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PubMedDate not supplied

[The "problem obesity": viewpoint of the internist].

The prevalence of obesity has reached epidemic dimension in industrialized countries and it is known that obesity is associated with increased risk of cardiovascular morbidity and mortality. Commonly, obesity is defined by the Body Mass Index (BMI). However, BMI fails to consider body fat distribution. The relationship between the risk of metabolic-cardiovascular diseases and body fat distribution indices such as the waist-to-hip ratio (WHR) and the waist circumference, rather than measures of the degree of body fatness as expressed by BMI, has long been recognized. Recently, clinical and epidemiological research has found waist circumference to be the best anthropometric indicator of both total body fat and intra-abdominal fat mass. Android or visceral obesity is associated with metabolic syndrome and increased cardiovascular morbidity and mortality through a variety of molecular mechanisms possibly linking the metabolic syndrome to hemostatic and vascular abnormalities. Obesity guidelines suggest the need for weight reduction using behavioural change to reduce caloric intake and increasing physical activity. A realistic goal for weight reduction is to reduce body weight by 5% to 10% over a period of 6 to 12 months. Combined intervention of a low calories diet, increased physical activity, and behaviour therapy provides better outcomes for long-term weight reduction and weight maintenance than programs that use only one or two of these modalities. The drugs used to promote weight loss have been anorexic drugs or appetite suppressants. All classes of anorexic drugs affect neurotransmitters in the brain. The new agent sibutramine has norepinephrine and serotonin effects. Another new agent, orlistat, has a different mechanism of action, the reduction of fat absorption. Weight loss drugs approved by the FDA for long-term use may be useful as an adjunct to diet, physical activity and behaviour therapy for patients with a BMI of > or =30 with no concomitant obesity-related risk factors or diseases, and for patients with a BMI of > or =27 with concomitant obesity-related risk factors or diseases.

Anti-Obesity Agents↗

PubMed2000

Adiposity as a risk determinant for postmenopausal breast cancer.

BACKGROUND: Cross-cultural studies have long suggested that the high incidence of breast cancer in developed Western countries may be linked to the high prevalence of obesity and to high total energy intake. Recent studies show that hyperinsulinemia, increased concentration of insulin-like growth factor 1 and greater abdominal fat accumulation are markers of high risk for breast cancer. Increased serum concentrations of free estradiol and free testosterone are similar risk markers and are frequent concomitants of hyperinsulinemia. MECHANISMS: The mechanism by which such metabolic-endocrine abnormality may promote mammary carcinogenesis is uncertain, but its effect is likely to predominate in the years approaching the menopause when obesity is common among Western women. In obese subjects, enlargement of adipose deposits is known to produce an excess of free fatty acids and tumor necrosis factor alpha, both of which may be involved in the pathogenesis of insulin resistance. In middle-aged women, the concomitants of hyperinsulinemia may activate invasive and proliferative activity in preneoplastic mammary lesions such as in situ duct carcinoma of the comedo type. This will enhance the risk of progression to invasive breast cancer, which is likely to manifest clinically mainly after the menopause. CONCLUSION: Weight reduction combined with a program of regular physical exercise has been shown to reduce both estrogen and insulin concentrations in obese women and such a regimen might be tested in clinical trials for an effect on breast cancer risk in obese women. Intervention is best begun around the age of 45 y, this being the age when in situ duct carcinoma would normally begin to show evidence of spontaneous involution in women without clinical evidence of invasive breast cancer. International Journal of Obesity (2000) 24, 527-533

Adipose Tissue↗

PubMed1981

Overweight and obesity in preschool children in New York City.

In an effort to ascertain the prevalence of obesity in young children, 48 nursery schools in Manhattan and Queens, New York City were surveyed. The weights and heights of 2606 children, ages 3 to 6 yr, were obtained. Three-hundred seventeen children (12.2%) were above 120% of ideal body weight and 122 (4.7%) were above 130% of ideal weight. Twenty percent of the children from schools attended by youngsters from low income families, 12% from schools attended by pupils from middle income families, and 5% from schools with pupils from families with a high income were classified as obese. Of the obese children's actual body weights 90% were at or greater than the 75th percentile for age while mean higher percentiles of the obese and nonobese children were not significantly different. Sex specific prevalence rates were similar for boys and girls. These data indicate that obesity is already prevalent in the nursery school population and that such obese children can be easily identified from weight and height measurements at a time when programs for successful permanent weight reduction and maintenance may be feasible.

