Journal of Obesity The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Race or Resource? BMI, Race, and Other Social Factors as Risk Factors for Interlimb Differences among Overweight Breast Cancer Survivors with Lymphedema Tue, 28 Jun 2016 06:30:51 +0000 Introduction. High BMI is a risk factor for upper body breast cancer-related lymphedema (BCRL) onset. Black cancer survivors are more likely to have high BMI than White cancer survivors. While observational analyses suggest up to 2.2 times increased risk of BCRL onset for Black breast cancer survivors, no studies have explored race or other social factors that may affect BCRL severity, operationalized by interlimb volume difference (ILD). Materials and Methods. ILD was measured by perometry for 296 overweight (25 > BMI < 50) Black () or White () breast cancer survivors (>6 months from treatment) in the WISER Survivor trial. Multivariable linear regression examined associations between social and physical factors and ILD. Results. Neither Black race (−0.26, ) nor BMI (0.22, ) was associated with ILD. Attending college (−4.89, ) was the strongest factor associated with ILD, followed by having more lymph nodes removed (4.75, ), >25% BCRL care adherence (4.10, ), and years since treatment (0.55, ). Discussion. Neither race nor BMI was associated with ILD among overweight cancer survivors. Education, a proxy for resource level, was the strongest factor associated with greater ILD. Tailoring physical activity and weight loss interventions designed to address BCRL severity by resource rather than race should be considered. Lorraine T. Dean, Anagha Kumar, Taehoon Kim, Matthew Herling, Justin C. Brown, Zi Zhang, Margaret Evangelisti, Renata Hackley, Jiyoung Kim, Andrea Cheville, Andrea B. Troxel, J. Sanford Schwartz, and Kathryn H. Schmitz Copyright © 2016 Lorraine T. Dean et al. All rights reserved. Reducing Societal Obesity: Establishing a Separate Exercise Model through Studies of Group Behavior Mon, 27 Jun 2016 14:22:07 +0000 The past 50 years has brought attention to high and increasing levels of human obesity in most of the industrialized world. The medical profession has noticed, has evaluated, and has developed models for studying, preventing, and reversing obesity. The current model prescribes activity in specific quantities such as days, minutes, heart rates, and footfalls. Although decreased levels of activity have come from changes revolving around built environments and social networks, the existing medical model to lower body weights by increasing activity remains individually prescriptive. It is not working. The study of societal obesity precludes the individual and must involve group behavioral studies. Such studies necessitate acquiring separate tools and, therefore, require a significant change in the evaluation and treatment of obesity. Finding groups with common activities and lower levels of obesity would allow the development of new models of land use and encourage active lifestyles through shared interests. J. S. Puterbaugh Copyright © 2016 J. S. Puterbaugh. All rights reserved. Maternal Feeding Styles and Food Parenting Practices as Predictors of Longitudinal Changes in Weight Status in Hispanic Preschoolers from Low-Income Families Sun, 26 Jun 2016 12:25:44 +0000 Objective. The aim was to investigate the influence of feeding styles and food parenting practices on low-income children’s weight status over time. Method. Participants were 129 Latina parents and their Head Start children participating in a longitudinal study. Children were assessed at baseline (4 to 5 years old) and again eighteen months later. At each time point, parents completed questionnaires and height and weight measures were taken on the child. Results. The indulgent feeding style (parent-report at baseline) was associated with increased child BMI -score eighteen months later compared to other feeding styles. Authoritative, authoritarian, and uninvolved feeding styles were not significantly associated with increased child BMI -score. Child BMI -score at Time 1 (strongest) and maternal acculturation were positive predictors of child BMI -score at Time 2. Maternal use of restriction positively predicted and maternal monitoring negatively predicted Time 2 BMI -score, but only when accounting for feeding styles. Conclusion. This is the first study to investigate the impact of feeding styles on child weight status over time. Results suggest that indulgent feeding predicts later increases in children’s weight status. The interplay between feeding styles and food parenting practices in influencing child weight status needs to be further explored. Sheryl O. Hughes, Thomas