Journal of Obesity The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Weight Fluctuation and Postmenopausal Breast Cancer in the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study Wed, 03 Feb 2016 09:28:52 +0000 Objective. The aim of this study is to investigate if weight fluctuation is an independent risk factor for postmenopausal breast cancer (PBC) among women who gained weight in adult years. Methods. NHANES I Epidemiologic Follow-Up Study (NHEFS) database was used in the study. Women that were cancers-free at enrollment and diagnosed for the first time with breast cancer at age 50 or greater were considered cases. Controls were chosen from the subset of cancers-free women and matched to cases by years of follow-up and status of body mass index (BMI) at 25 years of age. Weight fluctuation was measured by the root-mean-square-error (RMSE) from a simple linear regression model for each woman with their body mass index (BMI) regressed on age (started at 25 years) while women with the positive slope from this regression were defined as weight gainers. Data were analyzed using conditional logistic regression models. Results. A total of 158 women were included into the study. The conditional logistic regression adjusted for weight gain demonstrated positive association between weight fluctuation in adult years and postmenopausal breast cancers (odds ratio/OR = 1.67; 95% confidence interval/CI: 1.06–2.66). Conclusions. The data suggested that long-term weight fluctuation was significant risk factor for PBC among women who gained weight in adult years. This finding underscores the importance of maintaining lost weight and avoiding weight fluctuation. Marina Komaroff Copyright © 2016 Marina Komaroff. All rights reserved. Implementation of an Internet Weight Loss Program in a Worksite Setting Thu, 28 Jan 2016 09:14:54 +0000 Background. Worksite wellness programs typically produce modest weight losses. We examined whether an efficacious Internet behavioral weight loss program could be successfully implemented in a worksite setting. Methods. Participants were 75 overweight or obese employees/dependents of a large healthcare system who were given access to a 12-week Internet-based, multicomponent behavioral weight loss program. Assessments occurred at baseline, Month 3 (end of intervention), and Month 6 (follow-up). Results. Retention was excellent (93% at Month 3 and 89% at Month 6). Intent-to-treat analyses demonstrated that participants lost an average (±SE) of  kg from baseline to Month 3 and regained  kg from Month 3 to Month 6; overall, weight loss from baseline to Month 6 was  kg, . Men lost more weight than women, , and individuals who had a college degree or higher lost more weight than those with less education, . Adherence to viewing lessons (8 of 12) and self-monitoring (83% of days) was excellent and significantly associated with weight loss, . Conclusions. An Internet-based behavioral weight management intervention can be successfully implemented in a worksite setting and can lead to clinically significant weight losses. Given the low costs of offering this program, it could easily be widely disseminated. Kathryn M. Ross and Rena R. Wing Copyright © 2016 Kathryn M. Ross and Rena R. Wing. All rights reserved. The Obesity Paradox and Heart Failure: A Systematic Review of a Decade of Evidence Wed, 20 Jan 2016 11:08:46 +0000 There is scientific consensus that obesity increases the risk of cardiovascular diseases, including heart failure. However, among persons who already have heart failure, outcomes seem to be better in obese persons as compared with lean persons: this has been termed the obesity paradox, the mechanisms of which remain unclear. This study systematically reviewed the evidence of the relationship between heart failure mortality (and survival) and weight status. Search of the PubMed/MEDLINE and EMBASE databases was done according to the PRISMA protocol. The initial search identified 9879 potentially relevant papers, out of which ten studies met the inclusion criteria. One study was a randomized clinical trial and 9 were observational cohort studies: 6 prospective and 3 retrospective studies. All studies used the BMI, WC, or TSF as measure of body fatness and NYHA Classification of Heart Failure and had single outcomes, death, as study endpoint. All studies included in review were longitudinal studies. All ten studies reported improved outcomes for obese heart failure patients as compared with their normal weight counterparts; worse prognosis was demonstrated for extreme obesity ( kg/m2). The findings of this review will be of significance in informing the practice of asking obese persons with heart failure to lose weight. However, any such recommendation on weight loss must be consequent upon more conclusive evidence on the mechanisms of the obesity paradox in heart failure and exclusion of collider bias. Emmanuel Aja Oga and Olabimpe Ruth Eseyin Copyright © 2016 Emmanuel Aja Oga and Olabimpe Ruth Eseyin. All rights reserved. Clinical Manifestations Associated with Overweight/Obesity in Puerto Ricans with Fibromyalgia Syndrome Mon, 18 