Journal of Obesity The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Rethinking Obesity Counseling: Having the French Fry Discussion Sun, 19 Oct 2014 09:41:03 +0000 Childhood obesity is a complex problem that warrants early intervention. General recommendations for obesity prevention and nutrition counseling exist. However, these are notably imprecise with regard to early and targeted interventions to prevent and treat obesity in pediatric populations. This study examines family medicine primary care providers’ (PCPs) perceived barriers for preventing and treating pediatric obesity and their related practice behavior during well-child visits. Methods. A written survey addressing perceived barriers and current practices addressing obesity at well-child visits were administered to PCPs at eleven family medicine clinics in the Duke University Health System. Results. The most common perceived barriers identified by PCPs to prevention or treatment of obesity in children were families not getting enough exercise (93%) and families too often having fast food meals (86%). Most PCPs do not discuss fast foods at or prior to the twelve-month well-child visit. The two-year visit is the first well-child visit at which a majority of PCPs (68%) discuss fast food. Conclusion. No clear consensus exists as to when PCPs should discuss fast food in early well-child checks. Previous research has shown a profound shift in children’s dietary habits toward fast foods, such as French fries, that occurs between the one- and two-year well-child checks. Consideration should be given to having a “French Fry Discussion” at every twelve-month well-child care visit. Jonathan Bonnet, Aaron George, Pippa Evans, Mina Silberberg, and Diana Dolinsky Copyright © 2014 Jonathan Bonnet et al. All rights reserved. Association between Anxiety Levels and Weight Change in the Multiethnic Study of Atherosclerosis Wed, 08 Oct 2014 09:56:21 +0000 Objective. To examine the association between anxiety and weight change in a multiethnic cohort followed for approximately 10 years. Methods. The study population consisted of participants of the multiethnic study of atherosclerosis who met specified inclusion criteria (n = 5,799). Weight was measured at baseline and four subsequent follow-up exams. Anxiety was analyzed as sex-specific anxiety quartiles (QANX). The relationship between anxiety level and weight change was examined using a mixed-effect model with weight as the dependent variable, anxiety and time as the independent variables, and adjusted for covariates. Results. Average annual weight change (range) was −0.17 kg (−6.04 to 4.38 kg) for QANX 1 (lowest anxiety), −0.16 kg (−10.71 to 4.45 kg) for QANX 2, −0.15 kg (−8.69 to 6.39 kg) for QANX 3, and −0.20 kg (−7.12 to 3.95 kg) for QANX 4 (highest anxiety). No significant association was noted between QANX and weight change. However, the highest QANX was associated with a −2.48 kg (95% CI = −3.65, −1.31) lower baseline weight compared to the lowest QANX after adjustment for all covariates. Conclusions. Among adults, age 45–84, higher levels of anxiety, defined by the STPI trait anxiety scale, are associated with lower average baseline weight but not with weight change. Katherine Rieke, Ramon Durazo-Arvizu, Kiang Liu, Erin D. Michos, Amy Luke, and Holly Kramer Copyright © 2014 Katherine Rieke et al. All rights reserved. Barriers to Lose Weight from the Perspective of Children with Overweight/Obesity and Their Parents: A Sociocultural Approach Thu, 02 Oct 2014 09:09:57 +0000 Introduction. There are not enough studies about the barriers to lose weight from the perspective of children and their parents. Methods. Children and adolescents diagnosed with overweight/obesity in the Department of Endocrinology and their parents were invited to participate in a series of focus group discussions (FGD). Twenty-nine children 10–16 years old and 22 parents participated in 7 focus groups; 2 mothers and 2 adolescents participated in depth interviews. All interviews were recorded, transcribed, and analyzed through grounded theory. Results. Parents went to the hospital only when their children presented any obesity complication; for them, overweight was not a health problem. Parents referred to lack of time to supervise about a healthy diet and exercise; besides, the same parents, relatives, friends, and the mass media encourage the consumption of junk food. Children