Journal of Obesity The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Leptin, Leptin Soluble Receptor, and the Free Leptin Index following a Diet and Physical Activity Lifestyle Intervention in Obese Males and Females Tue, 06 Dec 2016 08:38:06 +0000 Leptin (LEP) is associated with appetite regulation and metabolism. Concentration is linear with adiposity, suggesting LEP resistance. LEP circulates freely and bound with its soluble receptor (sOB-r); the ratio is the free leptin index (FLI), an index of leptin resistance; lower FLI suggests reduced biological action. Purpose. The aim was to determine the effect of changes in adipose tissue distribution on LEP, sOB-r, and FLI following 6 months (6 M) of a diet/exercise weight loss program (WLP). In addition, we aim to identify predictors of the FLI. Methods. 6 M WLP consisted of diet/lifestyle interventions following ADA guidelines. Body composition was assessed by DXA. LEP and sOB-r analysis were done via ELISA. Results. 10 adults completed the WLP. Significant reductions were seen in total fat percentage (% fat), nontrunk fat, (NTF), and trunk fat (TF) from base to 3 m and 6 M (). The FLI were reduced at 3 M and 6 M for males and 6 M for females. Total body fat and body weight predicted the FLI in both sexes. Conclusions. LEP and FLI reductions following 6 M of WLP were achieved independent of sOB-r changes. We also demonstrate that the FLI can be predicted noninvasively through total fat mass and body weight in kilograms. Jeffrey E. Herrick, Gino S. Panza, and Jared M. Gollie Copyright © 2016 Jeffrey E. Herrick et al. All rights reserved. Impaired Visual Motor Coordination in Obese Adults Tue, 22 Nov 2016 08:35:29 +0000 Objective. To investigate whether obesity alters the sensory motor integration process and movement outcome during a visual rhythmic coordination task. Methods. 88 participants (44 obese and 44 matched control) sat on a chair equipped with a wrist pendulum oscillating in the sagittal plane. The task was to swing the pendulum in synchrony with a moving visual stimulus displayed on a screen. Results. Obese participants demonstrated significantly () higher values for continuous relative phase (CRP) indicating poorer level of coordination, increased movement variability (), and a larger amplitude () than their healthy weight counterparts. Conclusion. These results highlight the existence of visual sensory integration deficiencies for obese participants. The obese group have greater difficulty in synchronizing their movement with a visual stimulus. Considering that visual motor coordination is an essential component of many activities of daily living, any impairment could significantly affect quality of life. David Gaul, Arimin Mat, Donal O’Shea, and Johann Issartel Copyright © 2016 David Gaul et al. All rights reserved. Bariatric Surgery, Polycystic Ovary Syndrome, and Infertility Mon, 14 Nov 2016 13:35:32 +0000 Background. Polycystic ovary syndrome (PCOS) is the commonest cause of female infertility. Visceral obesity and insulin resistance are key pathophysiological mechanisms behind PCOS. Women suffering from this syndrome and infertility often seek bariatric surgery hoping that they would be able to conceive postoperatively. Objective. At present, there is no consensus on the role of bariatric surgery in the management of PCOS-associated infertility within the medical community, making it difficult to give specific advice to these women, so a review of the literature was necessary. Results. A detailed review of the literature was performed. Only 6 manuscripts were relevant and contained quantitative data. They demonstrated that bariatric surgery results in postoperative conception rates varying from 33% to 100%. Surgery is also associated with amelioration of menstrual irregularities, hormonal abnormalities, and hirsutism that are associated with PCOS. These studies were retrospective and only had a small number of participants with infertility. Conclusions. Bariatric surgery has been shown to conclusively improve life expectancy, quality of life, and comorbidities like type 2 diabetes and obstructive sleep apnea. However, further research is required to identify whether weight loss surgery results in significant improvement in fertility of women with PCOS and to investigate which operation has the best results. James Butterworth, Jean Deguara, and Cynthia-Michelle Borg Copyright © 2016 James