SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The association between increased prepregnancy weight for height and seven pregnancy complications was studied in a multi-racial sample of more than 4100 recent deliveries. Body mass indices were calculated and used to classify women as average weight (90-119 percent of ideal or BMI 19.21-25.60), moderately overweight (120-135 percent ideal or BMI 25.61-28.90), and very overweight (greater than 135 percent ideal or BMI greater than 28.91) prior to pregnancy. Compared to women of average weight for height, very overweight women had a higher risk of diabetes, hypertension, pregnancy-induced hypertension and primary cesarean section delivery. Moderately overweight women were also at higher risk than average for diabetes, pregnancy-induced hypertension and primary cesarean deliveries but the relative risks were of a smaller magnitude than for very overweight women. With women of average prepregnancy body mass as reference, moderately elevated, but not significant relative risks were found for perinatal mortality in the very overweight group, for urinary tract infections in both overweight groups, and a decreased risk for anemia was found in the very overweight group. However, post-hoc power analyses indicated that the number of overweight women in the sample did not allow adequate statistical power to detect these small differences in risk. To overcome limitations associated with low statistical power, the results of three recent studies of these outcomes in very overweight pregnant women were combined and summarized using Mantel-Haenzel techniques. This second, larger analysis suggested that very overweight women are at significantly higher risk for all seven outcomes studied. Summary results for moderately overweight women could not be calculated, since only two of the studies had evaluated moderately overweight women separately. These latter results support other findings that both moderate overweight and very overweight are risk factors during pregnancy, with the highest risk occurring in the heaviest group. Although these results indicate that moderate overweight is a risk factor during pregnancy, additional studies are needed to confirm the impact of being 20-35 percent above ideal weight prior to pregnancy. The results of this analysis also imply that since the baseline incidence of many perinatal complications is low, studies relating overweight and pregnancy complications should include large enough samples of overweight women so that there is adequate statistical power to reliably detect differences in complication rates.
BACKGROUND: Overweight in adults is associated with increased morbidity and mortality. In contrast, the long-term effect of overweight in adolescence on morbidity and mortality is not known. METHODS: We studied the relation between overweight and morbidity and mortality in 508 lean or overweight adolescents 13 to 18 years old who participated in the Harvard Growth Study of 1922 to 1935. Overweight adolescents were defined as those with a body-mass index that on two occasions was greater than the 75th percentile in subjects of the same age and sex in a large national survey. Lean adolescents were defined as those with a body-mass index between the 25th and 50th percentiles. Subjects who were still alive were interviewed in 1988 to obtain information about their medical history, weight, functional capacity, and other risk factors. For those who had died, information on the cause of death was obtained from death certificates. RESULTS: Overweight in adolescent subjects was associated with an increased risk of mortality from all causes and disease-specific mortality among men, but not among women. The relative risks among men were 1.8 (95 percent confidence interval, 1.2 to 2.7; P = 0.004) for mortality from all causes and 2.3 (95 percent confidence interval, 1.4 to 4.1; P = 0.002) for mortality from coronary heart disease. The risk of morbidity from coronary heart disease and atherosclerosis was increased among men and women who had been overweight in adolescence. The risk of colorectal cancer and gout was increased among men and the risk of arthritis was increased among women who had been overweight in adolescence. Overweight in adolescence was a more powerful predictor of these risks than overweight in adulthood. CONCLUSIONS: Overweight in adolescence predicted a broad range of adverse health effects that were independent of adult weight after 55 years of follow-up.