accepted eating a lot, not doing exercise, skipping meals, and not understanding overweight consequences. Both, parents and children, demanded support to do the time recommended for exercise inside the schools. They also suggested getting information from schools and mass media (TV) about overweight consequences, exercise, and healthy food by health workers; they recommended prohibiting announcements about junk food and its sale. Conclusions. The barriers detected were lack of perception of being overweight, its identification as a disease and its consequences, lack of time to supervise a healthy lifestyle, and a big social influence to eat junk food. Ana Lilia Rodríguez-Ventura, Ingris Pelaez-Ballestas, Reyna Sámano-Sámano, Carlos Jimenez-Gutierrez, and Carlos Aguilar-Salinas Copyright © 2014 Ana Lilia Rodríguez-Ventura et al. All rights reserved. Maternal Weight Gain in Pregnancy and Risk of Obesity among Offspring: A Systematic Review Thu, 02 Oct 2014 07:59:31 +0000 Objectives. To systematically review the evidence from prospective and retrospective cohort studies on the association between gestational weight gain (GWG) and offspring’s body weight. Methods. Electronic databases PubMed, Web of Science, CINAHL, and Academic Search Premiere were searched from inception through March 18, 2013. Included studies () were English articles that examined the independent associations of GWG with body mass index (BMI) and/or overweight status in the offspring aged 2 to 18.9 years. Two authors independently extracted the data and assessed methodological quality of the included studies. Results. Evidence from cohort studies supports that total GWG and exceeding the Institute of Medicine maternal weight gain recommendation were associated with higher BMI -score and elevated risk of overweight or obesity in offspring. The evidence of high rate of GWG during early- and mid-pregnancy is suggestive. Additionally, the evidence on inadequate GWG and net GWG in relation to body weight outcomes in offspring is insufficient to draw conclusions. Conclusions. These findings suggest that GWG is a potential risk factor for childhood obesity. However, findings should be interpreted with caution due to measurement issues of GWG and potential confounding effects of shared familial characteristics (i.e., genetics and maternal and child’s lifestyle factors). Erica Y. Lau, Junxiu Liu, Edward Archer, Samantha M. McDonald, and Jihong Liu Copyright © 2014 Erica Y. Lau et al. All rights reserved. A Preliminary Observation of Weight Loss Following Left Gastric Artery Embolization in Humans Tue, 30 Sep 2014 10:04:42 +0000 Background/Objectives. Embolization of the left gastric artery (LGA), which preferentially supplies the gastric fundus, has been shown to produce weight loss in animal models. However, weight loss after LGA embolization in humans has not been previously established. The aim of this study was to evaluate postprocedural weight loss in patients following LGA embolization. Subjects/Methods. A retrospective analysis of the medical records of patients who underwent LGA embolization for upper gastrointestinal (GI) bleeding was performed. Postprocedural weight loss in this group was compared to a control group of patients who had undergone embolization of other arteries for upper GI bleeding. Results. The experimental group () lost an average of 7.3% of their initial body weight within three months of LGA embolization, which was significantly greater than the 2% weight loss observed in the control group () (). No significant differences were seen between the groups in preprocedural body mass index (BMI), age, postprocedural care in the intensive care unit, history of malignancy, serum creatinine, or left ventricular ejection fraction. Conclusions. The current data suggest that body weight in humans may be modulated via LGA embolization. Continued research is warranted with prospective studies to further investigate this phenomenon. Andrew J. Gunn and Rahmi Oklu Copyright © 2014 Andrew J. Gunn and Rahmi Oklu. All rights reserved. High Fat Diet Induces Adhesion of Platelets to Endothelium in Two Models of Dyslipidemia Sun, 28 Sep 2014 08:47:00 +0000 Cardiovascular diseases (CVD) represent about 30% of all global deaths. It is currently accepted that, in the atherogenic process, platelets play an important role, contributing to endothelial activation and modulation of the