized least squares regression. An acceptability assessment was administered after intervention. Results. Participants (n = 24) were mostly of middle age (mean age 50.8 ± 6.3) with an average BMI of 39 ± 6.5. Compared to a gradual pre-intervention loss of HbA1c control and confidence in choosing restaurant foods, a significant post-intervention improvement in HbA1c (P = 0.03) and a near significant (P = 0.06) increase in confidence in choosing restaurant foods were observed with both returning to pre-intervention levels. 100% reported that they would recommend the study to other AA women with type 2 diabetes. Conclusion. The results support the potential efficacy of a group MNT/MI intervention in improving glycemic control and dietary self-care-related confidence in overweight/obese AA women with type 2 diabetes. Stephania T. Miller, Veronica J. Oates, Malinda A. Brooks, Ayumi Shintani, Tebeb Gebretsadik, and Darlene M. Jenkins Copyright © 2014 Stephania T. Miller et al. All rights reserved. FitKids360: Design, Conduct, and Outcomes of a Stage 2 Pediatric Obesity Program Wed, 20 Aug 2014 06:05:01 +0000 This paper describes FitKids360, a stage 2 pediatric weight management program. FitKids360 is a physician-referred, multicomponent, low-cost healthy lifestyle program for overweight and obese youth 5–16 years of age and their families. FitKids360 provides an evidence-based approach to the treatment of pediatric overweight by targeting patients’ physical activity, screen time, and dietary behaviors using a family-centered approach. The intervention begins with a two-hour orientation and assessment period followed by six weekly sessions. Assessments include lifestyle behaviors, anthropometry, and the Family Nutrition and Physical Activity (FNPA) survey, which screens for obesogenic risk factors in the home environment. Outcomes are presented from 258 patients who completed one of 33 FitKids360 classes. After completing FitKids360, patients increased moderate to vigorous physical activity by 14 minutes (), reduced screen time by 44 minutes (), and improved key dietary behaviors. Overall, FNPA scores increased by 9% () and 69% of patients with “high risk” FNPA scores at baseline dropped below the “high risk” range by followup. Patients also lowered BMIs () and age- and sex-adjusted BMI -scores () after completing the 7-week program. We hope this report will be useful to medical and public health professionals seeking to develop stage 2 pediatric obesity programs. Jared M. Tucker, Joey C. Eisenmann, Kathleen Howard, Emily H. Guseman, Kimbo E. Yee, Kimberly DeLaFuente, Jill Graybill, Meggie Roberts, Megan Murphy, Heather Saturley, and Tom Peterson Copyright © 2014 Jared M. Tucker et al. All rights reserved. Impact of Weight Regain on Metabolic Disease Risk: A Review of Human Trials Thu, 14 Aug 2014 00:00:00 +0000 Dietary restriction interventions are effective for weight loss and reduction of chronic disease risk. Unfortunately, most people tend to regain much of this lost weight within one year after intervention. While some studies suggest that minor degrees of weight regain have no effect on metabolic disease risk parameters, other studies demonstrate a complete reversal in metabolic benefits. In light of these conflicting findings, it is of interest to determine how complete weight maintenance versus mild weight regain affects key risk parameters. These findings would have important clinical implications, as they could help identify a weight regain threshold that could preserve the metabolic benefits of weight loss. Accordingly, this review examined the impact of no weight regain versus mild regain on various metabolic disease risk parameters, including plasma lipids, blood pressure, glucose, and insulin concentrations, in adult subjects. Cynthia M. Kroeger, Kristin K. Hoddy, and Krista A. Varady Copyright © 2014 Cynthia M. Kroeger et al. All rights reserved. Alterations in Metabolic Profile Occur in Normal-Weight and Obese Men during the Ramadan Fast Despite No Changes in Anthropometry Wed, 06 Aug 2014 07:46:40 +0000 We examined the variations in eating behavior, appetite ratings, satiety efficiency, energy expenditure, anthropometric and metabolic profile markers prior to, during as well as 1 and 4 months after Ramadan in normal-weight and obese men. Anthropometric, energy expenditure (indirect calorimetry and accelerometry), metabolic (fasting blood sample), appetite (visual analogue scales), and eating behavior (Three-Factor Eating Questionnaire) measurements were performed in 10 normal-weight (age: 25.2 ± 4.7 years; BMI: 24.4 ± 1.9 kg/m2) and 10 obese (age: 27.0 ± 4.5 years; BMI: 34.8 ± 3.7 kg/m2) men. The satiety quotient (SQ) was calculated 180 minutes after breakfast consumption. All anthropometric variables, as well as resting and total energy expenditure, were greater in obese compared to normal-weight participants (P = 0.02–0.0001). Similarly, obese participants had greater triglycerides, insulin, and homeostatic model assessment-insulin resistance concentrations (P = 0.02–0.002). Greater apolipoprotein B, glucose, total cholesterol, and low-density lipoprotein concentrations were noted during Ramadan (P = 0.04–0.0001). Dietary restraint scores were also greater during Ramadan (). No differences in anthropometry, other metabolic profile markers, energy expenditure, appetite ratings, and SQ were noted across sessions. Lastly, changes in anthropometric measurements correlated with delta metabolic profile markers, as well as changes in disinhibition eating behavior trait and dietary restraint scores. The