Body Height↗

PubMed2000

The effect of a high-fat diet and exercise on the expression of genetic obesity.

In the United States, there are 300,000 obesity-related premature deaths each year. Furthermore, no current obesity treatment program results in consistent weight reductions. Obesity is thought to be caused by complex genetic-environmental interactions. We studied the effect of two environmental factors, high-fat diet and non-weight-bearing exercise, on obesity expression. Young adult, female, genetically obese (fa/fa) rats (n = 52) and their lean (Fa/fa) littermates (n = 24) were studied using an experimental 2 x 2 x 2 factorial design (diet type, genetics, and exercise). Repeated measures ANOVA and secondarily stepwise regressions were used to analyze the data. The authors discovered that the effect of appetite on obesity expression is more limited than expected, and there may be critical stages when obesity expression is amenable to environmental modification.

Analysis of Variance↗

PubMed1996

Measuring body fatness in children and young adults: comparison of bioelectric impedance analysis, total body electrical conductivity, and dual-energy X-ray absorptiometry.

OBJECTIVE: To determine the level of agreement for body fatness measurements among four body composition measurement techniques. SUBJECTS: 99 healthy children and young adults (63 males, 36 females; ages: 5-22 y) MEASUREMENT: Bioelectrical impedance analysis (BIA), bioelectrical impedance spectroscopy (BIS), total body electrical conductivity (TOBEC), and dual-energy X-ray absorptiometry (DXA) measurements of body fat mass, and its percentage of body weight (% Fat). RESULTS: Estimates for body fat mass and % Fat were highly correlated (r = 0.72-0.97, P < 0.001) among the four methods. However, a Bland-Altman comparison among the estimates indicated significant differences between methods. The mean differences between methods for body fat ranged from -0.30 +/- 6.7 kg to 4.2 +/- 2.7 kg. Differences for % Fat ranged from 0.8% +/- 3.5% to -9.9% +/- 5.2%. Fatness classification of an individual as normal, overweight, or obese on the basis of his/her % Fat was significantly method dependent. CONCLUSIONS: The lack of interchangeability for fatness classification makes it difficult to ensure that similar groups of subjects can be accurately selected for the same true fat content or % Fat range when different methods are used. Furthermore, this limitation may restrict comparison of findings among different studies, such as in weight reduction, exercise, or therapy programs, when the subjects were not originally classified using the same measurement methods. That is, the reported values and changes for body fat or % Fat appear to be highly method dependent.

Absorptiometry, Photon↗

PubMed1998

Special topics in pediatric hypertension.

This review emphasizes four major areas of pediatric hypertension. Because hypertension is the most common reason student athletes fail the sports pre-participation examinations, we have attempted to provide a rationale approach to the decision process to permit a hypertensive child to partake in leisure and competitive sports. Without question, obesity is a major reason for referral for hypertension to a pediatric nephrologist. The work-up should be directed to diet control and an exercise program to achieve sustained weight reduction. Hypertension associated with chronic renal failure and renal disease secondary to insulin-dependent diabetes mellitus is a major problem in pediatric and adult nephrology. With adequate control of systemic blood pressure, progressive decline in renal function may be delayed. By understanding these common areas of associated pediatric hypertension, a more systematic approach to the evaluation and treatment can be achieved.

Adolescent↗

PubMed2005

Assessing communications effectiveness in meeting corporate goals of public health organizations.

Much evaluation of health communications in public health is considered from a program perspective of smoking cessation, weight reduction, education on sexually transmitted diseases, etc. These studies have advanced the knowledge base of communications theory and evaluation and have contributed to program effectiveness. In program-based evaluation the communications process is structured as part of the program itself. This article extends program-based communications evaluation to view communications from the perspective of the consumer and how effectively public health departments respond to consumer expectations. It develops a conceptual model for evaluating elements of communications such as its importance in defining mission and goals within the community, managing strategic constituencies, and enlisting individuals and groups as customers and co-producers of health. It gives a broader perspective on how communications in public heath organizations are managed and a basis for assessing whether they are being managed effectively.