Butterworth et al. All rights reserved. Establishing Waist-to-Height Ratio Standards from Criterion-Referenced BMI Using ROC Curves in Low-Income Children Thu, 03 Nov 2016 13:54:22 +0000 The purpose of this study was to establish health-related waist-to-height ratio (WHtR) cut-points associating with FITNESSGRAM’s body mass index (BMI) criterion-referenced standards in low-income children. A secondary aim was to examine the classification agreement between the derived WHtR cut-points and various cardiometabolic blood markers using current recommendations. Participants were 219 children from low-income schools (mean age = 10.5 ± 0.6 years). Waist circumference, height, weight, and cardiometabolic blood markers were collected in a fasting state before school hours. Receiver operating characteristic (ROC) curves were used to determine WHtR cut-points that associated with a child meeting FITNESSGRAM’s age- and sex-specific criterion-referenced standards for BMI. The derived WHtR cut-point was 0.50 (AUC = 0.89, ; sensitivity = 0.86, specificity = 0.82, and accuracy = 84.3%). Classification agreement using the derived WHtR cut-point with various blood marker standards was statistically significant but considered weak to fair (kappa 0.14–0.34, agreement = 59%–67%, and ). The WHtR cut-point of 0.50 can be used with strong accuracy to distinguish low-income children who met FITNESSGRAM’s criterion-referenced standards for body composition; however, the evidence was weaker for its use in distinguishing low-income children meeting specific cardiometabolic blood marker recommendations. Ryan D. Burns, Timothy A. Brusseau, Yi Fang, You Fu, and James C. Hannon Copyright © 2016 Ryan D. Burns et al. All rights reserved. An Anthropometric Risk Index Based on Combining Height, Weight, Waist, and Hip Measurements Tue, 18 Oct 2016 12:39:59 +0000 Body mass index (BMI) can be considered an application of a power law model to express body weight independently of height. Based on the same power law principle, we previously introduced a body shape index (ABSI) to be independent of BMI and height. Here, we develop a new hip index (HI) whose normalized value is independent of height, BMI, and ABSI. Similar to BMI, HI demonstrates a U-shaped relationship to mortality in the Third National Health and Nutrition Examination Survey (NHANES III) population. We further develop a new anthropometric risk index (ARI) by adding log hazard ratios from separate nonlinear regressions of the four indicators, height, BMI, ABSI, and HI, against NHANES III mortality hazard. ARI far outperforms any of the individual indicators as a linear mortality predictor in NHANES III. The superior performance of ARI also holds for predicting mortality hazard in the independent Atherosclerosis Risk in Communities (ARIC) cohort. Thus, HI, along with BMI and ABSI, can capture the risk profile associated with body size and shape. These can be combined in a risk indicator that utilizes complementary information from height, weight, and waist and hip circumference. The combined ARI is promising for further research and clinical applications. Nir Y. Krakauer and Jesse C. Krakauer Copyright © 2016 Nir Y. Krakauer and Jesse C. Krakauer. All rights reserved. Objectively Quantified Physical Activity and Sedentary Behavior in Predicting Visceral Adiposity and Liver Fat Thu, 29 Sep 2016 16:58:12 +0000 Objective. Epidemiologic studies suggest an inverse relationship between nonalcoholic fatty liver disease (NAFLD), visceral adipose tissue (VAT), and self-reported physical activity levels. However, subjective measurements can be inaccurate and prone to reporter bias. We investigated whether objectively quantified physical activity levels predicted liver fat and VAT in overweight/obese adults. Methods. Habitual physical activity was measured by triaxial accelerometry for four days (). Time spent in sedentary behavior (MET < 1.6) and light (MET 1.6 < 3), moderate (MET 3 < 6), and vigorous (MET 6 < 9) physical activity was quantified. Magnetic resonance imaging and spectroscopy were used to quantify visceral and liver fat. Bivariate correlations and hierarchical multiple regression analyses were performed. Results. There were no associations between physical activity or sedentary behavior and liver lipid. Sedentary behavior and moderate and vigorous physical activity accounted for just 3% of variance for VAT () and 0.003% for liver fat (). Higher