Jan 2016 09:10:50 +0000 Objective. To determine the clinical manifestations associated with overweight/obesity in Hispanics from Puerto Rico with fibromyalgia syndrome (FMS). Methods. A cross-sectional study was performed in 144 patients with FMS (per American College of Rheumatology (ACR) classification criteria). Sociodemographic features, FMS-related symptoms, tender points (per ACR criteria), comorbidities, and FMS treatment were examined. BMI was calculated and patients were grouped into two categories: BMI ≤ 24.9 kg/m2 (nonoverweight/obese) and BMI ≥ 25 kg/m2 (overweight/obese). Bivariate and multivariate analyses were used to evaluate differences between the study groups. Results. The mean (standard deviation (SD)) age of patients was 50.2 (9.9) years; 95.1% were females and 75.7% were overweight/obese. In the bivariate analysis, overweight/obese patients were more likely to have self-reported memory impairment, anxiety, shortness of breath, and urinary frequency than nonoverweight/obese patients. In addition, the tender point count was higher in the overweight/obese group. In the logistic regression analyses, self-reported memory impairment and urinary frequency differences remained significant after adjusting for confounding variables. Conclusion. In this population of Puerto Ricans with FMS, overweight/obese patients experienced more FMS-related manifestations than nonoverweight/obese individuals. However, prospective studies are needed to confirm these associations and to elucidate if weight reduction interventions could favorably impact the severity of FMS. Ruth M. Fred-Jiménez, Mariangelí Arroyo-Ávila, Ángel M. Mayor, Grissel Ríos, and Luis M. Vilá Copyright © 2016 Ruth M. Fred-Jiménez et al. All rights reserved. Obesity Severity, Dietary Behaviors, and Lifestyle Risks Vary by Race/Ethnicity and Age in a Northern California Cohort of Children with Obesity Thu, 14 Jan 2016 09:08:39 +0000 Identification of modifiable behaviors is important for pediatric weight management and obesity prevention programs. This study examined obesogenic behaviors in children with obesity in a Northern California obesity intervention program using data from a parent/teen-completed intake questionnaire covering dietary and lifestyle behaviors (frequency of breakfast, family meals, unhealthy snacking and beverages, fruit/vegetable intake, sleep, screen time, and exercise). Among 7956 children with BMI ≥ 95th percentile, 45.5% were females and 14.2% were 3–5, 44.2% were 6–11, and 41.6% were 12–17 years old. One-quarter (24.9%) were non-Hispanic white, 11.3% were black, 43.5% were Hispanic, and 12.0% were Asian/Pacific Islander. Severe obesity was prevalent (37.4%), especially among blacks, Hispanics, and older children, and was associated with less frequent breakfast and exercise and excess screen time, and in young children it was associated with consumption of sweetened beverages or juice. Unhealthy dietary behaviors, screen time, limited exercise, and sleep were more prevalent in older children and in selected black, Hispanic, and Asian subgroups, where consumption of sweetened beverages or juice was especially high. Overall, obesity severity and obesogenic behaviors increased with age and varied by gender and race/ethnicity. We identified several key prevalent modifiable behaviors that can be targeted by healthcare professionals to reduce obesity when counseling children with obesity and their parents. Margaret C. Ford, Nancy P. Gordon, Amanda Howell, Cheryl E. Green, Louise C. Greenspan, Malini Chandra, R. Grant Mellor, and Joan C. Lo Copyright © 2016 Margaret C. Ford et al. All rights reserved. A Copy Number Variant on Chromosome 20q13.3 Implicated in Thinness and Severe Obesity Thu, 31 Dec 2015 06:49:11 +0000 Background/Objectives. To identify copy number variants (CNVs) which are associated with body mass index (BMI). Subjects/Methods. CNVs were identified using array comparative genomic hybridization (aCGH) on members of pedigrees ascertained through severely obese (BMI ≥ 35 kg/m2) sib pairs (86 pedigrees) and thin (BMI ≤ 23 kg/m2) probands (3 pedigrees). Association was inferred through pleiotropy of BMI with CNV intensity ratio. Results. A 77-kilobase CNV on chromosome 20q13.3, confirmed by real-time qPCR, exhibited deletions in the obese subjects and duplications in the thin subjects (). Further support for the presence of a deletion derived from inference by likelihood analysis of null alleles for SNPs residing in the region. Conclusions. One or more of 7 genes residing in a chromosome 20q13.3 CNV region appears to influence BMI. The strongest candidate is ARFRP1, which affects glucose metabolism in mice. Sandra J. Hasstedt, Yuanpei Xin, Rong Mao, Tracey Lewis, Ted D. Adams, and Steven C. Hunt Copyright © 2015 Sandra J. Hasstedt et al. All rights reserved. Determinants of Weight Loss following Laparoscopic Sleeve Gastrectomy: The Role of Psychological Burden, Coping Style, and Motivation to Undergo Surgery Sun, 15 Nov 2015 07:28:40 +0000 Background. The amount of excess weight loss (%EWL) among obese patients after bariatric surgery varies greatly. However, reliable