Communication↗

PubMed1991

Randomized clinical trials of weight reduction in nonhypertensive persons.

Since 1987, four randomized controlled clinical trials with 872 nonhypertensive subjects have produced results on weight-reducing interventions, involving decreased caloric intake and/or increased expenditure, for effects on blood pressure (BP). The Hypertension Prevention Trial maintained a 3.5-kg net weight loss through 36 months with intake reduction alone. This program decreased BP by 2.4/1.8 mm Hg (systolic/diastolic) compared to controls, but both weight loss and blood pressure changes were smaller when combined with decreased sodium intake. A Stanford University trial achieved weight losses of 7.4 and 5.1 kg over 12 months with diet and exercise, respectively. Effects on clinic BP were in the range of 1.5 to 3.0 mm Hg and did not differ by intervention approach. The sole trial in children, conducted at University of Michigan, found similar weight loss (about 7 kg) and BP effects from limiting caloric intake over 20 weeks, regardless of inclusion of an exercise program; the latter did, however, result in greater reductions in percent body fat, heart rate, and serum insulin levels. The Primary Prevention of Hypertension trial tested a multifactor intervention including reductions in weight (mean, 2.7 kg), sodium and alcohol intake, and increased physical activity. During a 5-year period, clinic BP was reduced by 2.0/1.9 mm Hg, and the incidence of hypertension, by 52%. It is concluded that weight loss, however achieved, lowers BP in overweight nonhypertensive persons, and probably can contribute substantially to reducing the incidence of hypertension. Whether there are independent effects additive to weight loss from increasing physical activity and reducing sodium intake remains unknown.

Blood Pressure↗

PubMed2004

Managing atypical antipsychotic-associated weight gain: 12-month data on a multimodal weight control program.

BACKGROUND: The purpose of this study was to test prospectively the feasibility and efficacy of a multimodal weight control program for over-weight and obese severely mentally ill adults who had gained weight while taking atypical antipsychotic medications. METHOD: Thirty-one subjects with schizophrenia or schizoaffective disorder (DSM-IV), on treatment with atypical antipsychotics, participated in a 52-week, multimodal weight control program that incorporated nutrition, exercise, and behavioral interventions. The primary outcomes were measures of body mass index (BMI) and weight. A variety of secondary outcomes, including hemoglobin A(1c) level, systolic and diastolic blood pressure, and cholesterol level, were compared from baseline to endpoint. Weight and BMI changes in the intervention group were also compared with changes in 20 nonintervention patients ("usual care" group) who were contemporaneously treated in the same clinics. RESULTS: Twenty of the 31 subjects in the intervention group completed the program. Statistically significant pre-post improvements in weight (p <.02), BMI (p <.02), hemoglobin A(1c) levels (p <.001), diastolic (p <.001) and systolic (p <.05) blood pressure, exercise level (p <.003), nutrition knowledge (p <.0001), and stage of change (exercise [p <.0001] and weight [p <.008]) were seen in the intervention group. Patients attended a mean of 69% of the sessions during the year of the program. Weight and BMI also decreased significantly (p =.01) in the intervention group compared with the "usual care" group, who gained weight during the observation period. CONCLUSIONS: Individuals with schizophrenia and schizoaffective disorder were willing to attend, and benefited from, a weight control program that focused on nutrition, exercise, and motivation. The program resulted in clinically significant reductions in weight, BMI, and other risk factors for long-term poor health, including hemoglobin A(1c). In contrast, patients who did not receive the weight control intervention continued to gain weight.

Adult↗

PubMed2006

The effect of loss of body weight on lipid profile in overweight individuals.