Ramadan fast led to increases in certain metabolic profile markers despite no changes in appetite and anthropometry. Jessica McNeil, Mohamed M. Mamlouk, Karine Duval, Alexander Schwartz, Nelson Nardo Junior, and Éric Doucet Copyright © 2014 Jessica McNeil et al. All rights reserved. The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss Wed, 23 Jul 2014 12:32:27 +0000 Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community. Tracy L. Tylka, Rachel A. Annunziato, Deb Burgard, Sigrún Daníelsdóttir, Ellen Shuman, Chad Davis, and Rachel M. Calogero Copyright © 2014 Tracy L. Tylka et al. All rights reserved. Light to Moderate Alcohol Consumption Is Protective for Type 2 Diabetes Mellitus in Normal Weight and Overweight Individuals but Not the Obese Tue, 22 Jul 2014 10:58:34 +0000 Objective. To examine the association between alcohol consumption and risk of type 2 diabetes mellitus (T2DM) overall and by body mass index. Methods. Cross-sectional study of employed individuals. Daily alcohol intakes were calculated from a self-administered food frequency questionnaire by 5,512 Maori, Pacific Island, and European workers (3,992 men, 1520 women) aged 40 years and above. Results. There were 170 new cases of T2DM. Compared to the group with no alcohol consumption and adjusting for age, sex, and ethnicity, the group consuming alcohol had relative risks of T2DM of 0.23 (95% CI: 0.08, 0.65) in normal weight individuals, 0.38 (0.18, 0.81) in overweight individuals, and 0.99 (0.59, 1.67) in obese individuals. After further adjusting for total cholesterol, HDL-cholesterol, triglycerides, smoking habit, physical activity, socioeconomic status, body mass index, and hypertension, the relative risks of T2DM were 0.16 (0.05, 0.50) in normal weight individuals, 0.43 (0.19, 0.97) in overweight individuals, and 0.92 (0.52, 1.60) in overweight individuals. Across the categories of alcohol consumption, there was an approximate U-shaped relationship for new cases of T2DM. There was no significant association between alcohol consumption and IGT. Conclusions. Alcohol consumption was protective against diagnosis of T2DM in normal and overweight individuals but not in the obese. Patricia A. Metcalf, Robert K. R. Scragg, and Rod Jackson Copyright © 2014 Patricia A. Metcalf et al. All rights reserved. Using the Medical Research Council Framework for the Development and Evaluation of Complex Interventions in a Theory-Based Infant Feeding Intervention to Prevent Childhood Obesity: The Baby Milk Intervention and Trial Mon, 21 Jul 2014 00:00:00 +0000 Introduction. We describe our experience of using the Medical Research Council framework on complex interventions to guide the development and evaluation of an intervention to prevent obesity by modifying infant feeding behaviours. Methods. We reviewed the epidemiological evidence on early life risk factors for obesity and interventions to prevent obesity in this age group. The review suggested prevention of excess weight gain in bottle-fed babies and appropriate weaning as intervention targets; hence we undertook systematic reviews to further our understanding of these behaviours. We chose theory and behaviour change techniques that demonstrated evidence of effectiveness in altering dietary behaviours. We subsequently developed intervention materials and evaluation tools and conducted qualitative studies with mothers (intervention recipients) and healthcare professionals (intervention deliverers) to refine them. We developed a questionnaire to assess maternal attitudes and feeding practices to understand the mechanism of any intervention effects. Conclusions. In addition to informing development of our specific intervention and evaluation materials, use of the Medical Research Council framework has helped to build a generalisable evidence base for early life nutritional interventions. However, the process is resource intensive and prolonged, and this should be taken into account by public health research funders. This trial is registered with ISRTCN: 20814693 Baby Milk Trial. Rajalakshmi Lakshman, Simon Griffin, Wendy Hardeman, Annie Schiff, Ann Louise Kinmonth, and Ken K. Ong Copyright © 2014 Rajalakshmi Lakshman et al. All rights reserved. Effectiveness of a Cognitive Behavioral Therapy for Dysfunctional Eating among Patients Admitted for Bariatric Surgery: A Randomized Controlled Trial Mon, 21 Jul 2014 00:00:00 +0000 Objective. To examine whether cognitive behavioral therapy (CBT) alleviates dysfunctional eating (DE) patterns and symptoms of anxiety and depression in morbidly obese patients planned for bariatric surgery. Design and Methods. A total of 98 (68 females) patients with a mean (SD) age of 43 (10) years and BMI 43.5 (4.9) kg/m2 were randomly assigned to a CBT-group or a control group receiving usual care (i.e., nutritional support and education). The CBT-group received ten weekly intervention sessions. DE, anxiety, and depression were assessed by the TFEQ R-21 and HADS, respectively. Results. Compared with controls, the CBT-patients showed significantly less DE, affective symptoms, and a larger weight loss at follow-up. The effect sizes were large (DE-cognitive restraint, , ; DE-uncontrolled eating, , ), moderate (HADS-depression, , ; DE-emotional eating, , ; HADS-anxiety, , ), and low (BMI, , ). Conclusion. This study supports the use of CBT in helping patients preparing for bariatric surgery to reduce DE and to improve mental health. This clinical trial is registered with NCT01403558. Hege Gade, Jøran Hjelmesæth, Jan H. Rosenvinge, and Oddgeir Friborg Copyright © 