inflammatory phenomenon, promoting the beginning and formation of lesions and their subsequent thrombotic complications. The objective of the present work was to study using immunohistochemistry, the presence of platelets, monocytes/macrophages, and cell adhesion molecules (CD61, CD163, and CD54), in two stages of the atheromatous process. CF-1 mice fed a fat diet were used to obtain early stages of atheromatous process, denominated early stage of atherosclerosis, and ApoE−/− mice fed a fat diet were used to observe advanced stages of atherosclerosis. The CF-1 mice model presented immunostaining on endothelial surface for all three markers studied; the advanced atherosclerosis model in ApoE−/− mice also presented granular immunostaining on lesion thickness, for the same markers. These results suggest that platelets participate in atheromatous process from early stages to advance d stages. High fat diet induces adhesion of platelets to endothelial cells in vivo. These findings support studying the participation of platelets in the formation of atheromatous plate. Jaime Gonzalez, Wendy Donoso, Natalia Díaz, María Eliana Albornoz, Ricardo Huilcaman, Erik Morales, and Rodrigo Moore-Carrasco Copyright © 2014 Jaime Gonzalez et al. All rights reserved. Associations between Aspects of Friendship Networks, Physical Activity, and Sedentary Behaviour among Adolescents Wed, 24 Sep 2014 06:18:50 +0000 Background. Adolescent friendships have been linked to physical activity levels; however, network characteristics have not been broadly examined. Method. In a cross-sectional analysis of 1061 adolescents (11–15 years), achieving 60 minutes/day of moderate-to-vigorous physical activity (MVPA) and participating in over 2 hours/day of sedentary behaviour were determined based on friendship network characteristics (density; proportion of active/sedentary friends; betweenness centrality; popularity; clique membership) and perceived social support. Results. Adolescents with no friendship nominations participated in less MVPA. For boys and girls, a ten percent point increase in active friends was positively associated with achievement of 60 minutes/day of MVPA (OR 1.11; 95% CI 1.02–1.21, OR 1.14; 95% CI 1.02–1.27, resp.). For boys, higher social support from friends was negatively associated with achieving 60 minutes/day of MVPA (OR 0.63; 95% CI 0.42–0.96). Compared with low density networks, boys in higher density networks were more likely to participate in over 2 hours/day of sedentary behaviour (OR 2.93; 95% CI 1.32–6.49). Social support from friends also modified associations between network characteristics and MVPA and sedentary behaviour. Conclusion. Different network characteristics appeared to have different consequences. The proportion of active close friends was associated with MVPA, while network density was associated with sedentary behaviour. This poses challenges for intervention design. Keri Jo Sawka, Gavin R. McCormack, Alberto Nettel-Aguirre, Anita Blackstaffe, Rosemary Perry, and Penelope Hawe Copyright © 2014 Keri Jo Sawka et al. All rights reserved. Socioeconomic and Demographic Factors for Spousal Resemblance in Obesity Status and Habitual Physical Activity in the United States Tue, 23 Sep 2014 08:09:41 +0000 Studies suggested that the married population has an increased risk of obesity and assimilation between spouses’ body weight. We examined what factors may affect married spouses’ resemblance in weight status and habitual physical activity (HPA) and the association of obesity/HPA with spouses’ sociodemoeconomic characteristics and lifestyles. Medical Expenditure Panel Survey data of 11,403 adult married couples in the US during years 2006–2008 were used. Absolute-scale difference and relative-scale resemblance indices (correlation and kappa coefficients) in body mass index (BMI) and HPA were estimated by couples’ socioeconomic and demographic characteristics. We found that spousal difference in BMI was smaller for couples with a lower household income, for who were both unemployed, and for older spouses. Correlation coefficient between spouses’ BMI was 0.24, differing by race/ethnicity and family size. Kappa coefficient for weight status (obesity: BMI ≥ 30, overweight: 30 > BMI ≥ 25) was 0.11 and 0.35 for HPA. Never-working women’s husbands had lower odds of obesity than employed women’s husbands (OR = 0.69 (95% CI = 0.53–0.89)). Men’s unemployment status