OBJECTIVE: To determine the effect of reducing body weight and body mass index on serum lipid. METHODS: This is a prospective longitudinal study, which was implemented in Naim Primary Health Care Center in the Kingdom of Bahrain during May and June of 2004. The study included 55 individuals who were willing to participate. The criteria for the sample selection included being overweight, having high serum lipid and patients' willingness to reduce their weight. The patients were followed up for a 26 weeks period consisting of continuous health education program, maintenance on low caloric diet and exercise to help them reduce their body weight. This period included a lifestyle enhancement awareness program that included 4 health education sessions on weight loss, 4 sessions on weight loss maintenance and frequent and regular visits to the clinic to make sure that those patients were compliant with the given instructions. RESULTS: The study showed that patients who completed the designed program had a reduction in body weight, body mass index, and lipid level and an increase in physical activity and dietary readiness to control over-eating. Although in both genders there was a significant drop in all the parameters, only body mass index (p<0.002) and cholesterol (p=0.007) showed a statistically significant difference between men and women. In men, cholesterol level at the initial stage of the study was strongly related to the body weight (r=0.65, p<0.002) and body mass index (r=0.83, p<0.0005). Despite that the cholesterol level reduced more in women than men; women decreased less in weight (p<0.0005) and body mass index (p<0.0005) than men. CONCLUSION: Overweight individuals would benefit from a life enhancement program that increases their awareness on the danger of obesity and helps them in reducing body weight and serum lipid level.

Adult↗

PubMed2006

Healthy behavior change of adults with mental retardation: attendance in a health promotion program.

Participation in a health promotion program for 192 overweight and obese adults with mental retardation was associated with behavior change resulting in reduction of body mass index-BMI (weight in kg, divided by height in meters, squared) by the end of the program. We analyzed the mediating and intermediate factors contributing to weight reduction and found knowledge and exercise to be the primary contributing factors. The curriculum emphasized exercise, nutritional choices, and stress reduction. Participation in the program was associated with a reduction of 0.8 BMI or approximately 2.3 kg for 26% of the participants. Increased knowledge about healthy diet and exercise was the most significant mediator of program impact on BMI.

Adult↗

PubMed2001

Increase in plasma pollutant levels in response to weight loss in humans is related to in vitro subcutaneous adipocyte basal lipolysis.

OBJECTIVE: To examine whether weight loss-induced changes in in vitro basal lipolysis of subcutaneous abdominal and femoral fat cells were related to those in plasma organochlorine levels. DESIGN: A 15 week weight loss program induced by a moderate caloric restriction. SUBJECTS: Seventeen men and 20 women (age 36-50 y, body fat 25-50%). MEASUREMENTS: In vitro basal lipolysis of subcutaneous abdominal and femoral adipocytes and plasma levels of five polychlorinated biphenyl congeners (Aroclor 1260, PCBs 118, 138, 153 and 180) and three chlorinated pesticides (dichlorodiphenyl dichloroethene (p,p'-DDE), beta-hexachlorocyclohexane (beta-HCH) and hexachlorobenzene (HCB)) were measured before and after the weight reducing program. RESULTS: Both genders showed a similar reduction in body weight (approximately 11 kg) in response to treatment, although men lost significantly more fat mass than women (mean+/-s.d., 9.4+/-4.1 vs 5.9+/-5 kg, respectively, P<0.05). Mean basal fat cell lipolysis did not vary before and after weight reduction, regardless of depots and genders. In response to weight loss, significant increases of all organochlorines investigated were observed in men, whereas only p,p'-DDE, Aroclor 1260, PCBs 153 and 180 significantly rose in women. In men, higher the increase in basal lipolysis of subcutaneous abdominal or femoral adipocytes, greater the rise in plasma levels of most pollutants (HCB, Aroclor 1260, PCBs 118, 138 and 153) was in response to weight loss (0.51<r<0.70, P<0.05). Similar positive correlations were also observed in women but only a few reached statistical significance (p,p'-DDE, PCBs 118 and 180). CONCLUSION: The weight loss-induced increase in plasma pollutant levels is related to the rise in subcutaneous abdominal and femoral adipocyte basal lipolysis, especially in men.

Abdomen↗

PubMed1984

The effectiveness of a low lipid diet and exercise in the management of coronary artery disease.