2014 Hege Gade et al. All rights reserved. Cardiometabolic Risk Assessments by Body Mass Index z-Score or Waist-to-Height Ratio in a Multiethnic Sample of Sixth-Graders Mon, 14 Jul 2014 07:58:36 +0000 Convention defines pediatric adiposity by the body mass index -score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations () and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, attributed to BMIz or WHtR was 19%–28% among high-fatness and 8%–13% among lower-fatness students. for lipid variables was 4%–9% among high-fatness and 2%–7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13–0.20) than for WHtR (0.17–0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart. Henry S. Kahn, Laure El ghormli, Russell Jago, Gary D. Foster, Robert G. McMurray, John B. Buse, Diane D. Stadler, Roberto P. Treviño, Tom Baranowski, and HEALTHY Study Group Copyright © 2014 Henry S. Kahn et al. All rights reserved. The Trajectory and the Related Physical and Social Determinants of Body Mass Index in Elementary School Children: Results from the Child and Adolescent Behaviors in Long-Term Evolution Study Tue, 08 Jul 2014 09:21:26 +0000 This study explored developmental trajectory patterns of BMI and associated factors. Participants included 1,609 students who were followed from age 7 to 12 years. Data collection involved annual self-administered questionnaires and records of height and weight. An ecological model was used to identify the factors associated with BMI trajectories. Group-based trajectory models and multinomial logit models were used in the statistical analysis. There were gender differences in BMI trajectories. Among boys, four BMI trajectories were normal or slightly underweight, persistently normal weight, overweight becoming obese, and persistently obese. Among girls, four BMI trajectories were persistently slightly underweight, persistently normal weight, persistently overweight, and persistently obese. The mean BMI in each trajectory group demonstrated an upward trend over time. In boys, BMI trajectories were significantly associated with after-school exercise, academic performance, family interactions, overweight parents, and father’s education level. In girls, BMI trajectories were significantly associated with television viewing or computer use, family interactions, peer interactions, and overweight parents. Children under age 7 years who are already overweight or obese are an important target for interventions. The different factors associated with BMI trajectories can be used for targeting high risk groups. Li-Ju Lin, Hsing-Yi Chang, Dih-Ling Luh, Baai-Shyun Hurng, and Lee-Lan Yen Copyright © 2014 Li-Ju Lin et al. All rights reserved. Complicated Gallstones after Laparoscopic Sleeve Gastrectomy Thu, 03 Jul 2014 06:22:39 +0000 Background. The natural history of gallstone formation after laparoscopic sleeve gastrectomy (LSG), the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established. Methods. A retrospective review of prospectively collected database of 150 patients that underwent LSG was reviewed. Results. Preoperatively, gallbladder disease was identified in 32 of the patients (23.2%). Postoperatively, eight of 138 patients (5.8%) became symptomatic. Namely, three of 23 patients (13%) who had evident cholelithiasis preoperatively developed complicated cholelithiasis. From the cohort of patients without preoperative cholelithiasis, five of 106 patients (4.7%) experienced complicated gallstones after LSG. Total cumulative incidence of complicated gallstones was 4.7% (95% CI: 1.3–8.1%). The gallbladder disease-free survival rate was 92.2% at 2 years. No patient underwent cholecystectomy earlier than 9 months or later than 23 months indicating the post-LSG effect. Conclusion. A significant proportion of bariatric patients compared to the general population became symptomatic and soon developed complications after LSG, thus early cholecystectomy is warranted. Routine concomitant cholecystectomy could be considered because the proportion of patients who developed complications especially those with potentially significant morbidities is high and the time to develop complications is short and because of the real technical difficulties during subsequent cholecystectomy. Eleni Sioka, Dimitris Zacharoulis, Eleni Zachari, Dimitris Papamargaritis, Ourania Pinaka, Georgia Katsogridaki, and George Tzovaras Copyright © 2014 Eleni Sioka et al. All rights reserved. Associations of Body Mass Index with Sexual Risk-Taking and Injection Drug Use among US High School Students Tue, 01 Jul 2014 08:47:54 +0000 The purpose of this study was to determine if body mass index (BMI) is associated with behaviors that may increase risk for HIV and other sexually transmitted diseases (STDs) among US high school students. We analyzed nationally representative data from the 2005–2011 national Youth Risk Behavior Surveys (YRBS) to examine associations of BMI categories with sexual risk behaviors and injection drug use among sexually active high school students, using sex-stratified logistic regression models. Controlling for race/ethnicity and grade, among female and male students, both underweight (BMI < 5th percentile) and obesity (BMI ≥ 95th percentile) were associated with decreased odds of being currently sexually active (i.e., having had sexual intercourse during the past 3 months). However, among sexually active female students, obese females were more likely than normal weight females to have had 4 or more sex partners (odds ratio, OR = 1.59), not used a condom at last sexual intercourse (OR = 1.30), and