González-Muniesa, Pedro; Mártinez-González, Miguel-Angel; Hu, Frank B; Després, Jean-Pierre; Matsuzawa, Yuji; Loos, Ruth J F; Moreno, Luis A; Bray, George A; Martinez, J Alfredo
Excessive fat deposition in obesity has a multifactorial aetiology, but is widely considered the result of disequilibrium between energy intake and expenditure. Despite specific public health policies and individual treatment efforts to combat the obesity epidemic, >2 billion people worldwide are overweight or obese. The central nervous system circuitry, fuel turnover and metabolism as well as adipose tissue homeostasis are important to comprehend excessive weight gain and associated comorbidities. Obesity has a profound impact on quality of life, even in seemingly healthy individuals. Diet, physical activity or exercise and lifestyle changes are the cornerstones of obesity treatment, but medical treatment and bariatric surgery are becoming important. Family history, food environment, cultural preferences, adverse reactions to food, perinatal nutrition, previous or current diseases and physical activity patterns are relevant aspects for the health care professional to consider when treating the individual with obesity. Clinicians and other health care professionals are often ill-equipped to address the important environmental and socioeconomic drivers of the current obesity epidemic. Finally, understanding the epigenetic and genetic factors as well as metabolic pathways that take advantage of 'omics' technologies could play a very relevant part in combating obesity within a precision approach.
Obesity means having too much body fat. It is different from being overweight, which means weighing too ... what's considered healthy for his or her height. Obesity occurs over time when you eat more calories ...
Parikh, Rakesh M; Joshi, Shashank R; Menon, Padmavathy S; Shah, Nalini S
Waist circumference (WC) is globally used as a parameter to quantify central obesity, the key culprit in insulin resistance and related disorders. Hitherto globally in various definitions of metabolic syndrome and risk scores, WC is used to quantify central obesity. For defining central obesity, which is a single entity numerous WC cutoffs have been suggested, separately for males and females and various races. We believe that this difference is amenable to differences in their average heights. To quantify proportion of visceral fat in the total body fat, WC alone is not sufficient. We hereby hypothesize that Index of central obesity (ICO) defined by us, as a ratio of WC and height is a better parameter of central obesity. If ICO is used in place of WC we may do away with various WC cutoffs and may have a single cutoff applicable to all races and both genders. Using average heights of various countries and their respective WC cutoffs suggested by IDF consensus definition for defining metabolic syndrome (MS) we derived their ICO cutoffs mathematically. The ICO cutoffs obtained ranged from 0.51 to 0.58 among males and 0.47 to 0.54 among females. The range has narrowed down compared to wide range of cutoffs for WC i.e. 90-102 cm for males and 80-88 cm for females. To test superiority of ICO over WC even among people of same race and same gender we conducted a pilot study in which, we compared two subjects with same WC and body mass index (BMI), though they differed in their stature. Body fat distribution was compared on DEXA and oral glucose tolerance was tested. Percentage of total body fat contributed by truncal fat was 36.11% in taller subject (Dr. P) and 46.31% in the shorter one (Mr. P). On investigation Dr P had normal glucose tolerance while Mr. P was diagnosed to be diabetic. These differences unexplained by identical WC and BMI could be explained by difference in their ICO (0.557 vs 0.645). ICO has a potential to be a better parameter of central obesity. It
Corona, Giovanni; Rastrelli, Giulia; Filippi, Sandra; Vignozzi, Linda; Mannucci, Edoardo; Maggi, Mario
Erectile dysfunction (ED) is a frequent complication of obesity. The aim of this review is to critically analyze the framework of obesity and ED, dissecting the connections between the two pathological entities. Current clinical evidence shows that obesity, and in particular central obesity, is associated with both arteriogenic ED and reduced testosterone (T) levels. It is conceivable that obesity-associated hypogonadism and increased cardiovascular risk might partially justify the higher prevalence of ED in overweight and obese individuals. Conversely, the psychological disturbances related to obesity do not seem to play a major role in the pathogenesis of obesity-related ED. However, both clinical and preclinical data show that the association between ED and visceral fat accumulation is independent from known obesity-associated comorbidities. Therefore, how visceral fat could impair penile microcirculation still remains unknown. This point is particularly relevant since central obesity in ED subjects categorizes individuals at high cardiovascular risk, especially in the youngest ones. The presence of ED in obese subjects might help healthcare professionals in convincing them to initiate a virtuous cycle, where the correction of sexual dysfunction will be the reward for improved lifestyle behavior. Unsatisfying sexual activity represents a meaningful, straightforward motivation for consulting healthcare professionals, who, in turn, should take advantage of the opportunity to encourage obese patients to treat, besides ED, the underlying unfavorable conditions, thus not only restoring erectile function, but also overall health. PMID:24713832
Grigorakis, Dimitris A; Georgoulis, Michael; Psarra, Glykeria; Tambalis, Konstantinos D; Panagiotakos, Demosthenes B; Sidossis, Labros S
Central obesity is a strong risk factor for metabolic disorders and cardiometabolic diseases in children and adolescents. The aim of the present study was to evaluate the prevalence of central obesity and to determine its cross-sectional association with lifestyle habits in a sample of school-aged children in Greece. The study sample consisted of 124,113 children (9.9 ± 1.1 years old, 51 % boys) attending the third and fifth grade of primary school. Anthropometric measurements were performed by trained physical education teachers, and central obesity was defined as waist-to-height ratio ≥0.5. Children's lifestyle habits were assessed through 7-day recall questionnaires. Of the participating children, 33.4 % were classified as centrally obese. Central obesity was significantly more prevalent in boys than in girls (36.0 vs. 30.7 %, P < 0.001) and was present in 95 % of obese children, as well as in a significant percentage of overweight (69.5 %) and normal-weight ones (12.0 %). Children with central obesity, compared to their non-centrally obese counterparts, reported poorer dietary habits and were less physically active. According to multiple logistic regression analysis, frequent breakfast (OR 0.72, 95 % CI 0.69-0.75) and snack consumption (OR 0.70, 95 % CI 0.67-0.74), as well as frequent participation in sedentary activities (OR 1.10, 95 % CI 1.07-1.14), were the strongest lifestyle determinants of central obesity. Strategies for the prevention of central obesity and associated comorbidities are urgently needed, for both obese and non-obese children. Our results suggest the need for a shift towards a healthier environment for our children, with emphasis on specific lifestyle habits, such as regular meal consumption and low sedentariness.
Lanas, Fernando; Bazzano, Lydia; Rubinstein, Adolfo; Calandrelli, Matias; Chen, Chung-Shiuan; Elorriaga, Natalia; Gutierrez, Laura; Manfredi, Jose A; Seron, Pamela; Mores, Nora; Poggio, Rosana; Ponzo, Jacqueline; Olivera, Hector; He, Jiang; Irazola, Vilma E
Obesity is a major determinant of cardiovascular disease in South America. However, population-based data are limited. A total of 7,524 women and men, aged 35 to 74 years old, were randomly selected from 4 cities in the Southern Cone of Latin America between February 2010 and December 2011. Obesity clinical measurements and cardiovascular risk factors were measured using standard methodology. The prevalence of obesity and central obesity were 35.7% and 52.9%, respectively. The prevalence of obesity and central obesity were higher in women, and even higher in women with lower education compared with women with higher education. In men and women obesity was associated with a higher prevalence of diabetes, odds ratio (OR) 2.38 (95% Confidence Interval [CI]: 1.86 to 3.05) and 3.01 (95%CI 2.42 to 3.74) respectively, hypertension (OR 2.79 (95%CI 2.32 to 3.36) and 2.40 (95%CI 2.05 to 2.80) respectively, dyslipidemia (OR 1.83 (95%CI 1.50 to 2.24) and 1.69 (95%CI 1.45 to 1.98), respectively, low physical activity (OR 1.38(95%CI 1.14 to 1.68) and 1.38 (95%CI 1.18 to 1.62) respectively and a lower prevalence of smoking (OR, 0.65 (95%CI 0.53 to 0.80) and 0.58(95%CI 0.48 to 0.70) respectively. Obesity and central obesity are highly prevalent in the general population in the Southern Cone of Latin America and are strongly associated with cardiovascular risk factor prevalence. These data suggest that efforts toward prevention, treatment, and control of obesity should be a public health priority in the Southern Cone of Latin America.
Bazzano, Lydia; Rubinstein, Adolfo; Calandrelli, Matias; Chen, Chung-Shiuan; Elorriaga, Natalia; Gutierrez, Laura; Manfredi, Jose A.; Seron, Pamela; Mores, Nora; Poggio, Rosana; Ponzo, Jacqueline; Olivera, Hector; He, Jiang; Irazola, Vilma E.
Background Obesity is a major determinant of cardiovascular disease in South America. However, population-based data are limited. Methods A total of 7,524 women and men, aged 35 to 74 years old, were randomly selected from 4 cities in the Southern Cone of Latin America between February 2010 and December 2011. Obesity clinical measurements and cardiovascular risk factors were measured using standard methodology. Results The prevalence of obesity and central obesity were 35.7% and 52.9%, respectively. The prevalence of obesity and central obesity were higher in women, and even higher in women with lower education compared with women with higher education. In men and women obesity was associated with a higher prevalence of diabetes, odds ratio (OR) 2.38 (95% Confidence Interval [CI]: 1.86 to 3.05) and 3.01 (95%CI 2.42 to 3.74) respectively, hypertension (OR 2.79 (95%CI 2.32 to 3.36) and 2.40 (95%CI 2.05 to 2.80) respectively, dyslipidemia (OR 1.83 (95%CI 1.50 to 2.24) and 1.69 (95%CI 1.45 to 1.98), respectively, low physical activity (OR 1.38(95%CI 1.14 to 1.68) and 1.38 (95%CI 1.18 to 1.62) respectively and a lower prevalence of smoking (OR, 0.65 (95%CI 0.53 to 0.80) and 0.58(95%CI 0.48 to 0.70) respectively. Conclusions Obesity and central obesity are highly prevalent in the general population in the Southern Cone of Latin America and are strongly associated with cardiovascular risk factor prevalence. These data suggest that efforts toward prevention, treatment, and control of obesity should be a public health priority in the Southern Cone of Latin America. PMID:27741247
Jung, Chang Hee; Kim, Min-Seon
The rapidly increasing prevalence of obesity confers a huge health burden globally. The hypothalamus plays a central role in the regulation of energy homeostasis by integrating multiple metabolic signals from peripheral organs and modulating feeding behavior and energy metabolism. Leptin, a key appetite-regulating hormone derived from the white adipose tissue, primarily acts on hypothalamic neurons to activate catabolic pathway and inhibit anabolic pathway, which can result in anorexia and weight reduction. Despite striking obesity resulting from leptin deficiency, treatment with this hormone in human obesity has been unsuccessful due to leptin resistance. In this review, we describe recent researches extending our understanding of obesity-associated hypothalamic leptin resistance.
Mueller, W H; Joos, S K
The relationship between body fat distribution patterns and somatotype among 824 men was sought from Sheldon, Dupertuis and MacDermott's Atlas of Men (1954). The men were classified photoscopically into obese, overweight and normal weight classes and then into android (central), intermediate and gynoid (generalized) classes of body fat patterning independently and blindly by two observers. Android fat men were found by both observers to be older and more often classed as obese than gynoid fat men. The android obese were significantly more mesomorphic and less endomorphic than the gynoid obese (P less than 0.01). Results suggest that android obesity involves more than an upper body distribution of subcutaneous fat: it is a deep body obesity involving excess lean body mass as well.
Crowley, Vivion E F
Obesity is now regarded as a global epidemic affecting both adults and children, and is associated with significant morbidity and mortality. Thus the effective management of obesity has become an important clinical focus. Therefore, an understanding of the pathways controlling appetite, satiety and food intake is critical for gaining an insight into the pathogenesis of obesity and also for the development of diagnostic tests and therapeutic agents for use in the clinical management of this condition. Over the last decade or more research using both mouse and human genetic models has elucidated the critical role of the leptin-melanocortin pathway in the hypothalamus, in regulating mammalian energy balance. In tandem with this, a clearer understanding of the regulation of gut-derived hormones and their interaction with the central nervous system has further illuminated the complex interplay between central and peripheral aspects of energy regulation. The obesity epidemic and the expanded knowledge base relating to its aetiopathogenesis have specific implications for clinical biochemistry. In particular, an increase in workload may be expected due to biochemical investigation of obesity and its co-morbidities. Moreover, advice on the in-depth investigation of complex cases of obesity may be sought, including information on newer diagnostic tests, such as serum leptin or molecular genetic analysis. There may also be a substantive role for chemical pathologists in establishing and running clinical obesity services. Finally, clinical biochemistry has a role in research pertaining to obesity and cardiometabolic risk.
Valentino, Michael A.; Lin, Jieru E.; Waldman, Scott A.
Obesity has emerged as one of the principle worldwide health concerns of the modern era, and there exists a tremendous unmet clinical need for safe and effective therapies to combat this global pandemic. The prevalence of obesity and its associated co-morbidities, including cardiovascular and metabolic diseases, has focused drug discovery and development on generating effective modalities for the treatment and prevention of obesity. Early efforts in the field of obesity pharmacotherapy centered on agents with indeterminate mechanisms of action producing treatment paradigms characterized by significant off-target effects. During the past two decades, new insights have been made into the physiologic regulation of energy balance and the subordinate central and peripheral circuits coordinating appetite, metabolism, and lipogenesis. These studies have revealed previously unrecognized molecular targets for controlling appetite and managing weight from which has emerged a new wave of targeted pharmacotherapies to prevent and control obesity. PMID:20445536
Salinas-Martínez, Ana Maria; Hernández-Herrera, Ricardo Jorge; Mathiew-Quirós, Alvaro; González-Guajardo, Eduardo Enrique
Waist circumference (WC) is a useful measure for identifying children at higher risk of complications related with abdominal fat. We determined the magnitude of central adiposity, single and combined with overweight and obesity in infants 1-5 years old. We also identified smoothed age-and sex-specific WC percentile values, which were compared with other countries available data. This was a cross-sectional study in children of 8 day care centers located in Monterrey, Mexico (n = 903, 431 boys and 472 girls). Because the risk due to abdominal obesity begins at WC percentile > or = 75, we considered two thresholds, percentile 75 y 90. Overweight was defined based on body mass index at percentile 85-94 for age and sex; and obesity, at percentile > or = 95. Analysis consisted of point prevalence and 95% confidence intervals. The LMS Chart Maker Light software was used for smoothing WC percentile values. The study population mean age was 2.7 +/- 1.0 years. Mexican children's WC was 1 cm above that of Afro-American; and it was up to 4 cm below that Mexican-American. Prevalence of central obesity with WC at percentile 75 combined with overweight/obesity was 25.1% (95% CI 22.3-28.0) and single, 15.4% (95 CI% 13.0-17.8). Prevalence of single abdominal obesity with WC at percentile > or = 90 was 4.4% (IC 95% 3.0, 5.8). Day care centers represent a key opportunity for defying central obesity. WC can be used since early age for screening and caring children at higher cardiovascular risk.
Flores-Huerta, Samuel; Acosta-Cázares, Benjamín; Gutiérrez-Trujillo, Gonzalo
to estimate the prevalence of malnutrition in the population attending the Mexican Institute of Social Security. we studied a 25% subset of the National Survey of Coverage of Integrated Health Programs performed in 2003 to estimate weight and height with standardized procedures; in adults over 20, waist circumference was also measured. We considered central obesity as waist circumferences larger than 88 cm for females and 102 cm for males. Based on weight and height, the prevalence of low weight, overweight and general obesity was estimated; based on waist circumference, central obesity was assessed. the prevalence of low weight in men and women was, respectively, of 5.3 and 6.4% in children; 6 and 8.2% in adolescents; almost none in adults, and of 11.7 and 3.6% in seniors. On the other hand, we observed that the prevalence of overweight and obesity increased progressively in both sexes since the first decade of life up to 87% in females between 50 and 59 years old and 82% in males between 40 and 49. The risk of central obesity was very high in women older than 20 in all decades of life (36.6 to 74.2%). In men, this risk had lower prevalence (12 to 31.7%). In the northern part of the country, women presented more central obesity, while in the southeast, men did. this report highlights the alarming prevalence of malnutrition in the Mexican Institute of Social Security population. This information is relevant for future strategies aiming to prevent these serious health problems.
World-wide obesity and its effects are public health problems. Research on way of life and eating habits give some indications of etiological factors. Breast feeding and quantity of proteins intake in formulas are factors influencing the risks of obesity later on in life. Research undertaken by Rolland Cachera shows us the importance of the curve of BMI and how the obesity rebound can be predictive of obesity in later years allowing early decisions of weight control. Energy intake and energy expenditure are regulated by the central nervous system. It is a complex mechanism of afferent and efferent systems through the hypothalamus. The inverse effects of ghreline and of leptine on energy balance are more and more studied and cases of precocious obesity are explained by the identification of rare forms of monogenic obesity linked to the metabolism of leptine. The importance of inherited genes has a role and genetic predisposition is a reality. This new approach allows a clinical, etiological and, in the future, probably therapeutic attitude in case of severe precocious obesity.