predictors have not been established yet. The present study evaluated the preoperative psychological burden, coping style, and motivation to lose weight as factors determining postoperative treatment success. Methods. The sample included 64 morbidly obese patients with a preoperative BMI of  kg/m2 who had undergone laparoscopic sleeve gastrectomy (LSG). Well-established questionnaires were applied before surgery to assess the psychological burden in terms of “perceived stress” (PSQ-20), “depression” (PHQ-9), “anxiety” (GAD-7), and “mental impairment” (ISR) as well as coping style (Brief COPE) and motivation to lose weight. %EWL as an indicator for treatment success was assessed on average 20 months after surgery. Results. Based on the %EWL distribution, patients were classified into three %EWL groups: low (14–39%), moderate (40–59%), and high (60–115%). LSG patients with high %EWL reported significantly more “active coping” behavior prior to surgery than patients with moderate and low %EWL. Patients’ preoperative psychological burden and motivation to lose weight were not associated with %EWL. Conclusion. An “active coping” style might be of predictive value for better weight loss outcomes in patients following LSG intervention. Andrea Figura, Anne Ahnis, Andreas Stengel, Tobias Hofmann, Ulf Elbelt, Jürgen Ordemann, and Matthias Rose Copyright © 2015 Andrea Figura et al. All rights reserved. Perceived and Ideal Body Image in Young Women in South Western Saudi Arabia Wed, 11 Nov 2015 07:09:01 +0000 Objectives. The aim of this study was to investigate perceived and ideal body image (BI) and associated factors among female university students in Saudi Arabia. Methods. This cross-sectional study included 663 university female students. Anthropometric measurements including weight, height, BMI, and BI perception (the 9-figure silhouette) were obtained. Descriptive and logistic regression analysis were conducted. Results. An agreement between actual, perceived, and ideal BI was found in 23% of the participants. Behavioral (activity levels), social (presence of obese parents and fathers’ level of education), and economic factors (households’ monthly income, number of cars in the household, and kind of residence) were positively and significantly associated with the desire to be thinner. Similarly, socioeconomic associations (number of sisters and number of cars in the household) correlated positively and significantly with the desire to be heavier. Conclusions. The whole family should rather be considered in interventions related to appearance concerns and BI discrepancies. Furthermore, campaigns targeting improvement of adolescents’ physical self-image should be a major priority of the public health sector. Atika Khalaf, Albert Westergren, Vanja Berggren, Örjan Ekblom, and Hazzaa M. Al-Hazzaa Copyright © 2015 Atika Khalaf et al. All rights reserved. Gastrojejunal Anastomosis Complications and Their Management after Laparoscopic Roux-en-Y Gastric Bypass Sun, 18 Oct 2015 16:51:39 +0000 Background. Complications at the gastrojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass (LRYGB) are challenging in terms of diagnosis, therapy, and prevention. This study aims at identifying these complications and discussing their management. Methods. Data of 228 patients who underwent a LRYGB between October 2008 and December 2011 were reviewed retrospectively to evaluate the frequency and treatment of complications such as stenoses, marginal ulcers, perforated marginal ulcers, or anastomotic leaks related to the operation. Results. Follow-up information was available for 209 patients (91.7%) with a median follow-up of 38 months (range 24–62 months). Of these patients 16 patients (7.7%) experienced complications at the gastrojejunostomy. Four patients (1.9%) had stenoses and 12 patients (5.7%) marginal ulcers, one of them with perforation (0.5%). No anastomotic leaks were reported. One case with perforated ulcer and one with recurrent ulcers required surgical revision. Conclusion. Gastrojejunal anastomotic complications are frequent and occur within the first few days or up to several years after surgery. Stenoses or marginal ulcers are usually successfully treated nonoperatively. Laparoscopic repair, meanwhile, is an appropriate therapeutic option for perforated ulcers. Yannick Fringeli, Marc Worreth, and Igor Langer Copyright © 2015 Yannick Fringeli et al. All rights reserved. Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures Wed, 30 Sep 2015 16:35:05 +0000 Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve). We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed. Ramon Vilallonga, José Manuel Fort, Enric Caubet, Oscar Gonzalez, José Maria Balibrea, Andrea Ciudin, and Manel Armengol Copyright © 2015 Ramon Vilallonga et al. All rights reserved. Gender Differences in the Appetite Response to a Satiating Diet Wed, 09 Sep 2015 14:18:59 +0000 We examined gender differences in appetite sensations when exposed to Mediterranean diet (MedDiet) meals and determined whether there are gender differences in the change in the satiating properties of the MedDiet over time. Thirty-eight men and 32 premenopausal women consumed a 4-week isoenergetic MedDiet under controlled conditions. Visual analogue scales were used to measure perceived appetite sensations before and immediately after each meal consumed over the course of one day (Wednesday) of the first and the fourth week of intervention. Women reported greater decreases for desire to eat, hunger, and appetite score than men in response to the consumption of the MedDiet meals (gender-by-meal interactions, resp., , , and ). Fullness and prospective food consumption responses did not significantly differ between men and women. Between the first and the fourth week of intervention, premeal prospective food consumption increased with time in men () but not in women (; for gender-by-time interaction = 0.04). These results indicate gender differences in appetite sensations when exposed to the MedDiet. These results may be useful in order to have a better understanding of gender issues for body weight management. Alexandra Bédard, Anne-Marie Hudon, Vicky Drapeau, Louise Corneau, Sylvie Dodin, and Simone Lemieux Copyright © 2015 Alexandra Bédard et al. All rights reserved. Weight Maintenance with Litramine (IQP-G-002AS): A 24-Week Double-Blind, Randomized, Placebo-Controlled Study Mon, 07 Sep 2015 11:40:03 +0000 Background. Litramine (IQP-G-002AS) was shown to be effective and safe for weight loss in overweight and obese subjects. However, long-term effectiveness on maintenance of body weight loss has yet to be ascertained. Objective. To assess effect of Litramine on maintenance of body weight loss. Methods. A double-blind, randomised, placebo-controlled trial on overweight and obese patients was conducted over two sites in Germany for 24 weeks. Subjects with documented previous weight loss of 3% over the last 3–6 months were randomised to groups given either Litramine (3 g/day) or a matching placebo. Primary endpoints were difference of mean body weight (kg) between baseline and end of study and maintenance of initially lost body weight in verum group, where maintenance is defined as ≤1% weight gain. Results. Subjects who were taking Litramine lost significantly more body weight compared to the subjects taking placebo who gained weight instead ( kg versus  kg, ). More importantly, 92% of subjects in Litramine group were able to maintain their body weight after initial weight loss, versus 25% in placebo group. No serious adverse events were reported throughout. Conclusion. Litramine is effective and safe for long-term body weight maintenance. Trial Registration. This trial is registered with identifier: NCT01505387. Barbara Grube, Pee-Win Chong, Felix Alt, and Ralf Uebelhack Copyright © 2015 Barbara Grube et al. All rights reserved. Green Space and Child Weight Status: Does Outcome Measurement Matter? Evidence from an Australian Longitudinal Study Wed, 02 Sep 2015 09:04:01 +0000 Objective. To examine whether neighbourhood green space is beneficially associated with (i) waist circumference (WC) and (ii) waist-to-height ratio (WtHR) across childhood. Methods. Gender-stratified multilevel linear regressions were used to examine associations between green space and objective measures of weight status in the Longitudinal Study of Australian Children, a nationally representative source of data on 4,423 children aged 6 y to 13 y. WC and WtHR were measured objectively. Percentage green space within the local area of residence was calculated. Effect modification by age was explored, adjusting for socioeconomic confounding. Results. Compared to peers with 0–5% green space locally, boys and girls with >40% green space tended to have lower WC (  −1.15, 95% CI −2.44, 0.14;   −0.21, 95% CI −1.47, 1.05) and WtHR (  −0.82, 95% CI −1.65, 0.01;   −0.32, 95% CI −1.13, 0.49). Associations among boys were contingent upon age (  ) and robust to adjustment for socioeconomic variables. The benefits of greener neighbourhoods appeared from age 7, with mean WC and WtHR for boys aged 13 y with >40% green space at 73.85 cm and 45.75% compared to those with 0–5% green space at 75.18 cm and 46.62%, respectively. Conclusions. Greener neighbourhoods appear beneficial to alternative child weight status measures, particularly among boys. Taren Sanders, Xiaoqi Feng, Paul P. Fahey, Chris Lonsdale, and Thomas Astell-Burt Copyright © 2015 Taren Sanders et al. All rights reserved. The Influence of Urinary Concentrations of Organophosphate Metabolites on the Relationship between BMI and Cardiometabolic Health Risk Thu, 20 Aug 2015 11:53:48 +0000 The objective was to determine whether detectable levels of OP metabolites influence the relationship between BMI and cardiometabolic health. This cross-sectional study was conducted using 2227 adults from the 1999–2008 NHANES datasets. Urinary concentrations of six dialkyl phosphate metabolites were dichotomized to above and below the detection limit. Weighted multiple regression analysis was performed adjusting for confounding variables. Independent of BMI, individuals with detectable metabolites had higher diastolic blood pressure (for dimethylphosphate, diethylphosphate, and