injected illegal drugs (OR = 1.98). Among sexually active male students, overweight (85th percentile ≤ BMI < 95th percentile) was associated with not using a condom at last sexual intercourse (OR = 1.19) and obesity was associated with injection drug use (OR = 1.42). Among sexually active students, overweight and obesity may be indicators of increased risk for HIV and other STDs. Richard Lowry, Leah Robin, Laura Kann, and Deborah A. Galuska Copyright © 2014 Richard Lowry et al. All rights reserved. Do DSM-5 Eating Disorder Criteria Overpathologize Normative Eating Patterns among Individuals with Obesity? Thu, 26 Jun 2014 13:52:43 +0000 Background. DSM-5 revisions have been criticized in the popular press for overpathologizing normative eating patterns—particularly among individuals with obesity. To evaluate the evidence for this and other DSM-5 critiques, we compared the point prevalence and interrater reliability of DSM-IV versus DSM-5 eating disorders (EDs) among adults seeking weight-loss treatment. Method. Clinicians () assigned DSM-IV and DSM-5 ED diagnoses to 100 participants via routine clinical interview. Research assessors () independently conferred ED diagnoses via Structured Clinical Interview for DSM-IV and a DSM-5 checklist. Results. Research assessors diagnosed a similar proportion of participants with EDs under DSM-IV (29%) versus DSM-5 (32%). DSM-5 research diagnoses included binge eating disorder (9%), bulimia nervosa (2%), subthreshold binge eating disorder (5%), subthreshold bulimia nervosa (2%), purging disorder (1%), night eating syndrome (6%), and other (7%). Interrater reliability between clinicians and research assessors was “substantial” for both DSM-IV ( = 0.64, 84% agreement) and DSM-5 ( = 0.63, 83% agreement). Conclusion. DSM-5 ED criteria can be reliably applied in an obesity treatment setting and appear to yield an overall ED point prevalence comparable to DSM-IV. Jennifer J. Thomas, Katherine A. Koh, Kamryn T. Eddy, Andrea S. Hartmann, Helen B. Murray, Mark J. Gorman, Stephanie Sogg, and Anne E. Becker Copyright © 2014 Jennifer J. Thomas et al. All rights reserved. Prevalence of Obesity in Hail Region, KSA: In a Comprehensive Survey Wed, 25 Jun 2014 08:03:41 +0000 Background. Obesity contributes significantly to morbidity and mortality rates worldwide. We, therefore, aimed to provide epidemiological data on the prevalence of obesity in Hail, Kingdom of Saudi Arabia (KSA). Methodology. Data were collected during cross-sectional survey which included 5000 Saudi selected from 30 primary health care centers (PHCs) in Hail Region. Results. The overall prevalence of obesity in Hail was 63.6%. Moreover, the prevalence of males was 56.2% and the prevalence of females was 71%. Conclusion. Obesity is prevalent in the Hail Region which necessitates urgent interventions including health education. Hussain Gadelkarim Ahmed, Ibrahim Abdelmajeed Ginawi, Abdelbaset Mohamed Elasbali, Ibraheem M. Ashankyty, and Awdah M. Al-hazimi Copyright © 2014 Hussain Gadelkarim Ahmed et al. All rights reserved. Physical Activity in Different Preschool Settings: An Exploratory Study Tue, 24 Jun 2014 12:12:47 +0000 Introduction. Physical activity (PA) in preschoolers is vital to protect against obesity but is influenced by different early-life factors. The present study investigated the impact of different preschool programs and selected family factors on preschoolers’ PA in different countries in an explorative way. Methods. The PA of 114 children (age = 5.3 ± 0.65 years) attending different preschool settings in four cities of the trinational Upper Rhine region (Freiburg, Landau/Germany, Basel/Switzerland, and Strasbourg/France) was measured by direct accelerometry. Anthropometrical and family-related data were obtained. Timetables of preschools were analyzed. Results. Comparing the preschool settings, children from Strasbourg and Landau were significantly more passive than children from Basel and Freiburg (). With regard to the family context as an important early-life factor, a higher number of children in a family along with the mother’s and child’s anthropometrical status are predictors of engagement in PA. Conclusion. More open preschool systems such as those in Basel, Freiburg, and Landau do not lead to more PA “per se” compared to the highly regimented desk-based system in France. Preliminaries such as special training and the number of caregivers might be necessary elements to enhance PA. In family contexts, targeted PA interventions for special groups should be more focused in the future. Katrin Röttger, Elke Grimminger, Friederike Kreuser, Lorenz Assländer, Albert Gollhofer, and Ulrike Korsten-Reck Copyright © 2014 Katrin Röttger et al. All rights reserved. Hostility Modifies the Association between TV Viewing and Cardiometabolic Risk Mon, 23 Jun 2014 05:43:53 +0000 Background. It was hypothesized that television viewing is predictive of cardiometabolic risk. Moreover, people with hostile personality type may be more susceptible to TV-induced negative emotions and harmful health habits which increase occurrence of cardiometabolic risk. Purpose. The prospective association of TV viewing on cardiometabolic risk was examined along with whether hostile personality trait was a modifier. Methods. A total of 3,269 Black and White participants in the coronary artery risk development in young adults (CARDIA) study were assessed from age 23 to age 35. A cross-lagged panel model at exam years 5, 10, 15, and 20, covering 15 years, was used to test whether hours of daily TV viewing predicted cardiometabolic