Gao, Xiang; Zhang, Weidong; Wang, Yongbo; Pedram, Pardis; Cahill, Farrell; Zhai, Guangju; Randell, Edward; Gulliver, Wayne; Sun, Guang
Metabolic abnormalities are more associated with central obesity than peripheral obesity, but the underlying mechanisms are largely unknown. The present study was to identify serum metabolic biomarkers which distinguish metabolically unhealthy centrally obese (MUCO) from metabolically healthy peripherally obese (MHPO) individuals. A two-stage case-control study design was employed. In the discovery stage, 20 individuals (10 MHPO and 10 MUCO) were included and in the following validation stage, 79 individuals (20 normal weight (NW), 30 MHPO, 29 MUCO) were utilized. Study groups were matched for age, sex, physical activity and total dietary calorie intake with MHPO and MUCO additionally matched for BMI. Metabolic abnormality was defined as: 1) HOMA-IR > 4.27 (90(th) percentile), 2) high-density lipoprotein cholesterol < 1.03 mmol/L in men and < 1.30 mmol/L in women, 3) fasting blood glucose ≥ 5.6 mmol/L, and 4) waist circumference > 102 cm in men and > 88 cm in women. MUCO individuals had all of these abnormalities whereas MHPO and NW individuals had none of them. A targeted metabolomics approach was performed on fasting serum samples, which can simultaneously identify and quantify 186 metabolites. In the discovery stage, serum leucine, isoleucine, tyrosine, valine, phenylalanine, alpha-aminoadipic acid, methioninesulfoxide and propionylcarnitine were found to be significantly higher in MUCO, compared with MHPO group after multiple testing adjustment. Significant changes of five metabolites (leucine, isoleucine, valine, alpha-aminoadipic acid, propionylcarnitine) were confirmed in the validation stage. Significantly higher levels of serum leucine, isoleucine, valine, alpha-aminoadipic acid, propionylcarnitine are characteristic of metabolically unhealthy centrally obese patients. The finding provides novel insights into the pathogenesis of metabolic abnormalities in obesity.
Lim, S S; Davies, M J; Norman, R J; Moran, L J
BACKGROUND Polycystic ovary syndrome (PCOS) is closely associated with obesity but the prevalence of obesity varies between published studies. The objective of this research was to describe the prevalence of overweight, obesity and central obesity in women with and without PCOS and to assess the confounding effect of ethnicity, geographic regions and the diagnostic criteria of PCOS on the prevalence. METHODS MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and PSYCINFO were searched for studies reporting the prevalence of overweight, obesity or central obesity in women with and without PCOS. Data were presented as prevalence (%) and risk ratio (RR) [95% confidence interval (CI)]. Random-effect models were used to calculate pooled RR. RESULTS This systematic review included 106 studies while the meta-analysis included 35 studies (15129 women). Women with PCOS had increased prevalence of overweight [RR (95% CI): 1.95 (1.52, 2.50)], obesity [2.77 (1.88, 4.10)] and central obesity [1.73 (1.31, 2.30)] compared with women without PCOS. The Caucasian women with PCOS had a greater increase in obesity prevalence than the Asian women with PCOS compared with women without PCOS [10.79 (5.36, 21.70) versus 2.31 (1.33, 4.00), P < 0.001 between subgroups). CONCLUSIONS Women with PCOS had a greater risk of overweight, obesity and central obesity. Although our findings support a positive association between obesity and PCOS, our conclusions are limited by the significant heterogeneity between studies and further studies are now required to determine the source of this heterogeneity. Clinical management of PCOS should include the prevention and management of overweight and obesity.
Isganaitis, Elvira; Lustig, Robert H
Rates of obesity and insulin resistance have climbed sharply over the past 30 years. These epidemics are temporally related to a dramatic rise in consumption of fast food; until recently, it was not known whether the fast food was driving the obesity, or vice versa. We review the unique properties of fast food that make it the ideal obesigenic foodstuff, and elucidate the mechanisms by which fast food intake contributes to obesity, emphasizing its effects on energy metabolism and on the central regulation of appetite. After examining the epidemiology of fast food consumption, obesity, and insulin resistance, we review insulin's role in the central nervous system's (CNS) regulation of energy balance, and demonstrate the role of CNS insulin resistance as a cause of leptin resistance and in the promotion of the pleasurable or "hedonic" responses to food. Finally, we analyze the characteristics of fast food, including high-energy density, high fat, high fructose, low fiber, and low dairy intake, which favor the development of CNS insulin resistance and obesity.
Satija, Ambika; Hu, Frank B; Bowen, Liza; Bharathi, Ankalmadugu V; Vaz, Mario; Prabhakaran, Dorairaj; Reddy, K Srinath; Ben-Shlomo, Yoav; Davey Smith, George; Kinra, Sanjay; Ebrahim, Shah
Obesity is a growing problem in India, the dietary determinants of which have been studied using an 'individual food/nutrient' approach. Examining dietary patterns may provide more coherent findings, but few studies in developing countries have adopted this approach. The present study aimed to identify dietary patterns in an Indian population and assess their relationship with anthropometric risk factors. FFQ data from the cross-sectional sib-pair Indian Migration Study (IMS; n 7067) were used to identify dietary patterns using principal component analysis. Mixed-effects logistic regression was used to examine associations with obesity and central obesity. The IMS was conducted at four factory locations across India: Lucknow, Nagpur, Hyderabad and Bangalore. The participants were rural-to-urban migrant and urban non-migrant factory workers, their rural and urban resident siblings, and their co-resident spouses. Three dietary patterns were identified: 'cereals-savoury foods' (cooked grains, rice/rice-based dishes, snacks, condiments, soups, nuts), 'fruit-veg-sweets-snacks' (Western cereals, vegetables, fruit, fruit juices, cooked milk products, snacks, sugars, sweets) and 'animal-food' (red meat, poultry, fish/seafood, eggs). In adjusted analysis, positive graded associations were found between the 'animal-food' pattern and both anthropometric risk factors. Moderate intake of the 'cereals-savoury foods' pattern was associated with reduced odds of obesity and central obesity. Distinct dietary patterns were identified in a large Indian sample, which were different from those identified in previous literature. A clear 'plant food-based/animal food-based pattern' dichotomy emerged, with the latter being associated with higher odds of anthropometric risk factors. Longitudinal studies are needed to further clarify this relationship in India.
Asadipooya, Kamyar; Kalantar-Hormozi, Mohammadreza; Nabipour, Iraj
Based on the role of polycystic ovary syndrome as a cause of metabolic syndrome with chronic anovulation, obesity, hyperinsulinemia and hyperandrogenism, development of effective treatment for its obesity is a priority. We designed a study, involving 52 patients of 19-36 years of age, to test the pioglitazone in women with polycystic ovary syndrome. Subjects were assigned to receive pioglitazone for 3 months. Body mass index, waist circumference and hip circumference were measured before and after 3 months of pioglitazone prescription. Fifty patients completed the study. No complication reported during the study period. Waist circumference, hip circumference and waist to height ratio decreased significantly. Body weight and body mass index increased. No significant improvement was seen in acne, acanthosis, hirsutism and menstrual irregularities. Pioglitazone has beneficial effects on central obesity of the patients with polycystic ovary syndrome but other clinical consequences of the syndrome may not improve with the drug.
Chang, Jee-Eun; Kim, Hyerim; Ryu, Jung-Hee; Lee, Jung-Man; Hwang, Jin-Young
Central obesity may be related to the spread of spinal anesthesia in female patients. Fifty-seven female patients undergoing spinal anesthesia were allocated to either the central obesity or noncentral obesity group. After induction of spinal anesthesia, maximal sensory blockade (primary outcome), time for maximal sensory block, maximum motor block, time to maximum motor block, time to L2 regression, and time to Bromage scale 0 were evaluated. Multiple linear regression analyses showed that maximal sensory blockade was related to central obesity (P = .004). Central obesity is related to a more extensive spread of spinal anesthesia in female patients.
de Souza e Silva, Christina Grüne; Franklin, Barry A.; de Araújo, Claudio Gil Soares
OBJECTIVE: To assess the influence of central obesity on the magnitude of the error of estimate of maximal oxygen uptake in maximal cycling exercise testing. METHOD: A total of 1,715 adults (68% men) between 18-91 years of age underwent cardiopulmonary exercise testing using a progressive protocol to volitional fatigue. Subjects were stratified by central obesity into three quartile ranges: Q1, Q2-3 and Q4. Maximal oxygen uptake [mL.(kg.min)-1] was estimated by the attained maximal workload and body weight using gender- and population-specific equations. The error of estimate [mL.(kg.min)-1] and percent error between measured and estimated maximal oxygen uptake values were compared among obesity quartile ranges. RESULTS: The error of estimate and percent error differed (mean ± SD) for men (Q1=1.3±3.7 and 2.0±10.4; Q2-3=0.5±3.1 and -0.5±13.0; and Q4=-0.3±2.8 and -4.5±15.8 (p<0.05)) and for women (Q1=1.6±3.3 and 3.6±10.2; Q2-3=0.4±2.7 and -0.4±11.8; and Q4=-0.9±2.3 and -10.0±22.7 (p<0.05)). CONCLUSION: Central obesity directly influences the magnitude of the error of estimate of maximal oxygen uptake and should be considered when direct expired gas analysis is unavailable. PMID:27982162
Cardiovascular Diseases; Heart Diseases; Atherosclerosis; Hypertension; Obesity; Diabetes Mellitus, Non-insulin Dependent; Hyperinsulinism; Insulin Resistance; Coronary Arteriosclerosis; Diabetes Mellitus; Metabolic Syndrome X
Scott, William R; Zhang, Weihua; Loh, Marie; Tan, Sian-Tsung; Lehne, Benjamin; Afzal, Uzma; Peralta, Juan; Saxena, Richa; Ralhan, Sarju; Wander, Gurpreet S; Bozaoglu, Kiymet; Sanghera, Dharambir K; Elliott, Paul; Scott, James; Chambers, John C; Kooner, Jaspal S
South Asians are 1/4 of the world's population and have increased susceptibility to central obesity and related cardiometabolic disease. Knowledge of genetic variants affecting risk of central obesity is largely based on genome-wide association studies of common SNPs in Europeans. To evaluate the contribution of DNA sequence variation to the higher levels of central obesity (defined as waist hip ratio adjusted for body mass index, WHR) among South Asians compared to Europeans we carried out: i) a genome-wide association analysis of >6M genetic variants in 10,318 South Asians with focused analysis of population-specific SNPs; ii) an exome-wide association analysis of ~250K SNPs in protein-coding regions in 2,637 South Asians; iii) a comparison of risk allele frequencies and effect sizes of 48 known WHR SNPs in 12,240 South Asians compared to Europeans. In genome-wide analyses, we found no novel associations between common genetic variants and WHR in South Asians at P<5x10-8; variants showing equivocal association with WHR (P<1x10-5) did not replicate at P<0.05 in an independent cohort of South Asians (N = 1,922) or in published, predominantly European meta-analysis data. In the targeted analyses of 122,391 population-specific SNPs we also found no associations with WHR in South Asians at P<0.05 after multiple testing correction. Exome-wide analyses showed no new associations between genetic variants and WHR in South Asians, either individually at P<1.5x10-6 or grouped by gene locus at P<2.5x10-6. At known WHR loci, risk allele frequencies were not higher in South Asians compared to Europeans (P = 0.77), while effect sizes were unexpectedly smaller in South Asians than Europeans (P<5.0x10-8). Our findings argue against an important contribution for population-specific or cosmopolitan genetic variants underlying the increased risk of central obesity in South Asians compared to Europeans.
Ortiz, Ana Patricia; Thompson, Cheryl L; Chak, Amitabh; Berger, Nathan A; Li, Li
Increasing evidence supports insulin resistance (IR) as the underpinning of the obesity-colorectal neoplasia link. The homeostasis model assessment-IR (HOMA-IR) is a widely accepted index of evolving hyperinsulinemia and early IR. Studies of the relation between HOMA-IR and colorectal adenomas are limited. Therefore, the authors sought to determine the associations of HOMA-IR and central obesity (waist to hip ratio [WHR]) with risk of colorectal adenomas in a screening colonoscopy-based study. The authors collected lifestyle information and fasting blood samples from 1222 participants (320 incident adenoma cases and 902 without adenomas) before their screening colonoscopies. Unconditional logistic regression models were used to assess risk associations. In multivariate analysis of participants (n = 1093) reporting no antidiabetic medication use, those in the top quartile of WHR were twice as likely (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.33-3.57; P-trend = .003) and those in the top quartile of HOMA-IR were 63% more likely (OR, 1.63; 95% CI, 1.09-2.44; P-trend = .01) to have adenomas compared with those in the bottom quartiles. Stratified analysis revealed a statistically significant interaction between HOMA-IR and sex (P-interaction = .04), with the association largely limited to men; compared with those in the bottom tertile, men in the top tertile of HOMA-IR were twice more likely to have adenomas (OR, 2.11; 95% CI, 1.18-3.78; P-trend = .01). The results support central obesity and insulin resistance, particularly in men, as important risk factors for the development of early colorectal neoplasia. Copyright © 2011 American Cancer Society.
Martins, Clarice; Aires, Luisa; Júnior, Ismael Freitas; Silva, Gustavo; Silva, Alexandre; Lemos, Luís; Mota, Jorge
Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent complications associated with excess adiposity and has been identified as the leading cause of liver disease in pediatric populations worldwide. Because cardiorespiratory fitness (CRF) is related to physical activity (PA) levels, and increased PA plays a protective role against NAFLD risk factors, the aim of this study was to analyze the association between PA and a fatty liver marker (alanine aminotransferase - ALT) in obese children and adolescents, independently of central adiposity or CRF. 131 obese children (83 girls, 7-15 year-olds) involved in a PA promotion program comprised the sample. Measurements included anthropometric and body composition evaluations (DEXA), biological measurements (venipuncture), CRF (progressive treadmill test), PA (accelerometry), and maturational stage (Tanner criteria). The associations between ALT with PA intensities, central obesity, and CRF were calculated by three different models of linear regression, adjusted for potential confounders. Level of significance was set at 95%. RESULTS: ALT was negatively associated with MVPA (β = -0.305), and CRF (β = -0.426), and positively associated with central obesity (β=.468). After adjustment for central obesity the negative and statistically significant association between ALT with MVPA (β = -0.364) and CRF (β = -0.550) still persists while a positive and significantly correlation was shown between ALT and SB (β = 0.382). Additional adjustment for CRF (Model 3) showed significant associations for all the PA intensities analyzed including light activity. PA at different intensities is associated to a fatty liver marker in obese children and adolescents, independently of central adiposity or CRF. Key points In a previous study our group observed that there might be a potential protective effect of cardiorespiratory fitness (CRF) against abnormal ALT values; Considering that CRF is related to physical activity (PA
[Nutritional status of preschool children attending the Chilean National Nursery Schools Council Programs (JUNJI): assessment of the agreement among anthropometric indicators of obesity and central obesity].
Gutiérez-Gómez, Yareni; Kain, Juliana; Uauy, Ricardo; Galván, Marcos; Corvalán, Camila
Historically, the anthropometric assessment of nutritional welfare programs has been targeted to assess nutritional deficiencies based on weight-to-age and height-to-age indicators. Recently, given the increase on childhood obesity, it has been also recommended the measurement of indicators of obesity (i.e., weight-to-height) and central obesity (i.e., waist circumference). However, the agreement of these indicators in preschool children is unclear. The aims of this study were: (1) assess the nutritional status of children attending the Chilean National Nursery Schools Council Program (JUNJI); (2) assess the agreement between general and central obesity anthropometric measurements in these children. In 574 girls and 580 boys, 3.0 to 5.9 years old, we measured: weight, height, waist and hip circumference, and five skinfolds. We used the WHO 2006 growth standards to estimate Z-scores. We defined general obesity as WHZ or BAZ= 2, and central obesity as waist circumference > or =90 percentile of NHANES III. The participants were on average slightly shorter but considerably heavier and obese than the reference populations. Prevalence of general obesity was close to 16% with both indicators while prevalence of central obesity reached 15%. There was good agreement among general obesity indicators and central obesity indicators (Kappa = 0.6-0.7). In summary, we found a high prevalence of obesity and central obesity among Chilean preschool children beneficiaries of a welfare program. At this age, there was a good agreement among general obesity indicators and central obesity indicators. These results suggest that waist circumferences measurements should not be incorporated to the program.
Mazidi, Mohsen; Kengne, Andre Pascal
Despite growing evidence on the associations between nutrient patterns and obesity, very few studies have examined the association between patterns of nutrient intake and obesity. To identify major nutrient patterns in U.S. adults and investigate their association with general and central obesity. National Health and Nutrition Examination Survey (NHANES) participants from 2005 to 2012 were included. General obesity was defined as body mass index ≥30 kg/m2, and central obesity as a waist circumference >102 cm for men and >88 cm for women. Intakes of 60 nutrients were calculated. Factor analysis was applied to derive the major nutrient patterns. Statistical analyses accounted for the survey design and sample weights. Overall 24,182 eligible individuals including 8155 with general obesity and 11730 with central obesity were included. Three nutrient patterns explaining 50.8% of the variance in dietary nutrients consumption, were identified. The odds of all types of obesity increased across quarters of the first nutrient patterns (mostly representative of saturated/mono-unsaturated fatty acids), such that the fourth quarter was associated with odds ratio of 1.31 (95%CI: 1.13-1.51) for general obesity and 1.47 (95%CI: 1.30-1.66) for central obesity, relative to the first quarter. The second nutrient patterns (mostly representative of micro nutrients and vitamins) was associated with lower odds of general [0.32 (95%CI: 0.61-0.77]) or central obesity [0.31 (95%CI: 0.62-0.78). Nutrient patterns may have deleterious or protective effects on the risk of general and central obesity, with implication for food-based strategies to prevent and control obesity. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Niu, Jingjing; Seo, Dong-Chul
In Chinese adults, the trend of central obesity and its longitudinal association with hypertension, independent of general obesity, was examined. A 12-year longitudinal analysis was conducted using data retrieved from the China Health and Nutrition Survey. This study examined 6096 individuals (normotensive in 1997) who were followed up with in 2000, 2004, 2006, and 2009. Prevalence of hypertension in 2009 was predicted by baseline central obesity and waist circumference changes during a 12-year follow-up period along with confounding covariates using multiple logistic regressions. Between 1997 and 2009, the prevalence of central obesity increased from 17.3% to 39.4% and was highest among individuals ≥60 years of age in 1997. By 2009, 26.8% of the participants developed hypertension. The odds ratio of developing hypertension during the 12-year study period for Chinese adults with central obesity at baseline was 1.79 (95% confidence interval=1.36-2.35) compared to those without central obesity, controlling for general obesity, demographics, smoking/drinking behavior, and fat intake. Among Chinese adults, central obesity increases the risk for developing hypertension later in life, even after controlling for general obesity, smoking, drinking, and high fat intake among other factors. Waist circumference should be targeted in the efforts of hypertension prevention. Copyright © 2014 Elsevier Inc. All rights reserved.