G. Power, Teresia M. O’Connor, Jennifer Orlet Fisher, and Tzu-An Chen Copyright © 2016 Sheryl O. Hughes et al. All rights reserved. Changes in Weight Loss, Health Behaviors, and Intentions among 400 Participants Who Dropped out from an Insurance-Sponsored, Community-Based Weight Management Program Mon, 20 Jun 2016 08:14:10 +0000 The majority of weight management research is based on data from randomized controlled studies conducted in clinical settings. As these findings are translated into community-based settings, additional research is needed to understand patterns of lifestyle change and dropout. The purpose of this study was to examine reasons for and consequences associated with dropout (or removal) from an insurance-funded weight management program. Using a mixed methods approach with objectively measured changes in body weight and attendance along with quantitative and qualitative survey data, patterns of intention and behavior change were explored. The results from a sample of 400 respondents support the idea that there are both positive and negative consequences of program participation. Overall, 1 in 5 respondents lost a clinically significant amount of weight during the program (>5% of baseline body weight) and 1 in 3 experienced a positive consequence, while only 6% expressed a negative outcome of participation. Additionally, nearly 90% of all of the consequences that emerged from the data were positive. Attitude change was a major theme, including positive health intentions, perceived success, learning skills, and new appreciation of exercise. Sam J. Zizzi, Jana Lima Fogaca, Tammy Sheehy, Myia Welsh, and Christiaan Abildso Copyright © 2016 Sam J. Zizzi et al. All rights reserved. A Pilot Study of Parent Mentors for Early Childhood Obesity Thu, 09 Jun 2016 12:22:07 +0000 Objective. To assess the feasibility of a parent mentor model of intervention for early childhood obesity using positive deviance-based methods to inform the intervention. Methods. In this pilot, randomized clinical trial, parent-child dyads (age: 2–5) with children whose body mass index (BMI) was ≥95th percentile were randomized to parent mentor intervention or community health worker comparison. The child’s height and weight were measured at baseline, after the six-month intervention, and six months after the intervention. Feasibility outcomes were recruitment, participation, and retention. The primary clinical outcome was BMI -score change. Results. Sixty participants were enrolled, and forty-eight completed the six-month intervention. At baseline, the BMI -score in the parent mentor group was 2.63 (SD = 0.65) and in the community health worker group it was 2.61 (SD = 0.89). For change in BMI -score over time, there was no difference by randomization group at the end of the intervention: −0.02 (95% CI: −0.26, 0.22). At the end of the intervention, the BMI -score for the parent mentor group was 2.48 (SD = 0.58) and for the community health worker group it was 2.45 (SD = 0.91), both reduced from baseline, . Conclusion. The model of a parent mentor clinical trial is feasible, and both randomized groups experienced small, sustained effects on adiposity in an obese, Hispanic population. Byron A. Foster, Christian A. Aquino, Mario Gil, Jonathan A. L. Gelfond, and Daniel E. Hale Copyright © 2016 Byron A. Foster et al. All rights reserved. The Effect of Preoperative Type 2 Diabetes and Physical Fitness on Mental Health and Health-Related Quality of Life after Roux-en-Y Gastric Bypass Thu, 09 Jun 2016 06:33:17 +0000 Objective. To investigate the predictive value of type 2 diabetes and lack of physical activity for mental health and health-related quality of life after Roux-en-Y gastric bypass. Method. Forty severely obese patients undergoing Roux-en-Y gastric bypass were included in the GASMITO study. Information about physiological and psychological factors was prospectively assessed at four time points, two times prior to surgery and two times after surgery. Measures included oral and intravenous glucose tolerance tests, VO2max test, Symptoms Checklist (SCL-90), Short Form Health Survey 36 (SF-36), Body Image Questionnaire, and a questionnaire assessing sociodemographic factors and medical status. Results. Mean % excess weight loss was 65% (±12) at 18-month follow-up and 50% of the participants with diabetes experienced total remission. Also, significant improvements were observed with regard to physical fitness, mental distress, health-related quality of life, and weight-related body image (). The interaction between follow-up time and type 2 diabetes at baseline significantly predicted six of the thirteen psychological subscales () and, across the follow-ups, physical fitness level made modest contributions to variations in mental symptoms and HRQOL but not weight-related body image. Conclusion. The results suggest that baseline difference in mental symptoms and physical HRQOL between diabetic and nondiabetic patients declines across follow-ups and resolves around the time of surgery. Cathrine L. Wimmelmann, Michael T. Lund, Merethe Hansen, Flemming Dela, and Erik L. Mortensen Copyright © 2016 Cathrine L. Wimmelmann et al. All rights reserved. A Systematic Review and Meta-Analysis of Outcomes for Type 1 Diabetes after Bariatric Surgery Wed, 08 Jun 2016 06:03:36 +0000 Background. The utility of bariatric surgery in type 1 diabetes remains controversial. The aim of the present study is to evaluate glycemic control outcomes in obese patients with type 1 diabetes after bariatric surgery. Methods. A comprehensive search of electronic databases was completed. Inclusion criteria included human adult subjects with BMI ≥35 kg/m2 and a confirmed diagnosis of type 1 diabetes who underwent a bariatric surgical procedure. Results. Thirteen primary studies (86 patients) were included. Subjects had a mean age of years with a mean BMI of  kg/m2. There was a marked reduction in BMI postoperatively at 12 months and at study endpoint to  kg/m2 () and  kg/m2 (), respectively. Preoperative weighted mean total daily insulin requirement was  IU/d, which decreased significantly to  IU/d () and  IU/d () at 12 months and at study endpoint, respectively. An improvement in HbA1c was also seen from % preoperatively to % () and % () at 12 months and at study endpoint, respectively. Conclusion. Bariatric surgery in patients with type 1 diabetes leads to significant reductions in BMI and improvements in glycemic control. Alexandra Chow, Noah J. Switzer, Jerry Dang, Xinzhe Shi, Christopher de Gara, Daniel W. Birch, Richdeep S. Gill, and Shahzeer Karmali Copyright © 2016 Alexandra Chow et al. All rights reserved. For Researchers on Obesity: Historical Review of Extra Body Weight Definitions Mon, 30 May 2016 12:04:54 +0000 Rationale. The concept of obesity has been known since ancient world; however, the current standard definition of obesity was endorsed only about a decade ago. There is a need for researches to understand multiple approaches to defining obesity and how and why the standard definition was developed. The review will help to grasp the complexity of the problem and can lead to novel hypotheses in obesity research. Objective. This paper focuses on the objective to understand historical background on the development of “reference and standard tables” of weight as a platform for normal versus abnormal body weight definition. Methods. A systematic literature review was performed to chronologically summarize the definition of body weight from time of Hippocrates till the year of 2010. Conclusion. This paper presents the historical background on the development of “reference and standard tables” of weight as a platform for normal versus abnormal body weight definition. Knowledge of historical approaches to the concept of obesity can motivate researchers to find new hypotheses and utilize the appropriate obesity assessments to address their objectives. Marina Komaroff Copyright © 2016 Marina Komaroff. All rights reserved. Do Lactation-Induced Changes in Ghrelin, Glucagon-Like Peptide-1, and Peptide YY Influence Appetite and Body Weight Regulation during the First Postpartum Year? Mon, 23 May 2016 11:08:28 +0000 To determine whether fasting and meal-induced appetite-regulating hormones are altered during lactation and associated with body weight retention after childbearing, we studied 24 exclusively breastfeeding women (BMI = 25.2 ± 3.6 kg/m2) at 4-5 weeks postpartum and 20 never-pregnant controls (BMI = 24.0 ± 3.1 kg/m2). Ghrelin, PYY, GLP-1, and appetite ratings were measured before/and 150 minutes after a standardized breakfast and 60 minutes after an ad libitum lunch. Body weight/composition were measured at 6 and 12 months. Fasting and area under-the-curve responses for appetite-regulating hormones did not differ between lactating and control groups; , however, tended to track higher after the standardized breakfast in lactating women and was higher () after the ad libitum lunch despite a 24% higher energy intake ( < 0.05). By 12 months, lactating women lost 5.3 ± 2.2 kg (), whereas control women () remained weight stable (); fifteen of the lactating women returned to within ±2.0 kg of prepregnancy weight but three retained >6.0 kg. The retainers had greater () postmeal ghrelin rebound responses following breakfast. Overall these studies do not support