risk, controlling confounding variables. Multiple group analysis of additional cross-lagged panel models stratified by high and low levels of hostility was used to evaluate whether the association was modified by the hostile personality trait. Results. The cross-lagged association of TV viewing at years 5 and 15 on clustered cardiometabolic risk score at years 10 and 20 was significant ( and 0.051), but not at 10 to 15 years. This association was significant for those with high hostility ( for exam years 5 to 10 and 0.057 for exam years 15 to 20) but not low hostility. Conclusion. These findings indicate that TV viewing is positively associated with cardiometabolic risk. Further, they indicate that hostility might be a modifier for the association between TV viewing and cardiometabolic risk. Anthony Fabio, Chung-Yu Chen, Kevin H. Kim, Darin Erickson, David R. Jacobs Jr., Janice C. Zgibor, Tammy Chung, Karen A. Matthews, Steven Sidney, Carlos Iribarren, and Mark A. Pereira Copyright © 2014 Anthony Fabio et al. All rights reserved. Perception of Childhood Obesity and Support for Prevention Policies among Latinos and Whites Thu, 19 Jun 2014 13:18:26 +0000 A cross-sectional survey was administered to Latino and White residents of Omaha, NE, to assess perception of the childhood obesity problem, attribution of responsibility, and support for obesity-related policies. The sample included 40.8% () Latinos and 59.2% () Whites. Among Latinos, 25% did not see childhood obesity as a problem, compared to 6% of Whites (). This difference persisted after adjusting for age, gender, and education level (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.07–4.14). Latinos were more likely to agree that government was responsible for addressing childhood obesity compared to Whites (OR 2.81, 95% CI 1.82–4.35). Higher support for policy interventions was observed among individuals who perceived childhood obesity as a big problem compared to those who did not, independent of race, sex, age, or education level. The relationship between support for tax-based policies and perception of the childhood obesity problem was mainly evident among Latinos rather than Whites. Despite city-wide efforts to address obesity, differential penetration in community subgroups appears evident. There is room to further engage Latinos in the cause of obesity. Deepening community awareness about the consequences and complexity of childhood obesity can lead to stronger support for childhood obesity policy interventions. Douglas M. Puricelli Perin, Leah Frerichs, Sergio Costa, Amelie G. Ramirez, and Terry T.-K. Huang Copyright © 2014 Douglas M. Puricelli Perin et al. All rights reserved. Measuring Physical Inactivity: Do Current Measures Provide an Accurate View of “Sedentary” Video Game Time? Wed, 04 Jun 2014 11:38:57 +0000 Background. Measures of screen time are often used to assess sedentary behaviour. Participation in activity-based video games (exergames) can contribute to estimates of screen time, as current practices of measuring it do not consider the growing evidence that playing exergames can provide light to moderate levels of physical activity. This study aimed to determine what proportion of time spent playing video games was actually spent playing exergames. Methods. Data were collected via a cross-sectional telephone survey in South Australia. Participants aged 18 years and above () were asked about their video game habits, as well as demographic and socioeconomic factors. In cases where children were in the household, the video game habits of a randomly selected child were also questioned. Results. Overall, 31.3% of adults and 79.9% of children spend at least some time playing video games. Of these, 24.1% of adults and 42.1% of children play exergames, with these types of games accounting for a third of all time that adults spend playing video games and nearly 20% of children’s video game time. Conclusions. A substantial proportion of time that would usually be classified as “sedentary” may actually be spent participating in light to moderate physical activity. Simon Fullerton, Anne W. Taylor, Eleonora Dal Grande, and Narelle Berry Copyright © 2014 Simon Fullerton et al. All rights reserved. Risk Factors for Excessive Gestational Weight Gain in a Healthy, Nulliparous Cohort Tue, 03 Jun 2014 12:13:25 +0000 Objective. Excessive gestational weight gain (GWG) is associated with adverse maternal and child outcomes and contributes to obesity in women. Our aim was to identify early pregnancy factors associated with excessive GWG, in a contemporary nulliparous cohort. Methods. Participants in the SCOPE study were classified into GWG categories (“not excessive” versus “excessive”) based on pregravid body mass index (BMI) using 2009 Institute of Medicine (IOM) guidelines. Maternal characteristics and pregnancy risk factors at 14–16 weeks were compared between categories and multivariable analysis controlled for confounding factors. Results. Of 1950 women, 17% gained weight within the recommended range, 74% had excessive and 9% inadequate GWG. Women with excessive GWG were more likely to be overweight (adjOR 2.9 (95% CI 2.2–3.8)) or obese (adjOR 2.5 (95% CI 1.8–3.5)) before pregnancy compared to women with a normal BMI. Other factors independently associated with excessive GWG included recruitment in Ireland, younger maternal age, increasing maternal birthweight, cessation of smoking by 14–16 weeks, increased nightly sleep duration, high seafood diet, recent immigrant, limiting behaviour, and decreasing exercise by 14–16 weeks. Fertility