Karelina, Kate; Sarac, Benjamin; Freeman, Lindsey M; Gaier, Kristopher R; Weil, Zachary M
Traumatic brain injury (TBI)-induced impairments in cerebral energy metabolism impede tissue repair and contribute to delayed functional recovery. Moreover, the transient alteration in brain glucose utilization corresponds to a period of increased vulnerability to the negative effects of a subsequent TBI. In order to better understand the factors contributing to TBI-induced central metabolic dysfunction, we examined the effect of single and repeated TBIs on brain insulin signalling. Here we show that TBI induced acute brain insulin resistance, which resolved within 7 days following a single injury but persisted until 28 days following repeated injuries. Obesity, which causes brain insulin resistance and neuroinflammation, exacerbated the consequences of TBI. Obese mice that underwent a TBI exhibited a prolonged reduction of Akt (also known as protein kinase B) signalling, exacerbated neuroinflammation (microglial activation), learning and memory deficits, and anxiety-like behaviours. Taken together, the transient changes in brain insulin sensitivity following TBI suggest a reduced capacity of the injured brain to respond to the neuroprotective and anti-inflammatory actions of insulin and Akt signalling, and thus may be a contributing factor for the damaging neuroinflammation and long-lasting deficits that occur following TBI.
Haidar, Yarah M.; Cosman, Bard C.
Obesity has progressed in a few decades from a public health footnote in developed countries to a top-priority international issue. Because obesity implies increased morbidity and mortality from chronic, debilitating disorders, it is a major burden on individuals and health systems in both developing and developed countries. Obesity is a complex disorder unequally affecting all age groups and socioeconomic classes. Of special concern is increasing childhood obesity. This review presents the extent of the obesity epidemic and its impact worldwide by way of introduction to a discussion of colon and rectal surgery in the obese patient. PMID:23204935
Maidenberg, Michelle P
Because ofpoverty, the high prevalence of obesity, and the lack of adequate supports, Central Harlem's children, adolescents, and teenagers are at risk for major physiological, psychological, and social issues. This article discusses the public health concerns related to this population, especially the prevalence of obesity. This article identifies the prevalence of illness and obesity in the inner city and stipulates the causes and consequences of obesity among children, adolescents, and teenagers. In addition, it reports on the appropriate community intervention, using a coalition and a community collaborative organization that serve as models to build support for Central Harlem. A proposal is offered for reducing obesity among youths in the community. The intervention outlines a logic model that identifies a multisystemic approach at the micro and macro level for community intervention and policy initiatives to advocate for fundamental change. Further research recommendations are described to reduce the prevalence of childhood, adolescent, and teenage obesity in urban communities.
Maidenberg, Michelle P.
Because of poverty, the high prevalence of obesity, and the lack of adequate supports, Central Harlem’s children, adolescents, and teenagers are at risk for major physiological, psychological, and social issues. This article discusses the public health concerns related to this population, especially the prevalence of obesity. This article identifies the prevalence of illness and obesity in the inner city and stipulates the causes and consequences of obesity among children, adolescents, and teenagers. In addition, it reports on the appropriate community intervention, using a coalition and a community collaborative organization that serve as models to build support for Central Harlem. A proposal is offered for reducing obesity among youths in the community. The intervention outlines a logic model that identifies a multisystemic approach at the micro and macro level for community intervention and policy initiatives to advocate for fundamental change. Further research recommendations are described to reduce the prevalence of childhood, adolescent, and teenage obesity in urban communities. PMID:27263198
den Engelsen, Corine; van den Donk, Maureen; Gorter, Kees J; Salomé, Philippe L; Rutten, Guy E
Accumulation of advanced glycation end products (AGEs) is enhanced by chronic hyperglycemia and oxidative stress and this process may contribute to the pathogenesis of vascular disease. Skin autofluorescence (AF), a measure of accumulation of AGEs in skin collagen, is associated with vascular disease in patients with diabetes. Because central obesity enhances oxidative stress people with central obesity might already have increased accumulation of AGEs before diabetes or cardiovascular disease become manifest. To test this hypothesis, we compared the distribution of skin AF and its association with clinical and biochemical parameters in individuals with and without central obesity. Skin AF was measured by a validated AGE Reader in 816 persons with and 431 persons without central obesity, aged 20-70 y. Mean skin AF increased with age and smoking and was higher in centrally obese individuals compared with non-obese individuals (p = 0.001, after adjustment for age and smoking p = 0.13). Mean skin AF in the subgroups without central obesity and without other risk factors (n = 106), central obesity without other risk factors (n = 74) and central obesity with other risk factors (n = 742) was 1.63 ± 0.37, 1.74 ± 0.44 and 1.87 ± 0.43 AU, respectively (p for trend < 0.001, after adjustment for age and smoking p for trend = 0.12). In the group with central obesity age, current smoking, alcohol consumption, waist circumference, creatinine clearance and hs-CRP were independently associated with skin AF (R(2) = 29.4%). Waist circumference hardly contributed to the explained variance. The relationship between waist circumference and skin AF is not as obvious as we hypothesized.
Hao, Mingli; Ding, Lin; Xuan, Liping; Wang, Tiange; Li, Mian; Zhao, Zhiyun; Lu, Jieli; Xu, Yu; Chen, Yuhong; Wang, Weiqing; Bi, Yufang; Xu, Min; Ning, Guang
Bisphenol A (BPA) exposure has been associated with diabetes and related metabolic disorders, such as obesity, but studies of the association of urinary BPA concentrations with central obesity risk are limited. The aim of this study was to prospectively investigate the association between urinary BPA and incident central obesity in a Chinese population aged ≥40 years. The study followed 888 participants from Shanghai, China, who did not have central obesity at baseline (in 2009) for 4 years. Concentrations of BPA were measured in baseline morning spot urine samples. Central obesity was defined as waist circumference ≥90 cm in men and ≥80 cm in women. During a mean follow-up of 4 years, 124 (14.0%) participants developed central obesity. Each 1-unit increase in log [BPA] was positively associated with a 2.30-fold risk of incident central obesity (95% confidence interval [CI] 1.39-3.78; P < 0.001) after adjustment for confounders. Compared with the lowest tertile of urinary BPA concentration, Tertiles 2 and 3 were associated with a higher risk of incident central obesity (odds ratios 1.73 [95% CI 1.04-2.88] and 1.81 [95% CI 1.08-3.05], respectively). Stratified analysis showed significant associations of BPA with incident central obesity in women and individuals <60 years of age, with normal weight, non-smokers, non-drinkers, or non-hypertensives. The results indicate that higher urinary BPA concentrations may be associated with a greater risk of incident central obesity in Chinese adults. The study emphasizes the effects of BPA exposure on metabolic risk from a public health perspective. © 2017 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.
Sander, Christian; Minkwitz, Juliane; Thormann, Julia; Chittka, Tobias; Mergl, Roland; Kirkby, Kenneth C.; Faßhauer, Mathias; Stumvoll, Michael; Holdt, Lesca M.; Teupser, Daniel; Hegerl, Ulrich; Himmerich, Hubertus
Context Chronic systemic inflammation in obesity originates from local immune responses in visceral adipose tissue. However, assessment of a broad range of inflammation-mediating cytokines and their relationship to physical activity and adipometrics has scarcely been reported to date. Objective To characterize the profile of a broad range of pro- and anti-inflammatory cytokines and the impact of physical activity and energy expenditure in individuals with general obesity, central obesity, and non-obese subjects. Design, Setting, and Participants A cross-sectional study comprising 117 obese patients (body mass index (BMI) ≥ 30) and 83 non-obese community-based volunteers. Main Outcomes Measures Serum levels of interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12, IL-13, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN)-γ and tumor necrosis factor (TNF)-α were measured. Physical activity and energy expenditure (MET) were assessed with actigraphy. Adipometrics comprised BMI, weight, abdominal-, waist- and hip-circumference, waist to hip ratio (WHR), and waist-to-height-ratio (WHtR). Results General obesity was associated with significantly elevated levels of IL-5, IL-10, IL-12, IL-13, IFN-γ and TNF-α, central obesity with significantly elevated IL-5, IL-10, IL-12, IL-13 and IFN-γ-levels. In participants with general obesity, levels of IL-4, IL-10 and IL-13 were significantly elevated in participants with low physical activity, even when controlled for BMI which was negatively associated with physical acitivity. Cytokines significantly correlated with adipometrics, particularly in obese participants. Conclusions Results confirm up-regulation of certain pro- and anti-inflammatory cytokines in obesity. In obese subjects, physical activity may lower levels and thus reduce pro-inflammatory effects of cytokines that may link obesity, insulin resistance and diabetes. PMID:25781614
Rates of obesity in the United States have increased dramatically over the past 30 years. Approximately 35% of children and 66% of adults are currently considered overweight or obese. Although obesity is seen in all ethnicities and economic classes, ethnic minorities and those of lower socioeconomic...
Yuca, Sevil Ari, Ed.
This book aims to provide readers with a general as well as an advanced overview of the key trends in childhood obesity. Obesity is an illness that occurs due to a combination of genetic, environmental, psychosocial, metabolic and hormonal factors. The prevalence of obesity has shown a great rise both in adults and children in the last 30 years.…
Yuca, Sevil Ari, Ed.
This book aims to provide readers with a general as well as an advanced overview of the key trends in childhood obesity. Obesity is an illness that occurs due to a combination of genetic, environmental, psychosocial, metabolic and hormonal factors. The prevalence of obesity has shown a great rise both in adults and children in the last 30 years.…
Parikh, R; Mohan, V; Joshi, S
Waist circumference has been widely used as the parameter of central obesity in defining metabolic syndrome. Global consensus definition of metabolic syndrome has suggested various race- and gender-specific cutoffs of waist circumference for quantifying central obesity. We have earlier proposed that using index of central obesity (ICO), the need for race- and gender-specific cutoffs may be obviated. We propose that waist circumference be supplanted with index of central obesity in all definitions of metabolic syndrome. Using index of central obesity a common cutoff of 0.5 applicable across races and genders might be obtained. Moreover, it will enhance the sensitivity of definition by diagnosing subjects who are shorter than general population. Among 258 male and 242 female diabetic patients, subjects with metabolic syndrome (defined as per gender-specific waist circumference cutoffs), were found to have a common lower range of index of central obesity suggesting that a common cutoff of waist circumference may be obtained. In another study from National Health and Nutrition Examination Survey database, replacing index of central obesity with waist circumference was found to enhance the specificity and sensitivity of definition of metabolic syndrome. Copyright © 2011 John Wiley & Sons, Ltd.
García-García, Isabel; Jurado, María Ángeles; Garolera, Maite; Marqués-Iturria, Idoia; Horstmann, Annette; Segura, Bàrbara; Pueyo, Roser; Sender-Palacios, María José; Vernet-Vernet, Maria; Villringer, Arno; Junqué, Carme; Margulies, Daniel S; Neumann, Jane
Obesity is associated with structural and functional alterations in brain areas that are often functionally distinct and anatomically distant. This suggests that obesity is associated with differences in functional connectivity of regions distributed across the brain. However, studies addressing whole brain functional connectivity in obesity remain scarce. Here, we compared voxel-wise degree centrality and eigenvector centrality between participants with obesity (n=20) and normal-weight controls (n=21). We analyzed resting state and task-related fMRI data acquired from the same individuals. Relative to normal-weight controls, participants with obesity exhibited reduced degree centrality in the right middle frontal gyrus in the resting-state condition. During the task fMRI condition, obese participants exhibited less degree centrality in the left middle frontal gyrus and the lateral occipital cortex along with reduced eigenvector centrality in the lateral occipital cortex and occipital pole. Our results highlight the central role of the middle frontal gyrus in the pathophysiology of obesity, a structure involved in several brain circuits signaling attention, executive functions and motor functions. Additionally, our analysis suggests the existence of task-dependent reduced centrality in occipital areas; regions with a role in perceptual processes and that are profoundly modulated by attention. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
McAuley, Paul A; Blair, Steven N
In this review, we examine the original obesity paradox phenomenon (i.e. in cardiovascular disease populations, obese patients survive better), as well as three other related paradoxes (pre-obesity, "fat but fit" theory, and "healthy" obesity). An obesity paradox has been reported in a range of cardiovascular and non-cardiovascular conditions. Pre-obesity (defined as a body mass index of 25.0-29.9 kg · m⁻²) presents another paradox. Whereas "overweight" implies increased risk, it is in fact associated with decreased mortality risk compared with normal weight. Another paradox concerns the observation than when fitness is taken into account, the mortality risk associated with obesity is offset. The final paradox under consideration is the presence of a sizeable subset of obese individuals who are otherwise healthy. Consequently, a large segment of the overweight and obese population is not at increased risk for premature death. It appears therefore that low cardiorespiratory fitness and inactivity are a greater health threat than obesity, suggesting that more emphasis should be placed on increasing leisure time physical activity and cardiorespiratory fitness as the main strategy for reducing mortality risk in the broad population of overweight and obese adults.
Head, Geoffrey A; Lim, Kyungjoon; Barzel, Benjamin; Burke, Sandra L; Davern, Pamela J
The activation of the sympathetic nervous system is a major mechanism underlying both human and experimental models of obesity-related hypertension. While insulin and the adipokine leptin have long been thought to contribute to obesity-related neurogenic mechanisms, the evidence is now very strong that they play a major role, shown particularly in animal studies using selective receptor antagonists. There is not just maintenance of leptin's sympatho-excitatory actions as previously suggested but considerable amplification particularly in renal sympathetic nervous activity. Importantly, these changes are not dependent on short-term elevation or reduction in plasma leptin or insulin, but require some weeks to develop indicating a slow "neural adaptivity" within hypothalamic signalling. These effects can be carried across generations even when offspring are raised on a normal diet. A better understanding of the underlying mechanism should be a high research priority given the prevalence of obesity not just in the current population but also for future generations.
Chao, Chi-Yuan; Shih, Chi-Chen; Wang, Chi-Jen; Wu, Jin-Shang; Lu, Feng-Hwa; Chang, Chih-Jen; Yang, Yi-Ching
Obesity is related to social disparity. The objective of the study was to evaluate different indicators of parental SES with the association of central obesity in young adult Taiwanese students. This study was cross-sectionally designed and a total of 4552 subjects were recruited. Each subject completed a self-administrated questionnaire and received anthropometric and laboratory measurements. The indicators of SES in study subjects included parental education, occupation, household incomes, childhood and current index of social position (ISP), measured according to the modified Hollingshead's ISP. Central obesity was defined as waist circumference ≥90 cm in men and ≥80 cm in women. The prevalence of central obesity was 10.7% in this study. When compared to subjects with normal waist circumferences, subjects with central obesity were older, had a higher BMI, both systolic and diastolic blood pressure, a higher proportion of male gender, family history of diabetes and hypertension, alcohol consumption habit, and a higher proportion of low current household income, current parental blue collar occupational level, and lower current and childhood parental ISP level. Multivariate analysis showed the current parental household income and ISP were significantly higher indicators of risk of central obesity after adjustment for possible confounding factors. The odds ratios were 1.26 and 1.30, respectively. Our results showed that low household income and current ISP were independently associated with the risk of central obesity. Therefore, young adults with low SES should be an important target group for prevention and management of central obesity in school health promotion programs. © 2014 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.
Zhang, Yi; Liu, Ju; Yao, Jianliang; Ji, Gang; Qian, Long; Wang, Jing; Zhang, Guansheng; Tian, Jie; Nie, Yongzhan; Zhang, Yi Edi.; Gold, Mark S.; Liu, Yijun
Obesity presents a major health hazard of the 21st century. It promotes co-morbid diseases such as heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis. Excessive energy intake, physical inactivity, and genetic susceptibility are main causal factors for obesity, while gene mutations, endocrine disorders, medication, or psychiatric illnesses may be underlying causes in some cases. The development and maintenance of obesity may involve central pathophysiological mechanisms such as impaired brain circuit regulation and neuroendocrine hormone dysfunction. Dieting and physical exercise offer the mainstays of obesity treatment, and anti-obesity drugs may be taken in conjunction to reduce appetite or fat absorption. Bariatric surgeries may be performed in overtly obese patients to lessen stomach volume and nutrient absorption, and induce faster satiety. This review provides a summary of literature on the pathophysiological studies of obesity and discusses relevant therapeutic strategies for managing obesity. PMID:25412152
Brunner, Eric J; Chandola, Tarani; Marmot, Michael G
Positive energy balance is the major cause of obesity, and chronic stress may be a contributory factor. The authors examined cumulative work stress, using the Job Strain Questionnaire on four occasions, as a predictor of obesity in a prospective 19-year study of 6,895 men and 3,413 women (aged 35-55 years) in the Whitehall II cohort in London, United Kingdom (baseline: 1985-1988). A dose-response relation was found between work stress and risk of general obesity (body mass index > or =30 kg/m(2)) and central obesity (waist circumference >102 cm in men, >88 cm in women) that was largely independent of covariates. The imputed odds ratios of body mass index obesity for one, two, and three or more reports of work stress adjusted for age, sex, and social position were 1.17, 1.24, and 1.73 (trend p < 0.01), respectively. For waist obesity, the corresponding findings were 1.17, 1.41, and 1.61 (trend p < 0.01). Work stress effect was modestly attenuated after exclusion of obese individuals at baseline and further adjustments for smoking; intakes of dietary fiber, fruits and vegetables, and alcohol; and levels of physical activity during follow-up. This study provides prospective, population-based evidence that chronic work stress predicts general and central obesity.