the hypothesis that appetite-regulating hormones are altered during lactation and associated with postpartum weight retention. Altered ghrelin responses, however, deserve further exploration. D. Enette Larson-Meyer, Jessica Schueler, Erin Kyle, Kathleen J. Austin, Ann Marie Hart, and Brenda M. Alexander Copyright © 2016 D. Enette Larson-Meyer et al. All rights reserved. The Impact of Long-Term Physical Activity Interventions for Overweight/Obese Postmenopausal Women on Adiposity Indicators, Physical Capacity, and Mental Health Outcomes: A Systematic Review Mon, 16 May 2016 10:38:03 +0000 Physical activity interventions have recently become a popular strategy to help postmenopausal women prevent and manage obesity. The current systematic review evaluates the efficacy of physical activity interventions among overweight and obese postmenopausal women and sheds light on the behavioral change techniques that were employed in order to direct future research. Method. Five electronic databases were searched to identify all prospective RCT studies that examine the impact of physical activity on adiposity indicators, physical capacity, and/or mental health outcomes among healthy, sedentary overweight, and obese postmenopausal women in North America. The behavior change technique taxonomy was used to identify the various strategies applied in the programs. Results. Five RCTs met the inclusion criteria. The findings showed that adiposity indicators and physical capacity outcomes significantly improved following long-term interventions; however, mental health outcomes showed nonsignificant changes. Furthermore, 17 behavior change techniques were identified with the taxonomy across all trials. The intrapersonal-level techniques were the most common. Conclusion. Physical activity interventions had a positive effect on adiposity measures and physical capacity. Future research should focus on testing the effectiveness of physical activity interventions on mental health and incorporate strategies at the individual and environmental level to maximize the health impact on the population. Amanda Baker, Héloïse Sirois-Leclerc, and Heather Tulloch Copyright © 2016 Amanda Baker et al. All rights reserved. Obesity May Be Protective against Severe Perineal Lacerations Thu, 05 May 2016 06:30:02 +0000 Objective. To determine if there is an association between BMI and 3rd- or 4th-degree perineal lacerations in normal spontaneous and operative vaginal deliveries. Study Design. We performed a retrospective case control study using a large obstetric quality improvement database over a six-year period. Cases were identified as singleton gestations with third- and fourth-degree lacerations. Controls were obtained randomly from the database of patients without third- or fourth-degree lacerations in a 1 : 1 ratio. Univariate and multivariate logistic regression analyses were performed. Results. Of 32,607 deliveries, 22,011 (67.5%) charts with BMI documented were identified. Third- or fourth-degree lacerations occurred in 2.74% () of patients. 37% () were identified in operative vaginal deliveries. In the univariate analysis, obesity, older maternal age, non-Asian race, and birth weight <4000 g were all protective against 3rd- and 4th-degree lacerations. After controlling for age, race, mode of vaginal delivery, and birth weight, obesity remained significant. Conclusion. Being obese may protect against third- and fourth-degree lacerations independent of parity, race, birth weight, and mode of delivery. Diana Garretto, Brian B. Lin, Helen L. Syn, Nancy Judge, Karen Beckerman, Fouad Atallah, Arnold Friedman, Michael Brodman, and Peter S. Bernstein Copyright © 2016 Diana Garretto et al. All rights reserved. Racial Differences in Serum Adipokine and Insulin Levels in a Matched Osteoarthritis Sample: A Pilot Study Tue, 03 May 2016 07:16:36 +0000 Background. In an attempt to correlate biomarkers with disease, serum-based biomarkers often are compared between individuals with osteoarthritis (OA) and control subjects. However, variable results have been reported. Some studies have suggested an association between certain adipokines and insulin and OA. We know that there are racial differences in OA prevalence and incidence, and from general population-based studies, those of Asian race consistently demonstrate a unique adipokine/insulin serum concentration profile as compared to Caucasians. Whether similar racial differences exist within OA samples is unknown and may have implications for selecting appropriate controls in comparative studies. Methods. Serum levels of adipokines, leptin, and adiponectin, along with insulin, were determined by ELISA in