treatment was protective. Conclusions. Identification of potentially modifiable risk factors for excessive GWG provides opportunities for intervention studies to improve pregnancy outcome and prevent maternal obesity. Antonia Restall, Rennae S. Taylor, John M. D. Thompson, Deralie Flower, Gustaaf A. Dekker, Louise C. Kenny, Lucilla Poston, and Lesley M. E. McCowan Copyright © 2014 Antonia Restall et al. All rights reserved. Emphasising Personal Investment Effects Weight Loss and Hedonic Thoughts about Food after Obesity Surgery Mon, 02 Jun 2014 06:12:08 +0000 Obesity surgery is the most effective treatment method for the severely obese but does not work for everyone. Indications are that weight-loss success may be related to individuals’ sense of investment in surgery, with failure linked to higher automatic hedonic motivations to consume food and greater susceptibility to food in the environment. A pilot study using an independent experimental design recruited bariatric surgery patients via a UK obesity-surgery charity website who were randomly allocated to either the intervention or the control condition. The intervention involved raising the salience of the personal investment made in having weight-loss surgery in an attempt to reduce automatic hedonic thoughts about food and aid weight loss. Data was collected initially with subsequent weight loss measured at 3 months of follow-up. Following the intervention, participants reported significantly reduced hedonic thoughts, increased liking for low-fat foods, reduced liking of high-fat food, and higher self-efficacy for achieving sustained weight loss than controls. By 3 months, this was translated into significant differences in mean weight losses of 6.77 kg for the intervention group and 0.91 kg for control participants. To conclude, a quick simple cost-effective intervention encouraging participants to focus on investment helped weight loss and changed hedonic thoughts about food in bariatric patients. Margaret Husted and Jane Ogden Copyright © 2014 Margaret Husted and Jane Ogden. All rights reserved. Effect of Parental Migration Background on Childhood Nutrition, Physical Activity, and Body Mass Index Sun, 01 Jun 2014 08:00:09 +0000 Background. Poor nutrition, lack of physical activity, and obesity in children have important public health implications but, to date, their effects have not been studied in the growing population of children in Sweden with immigrant parents. Methods. We estimated the association between parental migration background and nutrition, physical activity, and weight in 8-year-old children born in Stockholm between 1994 and 1996 of immigrants and Swedish parents (). Data were collected through clinical examination and questionnaires filled out by parents. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using multivariable logistic regression. Results. Children of immigrants complied more closely with Nordic Nutrition Recommendations compared with those of Swedes (OR = 1.35, 95% CI 1.11–1.64). They had higher intake of dietary fibre, vitamins C, B6, and E, folic acid, and polyunsaturated fatty acids (omega-3 and omega-6) reflecting higher consumption of foods of plant origin, but lower intake of vitamins A and D, calcium, and iron reflecting lower consumption of dairy products. Children of immigrants had higher intake of sucrose reflecting higher consumption of sugar and sweets. Furthermore, these children had a higher risk of having low physical activity (OR = 1.31, 95% CI 1.06–1.62) and being overweight (OR = 1.33, 95% CI 1.06–1.65) compared with children of Swedish parents. The odds of having low physical activity and being overweight were even higher in children whose parents were both immigrants. A low level of parental education was associated with increased risk of low physical activity regardless of immigration background. Conclusions. Culturally appropriate tools to capture the diverse range of ethnic foods and other lifestyle habits are needed. Healthcare professionals should be aware of the low levels of physical activity, increased weight, and lack of consumption of some important vitamins among children of immigrants. Mohsen Besharat Pour, Anna Bergström, Matteo Bottai, Inger Kull, Magnus Wickman, Niclas Håkansson, Alicja Wolk, and Tahereh Moradi Copyright © 2014 Mohsen Besharat Pour et al. All rights reserved. Associations of Subjective Social Status with Physical Activity and Body Mass Index across Four Asian Countries Wed, 28 May 2014 11:44:46 +0000 Objective. The aims of this study were to (1) assess physical activity and weight status differences and (2) explore the direction and shape of subjective social status (SSS) association with physical activity and weight status within four Asian countries. Methods. Cross section data of adult respondents from the nationally representative East Asian Social Survey were used for analyses. Logistic regression stratified by gender was conducted for the first aim, and simple and quadratic logistic regression models were used for the second. Results. SSS was significantly associated with odds of weekly or daily physical activity across all countries and genders, except for South Korean and Japanese females. Quadratic models provided significantly better fit for Chinese males (LR (d.f. = 1) = 6.51, P value ) and females (LR (d.f. = 1) = 7.36, P value ), South Korean males (LR (d.f. = 1) = 4.40, P value ), and Taiwanese females (LR (d.f. = 1) = 4.87, P value ). Conclusions. This study provides a comparable cross Asian country measure of moderate-to-vigorous physical activity and new findings that a connection exists between SSS and physical activity. Differences of class distinction help explain the different shaped SSS relationships. Leah Frerichs, Terry T.