was associated with wives’ greater odds of obesity (OR = 1.31 (95% CI = 1.01–1.71)). HPA was associated with men’s employment status and income level, but not with women’s. The population representative survey showed that spousal resemblance in weight status and HPA varied with socioeconomic and demographic factors. Hsin-Jen Chen, Yinghui Liu, and Youfa Wang Copyright © 2014 Hsin-Jen Chen et al. All rights reserved. Comparison of Relative Waist Circumference between Asian Indian and US Adults Sun, 21 Sep 2014 08:40:16 +0000 Background. Relative to Europeans, Asian Indians have higher rates of type 2 diabetes and cardiovascular disease. Whether differences in body composition may underlie these population differences remains unclear. Methods. We compared directly measured anthropometric data from the Chennai Urban Rural Epidemiology Study (CURES) survey of southern Indians (I) with those from three US ethnic groups (C: Caucasians, A: African Americans, and M: Mexican Americans) from NHANES III (Third National Health and Nutrition Examination Survey). A total of 15,733 subjects from CURES and 5,975 from NHANES III met inclusion criteria (age 20–39, no known diabetes). Results. Asian Indian men and women had substantially lower body mass index, waist circumference, hip circumference, waist-to-hip ratio, and body surface area relative to US groups ( values <0.0001). In contrast, the mean (±se) waist-weight ratio was significantly higher () in I (men 1.35 ± 0.002 and women 1.45 ± 0.002) than in all the US groups (1.09, 1.21, and 1.14 in A, M, and C men; 1.23, 1.33, and 1.26 in A, M, and C women (se ranged from 0.005 to 0.006)). Conclusions. Compared to the US, the waist-weight ratio is significantly higher in men and women from Chennai, India. These results support the hypothesis that Southeast Asian Indians are particularly predisposed toward central adiposity. Harpreet S. Bajaj, Mark A. Pereira, Rajit Mohan Anjana, Raj Deepa, Viswanathan Mohan, Noel T. Mueller, Gundu H. R. Rao, and Myron D. Gross Copyright © 2014 Harpreet S. Bajaj et al. All rights reserved. Addressing Obesity in Special Populations Thu, 18 Sep 2014 13:52:02 +0000 Rachel A. Annunziato, Rachel M. Calogero, and Robyn Sysko Copyright © 2014 Rachel A. Annunziato et al. All rights reserved. Effects of Obesity on Bone Mass and Quality in Ovariectomized Female Zucker Rats Thu, 18 Sep 2014 11:42:24 +0000 Obesity and osteoporosis are two chronic conditions that have been increasing in prevalence. Despite prior data supporting the positive relationship between body weight and bone mineral density (BMD), recent findings show excess body weight to be detrimental to bone mass, strength, and quality. To evaluate whether obesity would further exacerbate the effects of ovariectomy on bone, we examined the tibiae and fourth lumbar (L4) vertebrae from leptin receptor-deficient female () Zucker rats and their heterozygous lean controls () that were either sham-operated or ovariectomized (Ovx). BMD of L4 vertebra was measured using dual-energy X-ray absorptiometry, and microcomputed tomography was used to assess the microstructural properties of the tibiae. Ovariectomy significantly () decreased the BMD of L4 vertebrae in lean and obese Zucker rats. Lower trabecular number and greater trabecular separation () were also observed in the tibiae of lean- and obese-Ovx rats when compared to sham rats. However, only the obese-Ovx rats had lower trabecular thickness (Tb.Th) () than the other groups. These findings demonstrated that ovarian hormone deficiency adversely affected bone mass and quality in lean and obese rats while obesity only affected Tb.Th in Ovx-female Zucker rats. Rafaela G. Feresin, Sarah A. Johnson, Marcus L. Elam, Edward Jo, Bahram H. Arjmandi, and Reza Hakkak Copyright © 2014 Rafaela G. Feresin et al. All rights reserved. Importance of Android/Gynoid Fat Ratio in Predicting Metabolic and Cardiovascular Disease Risk in Normal Weight as well as Overweight and Obese Children Mon, 15 Sep 2014 12:51:17 +0000 Numerous studies have shown that android or truncal obesity is associated with a risk for metabolic and cardiovascular disease, yet there is evidence that gynoid fat distribution may be protective. However, these studies have focused on adults and obese children. The purpose of our study was to determine if the android/gynoid fat ratio is positively correlated with insulin resistance, HOMA2-IR, and