Ahmad, Qazi Iqbal; Ahmad, Charoo Bashir; Ahmad, Sheikh Mushtaq
Obesity is increasing at an alarming rate throughout the world. Today it is estimated that there are more than 300 million obese people world-wide. Obesity is a condition of excess body fat often associated with a large number of debilitating and life-threatening disorders. It is still a matter of debate as to how to define obesity in young people. Overweight children have an increased risk of being overweight as adults. Genetics, behavior, and family environment play a role in childhood overweight. Childhood overweight increases the risk for certain medical and psychological conditions. Encourage overweight children to expand high energy activity, minimize low energy activity (screen watching), and develop healthful eating habits. Breast feeding is protective against obesity. Diet restriction is not recommended in very young children. Children are to be watched for gain in height rather than reduction in weight. Weight reduction of less than 10% is a normal variation, not significant in obesity. PMID:21448410
Monteiro, Mariana P
Obesity is one of the largest and fastest growing public health problems in the world. Last century social changes have set an obesogenic milieu that calls for micro and macro environment interventions for disease prevention, while treatment is mandatory for individuals already obese. The cornerstone of overweight and obesity treatment is diet and physical exercise. However, many patients find lifestyle modifications difficult to comply and prone to failure in the long-term; therefore many patients consider anti-obesity drugs an important adjuvant if not a better alternative to behavioral approach or obesity surgery. Since the pharmacological options for obesity treatment remain quite limited, this is an exciting research area, with new treatment targets and strategies on the horizon. This review discusses the development of innovative therapeutic agents, focusing in energy homeostasis regulation and the use of molecular vaccines, targeting hormones such as somatostatin, GIP and ghrelin, to reduce body weight. PMID:24365968
Monteiro, Mariana P
Obesity is one of the largest and fastest growing public health problems in the world. Last century social changes have set an obesogenic milieu that calls for micro and macro environment interventions for disease prevention, while treatment is mandatory for individuals already obese. The cornerstone of overweight and obesity treatment is diet and physical exercise. However, many patients find lifestyle modifications difficult to comply and prone to failure in the long-term; therefore many patients consider anti-obesity drugs an important adjuvant if not a better alternative to behavioral approach or obesity surgery. Since the pharmacological options for obesity treatment remain quite limited, this is an exciting research area, with new treatment targets and strategies on the horizon. This review discusses the development of innovative therapeutic agents, focusing in energy homeostasis regulation and the use of molecular vaccines, targeting hormones such as somatostatin, GIP and ghrelin, to reduce body weight.
Kim, Ki Ju; Lee, Ban Seok
Although central obesity is a risk factor for erosive esophagitis, information regarding the association between central obesity and non-erosive reflux disease (NERD) is still scarce. The purpose of this study was to investigate the risk factors for NERD by comparing NERD patients and healthy controls. Comprehensive clinical data from 378 patients who underwent esophagogastroduodenoscopy from December 2012 to May 2013 and had no visible esophageal mucosal breakage were analyzed. The Korean version of GerdQ questionnaire was used to diagnose NERD. The association between central obesity and NERD was assessed after matching subjects according to propensity scores. There were 119 NERD patients and 259 controls. In multivariate analysis, central obesity, female gender, and younger age were significantly associated with NERD [odds ratio (OR)=2.55, 1.93, and 1.80; p=0.001, 0.005, and 0.011, respectively]. After adjusting for 12 clinical variables using propensity score matching, 114 NERD patients were matched to 114 controls. All variables were well balanced between the two groups (average D before matching: 0.248, after matching: 0.066). Patients with NERD were more likely to have central obesity than healthy controls (28.1% vs. 7.9%). After adjusting for propensity scores and all covariates in multivariable logistic regression analyses, central obesity was still found to be a significant risk factor for NERD (OR=4.55, p<0.001). Central obesity appears to be an independent risk factor for NERD. This result supports the presence of an association between GERD and central obesity, even in the absence of esophageal erosion (NERD).
Rerksuppaphol, Sanguansak; Rerksuppaphol, Lakkana
Obesity and underweight are both a public health concern worldwide. Being overweight, and obesity are primary risk factors for the development of chronic conditions including hypertension. Data on obesity and the underweight as well as their association with hypertension in Thai children, specifically, are scant. This study was aimed to assess the relationship between obesity or underweight status and hypertension in Thai school children. Anthropometric data were collected from 3991 students (mean age of 9.5 yr) in Ongkharak district, central Thailand. The sex as well as the age-specific BMI criteria of the WHO were used to define what is overweight, obesity, underweight and severe underweight status of children. In order to calculate the odds ratio and the association between one's nutritional status and hypertension logistic regression was used. Obese and overweight children have a higher prevalence of hypertension compared with children with an average weight (49.5% and 26.5% versus 16.2%, respectively). The risks of developing hypertension is also high in obese children (OR 5.15; 95%CI: 4.27, 6.22), overweight children (1.87; 95% CI: 1.50, 2.32) and overweight/obese children (OR 3.30; 95% CI: 2.82, 3.86. Additionally, underweight children were not associated with an increased risk of hypertension (OR 1.04; 95% CI: 0.72, 1.42). Rates of hypertension in overweight and obese children are high in central Thailand and, as a result, this increased body weight is a risk factor for hypertension. Larger, multi-centric studies are required to evaluate the correlation between hypertension and obesity amongst children at the national level.
Bereket, A; Kiess, W; Lustig, R H; Muller, H L; Goldstone, A P; Weiss, R; Yavuz, Y; Hochberg, Z
Hypothalamic obesity is an intractable form of obesity syndrome that was initially described in patients with hypothalamic tumours and surgical damage. However, this definition is now expanded to include obesity developing after a variety of insults, including intracranial infections, infiltrations, trauma, vascular problems and hydrocephalus, in addition to acquired or congenital functional defects in central energy homeostasis in children with the so-called common obesity. The pathogenetic mechanisms underlying hypothalamic obesity are complex and multifactorial. Weight gain results from damage to the ventromedial hypothalamus, which leads, variously, to hyperphagia, a low-resting metabolic rate; autonomic imbalance; growth hormone-, gonadotropins and thyroid-stimulating hormone deficiency; hypomobility; and insomnia. Hypothalamic obesity did not receive enough attention, as evidenced by rarity of studies in this group of patients. A satellite symposium was held during the European Congress of Obesity in May 2011, in Istanbul, Turkey, to discuss recent developments and concepts regarding pathophysiology and management of hypothalamic obesity in children. An international group of leading researchers presented certain aspects of the problem. This paper summarizes the highlights of this symposium. Understanding the central role of the hypothalamus in the regulation of feeding and energy metabolism will help us gain insights into the pathogenesis and management of common obesity. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.
Bank, Sahar Saraf; Ghanjali, Naeimeh; Ghalaeh, Reihaneh Seyyed; Azadbakht, Leila
Nowadays, obesity is considered a worldwide problem. Although genetics is one of the factors associated with obesity, its predisposing factors include nutritional and environmental factors. Several studies have addressed the relationship between nutritional factors and general and central adiposity. Therefore, the purpose of this study was to determine the relationship between the consumption of dairy products and prevalence of obesity and central obesity in young female university students at the Isfahan University of Medical Sciences. This cross-sectional study was conducted on 236 healthy female university students in the age range of 18 and 30 years who were selected randomly from among the students at the Isfahan University of Medical Sciences, Iran. A previously validated semiquantitative food questionnaire was used to assess their entire dietary component intake. Physical activity was evaluated by recording daily physical activities. The prevalence of obesity, central adiposity, and excess weight was 1.7, 0.9, and 8.1%, respectively. The mean values of body mass index (BMI) and waist circumference were 21.54 kg/m(2) and 70.37 cm, respectively. Moreover, the mean value of dairy product consumption was 444.24 g/day. The results showed no significant relationship between dairy or calcium intake and weight and waist circumference as well as prevalence of obesity, central adiposity, and excess weight (P>0.05). There was no significant relationship between the consumption of dairy products and calcium intake and excess weight, obesity, and central adiposity among female university students. However, this study is important in that the prevalence of obesity, central adiposity, and excess weight along with the mean values of BMI and waist circumference are reported.
Bank, Sahar Saraf; Ghanjali, Naeimeh; Ghalaeh, Reihaneh Seyyed; Azadbakht, Leila
Background: Nowadays, obesity is considered a worldwide problem. Although genetics is one of the factors associated with obesity, its predisposing factors include nutritional and environmental factors. Several studies have addressed the relationship between nutritional factors and general and central adiposity. Therefore, the purpose of this study was to determine the relationship between the consumption of dairy products and prevalence of obesity and central obesity in young female university students at the Isfahan University of Medical Sciences. Materials and Methods: This cross-sectional study was conducted on 236 healthy female university students in the age range of 18 and 30 years who were selected randomly from among the students at the Isfahan University of Medical Sciences, Iran. A previously validated semiquantitative food questionnaire was used to assess their entire dietary component intake. Physical activity was evaluated by recording daily physical activities. Findings: The prevalence of obesity, central adiposity, and excess weight was 1.7, 0.9, and 8.1%, respectively. The mean values of body mass index (BMI) and waist circumference were 21.54 kg/m2 and 70.37 cm, respectively. Moreover, the mean value of dairy product consumption was 444.24 g/day. The results showed no significant relationship between dairy or calcium intake and weight and waist circumference as well as prevalence of obesity, central adiposity, and excess weight (P>0.05). Conclusion: There was no significant relationship between the consumption of dairy products and calcium intake and excess weight, obesity, and central adiposity among female university students. However, this study is important in that the prevalence of obesity, central adiposity, and excess weight along with the mean values of BMI and waist circumference are reported. PMID:24083266
Yin, Xue Yao; Zheng, Fen Ping; Zhou, Jia Qiang; Du, Ying; Pan, Qian Qian; Zhang, Sai Fei; Yu, Dan; Li, Hong
Central obesity is considered to be a central component of metabolic syndrome. Waist circumference (WC) has been widely used as a simple indicator of central obesity. This study is aimed to evaluate the sensitivity of WC cut-off values for predicting metabolic risk factors in middle-aged Chinese. The study involved 923 subjects aged 40-65 years. The metabolic risk factors were defined according to the Chinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. WC cut-off 85-90 cm and ⋝90 cm were used as cut-off values of central pre-obesity and central obesity in males, respectively, while WC 80-85 cm and ⋝85 cm were used as cut-off values of central pre-obesity and central obesity in females. First, WC values corresponding to body mass index (BMI) 24 kg/m2 and visceral fat area (VFA) 80 cm2 were 88.55 cm and 88.51 cm in males, and 81.46 cm and 82.51 cm in females respectively. Second, receiver operating characteristic curves showed that the optimal WC cut-off of value was 88.75 cm in males, higher than that in females (81.75 cm). Third, the subjects with higher WC values were more likely to have accumulating metabolic risk factors. The prevalence of metabolic risk factors increased linearly and significantly in relation to WC levels. WC cut-off values of central pre-/central obesity are optimal to predict multiple metabolic risk factors. Copyright © 2014 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.
This article draws on Mills' sociological imagination (from the 1959 publication "The Sociological Imagination") to consider the connections between personal trouble and social issues when it comes to the causes and consequences of obesity. These connections may be important for assuaging the "obesity bias" that pervades our…
Chueca, M; Azcona, C; Oyárzabal, M
Obesity during childhood and adolescence is an increasingly frequent cause for medical consultation. The increase in the prevalence of this disease, which has been considered as an epidemic by the World Health Organisation, is worrying. Obesity is a complex disease, whose aetiology still remains to be clarified due to the numerous factors involved: environmental, genetic, life style and behavioural, neuroendocrinological and metabolic. The persistence of childhood obesity until adulthood significantly increases the risk of suffering from diabetes mellitus, cardiovascular disease, hypertension, cholecystitis and cholelithiasis. Treatment of obesity is complicated and few patients regularly attend follow up examinations. A multidisciplinary team is required to carry out a suitable treatment, composed of paediatricians, dieticians, nurses, psychologists and psychiatrists. Successful treatment of obesity resides in reducing the calorie intake in relation to energy expenditure, and at the time providing instruction in appropriate eating habits and life styles that in the long term will promote the maintenance of the ideal weight.
The chronic diseases associated with overweight and obesity are major contributors to the excess disease burden of Aboriginal Australians. Surveillance of overweight and obesity is required to monitor these conditions, and to develop and evaluate interventions to improve health and wellbeing. Remote Aboriginal communities in Australia's Northern Territory (NT) are where approximately two-thirds of the NT Aboriginal people live, a proportion which has been stable over many years. However the remote communities suffer significant socioeconomic disadvantage including limited education and employment opportunities, and poor quality and overcrowded housing. Approximately one-third of Aboriginal people in NT live in central Australia, which consists of the Alice Springs and Barkly districts. The Healthy School-Aged Kids Program includes health promotion and child health screening, and is run in remote Aboriginal communities of NT. This report provides estimates of prevalences of overweight and obesity among children in central Australia who participated in health checks as part of Healthy School-Aged Kids Program in 2010. All children in remote central Australian Aboriginal communities were invited to participate in health checks. Children who attended were weighed and measured. Date of birth, sex, height and weight for each child were used to determine prevalence of overweight (≥+1 standard deviation [SD] BMI-for-age) and obesity (≥+2 SD BMI-for-age) according to WHO Growth standards. Differences in proportions of overweight and obesity by age group and sex, and their statistical significance were calculated. Weight, height, sex and age data were available for 996 children from a population of 1764. It was found that 22.1% of girls and 20.7% of boys were overweight; and 5.1% of girls and 5.8% of boys were obese as defined by BMI-for-age. Prevalence of overweight but not obesity increased with age (for overweight z=3.28, p=0.0011; for obesity z=0.68; p=0.50). The
Palou, Andreu; Bonet, M Luisa
Obesity is the main nutritional problem and one of the most important health problems in developed societies. Central to the challenge of obesity prevention and management is a thoroughly understanding of its determinants. Multiple socio-cultural, socio-economic, behavioural and biological factors--often interrelated and many of them still unknown or poorly understood--can contribute to the establishment and perpetuation of obese phenotypes. Here, we address current research challenges regarding basic aspects of obesity and emerging science for its control, including brown adipose tissue thermogenesis and browning of white fat as possible therapeutic targets for obesity, the influence of the microbioma, and genetics, epigenetics, nutrigenomics and nutrigenetics of obesity. We also highlight hot topics in relation to food and lifestyle as determinants of obesity, including the brain mechanisms underlying environmental motivation to eat, the biological control of spontaneous physical activity, the possible role of concrete foods and food components, and the importance of early life nutrition and environment. Challenges regarding the connections of obesity with other alterations and pathologies are also briefly addressed, as well as social and economical challenges in relation to healthy food production and lifestyle for the prevention of obesity, and technological challenges in obesity research and management. The objective is to give a panoramic of advances accomplished and still ahead relevant to the different stakeholders engaged in understanding and combating obesity.
Liu, Xuefeng; Chen, Yang; Boucher, Nicole L; Rothberg, Amy E
Central obesity is a major risk factor for cardiometabolic diseases. The prevalence of central obesity has not been reported fully among Asian adults in the United States (US). Cross-sectional data of 1288 Asian adults aged 20 years or over was selected from the US National Health and Nutrition Examination Survey with a stratified multi-stage sampling design. The prevalence of central obesity was calculated with 95% confidence intervals (CIs) and Chi-square tests were conducted to test the significance of the prevalence differences across characteristic groups. The overall prevalence of central obesity among US Asian adults was 58.1% in 2011-2014. The prevalence of central obesity was higher in older adults (73.5%) than in young adults (45.4%) (p < 0.0001). Women had 13.4% higher prevalence than men (64.4% vs 51.0%, p < 0.0001). The prevalence increased over time (2011-2012 vs 2013-2014) in young adults (39.2% vs 51.5%), men (45.4% vs 56.6%), adults with college education or above (54.2% vs 61.7%) and non-poor adults (55.4% vs 62.4%). Compared with men, women had higher prevalence in each subgroup of age, education, poverty, and length of time (except for the subgroup of "born in the US") (all p < 0.05) and in the subgroup of "married or living with partner" for marital status (p < 0.0001). Central obesity is prevalent in Asian adults, particularly in older adults and women. More efforts are needed to prevent and treat obesity in Asian adults as Asians are incurring the greatest increase in type 2 diabetes in parallel with the rising rate of central adiposity.
Britton, Willoughby B.; Howe, Chanelle J.; Gutman, Roee; Gilman, Stephen E.; Brewer, Judson; Eaton, Charles B.; Buka, Stephen L.