diethyldithiophosphate; ), lower HDL (for diethyldithiophosphate; ), and higher triglyceride (for dimethyldithiophosphate; ) than those below detection. Contrarily, those with detectable dimethylthiophosphate had better LDL, HDL, and total cholesterol, independent of BMI. Individuals at a higher BMI range who had detectable diethylphosphate (interaction: ) and diethylthiophosphate (interaction: ) exhibited lower HDL, while little difference existed between OP metabolite detection statuses at lower BMIs. Similarly, individuals with high BMIs and detectable diethylphosphate had higher triglyceride than those without detectable levels, while minimal differences between diethylphosphate detection statuses were observed at lower BMIs (interaction: ). Thus, cardiometabolic health outcome differs depending on the specific OP metabolite being examined, with higher BMIs amplifying health risk. Mahsa Ranjbar, Michael A. Rotondi, Chris I. Ardern, and Jennifer L. Kuk Copyright © 2015 Mahsa Ranjbar et al. All rights reserved. Genetic and Diet-Induced Obesity Increased Intestinal Tumorigenesis in the Double Mutant Mouse Model Multiple Intestinal Neoplasia X Obese via Disturbed Glucose Regulation and Inflammation Mon, 10 Aug 2015 12:42:54 +0000 We have studied how spontaneous or carcinogen-induced intestinal tumorigenesis was affected by genetic or diet-induced obesity in C57BL/6J- X C57BL/6J- mice. Obesity was induced by the obese (ob) mutation in the lep gene coding for the hormone leptin, or by a 45% fat diet. The effects of obesity were examined on spontaneous intestinal tumors caused by the multiple intestinal neoplasia (Min) mutation in the adenomatous polyposis coli (Apc) gene and on tumors induced by the dietary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP). F1 ob/ob (homozygous mutated) mice had increased body weight (bw) and number of spontaneous and PhIP-induced small intestinal tumors (in mice), versus ob/wt (heterozygous mutated) and wt/wt mice (homozygous wild-type). A 45% fat diet exacerbated bw and spontaneous tumor numbers versus 10% fat, but not PhIP-induced tumors. Except for bw, ob/wt and wt/wt were not significantly different. The obesity caused hyperglucosemia and insulinemia in ob/ob mice. A 45% fat diet further increased glucose, but not insulin. Inflammation was seen as increased TNFα levels in ob/ob mice. Thus the results implicate disturbed glucose regulation and inflammation as mechanisms involved in the association between obesity and intestinal tumorigenesis. Ob/ob mice had shorter lifespan than ob/wt and wt/wt mice. Ha Thi Ngo, Ragna Bogen Hetland, Unni Cecilie Nygaard, and Inger-Lise Steffensen Copyright © 2015 Ha Thi Ngo et al. All rights reserved. Response to: Comment on “Intervention Effects of a School-Based Health Promotion Programme on Obesity Related Behavioural Outcomes” Sun, 09 Aug 2015 08:42:54 +0000 Susanne Kobel, Tamara Wirt, Anja Schreiber, Dorothea Kesztyüs, Sarah Kettner, Nanette Erkelenz, Olivia Wartha, and Jürgen M. Steinacker Copyright © 2015 Susanne Kobel et al. All rights reserved. Sustained Weight Loss with Vagal Nerve Blockade but Not with Sham: 18-Month Results of the ReCharge Trial Sun, 12 Jul 2015 11:26:24 +0000 Background/Objectives. Vagal block therapy (vBloc) is effective for moderate to severe obesity at one year. Subjects/Methods. The ReCharge trial is a double-blind, randomized controlled clinical trial of 239 participants with body mass index (BMI) of 40 to 45 kg/m or 35 to 40 kg/m with one or more obesity-related conditions. Interventions were implantation of either vBloc or Sham devices and weight management counseling. Mixed models assessed percent excess weight loss (%EWL) and total weight loss (%TWL) in intent-to-treat analyses. At 18 months, 142 (88%) vBloc and 64 (83%) Sham patients remained enrolled in the study. Results. 18-month weight loss was 23% EWL (8.8% TWL) for vBloc and 10% EWL (3.8% TWL) for Sham (). vBloc patients largely maintained 12-month weight loss of 26% EWL (9.7% TWL). Sham regained over 40% of the 17% EWL (6.4% TWL) by 18 months. Most weight regain preceded unblinding. Common adverse events of vBloc through 18 months were heartburn/dyspepsia and abdominal pain; 98% of events were reported as mild or moderate and 79% had resolved. Conclusions. Weight loss with vBloc was sustained through 18 months, while Sham regained weight between 12 and 18 months. vBloc is effective with a low rate of serious complications. Scott A. Shikora, Bruce M. Wolfe, Caroline M. Apovian, Mehran Anvari, David B. Sarwer, Robert D. Gibbons, Sayeed Ikramuddin, Christopher J. Miller, Mark B. Knudson, Katherine S. Tweden, Michael G. Sarr, and Charles J. Billington Copyright © 2015 Scott A. Shikora et al. All rights reserved. Feasibility and Impact of a Combined Supervised Exercise and Nutritional-Behavioral Intervention following Bariatric Surgery: A Pilot Study Tue, 23 Jun 2015 11:18:10 +0000 Background. Lifestyle intervention programs after bariatric surgery have been suggested to maximise health outcomes. This pilot study aimed to investigate the feasibility and impact of an 8-week combined supervised exercise