To evaluate the effects of a high complex carbohydrate, low lipid diet on the management of coronary artery disease, we reviewed data on 32 patients, who had participated in a diet and exercise program, and compared the results with 40 patients who had been managed only with exercise. After a follow-up period of 10 to 16 weeks the patients on the diet-exercise program showed significant reduction in body weight (-6 +/- 2 kg mean +/- standard deviation), serum cholesterol (-43 +/- 41 mg/dl), and triglycerides (-51 +/- 70 mg/dl), while patients who were managed only with exercise had no significant changes in weight or serum lipids. Both the diet-exercise and the exercise groups showed significant improvement in working capacity and reduction in resting systolic blood pressure. Patients on the diet-exercise program had significantly less angina (21.9%) occurring on the exercise test after the program compared to before, even though the same double product was reached. Multiple logistic regression analysis of the data for patients with angina on the exercise test demonstrated that the only significant (p = 0.004) contributor for reduction in angina was the dietary intervention. Beta-blocking drugs did not affect the results. Although randomized controlled trials must be run in order to ascertain the significance of this finding, this study strongly suggests that a low lipid, high carbohydrate diet is a useful addition to exercise in the management of patients with coronary disease.

Adult↗

PubMedDate not supplied

Estimating software development costs for a patient multimedia education project.

The authors compare alternative methods of cost estimation for a patient multimedia education (PME) program, using a computerized weight-reduction PME project as an example. Data from the project planning and budgeting process and actual costs of the completed project are analyzed retrospectively to calculate three different estimates-pre-work, post-work, and actual work. Three traditional methods of estimating the cost of computer programs (the lines-of-code, function point, and task ratio analyses) underestimate costs in this example. A commercial program (Cost Xpert) that calculates the cost of developing a graphical user interface provided a better estimate, as did a tally reflecting the complexity and quality of media material in the project.

Costs and Cost Analysis↗

PubMed2001

Uli'eo Koa Program: incorporating a traditional Hawaiian dietary component.

Traditional Hawaiian Diet (THD) programs were developed over the past 15 years as a culturally appropriate community intervention for improving the health status of Native Hawaiians. THD programs are generally three weeks in length and incorporate a diet regimen of foods traditional to the Hawaiian culture, coupled with an education component that emphasizes cultural beliefs and practices that support health and wellness. In accordance with traditional practice, THD meals consist mainly of vegetable foods, with controlled amounts of protein. THD programs have demonstrated high success in weight reduction of severely overweight individuals, as well as reductions of serum cholesterol, triglycerides, glucose, and blood pressure. THD programs, to date, have focused on the reduction of these risk factors. The Uli'eo Koa Program, Warrior Preparedness Program, is a pilot study that incorporated a traditional Hawaiian diet component to ascertain its effects on a group of moderately active, non-obese Native Hawaiian adults--specifically the diet's contribution to wellness and physical fitness. Other components of the Uli'eo Koa Program were a physical exercise regimen and a traditional healing component. The purpose of the dietary component of the Uli'eo Koa Program was to provide the nutritional support needed to sustain nutritional requirements for increased physical activity within this group. The year-long Uli'eo Koa Program consisted of three phases. In Phase I, exercise was conducted twice a day and three meals, including snacks, were provided for participants over a three-week period. During Phase II, structured exercise time and meals were decreased to three times a week and two times a week, respectively, for eight weeks. Participants were responsible for maintaining these regimens on their own outside of the structured activities. In Phase III (in progress at the time of this manuscript preparation), the remainder of the program year, participants were solely responsible for structuring their own physical and dietary behaviors. The nutrient composition of the meals followed a traditional Hawaiian diet, which was typically high in complex carbohydrates, low (< 10%) in total dietary fat and limited in protein (as compared to a standard American diet). Dietary assessments were conducted at the onset (baseline) of the program, using a 24-hour dietary recall methodology. When the post-dietary assessments, conducted at the end of Phase II, were compared to the baseline assessments, positive results were indicated by the reported increases in intakes of all major nutrients, including key vitamins and minerals required for exercise. A final dietary assessment will be conducted at the end of the program year (Phase III) to determine maintenance of positive dietary habits. Implications and future research are discussed.

Adult↗

PubMedDate not supplied

The development and evaluation of lighten up, an Australian community-based weight management program.