patients scheduled for total hip or knee replacement surgery for OA. Fifteen Asian patients were matched 1 : 1 on age (±2 years), gender, body mass index (±1.5 kg/m2), and surgical joint with Caucasian patients. Differences in serum concentrations were tested using paired -tests. Results. Serum leptin and insulin levels were significantly higher in Asians compared to Caucasians (). While serum adiponectin levels were lower among Asians, the difference did not reach statistical significance (). Conclusion. Findings from this work suggest that when studying serum biomarker concentrations in OA versus controls, race may be an important factor to consider. Our findings warrant confirmation in larger studies. Rajiv Gandhi, Anirudh Sharma, Mohit Kapoor, Kala Sundararajan, and Anthony V. Perruccio Copyright © 2016 Rajiv Gandhi et al. All rights reserved. Stage of Change and Motivation to a Healthier Lifestyle before and after an Intensive Lifestyle Intervention Thu, 28 Apr 2016 15:03:35 +0000 Objective. Lifestyle modification programs are different but typically include both nutritional aspects and physical activity as main domains with different behavioral and/or psychological strategies designed to affect change. A fundamental role in modifying unhealthy habits is played by personal motivation for change. The present study sought to investigate, in a group of 100 overweight/obese outpatients with and/or without TMD2, treatment seeking, the effect of an intensive lifestyle program on medical measures and motivational profile for physical activity (PA) and healthy nutrition (NUTR). Method. Subjects participated in an intensive multidisciplinary lifestyle intervention at C.U.R.I.A.MO. Before and after the intervention, patients received a comprehensive evaluation of their clinical, anthropometric, and metabolic states and motivation to lifestyle changes. Results. Data showed differences before and after intervention in both medical and motivational measures. Before the intervention patients reported to be ready, open, and determined to change and gave importance to healthy habits. After the intervention patients continued to be determined but increased the actions toward the change showing a higher degree of maintenance and of acquisition of habits especially in the physical domain of the new lifestyle. Conclusion. Data support the notion that the motivation should be followed during all the lifestyle interventions to support the change on both domains of the lifestyle program. Buratta Livia, Reginato Elisa, Ranucci Claudia, Pippi Roberto, Aiello Cristina, Sbroma Tomaro Emilia, Perrone Chiara, Tirimagni Alberto, Russo Angelo, De Feo Pierpaolo, and Mazzeschi Claudia Copyright © 2016 Buratta Livia et al. All rights reserved. The Association of Physical Activity during Weekdays and Weekend with Body Composition in Young Adults Wed, 20 Apr 2016 12:50:17 +0000 Physical activity (PA) is a key contributor in long-term weight management but there remains limited research on the association between weekly PA patterns and weight change. The purpose of the present study was to examine the prospective association between weekly PA patterns and weight change in generally healthy young adults. Anthropometric measurements, including dual X-ray absorptiometry, were obtained every 3 months over a period of one year in 338 adults (53% male). At each measurement time, participants wore a multisensor device for a minimum of 10 days to determine total daily energy expenditure and time spent sleeping, sedentary, in light PA (LPA), in moderate PA (MPA), and in vigorous PA (VPA). PA did not differ between weekdays and the weekend at baseline. Twenty-four-hour sleep time, however, was significantly longer during weekends compared to weekdays, which was associated with less time spent sedentary. Weight loss was associated with a significant increase in LPA at the expense of sedentary time during the weekend but not during weekdays. Regression analyses further revealed an inverse association between change in VPA during the weekend and body composition at 12-month follow-up. Taken together, these results suggest that weekend PA plays an important role in long-term weight management. Clemens Drenowatz, Nicole Gribben, Michael D. Wirth, Gregory A. Hand, Robin P. Shook, Stephanie Burgess, and Steven N. Blair Copyright © 2016 Clemens Drenowatz et al. All rights reserved. Unhealthy Phenotype as Indicated by Salivary Biomarkers: Glucose, Insulin, VEGF-A, and IL-12p70 in Obese Kuwaiti Adolescents Wed, 16 Mar 2016 09:11:31 +0000 Objective. Here, we investigated the relationships between obesity and the salivary concentrations of insulin, glucose, and 