Purpose To evaluate whether dispositional mindfulness (defined as the ability to attend nonjudgmentally to one’s own physical and mental processes) is associated with obesity and central adiposity. Methods Study participants (n=394) were from the New England Family Study, a prospective birth cohort, with median age 47 years. Dispositional mindfulness was assessed using the Mindful Attention Awareness Scale (MAAS). Central adiposity was assessed using dual-energy X-ray absorptiometry (DXA) scans with primary outcomes android fat mass and android/gynoid ratio. Obesity was defined as body mass index ≥30 kg/m2. Results Multivariable-adjusted regression analyses demonstrated that participants with low vs. high MAAS scores were more likely to be obese (prevalence ratio for obesity= 1.34 (95 % confidence limit (CL): 1.02, 1.77)), adjusted for age, gender, race/ethnicity, birth weight, childhood socioeconomic status, and childhood intelligence. Furthermore, participants with low vs. high MAAS level had a 448 (95 % CL 39, 857) g higher android fat mass and a 0.056 (95 % CL 0.003, 0.110) greater android/gynoid fat mass ratio. Prospective analyses demonstrated that participants who were not obese in childhood and became obese in adulthood (n=154) had −0.21 (95 % CL −0.41, −0.01; p=0.04) lower MAAS scores than participants who were not obese in childhood or adulthood (n=203). Conclusions Dispositional mindfulness may be inversely associated with obesity and adiposity. Replication studies are needed to adequately establish whether low dispositional mindfulness is a risk factor for obesity and adiposity. PMID:26481650
Lakshman, Rajalakshmi; Elks, Cathy E.; Ong, Ken K.
Clinical summary Childhood obesity has important consequences for health and wellbeing both during childhood and also in later adult life. The rising prevalence of childhood obesity poses a major public health challenge in both developed and developing countries by increasing the burden of chronic non-communicable diseases. Despite the urgent need for effective preventative strategies, there remains disagreement over its definition due to a lack of evidence on the optimal cut-offs linking childhood BMI to disease risks, and limited evidence on the most effective components of interventions to prevent childhood obesity. This article reviews the trends in childhood obesity, its genetic, nutritional and other risk factors, and preventative and treatment strategies. Particular emphasis is given to early-onset obesity in pre-school children, which, as a precursor to later childhood and adult obesity, provides insights into the developmental and genetic origins of obesity and also offers the potential for early preventative approaches with long-lasting benefits. PMID:23027812
Young, T K
This paper reports on the sociocultural determinants of obesity among the Inuit people in the central Canadian Arctic, part of the Keewatin Health Assessment Study (KHAS), a comprehensive community health survey conducted during 1990/91 in eight Inuit communities in the Northwest Territories (n = 434 adults aged 18 yr +). On multivariate analysis, age is an independent predictor of obesity in both sexes. Among Inuit women, non-smoking status and a lower education is associated with various obesity indices. However, smoking is not a predictor in men, and the association with education is the reverse, i.e. the more highly educated are more likely to be obese. In addition, some obesity indices are associated with higher income, an admixed ethnic background, fluency in the Inuit language and less time spent on the land. In general Inuit men tend to show the pattern observed in developing societies, where obesity is more prevalent among those with higher SES status, whereas Inuit women are more characteristic of developed societies, where obesity is associated with a lower SES. The different sex roles in a rapidly modernizing population is most likely to be responsible for this phenomenon.
Morricone, L; Ferrari, M; Enrini, R; Inglese, L; Giardini, D; Garancini, P; Caviezel, F
To investigate the degree of coronary artery disease (CAD) in relation to obesity and fat distribution in obese patients with normal glucose tolerance, in comparison with CAD of diabetic obese patients and of normal weight subjects with CAD. Patients listed for coronary angiography with different body mass index (BMI) with or without diabetes: study of the correlation between severity of coronary damage and fat distribution. 92 patients subdivided into: 30 normal glucose tolerant obese (BMI 31.7+/-0.5, aged 53+/-1.7 y), 28 type 2 diabetic obese (BMI 30.7+/-0. 3, aged 57+/-1.2 y), and 34 normal weight patients (BMI 23.1+/-0.3, aged 54+/-1.7 y). CAD assessed by angiography and evaluated according to the method of Gensini. Fat mass and fat distribution assessed by bioelectrical impedance and anthropometry. Clinical, biochemical and hormonal variables, as well as smoking habits and alcohol intake. The angiographic coronary scores were similar in nondiabetic obese and in diabetic obese patients, and were significantly higher than those of normal weight subjects. In the entire population coronary score correlated with indices of abdominal fat distribution. In the stepwise analysis of each group separately, waist hip ratio (WHR) correlated with coronary score only in normal weight nondiabetic patients. CAD was inversely associated with BMI only in nondiabetic obese patients. CAD of obese patients: 1) is similar to that of diabetic obese patients; 2) is more severe than that of normal weight individuals; and 3) is inversely correlated with BMI. CAD appears to be associated with WHR, not with BMI, only in nondiabetic patients with normal body weight. On the contrary, CAD of diabetic obese patients is unrelated to BMI and parameters of fat distribution, but is associated with smoking habits.
Patterson, Christa M; Levin, Barry E
Many of the small percentage of previously obese humans who successfully maintain weight loss report high levels of physical activity, suggesting a role for exercise in the maintenance of their lower body weights. The rat model of diet-induced obesity (DIO) has been particularly useful, since it shares several common characteristics with human obesity and, unlike the human condition, allows a thorough investigation of the effects of exercise on the central pathways which regulate energy homeostasis. In rats with DIO, voluntary wheel running selectively reduces adiposity without causing a compensatory increase in energy intake. These effects are likely mediated by signals generated by the exercising body such as interleukin-6, fatty acids, and heat which feed back on the brain to regulate central neuropeptide systems involved in the regulation of energy homeostasis. While exercise provides temporary reductions in obesity in adult rats, early postweaning exercise reduces adiposity in high-fat-fed DIO rats long after exercise is terminated. This suggests that early-onset exercise may permanently alter the development of the central pathways which regulate energy homeostasis. Therefore, identification of exercise-induced central and peripheral factors and elucidation of their interactions with central modulatory pathways may aid in the identification of new targets for the pharmacological treatment of human obesity. (c) 2007 S. Karger AG, Basel
Mohammadi, Masoud; Mirzaei, Masoud
The prevalence of obesity has been increasing in Iran over the past decade. This study aimed to determine the population-attributable fraction (PAF) of hypertension associated with obesity, abdominal obesity, and the joint effect of both in the central provinces of Iran. Prevalence of hypertension was extracted from the Iranian Ministry of Health Non-Communicable Disease Risk Factor InfoBase 2009. Measure of association between obesity and hypertension was extracted from Tehran Lipid and Glucose Study, for males and females, in order to calculate the PAF of hypertension associated with obesity. Age standardization of the reported prevalence of obesity was done using the World Health Organization method. The PAF of hypertension associated with the joint effect of obesity and abdominal obesity in females was highest in Semnan Province: 22.7 [95% confidence interval (CI): 4.2-35.6], followed by Qom 21.09 (95% CI: 3.7-33.1), and Yazd 20.3 (95% CI: 3.5-32.1). In males, the highest PAF was observed in Qom Province 31.07 (95% CI: 16.7-41.1), followed by Semnan 29.6 (95% CI: 15.9-39.3), Qazvin 25.9 (95% CI: 13.7-34.5), Tehran 24.2 (95% CI: 12.7-32.3), and Isfahan 20.4 (95% CI: 3.5-27.4). Prevalence of hypertension is higher in more developed provinces. PAFs suggest that a sizable share of hypertension in these provinces is associated with obesity. It is recommended that health promotion programs focus on obesity in the provinces with a higher share of hypertension due to obesity.
Murakami, Kentaro; Livingstone, M Barbara E
Evidence of the association between eating frequency (EF) and adiposity is inconsistent. With the use of data from the NHANES 2003-2012, this cross-sectional study examined the associations between EF, meal frequency (MF), and snack frequency (SF) and overweight/obesity and central obesity. Dietary intake was assessed with the use of two 24-h dietary recalls in 18,696 US adults ≥20 y of age. All eating occasions providing ≥50 kcal of energy were divided into meals or snacks on the basis of contribution to energy intake (≥15% or <15%), self-report, and time (0600-1000, 1200-1500, 1800-2100, or other). Multivariable logistic regression was used to compute ORs and 95% CIs. When analyzed without adjustment for the ratio of energy intake to estimated energy requirement (EI:EER), all measures of EF, MF, and SF showed inverse or null associations. After adjustment for EI:EER, however, EF was positively associated with overweight/obesity (body mass index ≥25 kg/m2) and central obesity (waist circumference ≥102 cm in men and ≥88 cm in women). Compared with the lowest category (≤3 times/d), the OR (95% CI) for overweight/obesity in the highest category (≥5 times/d) was 1.54 (1.23, 1.93) in men (P-trend = 0.003) and 1.45 (1.17, 1.81) in women (P-trend = 0.001). The corresponding value for central obesity was 1.42 (1.15, 1.75) in men (P-trend = 0.002) and 1.29 (1.05, 1.59) in women (P-trend = 0.03). The self-report-based MF and time-based MF were positively associated with overweight/obesity, central obesity, or both, although MF based on energy contribution showed no associations. There were positive associations for all SF measures in men and for the energy-contribution-based SF in women. This cross-sectional study suggests that higher EF, MF, and SF are associated with an increased likelihood of overweight/obesity and central obesity in US adults. Prospective studies are needed to confirm the associations observed in this study. © 2015 American Society for
Díaz, María Elena; Jiménez, Santa; García, René Guillermo; Bonet, Mariano; Wong, Iraida
Introduction Prevalence of overweight and obesity is increasing worldwide in parallel with the growing burden of noncommunicable chronic diseases. According to the World Health Organization, in 2005 approximately 1.6 billion individuals aged ≥15 years were overweight and at least 400 million were obese; by 2015 these figures will almost double. Central distribution of adiposity has also been associated with higher rates of cardiovascular diseases and other conditions. Objective Determine the prevalence of overweight, obesity and central adiposity, and their association with noncommunicable chronic diseases and related lifestyle risk factors in Cuban adults. Methods The Second National Survey on Risk Factors and Chronic Diseases (ENFRENT II), conducted in 2000-2001, surveyed a representative sample of males and females aged ≥15 years using a stratified, multi-stage cluster sampling design. Data from a sub-sample of 19,519 individuals aged ≥20 years were analyzed and prevalence calculated for diabetes, hypertension, cardiovascular and cerebrovascular diseases, and for each of these variables in association with overweight, obesity and central distribution of adiposity, and with the presence of sedentary lifestyle, smoking, alcohol consumption, eating regular daily meals and daily breakfast. Results Estimated prevalence of overweight and obesity in the adult population was 30.8% (CI: 30.1-31.5) and 11.8% (CI: 11.2-12.4), respectively. Obesity prevalence was twice as high in women (15.4%; CI: 14.5-16.3) as in men (7.9%; CI: 7.3-8.6). Obesity was significantly more frequent in diabetics, hypertensives and people with heart disease, while central adiposity was significantly associated with a higher prevalence of diabetes mellitus, cardiovascular and cerebrovascular diseases, hypertension, obesity and overweight. Smoking and alcohol consumption were low among overweight and obese subjects, who exhibited a higher prevalence of irregular and inadequate eating patterns
Elkiran, Ozlem; Yilmaz, Erdal; Koc, Mustafa; Kamanli, Ayhan; Ustundag, Bilal; Ilhan, Necip
To examine relationship between carotid intima-media thickness (IMT) and central obesity, cardiovasculary risk factors, and chronic inflammation markers in overweight and obese schoolchildren in Eastern Turkey. A cross-sectional school-based survey on 2765 schoolchildren was performed. We collected the clinical data (age, sex, percentage of body fat, and measured systolic blood pressure [BP] and diastolic BP, triglycerides, high- and low-density lipoprotein cholesterol, glucose, insulin, homocysteine and high-sensitivity C-reactive protein) in 67 obese and 24 overweight children. The control group was composed of nonobese children of similar age and sex. Mean systolic and diastolic BP values in the cases of overweight and obese groups were higher than those in the control group cases (p=0.001). Obese and overweight children demonstrated a significantly thicker intima media as compared with the control group (p=0.001). Carotid IMT was significantly correlated to the body mass index (r=0.396, p=0.001), fat mass percentage (r=0.257, p=0.036), waist circumference (r=0.390, p=0.001), diastolic BP (r=0.266, p=0.030), glucose (r=0.250, p=0.042), and high-sensitivity C-reactive protein levels (r=0.269, p=0.001) in the obese group. In multiple linear regression analysis, carotid IMT correlated significantly to waist circumference (p=0.045), and diastolic BP (p=0.031) in obese group. Obesity is related to cardiovascular risk factors leading to early atherosclerosis in schoolchildren. There is a relationship between atherosclerosis, and central obesity, diastolic BP, and chronic inflammation. Waist circumference measurement is more sensitive than other anthropometric measurements in predicting obesity and associated complications. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Jobim Benedetti, Franceliane; Lúcia Bosa, Vera; Mariante Giesta, Juliana; Bueno Fischer, Gilberto
to determine the prevalence of asthma risk associated with anthropometric indicators of excess weight and body fat distribution. cross-sectional study including adolescents between 10 and 19 years of age. The anthropometric indicator used to classify excess weight was the body mass index (BMI-Z); those used for abdominal adiposity were waist circumference (WC), waist-to-height ratio (WHtR) and the conicity index (CI). Asthma characteristics were evaluated using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The significance level was 5%, and the analyses were performed using Statistical Package for the Social Sciences (SPSS) Version 18.0. adolescent students (n = 1362; 788 [57.9%] female) with a mean age of 15.65 ± 1.24 years were evaluated. A high prevalence of asthma, excess weight (BMI-Z) and excess abdominal adiposity (WC and WHtR) was observed in the females. Only CI values for excess abdominal adiposity were higher for males than for females. Adolescents with excess abdominal adiposity, as shown by the WHtR, had a 1.24 times higher risk of having asthma compared with non-obese adolescents. Boys with excess abdominal adiposity, as classified by CI, presented a 1.8 times greater risk of asthma. The risk of severe asthma was 3 times higher among adolescents who were classified as severely obese via the BMI-Z. this study showed that excess body weight and abdominal obesity are associated with an increased risk of asthma and asthma severity in adolescents. Thus, additional BMI measurements are suggested for asthmatics. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Zammit, Christopher; Liddicoat, Helen; Moonsie, Ian; Makker, Himender
The obesity epidemic is a global problem, which is set to increase over time. However, the effects of obesity on the respiratory system are often underappreciated. In this review, we will discuss the mechanical effects of obesity on lung physiology and the function of adipose tissue as an endocrine organ producing systemic inflammation and effecting central respiratory control. Obesity plays a key role in the development of obstructive sleep apnea and obesity hypoventilation syndrome. Asthma is more common and often harder to treat in the obese population, and in this study, we review the effects of obesity on airway inflammation and respiratory mechanics. We also discuss the compounding effects of obesity on chronic obstructive pulmonary disease (COPD) and the paradoxical interaction of body mass index and COPD severity. Many practical challenges exist in caring for obese patients, and we highlight the complications faced by patients undergoing surgical procedures, especially given the increased use of bariatric surgery. Ultimately, a greater understanding of the effects of obesity on the respiratory disease and the provision of adequate health care resources is vital in order to care for this increasingly important patient population.
Zammit, Christopher; Liddicoat, Helen; Moonsie, Ian; Makker, Himender
The obesity epidemic is a global problem, which is set to increase over time. However, the effects of obesity on the respiratory system are often underappreciated. In this review, we will discuss the mechanical effects of obesity on lung physiology and the function of adipose tissue as an endocrine organ producing systemic inflammation and effecting central respiratory control. Obesity plays a key role in the development of obstructive sleep apnea and obesity hypoventilation syndrome. Asthma is more common and often harder to treat in the obese population, and in this study, we review the effects of obesity on airway inflammation and respiratory mechanics. We also discuss the compounding effects of obesity on chronic obstructive pulmonary disease (COPD) and the paradoxical interaction of body mass index and COPD severity. Many practical challenges exist in caring for obese patients, and we highlight the complications faced by patients undergoing surgical procedures, especially given the increased use of bariatric surgery. Ultimately, a greater understanding of the effects of obesity on the respiratory disease and the provision of adequate health care resources is vital in order to care for this increasingly important patient population. PMID:21116339
Loucks, Eric B; Britton, Willoughby B; Howe, Chanelle J; Gutman, Roee; Gilman, Stephen E; Brewer, Judson; Eaton, Charles B; Buka, Stephen L
To evaluate whether dispositional mindfulness (defined as the ability to attend nonjudgmentally to one's own physical and mental processes) is associated with obesity and central adiposity. Study participants (n = 394) were from the New England Family Study, a prospective birth cohort, with median age 47 years. Dispositional mindfulness was assessed using the Mindful Attention Awareness Scale (MAAS). Central adiposity was assessed using dual-energy X-ray absorptiometry (DXA) scans with primary outcomes android fat mass and android/gynoid ratio. Obesity was defined as body mass index ≥30 kg/m(2). Multivariable-adjusted regression analyses demonstrated that participants with low vs. high MAAS scores were more likely to be obese (prevalence ratio for obesity = 1.34 (95 % confidence limit (CL): 1.02, 1.77)), adjusted for age, gender, race/ethnicity, birth weight, childhood socioeconomic status, and childhood intelligence. Furthermore, participants with low vs. high MAAS level had a 448 (95 % CL 39, 857) g higher android fat mass and a 0.056 (95 % CL 0.003, 0.110) greater android/gynoid fat mass ratio. Prospective analyses demonstrated that participants who were not obese in childhood and became obese in adulthood (n = 154) had -0.21 (95 % CL -0.41, -0.01; p = 0.04) lower MAAS scores than participants who were not obese in childhood or adulthood (n = 203). Dispositional mindfulness may be inversely associated with obesity and adiposity. Replication studies are needed to adequately establish whether low dispositional mindfulness is a risk factor for obesity and adiposity.