UNLABELLED: Programs of widely ranging size were conducted successfully in seven localities and thus the program was considered an operational success. The reductions in weight, blood pressure, and waist and hip measurements observed at the 3-month follow-up compared well with reports of other community-based programs. Almost all participants evaluated the program highly and reported positive changes in behaviors related to food and exercise. Qualitative data indicate that the coordinators developed a sense of ownership of the program--which will be vital to its sustainability. Rapport between coordinators and participants was more easily established in smaller programs than in larger ones and was an important underlying determinant of retention rates. SIGNIFICANCE: The Lighten Up program integrates environmental and individual strategies to facilitate changes towards a positive, lifestyle approach to long-term weight management. The program aims to establish sustainable social support networks with effective links to health services. This study has demonstrated that, with appropriate training and resources, existing public sector, primary health care personnel with no previous experience in health promotion can implement the program successfully in several communities concurrently. In the Australian context, this program can play an important role as one strategy in a range of interventions required to address the issue of obesity. The stepped-care model described by Brownell proposes that program options of varying intensity, and thus cost, be available to meet the variety of needs of overweight people who wish to lose weight. The Lighten Up program was close to the midpoint of that range in that it combined population strategies with one-on-one contact with health care personnel. LIMITATIONS: Participants in the study were self-selected people who had acted quickly to enroll in the program, and it is therefore likely that the sample was overrepresented with early adopters who may have been more successful than others would have been. We cannot tell from this developmental study whether or not the program will appeal to population groups known to be at high risk for obesity. This is an important question that needs to be addressed in future research. No control group was included in the design and thus we cannot be sure the benefits experienced by the participants resulted from the program. However, process evaluation data indicate that nothing that might explain the findings, other than the program, occurred in the communities during the time of the study. Further important issues to be evaluated include: the long-term maintenance of weight loss; whether or not the program will reach targeted populations, particularly groups of low socioeconomic status; and the extent to which the public health staff will maintain enthusiasm for the training and the programs.

Adult↗

PubMed1994

Relationship of weight loss to cardiovascular risk factors in morbidly obese individuals.

OBJECTIVES: This study critically examined the relationships between weight loss and changes in serum lipid and blood pressure levels. DESIGN: Eighty morbidly obese women and men were treated with an intensive very-low-calorie diet (VLCD) and behavioral education program. Body weight and blood pressure were measured weekly. Serum lipids were measured biweekly. RESULTS: Patients lost an average of 35.3 kg in 25.6 weeks. These values decreased significantly: fasting serum cholesterol, 15.1%; low density lipoprotein cholesterol, 17.0%; triglycerides, 14.2%; systolic blood pressure, 8.7%; and diastolic blood pressure, 10.2%. Changes in serum lipids and blood pressure were significantly (p < 0.001) correlated with baseline values and with changes in body mass index (BMI) after adjustment for baseline values. Patients maintained an average of 19.7 kg of their weight loss at the 2-year follow-up. CONCLUSIONS: Weight reduction through a multidisciplinary VLCD program significantly reduces risk factors for cardiovascular disease; for morbidly obese individuals, improvements in risk factors were significantly and linearly related to changes in the BMI.

Adult↗

PubMed1992

Metabolic impact of education in NIDDM.

OBJECTIVE: To evaluate the impact of a model program of diabetes education and weight reduction on diabetes control and weight loss in obese individuals with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: Eighty-two obese diabetic subjects were randomized to three levels of educational intensity: 1) a single individual session, 2) a 12-wk behavior-oriented diabetes education and weight control group intervention, or 3) group intervention plus six individual follow-up sessions. Repeated measures of weight, fasting blood glucose, and HbA1c were collected. Measures of diabetes knowledge, skills, and attitudes were also obtained. RESULTS: By 6 mo, all three intervention groups had a significant weight loss (P less than 0.01). The mean weight loss of approximately 10 lb was independent of treatment group and was maintained over the duration of the study. However, significant improvement in metabolic control was associated with participation in the diabetes education-weight reduction intervention. CONCLUSIONS: The findings of this study indicate that a cognitive behavioral group intervention of diabetes knowledge and weight reduction training can produce weight loss and improvements in diabetes control. The addition of individual counseling as a follow-up maintenance strategy does not appear to have any advantage.

Adult↗