dislipidemia in a child sample of varying body sizes. In 7–13-year-old children with BMI percentiles ranging from 0.1 to 99.6, the android/gynoid ratio was closely associated with insulin resistance and combined LDL + VLDL-cholesterol. When separated by sex, it became clear that these relationships were stronger in boys than in girls. Subjects were stratified into BMI percentile based tertiles. For boys, the android/gynoid ratio was significantly related to insulin resistance regardless of BMI tertile with and LDL + VLDL in tertiles 1 and 3. For girls, only LDL + VLDL showed any significance with android/gynoid ratio and only in tertile 2. We conclude that the android/gynoid fat ratio is closely associated with insulin resistance and LDL + VLDL-, “bad,” cholesterol in normal weight boys and may provide a measurement of metabolic and cardiovascular disease risk in that population. Lennie Samsell, Michael Regier, Cheryl Walton, and Lesley Cottrell Copyright © 2014 Lennie Samsell et al. All rights reserved. Intervention Effects of a School-Based Health Promotion Programme on Obesity Related Behavioural Outcomes Mon, 01 Sep 2014 06:06:43 +0000 Studies have shown preventive effects of an active lifestyle during childhood on later life; therefore, health promotion has to start early. The programme “Join the Healthy Boat” promotes a healthy lifestyle in primary school children. In order to evaluate it, children’s behaviours in respect of increased physical activity (PA), a decrease in screen media use (SMU), more regular breakfast, and a reduction of the consumption of soft drinks (SDC) were investigated. 1943 children (7.1 ± 0.6 years) participated in the cluster-randomised study and were assessed at baseline and 1736 of them at follow-up. Teachers delivered lessons, which included behavioural contracting and budgeting of SMU and SDC. Daily SMU, PA behaviours, SDC, and breakfast patterns were assessed via parental questionnaire. After one-year intervention, significant effects were found in the intervention group for SMU of girls, children without migration background, and children with parents having a low education level. In the control group, second grade children skipped breakfast significantly more often. Tendencies but no significant differences were found for PA and SDC. This intervention seems to affect groups, which are usually hard to reach, such as children of parents with low education levels, which shows that active parental involvement is vital for successful interventions. Susanne Kobel, Tamara Wirt, Anja Schreiber, Dorothea Kesztyüs, Sarah Kettner, Nanette Erkelenz, Olivia Wartha, and Jürgen M. Steinacker Copyright © 2014 Susanne Kobel et al. All rights reserved. Prognostic Value of Normal Stress Echocardiography in Obese Patients Sun, 31 Aug 2014 08:46:46 +0000 Background. Chest pain is a common problem in obese patients. Because of the body habitus, the results of noninvasive evaluation for CAD may be limited in this group. Methods. We reviewed the records of 1446 consecutive patients who had undergone clinically indicated stress echocardiography (SE). We compared major adverse cardiac events (MACE; myocardial infarction, cardiac intervention, cardiac death, subsequent hospitalization for cardiac events, and emergency department visits) at 1 year in normal weight, overweight, and obese subjects with normal SE. Results. Excluding patients with an abnormal and indeterminate SE and those who were lost to follow-up, a retrospective analysis of 704 patients was performed. There were 366 obese patients (BMI ≥ 30), 196 overweight patients (BMI 25–29.9), and 142 patients with normal BMI (18.5–24.9). There was no MACE in the groups at 1-year follow-up after a normal SE. Conclusions. In obese patients including those with multiple risk factors and symptoms concerning for cardiac ischemia, stress echocardiography is an effective and reliable noninvasive tool for identifying those with a low 1-year risk of cardiac events. Michele Murphy, Siva Krothapalli, Jose Cuellar, Somsupha Kanjanauthai, Brian Heeke, Pallavi S. Gomadam, Avirup Guha, Vernon A. Barnes, Sheldon E. Litwin, and Gyanendra K. Sharma Copyright © 2014 Michele Murphy et al. 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. 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. 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. 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.