Papoutsakis, Constantina; Chondronikola, Maria; Antonogeorgos, Georgios; Papadakou, Eleni; Matziou, Vasiliki; Drakouli, Maria; Konstantaki, Evanthia; Papadimitriou, Anastasios; Priftis, Kostas N
Evidence supports a significant yet weak association between high-body weight and asthma in children. However, most studies investigating the obesity-asthma link use Body Mass Index (BMI) to evaluate body fatness. The relationship between body fat distribution and asthma remains largely unknown, especially in children. This pediatric case-control investigation examined associations between central obesity/high-body weight and asthma diagnosis. Five-hundred and fourteen children (217 physician diagnosed asthma cases and 297 healthy controls) of 5-11 years were recruited. Height, weight and waist circumference were measured. Asthma symptoms, past medical history, personal lifestyle, socioeconomic status, diet and physical activity history were also collected. A higher proportion of children with asthma were centrally obese [(≥90th waist percentile) 15.2 vs. 9.4%, p<0.0001; (≥90th waist-to-height ratio percentile) 39.6 vs. 24.2%, p<0.0001)]. Regression analyses revealed that centrally obese children were more likely to have asthma (high-waist circumference (OR = 1.99, 95% CI: 1.07-3.68) and high-waist circumference to height ratio (OR = 2.24, 95% CI: 1.47-3.40), following adjustment for various confounders. Overweight/obese participants (BMI defined) were more likely to be asthmatic [odds ratio (OR) = 1.52, 95% confidence interval (CI): 1.03-2.70)] when compared to controls. Presence of central obesity and high-body weight (at least overweight) as assessed by waist circumference, waist-to-height ratio, and BMI are associated with asthma diagnosis. More studies are needed, especially in children and adolescents, to confirm these findings and better understand how body fat distribution impacts the obesity-asthma relationship.
Besharat, Sima; Poustchi, Hossein; Mohamadkhani, Ashraf; Roshandel, Gholamreza; Freedman, Neal D; Merat, Shahin; Malekzadeh, Reza
Chronic infection with the hepatitis B virus and obesity may both contribute synergistically to liver disease, although relatively few studies have investigated this hypothesis. Therefore, in this study, we evaluated the relationship between central obesity and the liver stiffness in the Golestan Hepatitis B cohort study (GHBCS). Our study included 304 chronic hepatitis B (CHB) patients enrolled from GHBCS. Liver stiffness measurement (LSM) and laboratory tests were performed after a follow-up of 4 years (2012). The hepatitis B viral load was measured at the baseline and follow-up using the real-time PCR method. Waist circumference ≥ 102 cm in men and ≥ 89 cm in women (central obesity) was considered to be abnormal. Advanced liver stiffness (ALS) was defined as LSM ≥ 8 KPa. Statistical analysis was performed using SPSS-V17. Logistic regression was used to test predictors of advanced liver stiffness (LSM ≥ 8 KPa). Linear regression was used to test the predictive value of variables in ALT (as a continuous variable). P-value of less than 0.05 was considered statistically significant. Among these CHB patients, 19 (7.4%) cases with a mean (±SD) age of 49.5 (±6.3) developed ALS after 4 years of follow-up. Multivariate analysis showed a significant predictive role of central obesity and viral load in ALS. Central obesity is related to the liver stiffness in chronic hepatitis B patients.
James, Philip T
Over the last decade, the prevalence of obesity in Western and Westernizing countries has more than doubled. A standardized classification of overweight and obesity, based on the body mass index now allows a comparison of prevalence rates worldwide for the first time. In children, the International Obesity Taskforce age, sex, and BMI specific cut-off points are increasingly being used. BMI data are being evaluated as part of a new analysis of the Global Burden of Disease. Prevalence rates for overweight and obese people are very different in each region with the Middle East, Central and Eastern Europe and North American having higher prevalence rates. Obesity is usually now associated with poverty even in developing countries. Relatively new data suggest that abdominal obesity in adults, with its associated enhanced morbidity, occurs particularly in those who had lower birth weights and early childhood stunting.
Budai, Kinga Anna; Mirzahosseini, Arash; Noszál Béla; Tóth, Gergő
Obesity is considered the most concerning and blatantly visible--yet most neglected--public health problem by the WHO. The steadily increasing number of overweight and obese people has reached 2.3 billion and 700 million worldwide, respectively. Obesity is a complex condition, one that presents serious health risks with respect to type 2 diabetes, ischemic heart disease, and hypertension, therefore controlling the global obesity epidemic decreases not only health problems, but also expenditure. The underlying cause of obesity is a metabolic disorder of genetic, central nervous system or endocrine etiology that manifests in increased nutritional intake and/or decreased physical activity ultimately leading to excessive lipogenesis. The natural treatment of obesity, that is often advised, is comprised of healthy lifestyle choices, namely low-calorie diet and exercise. However, the pharmaceutic treatment of obesity is just as important; having a better compliance rate, anti-obesity drugs also improve quality of life and patient-care outcome concerning accompanying diseases. In most countries only one drug is currently available against obesity: orlistat, which is a specific and irreversible lipase inhibitor. One of the reasons for the scarce number of anti-obesity drugs is the complex pathomechanism involved in obesity. Interference with the intricate biochemical processes that govern alimentation may lead to widespread adverse effects. The advances of the field however, have prompted novel drug leads. In the past few years FDA has approved new drugs for the treatment of obesity, recently liraglutide in 2014. The approval of drug combinations, such as phentermine/topiramate and bupropion/naltrexone are also noteworthy, the components of which have been previously approved, but not necessarily for obesity as main indication. Furthermore, there are many anti-obesity drug candidates currently in clinical phase trials, with promisingly modest adverse effect profiles; hence
Deng, Tuo; Lyon, Christopher J; Bergin, Stephen; Caligiuri, Michael A; Hsueh, Willa A
Obesity, a worldwide epidemic, confers increased risk for multiple serious conditions, including cancer, and is increasingly recognized as a growing cause of preventable cancer risk. Chronic inflammation, a well-known mediator of cancer, is a central characteristic of obesity, leading to many of its complications, and obesity-induced inflammation confers additional cancer risk beyond obesity itself. Multiple mechanisms facilitate this strong association between cancer and obesity. Adipose tissue is an important endocrine organ, secreting several hormones, including leptin and adiponectin, and chemokines that can regulate tumor behavior, inflammation, and the tumor microenvironment. Excessive adipose expansion during obesity causes adipose dysfunction and inflammation to increase systemic levels of proinflammatory factors. Cells from adipose tissue, such as cancer-associated adipocytes and adipose-derived stem cells, enter the cancer microenvironment to enhance protumoral effects. Dysregulated metabolism that stems from obesity, including insulin resistance, hyperglycemia, and dyslipidemia, can further impact tumor growth and development. This review describes how adipose tissue becomes inflamed in obesity, summarizes ways these mechanisms impact cancer development, and discusses their role in four adipose-associated cancers that demonstrate elevated incidence or mortality in obesity.
Gacci, Mauro; Sebastianelli, Arcangelo; Salvi, Matteo; De Nunzio, Cosimo; Tubaro, Andrea; Gravas, Stavros; Moncada, Ignacio; Serni, Sergio; Maggi, Mario; Vignozzi, Linda
In the developed and developing countries, the overall prevalence of central obesity in the elderly men is growing. In addition, the progressive aging of male population increased the possibilities of coexisting morbidities associated with obesity such as lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) or to prostate cancer (PCa) needing primary treatment, including radical prostatectomy (RP), which can further adversely affect the quality of life. Simple and radical prostatectomy are the most common surgical procedures in urologic unit all over the world for BPE and PCa, respectively. After both interventions, patients can present bothering storage LUTS that can worsen all the other clinical outcomes. Preset study will review the role of central obesity as a risk factor for storage LUTS or urinary incontinence, after prostatic surgery for BPE or PCa.
Aursulesei, Viviana; Cozma, A; Datcu, M D
Obesity has reached global epidemic proportions and is associated with major cardiovascular diseases and reduced overall survival. This paper reviews the metabolic and vascular consequences of dysfunctional adipocytokines in obesity as well as the pathological effects on blood pressure, cardiovascular structure and function. Despite this adverse association, numerous studies have documented an obesity paradox in which overweight and obese population with established cardiovascular disease have a better prognosis. There are potential explanations offered by literature for these puzzling data. For obese hypertensive patients the paradox is possibly linked to the lower systemic vascular resistance and plasma renin activity. In heart failure the excess body weight may confer some protective effects on mortality, due to a more metabolic reserve, higher levels of arterial pressure compatible with higher doses of cardioprotective medications, and a specific neuroendocrine profile with lower levels of circulating natriuretic atrial peptides, attenuated sympathetic nervous system and renin-angiotensin responses. For coronary heart disease and peripheral arterial disease the mechanisms are still uncertain. There are discussed a lesser severity of coronary lesions and left ventricular dysfunction, or a reduced prevalence of moderate-severe chronic obstructive pulmonary disease in patients selected for surgery. On the other hand, the constellation of data which supports purposeful weight reduction in the prevention and treatment of cardiovascular diseases, induces a controversial position regarding this new concept.
Su, Jian; Xiang, Quanyong; Lyu, Shurong; Pan, Xiaoqun; Qin, Yu; Yang, Jie; Zhou, Jinyi; Zhang, Yongqing; Wu, Ming; Tao, Ran
To explore the relationship between central obesity and cardiovascular risk factors and their clustering in adults of Jiangsu province. Multi-stratified clustering sampling method was used to sample 8 400 residents aged 18 years and over from 14 diseases surveillance units in Jiangsu province from October to December 2010. Information was obtained with face-to-face interview, physical examination and laboratory testing. A total of 8 380 residents finished the study protocol and their data were analyzed. Central obesity was defined as waist circumference ≥ 85 cm in males or ≥ 80 cm in females. Following complex weighting of the samples, level and proportion of cardiovascular risk factors in group with different waist circumference were analyzed. The prevalence of central obesity among adults in Jiangsu province was 46.2%, the proportion of males and females was 46.4% and 46.1%, respectively (P > 0.05). The prevalence of center obesity varied significantly in residents with different age, area, education and occupation (all P < 0.01). The level of systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, high density lipoprotein cholesterol and low density lipoprotein cholesterol was also significantly different in residents with different degree of waist circumference (all P < 0.01). The prevalence of hypertension, diabetes, dyslipidemia and clustering of cardiovascular risk factors increased in proportion to increasing waist circumference (all P < 0.05). Multivariate logistic regression analysis showed that the risk of hypertension, diabetes, dyslipidemia and clustering of cardiovascular risk factors was 2.2 (OR = 2.2, 95% CI: 2.0-2.4) and 4.7 (OR = 4.7, 95% CI: 3.9-5.7); 2.1 (OR = 2.1, 95% CI: 1.7-2.5) and 3.8 (OR = 3.8, 95% CI: 3.2-4.5); 2.3 (OR = 2.3, 95% CI: 1.8-2.9) and 4.1 (OR = 4.1, 95% CI: 3.2-5.3); 3.4 (OR = 3.4, 95% CI: 2.9-3.9) and 8.0 (OR = 8.0, 95% CI: 6.2-10.2) fold higher in residents with mild and
Goni, Leticia; Milagro, Fermín I; Cuervo, Marta; Martínez, J Alfredo
Visceral fat is strongly associated with the development of specific obesity-related metabolic alterations. Genetic and epigenetic mechanisms seem to be involved in the development of obesity and visceral adiposity. The aims of this review are to identify the single-nucleotide polymorphisms related to central obesity and to summarize the main findings on DNA methylation and obesity. A search of the MEDLINE database was conducted to identify genome-wide association studies, meta-analyses of genome-wide association studies, and gene-diet interaction studies related to central obesity, and, in addition, studies that analyzed DNA methylation in relation to body weight regulation. A total of 8 genome-wide association studies and 9 meta-analyses of genome-wide association studies reported numerous single-nucleotide polymorphisms to be associated with central obesity. Ten studies analyzed gene-diet interactions and central obesity, while 2 epigenome-wide association studies analyzed DNA methylation patterns and obesity. Nine studies investigated the relationship between DNA methylation and weight loss, excess body weight, or adiposity outcomes. Given the development of new sequencing and omics technologies, significantly more knowledge on genomics and epigenomics of obesity and body fat distribution will emerge in the near future.
Wang, Xuhong; Zhang, Ning; Yu, Caiguo; Ji, Zhili
Objectives: To evaluate whether neck circumference (NC) could be used as a valid and effective method for identifying obesity and insulin resistance (IR) in Chinese adults. Methods: A total of 3307 adults aged 20-65 years were randomly recruited from two communities of Tongzhou, Beijing. Height, weight, waist circumference (WC), hip circumference (HC), neck circumference (NC), blood pressure, fasting plasma glucose (FPG), fasting serum insulin (FINS), total cholesterol (TC), serum triglyceride (TG), High-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and Urinary albumin (UAlb) were measured. Pearson correlation coefficient was used to explore the relationship between NC and other measurements. Furthermore, the best cutoff values of NC for central obesity identification were determined by applying the receiver operating characteristic (ROC) curve analysis. Results: NC correlated positively with BMI, SBP and WC In both sexes. Both WC and NC correlated significantly positively with IR. A positive correlation between NC and FPG as well as a negative correlation between NC and HDL were found in obese men. NC≥38.5 cm for men and ≥34.5 cm for women were determined to be the best cutoff levels for identifying subjects with central obesity, with 82.9% accuracy for men and 79.9% accuracy for women. Conclusions: NC correlated positively with BMI and WC in both genders, indicating that NC could be used as a valid marker for both overall obesity and central obesity. In addition, measuring NC was shown to be a useful test for IR identification. Large number of NC is suggested to be associated with high risk of developing metabolic disorders, such as diabetes and dyslipidemia. PMID:26770540
Zhang, Qiang; Chen, Xinguang; Liu, Zhitao; Varma, Deepthi S; Wan, Rong; Wan, Qingqing; Zhao, Shiwen
Dietary patterns represent a broader picture of food consumption, and are better correlated with a variety of health outcomes. However, few studies have been conducted to explore the associations between dietary patterns and obesity in Southwest China. Data from the 2010-2012 National Nutrition Survey in the province of Yunnan, Southwest China, were analyzed (n = 1604, aged 18-80 years). Dietary data were collected using the 24 h dietary recall over three consecutive days. Height, weight, and waist circumference were measured following standard methods. Exploratory factor analysis was used to identify dietary patterns. Logistic regression was used to explore the association between dietary patterns and obesity. Three distinct dietary patterns were identified, which were labeled as traditional, modern, and tuber according to their key components. With potential confounders adjusted, adults in the highest quartile of the modern pattern were at higher risk of general and central obesity (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.15-3.48; OR 2.01, 95% CI 1.37-2.93). In contrast, adults in the highest quartile of the tuber pattern were at lower risk of general and central obesity (OR 0.34, 95% CI 0.15-0.61; OR 0.64, 95% CI 0.43-0.95) but at higher risk of underweight (OR 2.57, 95% CI 1.20-6.45). No significant association was found between the traditional pattern and obesity. Moreover, dietary pattern differences occurred due to the differences in socio-demographic characteristics. In conclusion, the modern dietary pattern was positively, and the tuber pattern negatively, associated with general and central obesity among adults in Southwest China.
Zhang, Qiang; Chen, Xinguang; Liu, Zhitao; Varma, Deepthi S.; Wan, Rong; Wan, Qingqing; Zhao, Shiwen
Dietary patterns represent a broader picture of food consumption, and are better correlated with a variety of health outcomes. However, few studies have been conducted to explore the associations between dietary patterns and obesity in Southwest China. Data from the 2010–2012 National Nutrition Survey in the province of Yunnan, Southwest China, were analyzed (n = 1604, aged 18–80 years). Dietary data were collected using the 24 h dietary recall over three consecutive days. Height, weight, and waist circumference were measured following standard methods. Exploratory factor analysis was used to identify dietary patterns. Logistic regression was used to explore the association between dietary patterns and obesity. Three distinct dietary patterns were identified, which were labeled as traditional, modern, and tuber according to their key components. With potential confounders adjusted, adults in the highest quartile of the modern pattern were at higher risk of general and central obesity (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.15–3.48; OR 2.01, 95% CI 1.37–2.93). In contrast, adults in the highest quartile of the tuber pattern were at lower risk of general and central obesity (OR 0.34, 95% CI 0.15–0.61; OR 0.64, 95% CI 0.43–0.95) but at higher risk of underweight (OR 2.57, 95% CI 1.20–6.45). No significant association was found between the traditional pattern and obesity. Moreover, dietary pattern differences occurred due to the differences in socio-demographic characteristics. In conclusion, the modern dietary pattern was positively, and the tuber pattern negatively, associated with general and central obesity among adults in Southwest China. PMID:27827895
Lasikiewicz, N; Hendrickx, H; Talbot, D; Dye, L
Extensive research has shown that psychosocial stress can induce cognitive impairment. However, few studies have explored impairment following acute stress exposure in individuals with central obesity. Central obesity co-occurs with glucocorticoid excess and can lead to elevated cortisol responses to stress. It is not clear whether centrally obese individuals exhibit greater cognitive impairment following acute stress. Cortisol responses to stress versus no-stress control were compared in 66 high- and low waist to hip ratio (WHR) middle-aged adults (mean age of 46 ± 7.17 years). Cognitive performance post exposure was assessed using Cambridge Automated Neuropsychological Test Battery. It was hypothesised that high WHR would exhibit greater cortisol in response to stress exposure and would show poorer cognitive performance. Males, particularly of high WHR, tended to secrete greater cortisol during stress exposure. Exposure to stress and increasing WHR were specifically associated with poorer performance on declarative memory tasks (spatial recognition memory and paired associates learning). These data tentatively suggest a reduction in cognitive performance in those with central obesity following exposure to acute stress. Further research is needed to elucidate the effects of stress on cognition in this population.