levels of VAT were associated with time spent in moderate activity (, ), but there was no association with sedentary behavior. Known risk factors for obesity-related NAFLD accounted for 62% and 40% of variance in VAT and liver fat, respectively (). Conclusion. Objectively measured levels of habitual physical activity and sedentary behavior did not influence VAT or liver fat. Shelley E. Keating, Helen M. Parker, Toby G. Pavey, Michael K. Baker, Ian D. Caterson, Jacob George, and Nathan A. Johnson Copyright © 2016 Shelley E. Keating et al. All rights reserved. Limited Effects of Endurance or Interval Training on Visceral Adipose Tissue and Systemic Inflammation in Sedentary Middle-Aged Men Thu, 29 Sep 2016 08:14:36 +0000 Purpose. Limited data exists for the effects of sprint-interval training (SIT) and endurance training (ET) on total body composition, abdominal visceral adipose tissue, and plasma inflammation. Moreover, whether “active” or “passive” recovery in SIT provides a differential effect on these measures remains uncertain. Methods. Sedentary middle-aged men (;  y;  kg·m2) underwent abdominal computed tomography, dual-energy X-ray absorptiometry, venepuncture, and exercise testing before and after the interventions, which included the following: 12 wks 3 d·wk−1 ET (; 50–60 min cycling; 80% ), SIT (4–10 × 30 s sprint efforts) with passive (P-SIT; ) or active recovery (A-SIT; ); or nonexercise control condition (CON; ). Changes in cardiorespiratory fitness, whole-body and visceral fat mass, and plasma systemic inflammation were examined. Results. Compared to CON, significant increases in interpolated power output (P-SIT, ; ET, ; A-SIT, ) and test duration (P-SIT, ; ET, ; A-SIT, ) occurred after training. Final VO2 consumption was increased after P-SIT only (). Despite >90% exercise compliance, there was no change in whole-body or visceral fat mass or plasma inflammation (). Conclusion. In sedentary middle-aged men, SIT was a time-effective alternative to ET in facilitating conditioning responses yet was ineffective in altering body composition and plasma inflammation, and compared to passive recovery, evidenced diminished conditioning responses when employing active recovery. Joshua H. F. Cooper, Blake E. G. Collins, David R. Adams, Robert A. Robergs, and Cheyne E. Donges Copyright © 2016 Joshua H. F. Cooper et al. All rights reserved. Breastfeeding Practices among Native Hawaiians and Pacific Islanders Wed, 28 Sep 2016 11:11:41 +0000 Background. Breastfeeding is associated with a decreased risk of obesity in the early and adult years. Native Hawaiians and Pacific Islanders (NHPI) experience high rates of obesity which is often obfuscated with aggregated data. Using disaggregated data, we examined breastfeeding practices among NHPI. Methods. Seven databases and reference lists were searched. Two independent researchers extracted relevant studies based on predetermined criteria. Nine studies met our inclusion criteria and a meta-analysis was conducted using random-effects, inverse-various weighted models. Results. Few studies disaggregated NHPI populations when examining breastfeeding practices. Most studies were cross-sectional and our search yielded no randomized or quasirandomized control trials. The results of the meta-analysis indicated that 46.5% NHPI women initiated breastfeeding with 40.8% breastfeeding exclusively. These pooled analyses show that NHPI breastfeeding practices are below the recommended national and international goals and guidelines. Conclusion. Breastfeeding practices among NHPI are heterogeneous and critical disparities exist among certain NHPI subgroups and additional research needs to be conducted to determine the reasons for the disparity. Future studies should work to disaggregate data for NHPI and the various subpopulations. Multicomponent, multilevel strategies are needed to support breastfeeding practices among NHPI. Ingrid K. Richards Adams, Chizimuzo T. C. Okoli, Akilah Dulin Keita, Ana Maria Linares, Keiko Tanaka, Joshua R. Polanin, and Annie Koempel Copyright © 2016 Ingrid K. Richards Adams et al. All rights reserved. Cardiovascular Endurance, Body Mass Index, Physical Activity, Screen Time, and Carotenoid Intake of Children: NHANES National Youth Fitness Survey Tue, 27 Sep 2016 11:44:46 +0000 Background. Approximately 17% of children aged 6–11 years were classified as obese in the United States. Obesity adversely affects