with nutritional-behavioral intervention following Roux-en-Y gastric bypass and sleeve gastrectomy. Methods. Eight female patients (44 ± 8 years old, BMI = 38.5 ± 7.2 kgm−2) completed the program. Before and after intervention, anthropometric measures, six-minute walk test (6MWT), physical activity level, eating behavior, and quality of life (QoL) were assessed. Percentage weight loss (%WL) outcomes were compared with a historical matched control group. Results. The program significantly improved functional capacity (mean increment in 6MWT was 127 ± 107 meters, ), increased strenuous intensity exercise (44 ± 49 min/week, ), increased consumption of fruits and vegetables (), reduced consumption of ready meals (), and improved “Change in Health” in QoL domain (). The intervention group exhibited greater %WL in the 3–12-month postsurgery period compared to historical controls, 12.2 ± 7.5% versus 5.1 ± 5.4%, respectively (). Conclusions. Lifestyle intervention program following bariatric surgery is feasible and resulted in several beneficial outcomes. A large randomised control trial is now warranted. Friedrich C. Jassil, Sean Manning, Neville Lewis, Siri Steinmo, Helen Kingett, Fiona Lough, Andrea B. F. Pucci, W. H. Cheung, Nicholas Finer, Judith Walker, Jaqueline Doyle, and Rachel L. Batterham Copyright © 2015 Friedrich C. Jassil et al. All rights reserved. Targeting Feeding and Eating Behaviors: Development of the Feeding Dynamic Intervention for Caregivers of 2- to 5-Year-Old Children Tue, 23 Jun 2015 10:13:21 +0000 Targeting feeding dynamics, a concept centered on the roles and interaction of the caregiver and child in a feeding relationship, may have significant potential for obesity intervention. The aim of this paper is to describe the 3-phase development of the Feeding Dynamics Intervention (FDI), an acceptability and feasibility study on implementing the feeding dynamic roles (Study 1), development of the FDI content (Study 2), and a pilot study on use of the 6-lesson FDI to promote behaviors consistent with a feeding dynamic approach (Study 3). Sample population was mothers with young children, 2–5 years old. An effect size (Hedges’ g) greater than 0.20 was seen in more than half (57%) of maternal feeding behaviors, with the largest effect sizes (Hedges’ ) occurring with behaviors that represent the mother adopting her roles of determining what food is served, not using food as a reward, and not controlling her child’s intake. There was a significant decline in Pressure to Eat behaviors (2.9 versus 2.2, ) and Monitoring (4.1 versus 3.5, ). The FDI emerged as an acceptable and implementable intervention. Future studies need to investigate effects of the FDI on the child’s eating behaviors, self-regulation of energy intake, and anthropometrics. Ihuoma U. Eneli, Tracy L. Tylka, Rosanna P. Watowicz, Jessica Hummel, Jan Ritter, and Julie C. Lumeng Copyright © 2015 Ihuoma U. Eneli et al. All rights reserved. Protective Effects of Tamarillo (Cyphomandra betacea) Extract against High Fat Diet Induced Obesity in Sprague-Dawley Rats Thu, 11 Jun 2015 12:34:55 +0000 This study aims to investigate the protective effect of Cyphomandra betacea in adult male Sprague-Dawley rats fed with high fat diet. Rats were fed on either normal chow or high fat diet for 10 weeks for obesity induction phase and subsequently received C. betacea extract at low dose (150 mg kg−1), medium dose (200 mg kg−1), or high dose (300 mg kg−1) or placebo via oral gavages for another 7 weeks for treatment phase. Treatment of obese rats with C. betacea extracts led to a significant decrease in total cholesterol and significant increase in HDL-C (). Also there was a trend of positive reduction in blood glucose, triglyceride, and LDL-C with positive reduction of body weight detected in medium and high dosage of C. betacea extract. Interestingly, C. betacea treated rats showed positive improvement of superoxide dismutase (SOD) activity and glutathione peroxidase (GPx) activity along with a significant increase of total antioxidant status (TAS) (). Further, rats treated with C. betacea show significantly lower in TNF-α and IL-6 activities (). This study demonstrates the potential use of Cyphomandra betacea extract for weight maintenance and complimentary therapy to suppress some obesity complication signs. Noor Atiqah Aizan Abdul Kadir, Asmah Rahmat, and Hawa Z. E. Jaafar Copyright © 2015 Noor Atiqah Aizan Abdul Kadir et al. All rights reserved. Comment on “School-Based Obesity Prevention Intervention in Chilean Children: Effective in Controlling, but not Reducing Obesity” Thu, 11 Jun 2015 08:14:59 +0000 Peng Li, Andrew W. Brown, J. Michael Oakes, and David B. Allison Copyright © 2015 Peng Li et al. All rights reserved. Health Care Consumption during Pregnancy in relation to Maternal Body Mass Index: A Swedish Population Based Observational Study Tue, 26 May 2015 08:49:01 +0000 Objective. To assess whether antenatal health care consumption is associated with maternal body mass index (BMI). Design. A register based observational study. Methods. The Swedish Medical Birth Register, the Maternal Health Care