Herrera, Blanca M; Lindgren, Cecilia M
Obesity is a result of excess body fat accumulation. This excess is associated with adverse health effects such as CVD, type 2 diabetes, and cancer. The development of obesity has an evident environmental contribution, but as shown by heritability estimates of 40% to 70%, a genetic susceptibility component is also needed. Progress in understanding the etiology has been slow, with findings largely restricted to monogenic, severe forms of obesity. However, technological and analytical advances have enabled detection of more than 20 obesity susceptibility loci. These contain genes suggested to be involved in the regulation of food intake through action in the central nervous system as well as in adipocyte function. These results provide plausible biological pathways that may, in the future, be targeted as part of treatment or prevention strategies. Although the proportion of heritability explained by these genes is small, their detection heralds a new phase in understanding the etiology of common obesity.
Herrera, Blanca M.
Obesity is a result of excess body fat accumulation. This excess is associated with adverse health effects such as CVD, type 2 diabetes, and cancer. The development of obesity has an evident environmental contribution, but as shown by heritability estimates of 40% to 70%, a genetic susceptibility component is also needed. Progress in understanding the etiology has been slow, with findings largely restricted to monogenic, severe forms of obesity. However, technological and analytical advances have enabled detection of more than 20 obesity susceptibility loci. These contain genes suggested to be involved in the regulation of food intake through action in the central nervous system as well as in adipocyte function. These results provide plausible biological pathways that may, in the future, be targeted as part of treatment or prevention strategies. Although the proportion of heritability explained by these genes is small, their detection heralds a new phase in understanding the etiology of common obesity. PMID:20931363
Obesity is a heterogeneous pathologic condition that is driven by interactions between multiple genetic and environmental factors. The discovery of leptin has provided the useful clue to the molecular dissection of central pathways involved in the regulation of food intake and body weight. Monogenic obesity in human has been documented. Several obesity causing genes within the leptin-POMC-melanocortin axis have been identified: Leptin, leptin receptor, proopiomelanocortin (POMC), prohormone convertase 1 (PC1), and melanocortin receptor-4 (MC4-R) genes. The patients who have a mutation of such genes developed early onset of obesity and distinct metabolic abnormalities. Also, several gene mutations have been identified in some syndromes presenting hereditary symptomatic obesity.
Shaw, Eileen; Farris, Megan; McNeil, Jessica; Friedenreich, Christine
Endometrial cancer is the sixth most common cancer in women worldwide and the most common gynecologic malignancy in the developed world. This chapter explores the current epidemiologic evidence on the association between obesity and endometrial cancer risk and mortality. Using body mass index (BMI) as a measure of obesity, we found that obesity (defined as BMI > 30 and < 35 kg/m(2)) was associated with a 2.6-fold increase in endometrial cancer risk, while severe obesity (BMI > 35 kg/m(2)) was associated with a 4.7-fold increase compared to normal-weight women (BMI < 25 kg/m(2)). Increased central adiposity also increased endometrial cancer risk by 1.5- to twofold. Among both healthy and endometrial cancer patient populations, obesity was associated with a roughly twofold increase in endometrial cancer-specific mortality. This risk reduction was also observed for obesity and all-cause mortality among endometrial cancer patients. In the few studies that assessed risk associated with weight change, an increased endometrial cancer risk with weight gain and weight cycling was observed, whereas some evidence for a protective effect of weight loss was found. Furthermore, early-life obesity was associated with a moderately increased risk of endometrial cancer later in life. There are several mechanisms whereby obesity is hypothesized to increase endometrial cancer risk, including increased endogenous sex steroid hormones, insulin resistance, chronic inflammation and adipokines. Further research should focus on histological subtypes or molecular phenotypes of endometrial tumors and population subgroups that could be at an increased risk of obesity-associated endometrial cancer. Additionally, studies on weight gain, loss or cycling and weight loss interventions can provide mechanistic insight into the obesity-endometrial cancer association. Sufficient evidence exists to recommend avoiding obesity to reduce endometrial cancer risk.
Samuels, Sarah E.; Capitman, John; Ruwe, Mathilda; Boyle, Maria; Flores, George
The goals of the Central California Regional Obesity Prevention Program (CCROPP) are to promote safe places for physical activity, increase access to fresh fruits and vegetables, and support community and youth engagement in local and regional efforts to change nutrition and physical activity environments for obesity prevention. CCROPP has created a community-driven policy and environmental change model for obesity prevention with local and regional elements in low-income, disadvantaged ethnic and rural communities in a climate of poor resources and inadequate infrastructure. Evaluation data collected from 2005–2009 demonstrate that CCROPP has made progress in changing nutrition and physical activity environments by mobilizing community members, engaging and influencing policymakers, and forming organizational partnerships. PMID:20864732
D'Adamo, Ebe; Cali, Anna M.G.; Weiss, Ram; Santoro, Nicola; Pierpont, Bridget; Northrup, Veronika; Caprio, Sonia
OBJECTIVE We evaluated the role of fatty liver in the alteration of insulin sensitivity and β-cell function in two groups of obese adolescents, differing in hepatic fat content (hepatic fat fraction [HFF]) but with similar intrabdominal intramyocellular lipid content (IMCL) and overall degree of obesity. RESEARCH DESIGN AND METHODS We studied 23 obese adolescents with high HFF (HFF >5.5%) and 20 obese adolescents with low HFF (HFF <5.5%), matched for age, Tanner stage, BMI z score, and percentages of body fat, visceral fat, and IMCL. All subjects underwent an oral glucose tolerance test and a two-step hyperinsulinemic-euglycemic clamp, magnetic resonance imaging and 1H nuclear magnetic resonance to assess abdominal fat distribution, HFF, and IMCL, respectively. RESULTS The high HFF group showed significantly lower whole-body insulin sensitivity index (P = 0.001) and estimates of insulin secretion (P = 0.03). The baseline hepatic glucose production (EGP) rate was not different between the two groups. Suppression of EGP was significantly lower (P = 0.04) in the high HFF group during low-dose insulin; no differences were observed during the second step. Baseline fatty acids, glycerol concentrations, and clamp suppression of glycerol turnover did not differ between the groups. During the second step, the glucose disposal rate was significantly lower (P = 0.01) in the high HFF group. CONCLUSIONS Fatty liver, independent of visceral fat and IMCL, plays a central role in the insulin-resistant state in obese adolescents. PMID:20668154
Jiang, Yong; Zhang, Mei; Li, Yi-chong; Li, Xiao-yan; Wang, Li-min; Zhao, Wen-hua
To study the relationship between prevalence of central obesity and clustering of cardiometabolic diseases among Chinese elder people over 60 years old. A complex multistage stratified sampling survey on chronic diseases was conducted in 162 surveillance points, 31 provinces, China in 2010 by China CDC. The survey included face-to-face interview, physical measurement (body height, weight, waist circumference (WC) and blood pressure) and laboratory test (blood sugar, blood lipid and hemoglobin A1C), to collect the information about the prevalence of the risk factors as smoking, drinking, diet and physical activities and the prevalence of hypertension, diabetes and dyslipidemia. The survey selected 19 966 subjects who were over 60 years old. Central obesity was defined as WC ≥ 85 cm in males or ≥ 80 cm in females. The prevalence of central obesity among the elder people over 60 years old in different districts and populations was calculated; and the proportion of cardiometabolic diseases in groups of different WC was then analyzed. The prevalence of central obesity among elderly population over 60 years old was 48.6% (95%CI:46.1%-51.2%), including 39.7% (95%CI:37.2%-42.2%) males and 57.3% (95%CI:54.5%-60.1%) females. The proportion of females was higher than that of males (χ(2) = 474.63, P < 0.01). The higher the education level, the higher the prevalence of central obesity among elderly men. There was no significant association among females. The higher the family income, the higher the prevalence of central obesity. The prevalence of central obesity was 59.2% in urban area, which was much higher than that in rural area (43.5%) (χ(2) = 50.06, P < 0.01). The proportion of hypertension, diabetes and clustering of cardiometabolic disease was separately 18.8% (95%CI:16.1%-21.5%) , 66.2% (95%CI:63.0%-69.4%) and 47.5% (95%CI:44.1%-50.8%) among elderly men with WC between 85 and 89 cm, and separately 24.0% (95%CI:21.2%-26.8%), 78.2% (95%CI:75.6%-80.8%) and 64.0% (95
Al Hazzouri, Adina Zeki; Haan, Mary N.; Whitmer, Rachel A.; Yaffe, Kristine; Neuhaus, John
Background/Aims Central obesity is a risk factor for cognitive decline. Leptin is secreted by adipose tissue and has been associated with better cognitive function. Aging Mexican-Americans have higher levels of obesity than Non-Hispanic Whites, but no investigations examined the relationship between leptin and cognitive decline among them or the role of central obesity in this association. Methods We analyzed 1480 dementia-free older Mexican-Americans who were followed over ten years. Cognitive function was assessed every 12 to 15 months with the Modified Mini Mental State Exam (3MSE) and the Spanish and English Verbal Learning Test (SEVLT). Results For females with small waist circumference (≤35inches), an interquartile range (IQR) difference in leptin was associated with 35% less 3MSE errors and 22% less decline in SEVLT score over 10 years. For males with small waist circumference (≤40inches), an IQR difference in leptin was associated with 44% less 3MSE errors and 30% less decline in SEVLT score over 10 years. There was no association between leptin and cognitive decline among females or males with large waist circumference. Conclusion Leptin interacts with central obesity in shaping cognitive decline. Our findings provide valuable information about the effects of metabolic risk factors on cognitive function. PMID:22814127
Luchsinger, José A; Cheng, Derek; Tang, Ming Xin; Schupf, Nicole; Mayeux, Richard
The evidence relating obesity measured with body mass index (BMI) in the elderly to late-onset Alzheimer disease (LOAD) is conflicting. Central obesity in middle age is related to a higher risk of LOAD, but data in the elderly are lacking. We explored whether measures of central obesity, waist circumference, and waist to hip ratio (WHR) were better predictors of LOAD compared with BMI in the elderly. Participants were 1459 persons aged 65 years and older without dementia at baseline, with follow-up, and with anthropometric data from a longitudinal study of aging in New York City. Proportional hazards regression was used for multivariable analyses relating BMI, waist circumference, and WHR to LOAD. There were 145 cases of Alzheimer disease in 5734 person-years of follow-up. Only WHR was related to higher LOAD risk (hazard ratio of the fourth quartile compared with the first=2.5; 95% confidence interval=1.3, 4.7) after adjustment for age, sex, education, ethnic group, Apolipoprotein E-ε4, type 2 diabetes, hypertension, non-high-density lipoprotein-cholesterol, high-density lipoprotein cholesterol, and stroke. Our results support the notion that central obesity is related to a higher risk of LOAD.
Mokha, Jasmeet S; Srinivasan, Sathanur R; Dasmahapatra, Pronabesh; Fernandez, Camilo; Chen, Wei; Xu, Jihua; Berenson, Gerald S
Body Mass Index (BMI) is widely used to assess the impact of obesity on cardiometabolic risk in children but it does not always relate to central obesity and varies with growth and maturation. Waist-to-Height Ratio (WHtR) is a relatively constant anthropometric index of abdominal obesity across different age, sex or racial groups. However, information is scant on the utility of WHtR in assessing the status of abdominal obesity and related cardiometabolic risk profile among normal weight and overweight/obese children, categorized according to the accepted BMI threshold values. Cross-sectional cardiometabolic risk factor variables on 3091 black and white children (56% white, 50% male), 4-18 years of age were used. Based on the age-, race- and sex-specific percentiles of BMI, the children were classified as normal weight (5th - 85th percentiles) and overweight/obese (≥ 85th percentile). The risk profiles of each group based on the WHtR (<0.5, no central obesity versus ≥ 0.5, central obesity) were compared. 9.2% of the children in the normal weight group were centrally obese (WHtR ≥0.5) and 19.8% among the overweight/obese were not (WHtR < 0.5). On multivariate analysis the normal weight centrally obese children were 1.66, 2.01, 1.47 and 2.05 times more likely to have significant adverse levels of LDL cholesterol, HDL cholesterol, triglycerides and insulin, respectively. In addition to having a higher prevalence of parental history of type 2 diabetes mellitus, the normal weight central obesity group showed a significantly higher prevalence of metabolic syndrome (p < 0.0001). In the overweight/obese group, those without central obesity were 0.53 and 0.27 times less likely to have significant adverse levels of HDL cholesterol and HOMA-IR, respectively (p < 0.05), as compared to those with central obesity. These overweight/obese children without central obesity also showed significantly lower prevalence of parental history of hypertension (p = 0.002), type 2
Zhang, Peng; Wang, Rui; Gao, Chunshi; Jiang, Lingling; Lv, Xin; Song, Yuanyuan; Li, Bo
Objectives The present study aimed to investigate the prevalence of central obesity among adults with normal BMI and its association with metabolic diseases in Jilin Province, China. Methods A population-based cross-sectional study was conducted in 2012 in Jilin Province of China. Information was collected by face to face interview. Descriptive data analysis and 95% confidence intervals (CI) of prevalence/frequency were conducted. Log-binomial regression analyses were used to find the independent factors associated with central obesity and to explore the adjusted association between central obesity and metabolic diseases among adults with normal BMI. Results Among the adult residents with normal BMI in Jilin Province, 55.6% of participants with central obesity self-assessed as normal weight and 27.0% thought their body weight were above normal. 12.7% of central obesity people took methods to lose weight, while 85.3% didn’t. Female, older people and non-manual worker had higher risk to be central obesity among adults with normal BMI. Hypertension, diabetes and hyperlipidemia were significantly associated with central obesity among adults with normal BMI, the PRs were 1.337 (1.224–1.461), 1.323 (1.193–1.456) and 1.261 (1.152–1.381) separately when adjusted for gender, age and BMI. Conclusions Hypertension, diabetes and hyperlipidemia were significantly associated with central obesity among adults with normal BMI in Jilin Province, China. The low rates of awareness and control of central obesity among adults with normal BMI should be improved by government and health department. PMID:27467819
Holmberg, Sara; Thelin, Anders
To study associations between dairy fat intake and development of central obesity. A prospective population-based cohort study with two surveys 12 years apart. Nine municipalities selected from different parts of Sweden representing the rural areas in the country. 1782 men (farmers and non-farmers) aged 40-60 years at baseline participated in a baseline survey (participation rate 76%) and 1589 men participated at the follow-up. 116 men with central obesity at baseline were excluded from the analyses. Central obesity at follow-up defined as waist hip ratio ≥ 1. 197 men (15%) developed central obesity during follow-up. A low intake of dairy fat at baseline (no butter and low fat milk and seldom/never whipping cream) was associated with a higher risk of developing central obesity (OR 1.53, 95% CI 1.05-2.24) and a high intake of dairy fat (butter as spread and high fat milk and whipping cream) was associated with a lower risk of central obesity (OR 0.52, 95% CI 0.33-0.83) as compared with medium intake (all other combinations of spread, milk, and cream) after adjustment for intake of fruit and vegetables, smoking, alcohol consumption, physical activity, age, education, and profession. The associations between dairy fat intake and central obesity were consistent across body mass index categories at baseline. A high intake of dairy fat was associated with a lower risk of central obesity and a low dairy fat intake was associated with a higher risk of central obesity.
Zhang, Peng; Wang, Rui; Gao, Chunshi; Jiang, Lingling; Lv, Xin; Song, Yuanyuan; Li, Bo
The present study aimed to investigate the prevalence of central obesity among adults with normal BMI and its association with metabolic diseases in Jilin Province, China. A population-based cross-sectional study was conducted in 2012 in Jilin Province of China. Information was collected by face to face interview. Descriptive data analysis and 95% confidence intervals (CI) of prevalence/frequency were conducted. Log-binomial regression analyses were used to find the independent factors associated with central obesity and to explore the adjusted association between central obesity and metabolic diseases among adults with normal BMI. Among the adult residents with normal BMI in Jilin Province, 55.6% of participants with central obesity self-assessed as normal weight and 27.0% thought their body weight were above normal. 12.7% of central obesity people took methods to lose weight, while 85.3% didn't. Female, older people and non-manual worker had higher risk to be central obesity among adults with normal BMI. Hypertension, diabetes and hyperlipidemia were significantly associated with central obesity among adults with normal BMI, the PRs were 1.337 (1.224-1.461), 1.323 (1.193-1.456) and 1.261 (1.152-1.381) separately when adjusted for gender, age and BMI. Hypertension, diabetes and hyperlipidemia were significantly associated with central obesity among adults with normal BMI in Jilin Province, China. The low rates of awareness and control of central obesity among adults with normal BMI should be improved by government and health department.
Heidari, Zahra; Hosseinpanah, Farhad; Barzin, Maryam; Safarkhani, Maryam; Azizi, Fereidoun
This study aimed to investigate the mother-daughter correlation for central obesity and other noncommunicable disease risk factors. The authors used metabolic and anthropometric data from the Tehran Lipid and Glucose Study, enrolling 1041 mother-daughter pairs for the current study. Three age strata were defined: 3 to 9 years for childhood (146 mother-daughter pairs), 10 to 17 years for adolescence (395 mother-daughter pairs), and 18 to 25 years for early adulthood (500 mother-daughter pairs). Familial associations for central obesity and other noncommunicable disease risk factors were assessed. The prevalence of central obesity was 44.7% in mothers and 11.2% in daughters (6.2% in the 3-9, 19.2% in the 10-17, and 6.4% in the 18-25 years groups). Mothers with central obesity were more likely than nonobese mothers to have daughters with central obesity (10.5% and 1.7%, respectively; P = .0001). Central obesity indices among daughters were positively correlated with those of their mothers in all 3 age strata. Correlations for other noncommunicable disease risk factors were analyzed before and after adjusting the risk factor levels for mothers' and daughters' waist circumferences (WCs) within each group to determine whether risk factor correlations were, in part, a result of the central obesity correlations. After the non-communicable disease risk factor levels of participants were adjusted for their WCs, the mother-daughter correlations remained significant. The consistent association of central obesity between mothers and daughters may indicate the key role that could be played by the mother in the primary prevention of central obesity, particularly in high-risk families.