physical functioning and leads to reduced quality of life. Heart function for overweight and obese children has not been reported. Methods. Data for this study were from NHANES National Youth Fitness Survey (NNYFS) conducted in conjunction with the National Health and Nutrition Examination Survey (NHANES) in 2012. This study used data from children aged 6–12 () that had the cardiorespiratory endurance measure, body mass index for age and sex, and dietary data (). Cardiovascular endurance was estimated by heart rate reserve. Results. Compared to the highest percentile of heart rate reserve, those in the first percentile had 3.52 (2.36, 5.24) odds and those in the second percentile had 3.61 (1.84, 7.06) odds of being in the overweight/obese as compared to the under/normal weight category. Considering the highest percentile, boys had a heart rate reserve of 35%, whereas girls had a heart rate reserve of 13% (less than half that of boys). Conclusion. Having an overweight or obese classification for children in this study demonstrated a compromise in cardiovascular endurance. Parental awareness should be raised as to the detrimental consequence of overweight and heart health. Joan A. Vaccaro and Fatma G. Huffman Copyright © 2016 Joan A. Vaccaro and Fatma G. Huffman. All rights reserved. Altered Left Ventricular Ion Channel Transcriptome in a High-Fat-Fed Rat Model of Obesity: Insight into Obesity-Induced Arrhythmogenesis Sun, 25 Sep 2016 09:21:23 +0000 Introduction. Obesity is increasingly common and is associated with an increased prevalence of cardiac arrhythmias. The aim of this study was to see whether in obesity there is proarrhythmic gene expression of ventricular ion channels and related molecules. Methods and Results. Rats were fed on a high-fat diet and compared to control rats on a normal diet (). After 8 weeks, rats on the high-fat diet showed significantly greater weight gain and higher adiposity. Left ventricle samples were removed at 8 weeks and mRNA expression of ion channels and other molecules was measured using qPCR. Obese rats had significant upregulation of , HCN4, , RYR2, NCX1, SERCA2a, and RYR2 mRNA and downregulation of ERG mRNA. In the case of HCN4, it was confirmed that there was a significant increase in protein expression. The potential effects of the mRNA changes on the ventricular action potential and intracellular Ca2+ transient were predicted using computer modelling. Modelling predicted prolongation of the ventricular action potential and an increase in the intracellular Ca2+ transient, both of which would be expected to be arrhythmogenic. Conclusion. High-fat diet causing obesity results in arrhythmogenic cardiac gene expression of ion channels and related molecules. Reza Ashrafi, Marianne Yon, Lucy Pickavance, Joseph Yanni Gerges, Gershan Davis, John Wilding, Kun Jian, Henggui Zhang, George Hart, and Mark Boyett Copyright © 2016 Reza Ashrafi et al. All rights reserved. Positioning of Weight Bias: Moving towards Social Justice Thu, 22 Sep 2016 12:31:40 +0000 Weight bias is a form of stigma with detrimental effects on the health and wellness of individuals with large bodies. Researchers from various disciplines have recognized weight bias as an important topic for public health and for professional practice. To date, researchers from various areas have approached weight bias from independent perspectives and from differing theoretical orientations. In this paper, we examined the similarities and differences between three perspectives (i.e., weight-centric, non-weight-centric (health-centric), and health at every size) used to understand weight bias and approach weight bias research with regard to (a) language about people with large bodies, (b) theoretical position, (c) identified consequences of weight bias, and (d) identified influences on weight-based social inequity. We suggest that, despite differences, each perspective acknowledges the negative influences that position weight as being within individual control and the negative consequences of weight bias. We call for recognition and discussion of weight bias as a social justice issue in order to change the discourse and professional practices extended towards individuals with large bodies. We advocate for an emphasis on social justice as a uniting framework for interdisciplinary research on weight bias. Sarah Nutter, Shelly Russell-Mayhew, Angela S. Alberga, Nancy Arthur, Anusha Kassan, Darren