-K. Huang, and Duan-Rung Chen Copyright © 2014 Leah Frerichs et al. All rights reserved. Lifestyle Interventions Targeting Body Weight Changes during the Menopause Transition: A Systematic Review Mon, 26 May 2014 13:33:45 +0000 Objective. To determine the effectiveness of exercise and/or nutrition interventions and to address body weight changes during the menopause transition. Methods. A systematic review of the literature was conducted using electronic databases, grey literature, and hand searching. Two independent researchers screened for studies using experimental designs to evaluate the impact of exercise and/or nutrition interventions on body weight and/or central weight gain performed during the menopausal transition. Studies were quality appraised using Cochrane risk of bias. Included studies were analyzed descriptively. Results. Of 3,564 unique citations screened, 3 studies were eligible (2 randomized controlled trials, and 1 pre/post study). Study quality ranged from low to high risk of bias. One randomized controlled trial with lower risk of bias concluded that participation in an exercise program combined with dietary interventions might mitigate body adiposity increases, which is normally observed during the menopause transition. The other two studies with higher risk of bias suggested that exercise might attenuate weight loss or weight gain and change abdominal adiposity patterns. Conclusions. High quality studies evaluating the effectiveness of interventions targeting body weight changes in women during their menopause transition are needed. Evidence from one higher quality study indicates an effective multifaceted intervention for women to minimize changes in body adiposity. Janet Jull, Dawn Stacey, Sarah Beach, Alex Dumas, Irene Strychar, Lee-Anne Ufholz, Stephanie Prince, Joseph Abdulnour, and Denis Prud’homme Copyright © 2014 Janet Jull et al. All rights reserved. Malnutrition, Overweight, and Obesity among Urban and Rural Children in North of West Azerbijan, Iran Sun, 25 May 2014 11:55:21 +0000 Introduction. Malnutrition is one of the most important causes for improper physical and mental development of children. Childhood obesity is a worldwide public health problem. The increasing prevalence of childhood obesity has become a growing matter of public health concern worldwide. The aim of the current study was to determine the prevalence of malnutrition and obesity in children under 5 years old in Salmas district. Methods. The current study is a cross-sectional study conducted on 902 of children under 5 years old to assess the nutritional status in Salmas district and performed from 16 until 30 October, 2011, with the cooperation of the Office of Community Nutrition Improvement and the United Nations Children’s Fund. ENA (Emergency Nutrition Assessment) and Spss software were used for data analysis. Results. 49.6% of children were boys and 50.4% were girls. The prevalence of malnutrition based on underweight, stunting, and wasting was estimated to be 2.3%, 7.3%, and 1.4% among children, respectively. Stunting was more common in rural areas and this difference was significant (). Conclusion. In this area stunting, overweight and obesity were the most important priorities that health officials must pay more attention to. ENA software has a special ability to determine the samples and clusters and is a simple, rapid, and accurate method, especially in epidemiological studies in the country, and can be a convenient tool and its use is suggested for the same studies. Sakineh Nouri Saeidlou, Fariba Babaei, and Parvin Ayremlou Copyright © 2014 Sakineh Nouri Saeidlou et al. All rights reserved. Comparison of the Effectiveness of Four Bariatric Surgery Procedures in Obese Patients with Type 2 Diabetes: A Retrospective Study Thu, 22 May 2014 05:55:42 +0000 Aim. The aim of the present retrospective study was to evaluate the efficacy of four bariatric surgical procedures to induce diabetes remission and lower cardiovascular risk factors in diabetic obese patients. Moreover, the influence of surgery on weight evolution in the diabetic population was compared with that observed in a nondiabetic matched population. Methods. Among 970 patients who were operated on in our center since 2001, 81 patients were identified as type 2 diabetes. Laparoscopic adjustable gastric banding (GB), intervention type Mason (MA), gastric bypass (RYGB), and sleeve gastrectomy (SG) were performed, respectively, in 25%, 17%, 28%, and 30% of this diabetic population. Results. The resolution rate of diabetes one year after surgery was significantly higher after SG than GB (62.5% versus 20%, ), but not significantly different between SG and RYGB. In terms of LDL-cholesterol reduction, RYGB was equivalent to SG and superior to CGMA or GB. Considering the other cardiovascular risk factors, there was no significant difference according to surgical procedures. The weight loss was not statistically different between diabetic and nondiabetic matched patients regardless of the surgical procedures used. Conclusion. Our data confirm that the efficacy of surgery to treat diabetes is variable among the diverse procedures and SG might be an interesting option in this context. Sylvie Pham, Antoine Gancel, Michel Scotte, Estelle Houivet, Emmanuel Huet, Hervé Lefebvre, Jean-Marc Kuhn, and Gaetan Prevost Copyright © 2014 Sylvie Pham et al. All rights reserved. Binge Eating Behavior and Weight Loss Maintenance over a 2-Year Period Thu, 08 May 2014 00:00:00 +0000 Objective. To investigate the relationship between binge eating behavior and weight loss maintenance over a two-year period in adults. Design. Secondary data analysis using the Keep It Off study, a randomized trial evaluating an intervention to promote weight loss maintenance. Participants. 