Register, and the Inpatient Register were used to determine antenatal health care consumption according to BMI categories for primiparous women with singleton pregnancies, from 2006 to 2008, . Pairwise comparisons among BMI groups are obtained post hoc by Tukey HSD test. Result. Obese women were more often admitted for in-patient care (), had longer antenatal hospital stays (), and were more often sick-listed by an obstetrician () during their pregnancy, compared to women with normal weight women. Preeclampsia was more than four times as common, hypertension five times as common, and gestational diabetes 11 times as common when comparing in-patient care, obese to normal weight women ( for all comparisons). Underweight mothers had longer stay in hospitals () and hydronephrosis and hyperemesis gravidarum were more than twice as common (both ). Conclusion. Obese and underweight mothers consumed significantly more health care resources and obese women were significantly more often sick-listed during their pregnancy when compared to pregnant women of normal weight. Elisabeth S. Lindholm, Daniel Altman, Margareta Norman, and Marie Blomberg Copyright © 2015 Elisabeth S. Lindholm et al. All rights reserved. Comment on “Intervention Effects of a School-Based Health Promotion Programme on Obesity Related Behavioural Outcomes” Mon, 25 May 2015 10:48:50 +0000 Peng Li, Andrew W. Brown, J. Michael Oakes, and David B. Allison Copyright © 2015 Peng Li et al. All rights reserved. Associations of Physical Activity and Sedentary Behaviors with Dietary Behaviors among US High School Students Mon, 25 May 2015 06:51:47 +0000 Background. Physical activity (PA), sedentary behaviors, and dietary behaviors are each associated with overweight and obesity among youth. However, the associations of PA and sedentary behaviors with dietary behaviors are complex and not well understood. Purpose. To describe the associations of PA and sedentary behaviors with dietary behaviors among a representative sample of US high school students. Methods. We analyzed data from the 2010 National Youth Physical Activity and Nutrition Study (NYPANS). Using logistic regression models which controlled for sex, race/ethnicity, grade, body weight status, and weight management goals, we compared dietary behaviors among students who did and did not meet national recommendations for PA and sedentary behaviors. Results. Students who participated in recommended levels of daily PA (DPA) and muscle strengthening PA (MSPA) were more likely than those who did not to eat fruits and vegetables. Students who exceeded recommended limits for television (TV) and computer/video game (C/VG) screen time were less likely than those who did not to consume fruits and vegetables and were more likely to consume fast food and sugar-sweetened beverages. Conclusions. Researchers may want to address PA, sedentary behaviors, and dietary behaviors jointly when developing health promotion and obesity prevention programs for youth. Richard Lowry, Shannon Michael, Zewditu Demissie, Laura Kann, and Deborah A. Galuska Copyright © 2015 Richard Lowry et al. All rights reserved. The Molecular Mechanism Underlying Continuous Exercise Training-Induced Adaptive Changes of Lipolysis in White Adipose Cells Wed, 13 May 2015 11:37:56 +0000 Physical exercise accelerates the mobilization of free fatty acids from white adipocytes to provide fuel for energy. This happens in several tissues and helps to regulate a whole-body state of metabolism. Under these conditions, the hydrolysis of triacylglycerol (TG) that is found in white adipocytes is known to be augmented via the activation of these lipolytic events, which is referred to as the “lipolytic cascade.” Indeed, evidence has shown that the lipolytic responses in white adipocytes are upregulated by continuous exercise training (ET) through the adaptive changes in molecules that constitute the lipolytic cascade. During the past few decades, many lipolysis-related molecules have been identified. Of note, the discovery of a new lipase, known as adipose triglyceride lipase, has redefined the existing concepts of the hormone-sensitive lipase-dependent hydrolysis of TG in white adipocytes. This review outlines the alterations in the lipolytic molecules of white adipocytes that result from ET, which includes the molecular regulation of TG lipases through the lipolytic cascade. Junetsu Ogasawara, Tetsuya Izawa, Tomonobu Sakurai, Takuya Sakurai, Ken Shirato, Yoshinaga Ishibashi, Hitoshi Ishida, Hideki Ohno, and Takako Kizaki Copyright © 2015 Junetsu Ogasawara et al. All rights reserved. Frequent Self-Weighing and Visual Feedback for Weight Loss in Overweight Adults Tue, 12 May 2015 06:22:47 +0000 Evidence has suggested that self-weighing may be beneficial for weight control in adults, but few studies have independently assessed the contribution of this behavior to weight loss. This study experimentally tested daily self-weighing and visual feedback (the Caloric Titration Method (CTM)) as a weight loss and weight loss maintenance intervention over 2 years. 