E. Lund, Monica Sesma-Vazquez, and Emily Williams Copyright © 2016 Sarah Nutter et al. All rights reserved. Influence of Nutrition Claims on Appetite Sensations according to Sex, Weight Status, and Restrained Eating Tue, 20 Sep 2016 16:53:28 +0000 Nutrition claims may help people to adopt healthier eating habits, but little is known about the potential cognitive effects of such claims on appetite sensations. The main purpose of this study was to evaluate the impact of nutrition claims and individual factors on perceived appetite sensations. According to a three (“healthy” versus “diet” (i.e., satiating) versus “hedonic”) by two (restrained or not restrained) by two (normal-weight or overweight/obese) by two (men versus women) factorial design, 164 males and 188 females aged 18–65 were invited to taste an oatmeal-raisin snack in a blinded and ad libitum context. Visual analog scales (150 mm) were used to evaluate appetite sensations before and over 1 h after consumption period. BMI and Restraint Scale were used to categorize participants according to their weight and restraint status. No main condition effect was observed for any of the four appetite sensations. However, subgroups analysis revealed significant differences among specific subgroups. A main effect of sex was also observed for all appetite sensations with men reporting higher levels of desire to eat, hunger and prospective food consumption, and lower levels of fullness than women. These findings highlight the importance of considering individual characteristics in interaction when studying appetite sensations. Geneviève Painchaud Guérard, Simone Lemieux, Éric Doucet, Sonia Pomerleau, and Véronique Provencher Copyright © 2016 Geneviève Painchaud Guérard et al. All rights reserved. Disparities in Risk Factors Associated with Obesity between Zanzibar and Tanzania Mainland among Women of Reproductive Age Based on the 2010 TDHS Sun, 18 Sep 2016 14:31:50 +0000 The occurrence of overweight and obesity has serious health implications. The 2010 Tanzania Demographic and Health Survey data set was reanalysed to compare the prevalences of overweight and obesity between Mainland Tanzania and Zanzibar and to determine how demographic factors can predict overweight and obesity across the United Republic of Tanzania. About 7.92% of the Tanzanian women of reproductive age were obese, 15% were overweight, and 11.5% were underweight. Women from Mainland Tanzania (6.56%) were significantly less likely (AOR = 0.66, 95% CI: 0.53–0.82) to be affected by obesity as compared to women from Zanzibar (12.19%). The common predictors of obesity in Mainland Tanzania and Zanzibar were wealth index, marital status, and age. Whereas the place of residence and education level emerged as predictors of obesity in the Mainland Tanzania alone, the number of meals per day did so in Zanzibar. Most importantly, Zanzibar had a greater prevalence of obesity compared to Mainland Tanzania. Edwin Paul, Abdalla H. Mtumwa, Julius Edward Ntwenya, and Said A. H. Vuai Copyright © 2016 Edwin Paul et al. All rights reserved. Role of Gut Microbiota in the Aetiology of Obesity: Proposed Mechanisms and Review of the Literature Thu, 15 Sep 2016 12:22:32 +0000 The aetiology of obesity has been attributed to several factors (environmental, dietary, lifestyle, host, and genetic factors); however none of these fully explain the increase in the prevalence of obesity worldwide. Gut microbiota located at the interface of host and environment in the gut are a new area of research being explored to explain the excess accumulation of energy in obese individuals and may be a potential target for therapeutic manipulation to reduce host energy storage. Several mechanisms have been suggested to explain the role of gut microbiota in the aetiology of obesity such as short chain fatty acid production, stimulation of hormones, chronic low-grade inflammation, lipoprotein and bile acid metabolism, and increased endocannabinoid receptor system tone. However, evidence from animal and human studies clearly indicates controversies in determining the cause or effect relationship between the gut microbiota and obesity. Metagenomics based studies indicate that functionality rather than the composition of gut microbiota may be important. Further mechanistic studies controlling for environmental and epigenetic factors are therefore required to help unravel obesity pathogenesis. Muhammad