From a population of singleton pregnancies, 152 overweight women (greater than 110% of standard) were matched with normal weight women (95-110%) for age, height, parity, race, and smoking habits. Comparisons were made of initial weight (weight at the first prenatal visit) and gestational weight gain and pregnancy outcome. Mean birth weights and gestational ages of infants of normal and overweight women were not significantly different. For normal weight women birth weight increased significantly as height, initial weight, and body mas index increased (p less than 0.01), but no such relationship existed for overweight women. The lack of effect of initial weight on birth weight in overweight women is attributable, in part, to the significantly less gestational weight gains of these mothers (6.3 kg vs 8.2 kg). When normal and overweight gravida had gestational weight gains of less than 7 kg, offspring of overweight mothers were significantly heavier. Gestational weight gain was positively correlated with birth weight for both normal (p less than 0.0001) and overweight women (p less than 0.001). Within the overweight and normal weight groups, smokers had lower initial weights and gestational weight gains than nonsmokers. Offspring of normal weight smokers had a mean birth weight 232 g less than that of nonsmokers (p less than 0.01). The difference in birth weight between overweight smokers and nonsmokers (135 g) was not statistically significant. While there is substantial data to support a weight gain of 10-12 kg in normal weight gravida, it would appear that a gain of approximately 7 kg in overweight middle class women does not impair fetal growth as measured by birth weight.(ABSTRACT TRUNCATED AT 250 WORDS)
Relationships between psychological factors and physical factors such as body mass, overweight, and blood pressure were examined in a sample of black and white adolescents enrolled in health science courses. Black female adolescents were significantly more overweight and obese than either other group. Psychological factors were not significantly associated with body mass (weight/height) for females. A small percentage of the variance in body mass for black (6%) and white (4%) males was explained by Trait Anger, the frequent experience of anger and the intensity of anger (S-Anger-Reaction/TP) in pressure situations. Trait Anger also significantly (p less than 0.01) discriminated between black male adolescents who were normal weight and those 20% overweight for age and height. The relationships between traditional risk factors and blood pressure among adolescents who were 20% underweight, normal weight, and 20% overweight for age and height suggest that few traditional risk factors contribute significantly to the prediction of blood pressure in overweight adolescents. In contrast, psychological measures of suppressed anger (Anger-In, Anger Expression) were significantly (p less than 0.001) associated with blood pressure among overweight adolescents. The findings regarding the associations between overweight and psychological factors are complex. Prospective studies using better measures of overweight are needed to clarify the processes involved.
When height and weight cannot be directly measured percent overweight can be estimated using self-reported height and weight, reports of others for height and weight, and matching of body shape to silhouettes. The present study assessed the relative benefits of each method for estimating percent overweight within families, as well as the potential for using matching of silhouettes for diagnosing obesity. Analysis of the relationship between percent overweight and silhouette ratings showed increases in percent overweight across the silhouettes. Correlations between self- or other-reported and measured percent overweight showed that self-reports correlated very highly with measured reports of percent overweight (r = .97, .96 for parents and children, respectively), but parent reports of their spouses and children percent overweight were lower (r = .87, .87) and child reports of sibling or parent percent overweight were even lower (r = .75, .75). Significant increases in accuracy of diagnosing obesity were observed when the combination of adjusted self-reports and silhouettes were used in comparison to self-reports alone.
Using data on 19,405 adults from telephone interviews across the US, 1981-1983, we examined the sociodemographic characteristics, health-risk behaviors, body image, and dieting of overweight adults classified by the 1959 Metropolitan Life Insurance tables for weight and height. By self-report, 23% were overweight vs 29% in 1960-62. This modest decline in overweight remained after age-adjusting the 1981-1983 rate to the 1960 population. In 1981-1983, more blacks and Hispanics than whites were overweight [rate ratio (RR) = 1.43]. After adjustment for age and education, more over- than average-weight adults had uncontrolled hypertension, were binge drinking, and had a sedentary lifestyle. Among overweight men and women, 72% and 52%, respectively, were not dieting. Overweight adults acknowledging they were overweight were dieting more often than those without this perception (RR = 1.53). Results are discussed in light of research documenting weight gain and overweight as independent risk factors for cardiovascular disease incidence and mortality.
The prevalence and incidence of overweight and obesity has been studied in a young adult population aged 19-35 years. Special attention was given to the relation with psychosociological variables and life-style. The prevalence of overweight and obesity was also studied in a representative population for The Netherlands, in which population also the relation with self-reported illness and subjective health was studied. In the patient population of four general practices the relation of overweight and obesity with disease was investigated in a retrospective design. Also the influence of the body fat distribution was studied. The prevalence of overweight (BMI greater than 25 kg/m2) in the Dutch adult population was 34% in men and 24% in women. The prevalence of obesity (BMI greater than 30 kg/m2) was 4 and 6% in men and women, respectively. The prevalence of overweight and obesity was negatively related with social class and increased with age. Also, life-style variables such as coffee consumption, alcohol consumption, smoking and amount of hours sleep (CASS behavior), physical activity during leisure time, slimming behavior and health-conscious behavior were correlated with the prevalence of overweight. Life events caused an increase in body weight, but in women (not in men) this gain was suppressed by following slimming periods. Thus, emotional eating seems to be an important factor in the etiology of obesity. The results of our studies on the relation of overweight and obesity with morbidity aspects show a clear relation of some diseases and subjective health with overweight, especially in men and women with an abdominal fat distribution. From the results of this study starting points for the prevention and treatment of obesity are proposed.