20 metabolic biomarkers in Kuwaiti adolescents. Previously, we have shown that certain salivary metabolic markers can act as surrogates for blood concentrations. Methods. Salivary samples of whole saliva were collected from 8,317 adolescents. Salivary glucose concentration was measured by a high-sensitivity glucose oxidase method implemented on a robotic chemical analyzer. The concentration of salivary insulin and 20 other metabolic biomarkers was assayed in 744 randomly selected saliva samples by multiplexed bead-based immunoassay. Results. Obesity was seen in 26.5% of the adolescents. Salivary insulin predicting hyperinsulinemia occurred in 4.3% of normal-weight adolescents, 8.3% of overweight adolescents, and 25.7% of obese adolescents (). Salivary glucose predicting hyperglycemia was found in only 3% of obese children and was not predictive (). Elevated salivary glucose and insulin occurring together was associated with elevated vascular endothelial growth factor and reduced salivary interleukin-12. Conclusion. Considering the surrogate nature of salivary insulin and glucose, this study suggests that elevated insulin may be a dominant sign of metabolic disease in adolescent populations. It also appears that a proangiogenic environment may accompany elevated glucose in obese adolescents. Mor-Li Hartman, J. Max Goodson, Ping Shi, Jorel Vargas, Tina Yaskell, Danielle Stephens, Maryann Cugini, Hatice Hasturk, Roula Barake, Osama Alsmadi, Sabiha Al-Mutawa, Jitendra Ariga, Pramod Soparkar, Jawad Behbehani, Kazem Behbehani, and Francine Welty Copyright © 2016 Mor-Li Hartman et al. All rights reserved. Corrigendum to “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” Wed, 02 Mar 2016 09:40:21 +0000 Ha Thi Ngo, Ragna Bogen Hetland, Unni Cecilie Nygaard, and Inger-Lise Steffensen Copyright © 2016 Ha Thi Ngo et al. All rights reserved. Bile Acids, FXR, and Metabolic Effects of Bariatric Surgery Wed, 24 Feb 2016 08:08:54 +0000 Overweight and obesity represent major risk factors for diabetes and related metabolic diseases. Obesity is associated with a chronic and progressive inflammatory response leading to the development of insulin resistance and type 2 diabetes (T2D) mellitus, although the precise mechanism mediating this inflammatory process remains poorly understood. The most effective intervention for the treatment of obesity, bariatric surgery, leads to glucose normalization and remission of T2D. Recent work in both clinical studies and animal models supports bile acids (BAs) as key mediators of these effects. BAs are involved in lipid and glucose homeostasis primarily via the farnesoid X receptor (FXR) transcription factor. BAs are also involved in regulating genes involved in inflammation, obesity, and lipid metabolism. Here, we review the novel role of BAs in bariatric surgery and the intersection between BAs and immune, obesity, weight loss, and lipid metabolism genes. Olivier F. Noel, Christopher D. Still, George Argyropoulos, Michael Edwards, and Glenn S. Gerhard Copyright © 2016 Olivier F. Noel et al. All rights reserved. Impact of Severe Obesity and Weight Loss on Systolic Left Ventricular Function and Morphology: Assessment by 2-Dimensional Speckle-Tracking Echocardiography Tue, 23 Feb 2016 14:01:34 +0000 Obesity is associated with an increased risk of heart failure. Little is known about the impact of dietary changes on the cardiac sequelae in obese patients. Twenty-one obese subjects underwent a 12-week low calorie fasting phase of a formula diet. Transthoracic two-dimensional speckle-tracking echocardiography was performed to obtain systolic left ventricular strain before and after weight loss. Body mass index decreased significantly from to  kg/m2, and the total percentage fat loss was 19%. Weight reduction was associated with a reduction in blood pressure and heart rate. Left ventricular longitudinal global peak systolic strain was in the lower normal range (−%) before weight loss and was unchanged (−%) after 12 weeks on diet with substantial weight loss. Also, no significant change in global radial strain after weight loss was noted ( versus , ). Left atrial and ventricular dimensions were in normal range before fasting and remained unchanged after weight loss. In our study obesity was associated with normal systolic left ventricular function. A 12-week low calorie diet with successful weight loss can reduce blood pressure and heart rate. Systolic left ventricular function and morphology were not affected by rapid weight reduction. Sevda Karimian, Jürgen Stein, Boris Bauer, and Claudius Teupe Copyright © 2016 Sevda Karimian et al. 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.