Jaffar Khan, Konstantinos Gerasimidis, Christine Ann Edwards, and M. Guftar Shaikh Copyright © 2016 Muhammad Jaffar Khan et al. All rights reserved. Appetite Suppression and Antiobesity Effect of a Botanical Composition Composed of Morus alba, Yerba mate, and Magnolia officinalis Tue, 06 Sep 2016 17:34:09 +0000 Background. Obesity and its comorbidities continue to challenge the world at an alarming rate. Although the long term solution lies on lifestyle changes in the form of dieting and exercising, drug, medical food, or dietary supplement interventions are required for those who are already obese. Here we describe a standardized blend composed of extracts from three medicinal plants: Morus alba, Yerba mate, and Magnolia officinalis for appetite suppression and metabolic disorders management. Method. Extracts were standardized to yield a composition designated as UP601. Appetite suppression activity was tested in acute feed intake rat model. Efficacy was evaluated in C57BL/6J mouse models treated with oral doses of 1.3 g/kg/day for 7 weeks. Orlistat at 40 mg/kg/day was used as a positive control. Body compositions of mice were assessed using a dual energy X-ray absorptiometry (DEXA). ELISA was done for insulin, leptin, and ghrelin level quantitation. Nonalcoholic steatohepatitis (NASH) scoring was conducted. Results. Marked acute hypophagia with 81.8, 75.3, 43.9, and 30.9% reductions in food intake at 2, 4, 6, and 24 hours were observed for UP601. Decreases in body weight gain (21.5% compared to the HFD at weeks 7 and 8.2% compared to baseline) and calorie intake (40.5% for the first week) were observed. 75.9% and 46.8% reductions in insulin and leptin, respectively, 4.2-fold increase in ghrelin level, and reductions of 18.6% in cholesterol and 59% in low-density lipoprotein were documented. A percentage body fat of 18.9%, 47.8%, 46.1%, and 30.4% was found for mice treated with normal control, HFD, Orlistat, and UP601, respectively. 59.3% less mesenteric fat pad and improved NASH scores were observed for UP601. Conclusion. UP601, a standardized botanical composition from Morus alba, Yerba mate, and Magnolia officinalis could be used as a natural alternative for appetite suppression, maintaining healthy body weight and metabolism management. Mesfin Yimam, Ping Jiao, Mei Hong, Lidia Brownell, Young-Chul Lee, Eu-Jin Hyun, Hyun-Jin Kim, Tae-Woo Kim, Jeong-Bum Nam, Mi-Ran Kim, and Qi Jia Copyright © 2016 Mesfin Yimam et al. All rights reserved. Design of a Digital-Based, Multicomponent Nutrition Guidance System for Prevention of Early Childhood Obesity Thu, 18 Aug 2016 06:22:35 +0000 Interventions targeting parenting focused modifiable factors to prevent obesity and promote healthy growth in the first 1000 days of life are needed. Scale-up of interventions to global populations is necessary to reverse trends in weight status among infants and toddlers, and large scale dissemination will require understanding of effective strategies. Utilizing nutrition education theories, this paper describes the design of a digital-based nutrition guidance system targeted to first-time mothers to prevent obesity during the first two years. The multicomponent system consists of scientifically substantiated content, tools, and telephone-based professional support delivered in an anticipatory and sequential manner via the internet, email, and text messages, focusing on educational modules addressing the modifiable factors associated with childhood obesity. Digital delivery formats leverage consumer media trends and provide the opportunity for scale-up, unavailable to previous interventions reliant on resource heavy clinic and home-based counseling. Designed initially for use in the United States, this system’s core features are applicable to all contexts and constitute an approach fostering healthy growth, not just obesity prevention. The multicomponent features, combined with a global concern for optimal growth and positive trends in mobile internet use, represent this system’s future potential to affect change in nutrition practice in developing countries. Keriann H. Uesugi, Anne M. Dattilo, Maureen M. Black, and Jose M. Saavedra Copyright © 2016 Keriann H. Uesugi et al. All rights reserved. Receptivity to Bariatric Surgery in Qualified Patients Tue, 19 Jul 2016 09:55:44 +0000 Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to complete an elective questionnaire between February 