Subjective health status was assessed in relation to overweight by administering a list of 51 health complaints to adult men and women who were either chronically overweight as defined by Body Mass Index (BMI) or not overweight, in a continuous morbidity registration in four general practices during the period 1967-83. Responses were received from 455 men (182 overweight) and 790 women (386 overweight), ages 26-66 years. Response rate (71 per cent) and age distribution (mean age 48) were similar in overweight and non-overweight groups of both sexes. BMI was correlated with the total number of complaints in women (r = 0.15) but not in men (r = 0.07). Multiple regression analysis revealed, however, that age was an effect modifier in this relation, there being a negative association between BMI and subjective health in younger men and a positive association in older men, whereas in women the association between BMI and subjective health was much more pronounced at younger ages than at older ages. In addition, current smoking habits and social class (in men and women) and reported slimming behavior (in women) had an independent relation to the total number of health complaints. BMI was also related to specific complaints and groups of complaints, particularly in women.
A relationship between the occurrence of fatty liver and moderate alcohol intake, maturity onset diabetes, overweight--and combinations of these three factors--was searched for in 112 patients. Fifty-three of 59 patients with moderate alcohol consumption, 49 of 57 overweight patients, and 42 of 51 diabetic patients had fatty liver. Patients who had a moderate alcohol consumption or suffered from a combination of diabetes and overweight were found to have a significantly higher frequency and degree of fatty liver than patients in the control group. Diabetes alone, and overweight alone were not significantly related to fatty liver. Whether the diabetic state was overt of latent, there was no influence on the frequency or degree of fatty liver. A correlation between the degree of overweight and the degree of fatty liver was found only in the group of overweight patients with moderate alcohol consumption. The degree of fatty liver produced by the combination of overweight and diabetes was not significantly increased by moderate alcohol consumption.
A retrospective cohort-study with a follow-up of 6-17 years was carried out in four general practices in the Netherlands in the period 1967-1983. In total 317 overweight men and 565 overweight women were followed in a continuous morbidity registration, starting in the year they were diagnosed as overweight (at age 20-50 years). Incidence of illnesses in this group was compared to that in a control group (444 men and 627 women not registered overweight), matched on sex, age and calendar-year at start of follow-up. The incidence of registered morbidity in the overweight group was higher for diabetes, gout, arteriosclerotic disease, arthrosis for men and women, and also for varicose veins for women. Increasing BMI at start of follow-up was associated with increased risk for most illnesses under study. For gout and arteriosclerotic disease in men, overweight appeared to be a risk factor at lower levels of BMI than in women.
Serum proinsulin and insulin levels were measured on 55 normal or overweight women before and after oral glucose administration. The proinsulin proportion of basal total insulin was 70% in women of normal weight. With increasing overweight the relation shifted in favour of insulin. After stimulation with glucose, proinsulin levels were significantly raised, analogous to total insulin, but les marked than the latter. The increased total insulin excretion in obesity was, therefore, largely due to insulin and less to proinsulin. The greater the overweight the later maximal insulin levels were reached after oral glucose administration: proinsulin peaks occurred later than insulin peaks. Measurement of areas from single values and corresponding times for proinsulin and insulin, after stimulation, indicated their significant correlation with the degree of overweight. In women of more than 70% overweight (Broca index), reactive proinsulin and insulin excretion decreased again despite an increase in body weight. They had a definitely reduced carbohydrate tolerance. After reduction in body weight previously increased proinsulin levels fell again. The significance of higher proinsulin levels in fasting subjects, which increased after stimulation and with overweight but were in percentage terms less than those of reactive insulin, remains unexplained.