162 overweight individuals were randomized to the CTM intervention or delayed treatment control group. In year 1, weight change was compared between groups, and in year 2, the control group started using the CTM while the intervention group continued using the CTM for maintenance. A significant difference in weight loss over the first year (CTM n = 70; 2.6 ± 5.9 kg versus control n = 65; 0.5 ± 4.4 kg, p = 0.019) was qualified by a group × gender × time interaction (p = 0.002) such that men lost more weight using the CTM. In year 2, the CTM group maintained their weight and the control group lost an amount similar to the intervention group in year 1. Daily self-weighing and visual feedback facilitated a minimal amount of weight loss and maintenance of this loss. Future research investigating characteristics of those who benefit from this type of self-directed intervention is warranted. Carly R. Pacanowski and David A. Levitsky Copyright © 2015 Carly R. Pacanowski and David A. Levitsky. All rights reserved. Early Obesity Prevention: A Randomized Trial of a Practice-Based Intervention in 0–24-Month Infants Mon, 11 May 2015 13:19:16 +0000 Objective. A pediatric office-based intervention was implemented following a randomized, controlled design, aimed at improving child feeding practices and growth patterns and ultimately reducing risk for overweight and obesity later in life. Methods. Four clinics (232 infants) were randomized to control or intervention (I), the latter delivered by health care provider at each of 7–9 well-baby visits over 2 years, using a previously developed program (Growing Leaps and Bounds) that included verbal, visual, and text advice and information for parents. Results. The I group offered significantly less soda , sweetened tea , punch and/or cow’s milk to infants and delayed the introduction of drink/food other than breast milk . Parents in the I group had a higher perceived parental monitoring and restriction on infant feeding. While the I group exhibited at baseline more adverse socioeconomic indicators than the control group, growth trajectory or body size indices did not significantly differ between groups. Conclusions. Education provided by health care providers in addition to follow-up monthly phone calls may help modify parental behaviors related to child feeding and increase parental sense of responsibility toward child eating behaviors. Natalia Schroeder, Berenice Rushovich, Edward Bartlett, Sangita Sharma, Joel Gittelsohn, and Benjamin Caballero Copyright © 2015 Natalia Schroeder et al. All rights reserved. Edmonton Obesity Staging System Prevalence and Association with Weight Loss in a Publicly Funded Referral-Based Obesity Clinic Tue, 28 Apr 2015 08:29:33 +0000 Objectives. To determine the distribution of EOSS stages and differences in weight loss achieved according to EOSS stage, in patients attending a referral-based publically funded multisite weight management clinic. Subjects/Methods. 5,787 obese patients were categorized using EOSS staging using metabolic risk factors, medication use, and severity of doctor diagnosis of obesity-related physiological, functional, and psychological comorbidities from electronic patient files. Results. The prevalence of EOSS stages 0 (no risk factors or comorbidities), 1 (mild conditions), 2 (moderate conditions), and 3 (severe conditions) was 1.7%, 10.4%, 84.0%, and 3.9%, respectively. Prehypertension (63%), hypertension (76%), and knee replacement (33%) were the most common obesity-related comorbidities for stages 1, 2, and 3, respectively. In the models including age, sex, initial BMI, EOSS stage, and treatment time, lower EOSS stage and longer treatment times were independently associated with greater absolute (kg) and percentage of weight loss relative to initial body weight . Conclusions. Patients attending this publicly funded, referral-based weight management clinic were more likely to be classified in the higher stages of EOSS. Patients in higher EOSS stages required longer treatment times to achieve similar weight outcomes as those in lower EOSS stages. Karissa L. Canning, Ruth E. Brown, Sean Wharton, Arya M. Sharma, and Jennifer L. Kuk Copyright © 2015 Karissa L. Canning et al. All rights reserved. Maternal Obesity Management Using Mobile Technology: A Feasibility Study to Evaluate a Text Messaging Based Complex Intervention during Pregnancy Thu, 16 Apr 2015 11:24:42 +0000 Background. Maternal obesity and excessive gestational weight gain (GWG) are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech) study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30) with healthier lifestyles and limit GWG. Methods. Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention’s acceptability and suggested improvements. Results. Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg) and few (28% versus 50%) exceeded the Institute of Medicine’s upper limit of 9 kg GWG for obese women. Conclusions. MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits. Hora Soltani, Alexandra M. S. Duxbury, Madelynne A. Arden, Andy Dearden, Penny J. Furness, and Carolyn Garland Copyright © 2015 Hora Soltani et al. 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.