2013 and April 2014. Results. A total of 371 patients (72% female) completed the questionnaire. Only 87 of 371 (23%) participants were interested in bariatric surgery. Individuals interested in bariatric surgery had a higher BMI (48.0 versus 46.2 kg/m2, ) and believed that they would lose more weight with surgery (51 versus 44 kg, ). Those who scored highly on past weight loss success and financial concerns were less likely to be interested in bariatric surgery, whereas those who scored highly on high receptivity to surgery and positive social support were more likely to be interested in bariatric surgery. Conclusion. Although participants overestimated the effect of bariatric surgery on weight loss, most were still not interested in bariatric surgery. Michael Fung, Sean Wharton, Alison Macpherson, and Jennifer L. Kuk Copyright © 2016 Michael Fung et al. All rights reserved. Community Engaged Lifestyle Modification Research: Engaging Diabetic and Prediabetic African American Women in Community-Based Interventions Thu, 14 Jul 2016 14:22:54 +0000 Purpose. The I Am Woman (IAW) Program is a community-based, culturally responsive, and gender-specific nutrition, obesity, and diabetes educational prevention program designed for African American women (AAW). Chronic nutrition-related health conditions such as excess body weight, diabetes mellitus, cardiovascular disease, and some forms of cancer are common among many African American women. Methods. IAW engaged AAW at risk for such deleterious health conditions by developing a health education intervention that aimed to support weight loss and management, improve knowledge about healthy lifestyle behavioral choices, and facilitate increased access to comprehensive healthcare. This Community Health Worker- (CHW-) led program enrolled 79 AAW aged 18 and older in a 7-week group health education intervention. Results. Following the intervention, results indicated that participants had greater knowledge about nutrition and health, strategies for prevention and management of obesity and diabetes, increased engagement in exercise and fitness activities, and decreased blood pressure, weight, body, and mass index. Cholesterol levels remained relatively unchanged. Additionally, AAW visited a primary care doctor more frequently and indicated greater interest in addressing their health concerns. Conclusion. This model of prevention appears to be a promising approach for increasing awareness about ways to improve the health and well-being of AAW. Starla Hairston Blanks, Henrie Treadwell, Anya Bazzell, Whitney Graves, Olivia Osaji, Juanita Dean, James T. McLawhorn, and Jareese Lee Stroud Copyright © 2016 Starla Hairston Blanks et al. All rights reserved. Let’s Wiggle with 5-2-1-0: Curriculum Development for Training Childcare Providers to Promote Activity in Childcare Settings Mon, 04 Jul 2016 08:41:24 +0000 Overweight and obesity are increasing in preschool children in the US. Policy, systems, and environmental change interventions in childcare settings can improve obesity-related behaviors. The aim of this study was to develop and pilot an intervention to train childcare providers to promote physical activity (PA) in childcare classrooms. An evidence scan, key informant () and focus group () interviews with childcare directors and staff, and environmental self-assessment of childcare facilities () informed the design of the training curriculum. Feedback from the interviews indicated that childcare providers believed in the importance of teaching children about PA and were supportive of training teachers to incorporate PA into classroom settings. The Promoting Physical Activity in Childcare Setting Curriculum was developed and training was implemented with 16 teachers. Participants reported a positive experience with the hands-on training and reported acquiring new knowledge that they intended to implement in their childcare settings. Our findings highlight the feasibility of working with childcare staff to develop PA training and curriculum. Next steps include evaluating the curriculum in additional childcare settings and childcare staff implementation of the curriculum to understand the effectiveness of the training on PA levels of children. Debra M. Vinci, Melicia C. Whitt-Glover, Christopher K. Wirth, Caroline Kraus, and Alexandra P. Venezia Copyright © 2016 Debra M. Vinci et al. 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.