We investigated the contributions of low energy expenditure and high energy intake to excessive weight gain in infants born to overweight mothers. The subjects were infants of 6 lean and 12 overweight mothers, recruited soon after birth. Total energy expenditure and metabolizable energy intake were measured with a new doubly labeled water method over a period of seven days when the infants were 3 months of age, and the postprandial metabolic rate was measured by indirect calorimetry when the infants were 0.1 and 3 months of age. The results were related to weight gain in the first year of life. No significant difference was observed between infants who became overweight by the age of one year (50 percent of infants born to overweight mothers) and those who did not, with respect to weight, length, skinfold thicknesses, metabolic rate at 0.1 and 3 months of age, and metabolizable energy intake at 3 months. However, total energy expenditure at three months of age was 20.7 percent lower in the infants who became overweight than in the other infants (means +/- SE, 256 +/- 27 and 323 +/- 12 kJ per kilogram of body weight per day; P less than 0.05). This difference could account for the mean difference in weight gain. These data suggest that reduced energy expenditure, particularly on physical activity, was an important factor in the rapid weight gain during the first year of life in infants born to overweight mothers.
Preliminary, exploratory studies examine self-perceptions of the stigma of overweight in relatiopship to weight-losing patterns of female and male children of different ages. It is suggested that the concept of stigma may be a viable analytical tool in studying overweight as: an exclusive focus in interaction, related to a negative body image, overwhelming others with mixed emotions, clashing with other attributes of the person, an equivocal predictor of activities, and related to one's sense of responsibility for one's overweight. Female adolescents in the Slimnastics class in a high school and children and adolescents in an obesity clinic in a hospital were studied. Male children and female adolescents had more trouble losing weight than did female children and male adolescents. Youth who viewed overweight as both one's responsibility and as an illness that required the joint efforts of oneself and others, especially professional experts, were more successful in losing weight than those youth who believed that overweight was solely their responsibility or not at all their responsibility. Intensive focusing on one's overweight and one one's negative body image seemed to inhibit or deter weight losing for some youth.
Data from the Behavioral Risk Factor Surveillance System, 1985-1988, were used to assess differences in weight-loss practices of overweight adults by sex and race. Data were available for 112,108 respondents from 21 states, aged greater than or equal to 18 y. Overweight was defined as body mass index greater than or equal to 27.3 for women and greater than or equal to 27.8 for men. Weight-loss practices were defined as increasing physical activity only, eating fewer calories only, increasing physical activity and eating fewer calories only, increasing physical activity and eating fewer calories, and not trying to lose weight. The weight-loss practice most frequently reported by overweight women was increasing physical activity and eating fewer calories (blacks, 32%; whites, 33%). Overweight men most frequently reported not trying to lose weight (blacks, 55%; whites, 49%). Although the prevalence of overweight for black women was twice that for white women, weight-loss practices were similar for both groups. Prevalence of overweight was similar for black and white men but weight-loss practices differed slightly.
Studies were conducted to evaluate the role of water-sodium balance and renal dopaminergic activity in the hypertensive mechanisms of overweight patients with essential hypertension (EHT). The body mass index (BMI) was correlated positively with mean arterial pressure, plasma volume, extracellular fluid volume, or total exchangeable sodium and negatively with plasma noradrenaline concentration or plasma renin activity in patients with EHT. Fractional excretion of sodium (FENa) was significantly lower in overweight patients than in normal weight patients with EHT. Hypotensive effect of sodium restriction or the natriuretic response to infused dopamine was more remarkable in overweight patients with EHT than in normal weight patients with EHT. Urinary excretion of free dopamine (UDA) was correlated positively with simultaneously measured urinary excretion of sodium or FENa and negatively with the natriuretic response to dopamine infusion. In addition, UDA was positively correlated with the BMI in normal weight patients with EHT, whereas the relation between the UDA and the BMI was significantly negative in overweight patients with EHT. These findings suggest that the expansion of body fluid volume and sodium might result from the blunted natriuretic ability due to an attenuation of the renal dopaminergic activity in overweight patients with EHT. The expansion of body fluid volume and sodium may play an important role in the hypertensive mechanisms of overweight patients with EHT.