419 men and women (ages: 20 to 70 y; BMI: 20–44 kg/m2) who had intentionally lost ≥10% of their weight during the previous year. Measurements. Body weight was measured and binge eating behavior over the past 6 months was reported at baseline, 12 months and 24 months. Height was measured at baseline. Results. Prevalence of binge eating at baseline was 19.4% (). Prevalence of binge eating at any time point was 30.1% (). Although rate of weight regain did not differ significantly between those who did or did not report binge eating at baseline, binge eating behavior across the study period (additive value of presence or absence at each time point) was significantly associated with different rates of weight regain. Conclusion. Tailoring weight loss maintenance interventions to address binge eating behavior is warranted given the prevalence and the different rates of weight regain experienced by those reporting this behavior. Carly R. Pacanowski, Meghan M. Senso, Kristin Oriogun, A. Lauren Crain, and Nancy E. Sherwood Copyright © 2014 Carly R. Pacanowski et al. All rights reserved. Sexual Orientation Disparities in BMI among US Adolescents and Young Adults in Three Race/Ethnicity Groups Tue, 29 Apr 2014 08:10:32 +0000 Obesity is a key public health issue for US youth. Previous research with primarily white samples of youth has indicated that sexual minority females have higher body mass index (BMI) and sexual minority males have lower BMI than their same-gender heterosexual counterparts, with sexual orientation differences in males increasing across adolescence. This research explored whether gender and sexual orientation differences in BMI exist in nonwhite racial/ethnic groups. Using data from Waves I–IV (1995–2009) of the US National Longitudinal Study of Adolescent Health (N = 13,306, ages 11–34 years), we examined associations between sexual orientation and BMI (kg/m2) over time, using longitudinal linear regression models, stratified by gender and race/ethnicity. Data were analyzed in 2013. Among males, heterosexual individuals showed greater one-year BMI gains than gay males across all race/ethnicity groups. Among females, white and Latina bisexual individuals had higher BMI than same-race/ethnicity heterosexual individuals regardless of age; there were no sexual orientation differences in black/African Americans. Sexual orientation disparities in BMI are a public health concern across race/ethnicity groups. Interventions addressing unhealthy weight gain in youth must be relevant for all sexual orientations and race/ethnicities. Sabra L. Katz-Wise, Emily A. Blood, Carly E. Milliren, Jerel P. Calzo, Tracy K. Richmond, Holly C. Gooding, and S. Bryn Austin Copyright © 2014 Sabra L. Katz-Wise et al. All rights reserved. Reaching Perinatal Women Online: The Healthy You, Healthy Baby Website and App Mon, 28 Apr 2014 14:02:39 +0000 Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs) to offer healthy lifestyle counselling. In response, today’s Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff. Lydia Hearn, Margaret Miller, and Leanne Lester Copyright © 2014 Lydia Hearn et al. All rights reserved. Erratum to “Associations of Cardiorespiratory Fitness and Fatness with Metabolic Syndrome in Rural Women with Prehypertension” Mon, 28 Apr 2014 12:51:35 +0000 Patricia A. Hageman, Carol H. Pullen, Melody Hertzog, Linda S. Boeckner, and Susan Noble Walker Copyright © 2014 Patricia A. Hageman et al. All rights reserved. School-Based Obesity Prevention Intervention in Chilean Children: Effective in Controlling, but not Reducing Obesity Sun, 27 Apr 2014 14:03:25 +0000 Objective. To evaluate the effectiveness of a 12-month multicomponent obesity prevention intervention. Setting. 9 elementary schools in Santiago, Chile. Subjects. 6–8 y old low-income children (). Design. Randomized controlled study; 5 intervention/4 control schools. We trained teachers to deliver nutrition contents and improve the quality of PE classes. We determined % healthy snacks brought from home, children’s nutrition knowledge, nutritional status, duration of PE classes, and % time in moderate/vigorous activity (MVA). Effectiveness was determined by comparing BMI between intervention and control children using PROCMIXED. Results. % obesity increased in boys from both types of schools and in girls from control schools, while decreasing in girls from intervention schools (all nonsignificant). % class time in MVA declined (24.5–16.2) while remaining unchanged (24.8–23.7%) in classes conducted by untrained and trained teachers, respectively. In boys, BMI declined (1.33–1.24) and increased (1.22–1.35) in intervention and control schools, respectively. In girls, BMI remained unchanged in intervention schools, while increasing significantly in control schools (0.91–1.06, ). Interaction group time was significant for boys () and girls (). Conclusions. This intervention was effective in controlling obesity, but not preventing it. Even though impact was small, results showed that when no intervention is implemented, obesity increases. Juliana Kain, Fernando Concha, Lorena Moreno, and Bárbara Leyton Copyright © 2014 Juliana Kain et al. All rights reserved.