Abstract Objective To study associations between dairy fat intake and development of central obesity. Design A prospective population-based cohort study with two surveys 12 years apart. Setting Nine municipalities selected from different parts of Sweden representing the rural areas in the country. Subjects 1782 men (farmers and non-farmers) aged 40–60 years at baseline participated in a baseline survey (participation rate 76%) and 1589 men participated at the follow-up. 116 men with central obesity at baseline were excluded from the analyses. Main outcome measures Central obesity at follow-up defined as waist hip ratio ≥ 1. Results 197 men (15%) developed central obesity during follow-up. A low intake of dairy fat at baseline (no butter and low fat milk and seldom/never whipping cream) was associated with a higher risk of developing central obesity (OR 1.53, 95% CI 1.05–2.24) and a high intake of dairy fat (butter as spread and high fat milk and whipping cream) was associated with a lower risk of central obesity (OR 0.52, 95% CI 0.33–0.83) as compared with medium intake (all other combinations of spread, milk, and cream) after adjustment for intake of fruit and vegetables, smoking, alcohol consumption, physical activity, age, education, and profession. The associations between dairy fat intake and central obesity were consistent across body mass index categories at baseline. Conclusion A high intake of dairy fat was associated with a lower risk of central obesity and a low dairy fat intake was associated with a higher risk of central obesity. PMID:23320900
Pérez Rodrigo, Carmen
Obesity is a major risk factor for non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases, and cancers. The worldwide prevalence of obesity has almost doubled between 1980 and 2008. In some regions, such as Europe, the Eastern Mediterranean and the Americas, more than 50% of women are overweight. Tonga, Nauru and the Cook Islands show the highest prevalence of obesity worldwide, above 60% in men and in women. China and the United States are the countries that experienced the largest absolute increase in the number of overweight and obese people between 1980 and 2008, followed by Brazil and Mexico. The regions with the largest increase in the prevalence of female obesity were Central Latin America, Oceania and Southern Latin America. Updated data provide evidence that the progression of the epidemic has effectively slowed for the past ten years in several countries. In low-income countries obesity is generally more prevalent among the better-off, while disadvantaged groups are increasingly affected as countries grow. Many studies have shown an overall socio-economic gradient in obesity in modern industrialized societies. Rates tend to decrease progressively with increasing socio-economic status. Children obesity rates in Spain are amongst the highest in the OECD. One in 3 children aged 13 to 14 are overweight. Overweight in infants and young children is observed in the upper middle-income countries. However, the fastest growth occurs in the group of lower middle-income countries. There is a growing body of evidence for an inverse association between SES and child obesity in developed countries. The prevalence of overweight and obesity is high in all age groups in many countries, but especially worrying in children and adolescents in developed countries and economies in transition. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.
Germain, Cassandra M.; Batsis, John A.; Vasquez, Elizabeth; McQuoid, Douglas R.
Background. Obesity and muscle weakness are independently associated with increased risk of physical and functional impairment in older adults. It is unknown whether physical activity (PA) and muscle strength combined provide added protection against functional impairment. This study examines the association between muscle strength, PA, and functional outcomes in older adults with central obesity. Methods. Prevalence and odds of physical (PL), ADL, and IADL limitation were calculated for 6,388 community dwelling adults aged ≥ 60 with central obesity. Individuals were stratified by sex-specific hand grip tertiles and PA. Logistic models were adjusted for age, education, comorbidities, and body-mass index and weighted. Results. Overall prevalence of PL and ADL and IADL limitations were progressively lower by grip category. Within grip categories, prevalence was lower for individuals who were active than those who were inactive. Adjusted models showed significantly lower odds of PL OR 0.42 [0.31, 0.56]; ADL OR 0.60 [0.43, 0.84], and IADL OR 0.46 [0.35, 0.61] for those in the highest grip strength category as compared to those in the lowest grip category. Conclusion. Improving grip strength in obese elders who are not able to engage in traditional exercise is important for reducing odds of physical and functional impairment. PMID:27034833
Łuczyński, Włodzimierz; Grubczak, Kamil; Moniuszko, Marcin; Głowińska-Olszewska, Barbara; Bossowski, Artur
It is believed that the recently discovered interleukin 17-producing Th17 cells play a role in the pathogenesis of chronic inflammation in the course of obesity and diabetes. The purpose of our study was to complete data on this subject in children. We assessed Th17 cell levels in the peripheral blood of children diagnosed with central obesity (n = 14) and compared the results with data obtained in patients with newly diagnosed (n = 11) and long-term type 1 diabetes mellitus (n = 18), and in a control group as well (n = 24). (i) Children with central obesity were characterized by higher percentages of Th17 cells as compared to children from the control group; (ii) in the peripheral blood of patients with long-term type 1 diabetes the Th17 cell counts were higher compared to the control group; (iii) total plasma cholesterol concentration correlated positively with Th17/Treg cells ratio; and (iv) among patients with long-term diabetes, disease duration correlated positively with Th17 cell count and Th17/Th1 cell ratio. The results of our study indicate that Th17 cells may be involved in chronic inflammation accompanying obesity and type 1 diabetes mellitus in children.
Vucetic, Zivjena; Reyes, Teresa M
Prevalence of obesity in the general population has increased in the past 15 years from 15% to 35%. With increasing obesity, the coincident medical and social consequences are becoming more alarming. Control over food intake is crucial for the maintenance of body weight and represents an important target for the treatment of obesity. Central nervous system mechanisms responsible for control of food intake have evolved to sense the nutrient and energy levels in the organism and to coordinate appropriate responses to adjust energy intake and expenditure. This homeostatic system is crucial for maintenance of stable body weight over long periods of time of uneven energy availability. However, not only the caloric and nutritional value of food but also hedonic and emotional aspects of feeding affect food intake. In modern society, the increased availability of highly palatable and rewarding (fat, sweet) food can significantly affect homeostatic balance, resulting in dysregulated food intake. This review will focus on the role of hypothalamic and mesolimbic/mesocortical dopaminergic (DA) circuitry in coding homeostatic and hedonic signals for the regulation of food intake and maintenance of caloric balance. The interaction of dopamine with peripheral and central indices of nutritional status (e.g., leptin, ghrelin, neuropeptide Y), and the susceptibility of the dopamine system to prenatal insults will be discussed. Additionally, the importance of alterations in dopamine signaling that occur coincidently with obesity will be addressed.
Sharma, Saurabh; Batsis, John A; Coutinho, Thais; Somers, Virend K; Hodge, David O; Carter, Rickey E; Sochor, Ondrej; Kragelund, Charlotte; Kanaya, Alka M; Zeller, Marianne; Park, Jong-Seon; Køber, Lars; Torp-Pedersen, Christian; Lopez-Jimenez, Francisco
To study the relationship between body mass index (BMI) and central obesity and mortality in elderly patients with coronary artery disease (CAD). We identified 7057 patients 65 years or older from 5 cohort studies assessing mortality risk using either waist circumference (WC) or waist-hip ratio (WHR) in patients with CAD from January 1, 1980, to December 31, 2008. Normal weight, overweight, and obesity were defined using standard BMI cutoffs. High WHR was defined as 0.85 or more for women and 0.90 or more for men. High WC was defined as 88 cm or more for women and 102 cm or more for men. Separate models examined WC or WHR in combination with BMI (6 categories each) as the primary predictor (referent = normal BMI and normal WC or WHR). Cox proportional hazards models investigated the relationship between these obesity categories and mortality. Patients' mean age was 73.0±6.0 years (3741 [53%] women). The median censor time was 7.1 years. A normal BMI with central obesity (high WHR or high WC) demonstrated highest mortality risk (hazard ratio [HR], 1.29; 95% CI, 1.14-1.46; HR, 1.29; 95% CI, 1.12-1.50, respectively). High WHR was also predictive of mortality in the overall (HR, 2.14; 95% CI, 1.93-2.38) as well as in the sex-specific cohort. In the overall cohort, high WC was not predictive of mortality (HR, 1.04; 95% CI, 0.97-1.12); however, it predicted higher risk in men (HR, 1.12; 95% CI, 1.01-1.24). In older adults with CAD, normal-weight central obesity defined using either WHR or WC is associated with high mortality risk, highlighting a need to combine measures in adiposity-related risk assessment. Copyright © 2016. Published by Elsevier Inc.
Samuelsson, Anne-Maj S.; Mullier, Amandine; Maicas, Nuria; Oosterhuis, Nynke R.; Eun Bae, Sung; Novoselova, Tatiana V.; Chan, Li F.; Pombo, Joaquim M.; Taylor, Paul D.; Joles, Jaap A.; Coen, Clive W.; Balthasar, Nina; Poston, Lucilla
Melanocortin-4 receptor (Mc4r)–expressing neurons in the autonomic nervous system, particularly in the paraventricular nucleus of the hypothalamus (PVH), play an essential role in blood pressure (BP) control. Mc4r-deficient (Mc4rKO) mice are severely obese but lack obesity-related hypertension; they also show a reduced pressor response to salt loading. We have previously reported that lean juvenile offspring born to diet-induced obese rats (OffOb) exhibit sympathetic-mediated hypertension, and we proposed a role for postnatally raised leptin in its etiology. Here, we test the hypothesis that neonatal hyperleptinemia due to maternal obesity induces persistent changes in the central melanocortin system, thereby contributing to offspring hypertension. Working on the OffOb paradigm in both sexes and using transgenic technology to restore Mc4r in the PVH of Mc4rKO (Mc4rPVH) mice, we have now shown that these mice develop higher BP than Mc4rKO or WT mice. We have also found that experimental hyperleptinemia induced in the neonatal period in Mc4rPVH and WT mice, but not in the Mc4rKO mice, leads to heightened BP and severe renal dysfunction. Thus, Mc4r in the PVH appears to be required for early-life programming of hypertension arising from either maternal obesity or neonatal hyperleptinemia. Early-life exposure of the PVH to maternal obesity through postnatal elevation of leptin may have long-term consequences for cardiovascular health. PMID:27791019
Griera Borrás, José Luis; Contreras Gilbert, José
It is currently postulated that not all obese individuals have to be considered as pathological subjects. From 10% to 20% of obese people studied do not show the metabolic changes common in obese patients. The term "healthy obese" has been coined to refer to these patients and differentiate them from the larger and more common group of pathological obese subjects. However, the definition of "healthy obese" is not clear. Use of "healthy obese" as a synonym for obese without metabolic complications is risky. Clinical markers such as insulin resistance are used to identify this pathology. It is not clear that healthy obese subjects have lower morbidity and mortality than pathologically obese patients. According to some authors, healthy obese would represent an early stage in evolution towards pathological obesity. There is no agreement as to the need to treat healthy obese subjects.
King, Lauren K; March, Lyn; Anandacoomarasamy, Ananthila
The most significant impact of obesity on the musculoskeletal system is associated with osteoarthritis (OA), a disabling degenerative joint disorder characterized by pain, decreased mobility and negative impact on quality of life. OA pathogenesis relates to both excessive joint loading and altered biomechanical patterns together with hormonal and cytokine dysregulation. Obesity is associated with the incidence and progression of OA of both weight-bearing and non weight-bearing joints, to rate of joint replacements as well as operative complications. Weight loss in OA can impart clinically significant improvements in pain and delay progression of joint structural damage. Further work is required to determine the relative contributions of mechanical and metabolic factors in the pathogenesis of OA.
Thillai, Manoj; Nain, Prabhdeep Singh; Ahuja, Ashish; Vayoth, Sudheer Othiyil; Khurana, Preetika
Introduction Increasing incidence of obesity in Indian population has led to an exponential rise in the number of bariatric operations performed annually. Laparoscopic Sleeve Gastrectomy (LSG) has been proposed to cause rapid remission of Type 2 Diabetes Melitus (T2DM) and metabolic syndrome in a weight loss independent manner. Aim To evaluate the effects of LSG on metabolic syndrome and central obesity in morbidly and severely obese Indian adults. Material and Methods: Study was conducted on 91 morbidly obese [Body Mass Index (BMI)>40 kg/m2] and severely obese (BMI>35 kg/m2) individuals who were suffering from diabetes, hypertension or dyslipidemia. The patients were followed up for six months and the trends of glycaemic control, mean blood pressure, lipid profile, weight loss parameters and changes in parameters of central obesity were studied. Results Weight loss was significant at three months postsurgery and was sustained through six months. There was significant improvement in glycaemic control leading to reduction in need for oral hypoglycaemic agents or insulin in majority of them and even discontinuation of these medications in few patients. Hypertension and dyslipidemia also showed an improving trend through six months postsurgery. There was a significant impact on reduction of central obesity in these patients as marked by significant reduction in waist to hip ratio. Conclusion LSG produces sustainable weight loss with significant improvement in glycaemic status and control of metabolic syndrome in severe to morbidly obese patients. LSG is also efficacious in reducing central obesity in Indian population which is a major depressive ailment amongst obese individuals. PMID:28273998
Sethi, Pulkit; Thillai, Manoj; Nain, Prabhdeep Singh; Ahuja, Ashish; Vayoth, Sudheer Othiyil; Khurana, Preetika
Increasing incidence of obesity in Indian population has led to an exponential rise in the number of bariatric operations performed annually. Laparoscopic Sleeve Gastrectomy (LSG) has been proposed to cause rapid remission of Type 2 Diabetes Melitus (T2DM) and metabolic syndrome in a weight loss independent manner. To evaluate the effects of LSG on metabolic syndrome and central obesity in morbidly and severely obese Indian adults. Material and Methods: Study was conducted on 91 morbidly obese [Body Mass Index (BMI)>40 kg/m(2)] and severely obese (BMI>35 kg/m(2)) individuals who were suffering from diabetes, hypertension or dyslipidemia. The patients were followed up for six months and the trends of glycaemic control, mean blood pressure, lipid profile, weight loss parameters and changes in parameters of central obesity were studied. Weight loss was significant at three months postsurgery and was sustained through six months. There was significant improvement in glycaemic control leading to reduction in need for oral hypoglycaemic agents or insulin in majority of them and even discontinuation of these medications in few patients. Hypertension and dyslipidemia also showed an improving trend through six months postsurgery. There was a significant impact on reduction of central obesity in these patients as marked by significant reduction in waist to hip ratio. LSG produces sustainable weight loss with significant improvement in glycaemic status and control of metabolic syndrome in severe to morbidly obese patients. LSG is also efficacious in reducing central obesity in Indian population which is a major depressive ailment amongst obese individuals.
Zhou, Xue-Lian; Fu, Jun-Fen; Jin, Ju-Hua; Dong, Guan-Ping; Jiang, You-Jun; Huang, Ke; Chen, Xue-Feng; Wu, Wei
To explore the effects of obesity on the peak level of luteinizing hormone (LH) in the gonadotropin-releasing hormone (GnRH) agonist test and obesity-related hormones in girls with central precocious puberty (CPP). Three hundred and thirty-three girls with CPP who underwent the GnRH agonist test between 2012 and 2014 were classified into three groups: normal weight (n=123), overweight (n=108), and obesity (n=102), according to body mass index (BMI). The sexual development indices were compared between the three groups. Twenty girls were randomly selected from each group for evaluation of the serum levels of leptin, sex hormone binding globulin (SHBG), neurokinin B, and kisspeptin. The correlation of BMI with the levels of various hormones was assessed using Pearson correlation analysis. There was no significant difference in mean age at diagnosis between the three groups; however, the bone age was significantly higher in the overweight and obesity groups than in the normal weight group (P<0.05). The peak level of LH in the GnRH agonist test and SHBG level in the normal weight group were significantly higher than those in the overweight and the obesity groups, while the serum levels of leptin and neurokinin B were significantly lower in the normal weight group than in the overweight and the obesity groups (P<0.05). BMI was negatively correlated with the peak level of LH in the GnRH agonist test and SHBG level (P<0.05), and positively correlated with the levels of leptin and neurokinin B (P<0.05). The effects of BMI on the result of the GnRH agonist test and levels of obesity-related hormones should be taken into account in girls with precocious puberty.
Yu, Canqing; Shi, Zumin; Lv, Jun; Du, Huaidong; Qi, Lu; Guo, Yu; Bian, Zheng; Chang, Liang; Tang, Xuefeng; Jiang, Qilian; Mu, Huaiyi; Pan, Dongxia; Chen, Junshi; Chen, Zhengming; Li, Liming
Limited evidence exists for the association between diet pattern and obesity phenotypes among Chinese adults. In the present study, we analyzed the cross-sectional data from 474,192 adults aged 30–79 years from the China Kadoorie Biobank baseline survey. Food consumption was collected by an interviewer-administered questionnaire. Three dietary patterns were extracted by factor analysis combined with cluster analysis. After being adjusted for potential confounders, individuals following a traditional southern dietary pattern had the lowest body mass index (BMI) and waist circumference (WC); the Western/new affluence dietary pattern had the highest BMI; and the traditional northern dietary pattern had the highest WC. Compared to the traditional southern dietary pattern in multivariable adjusted logistic models, individuals following a Western/new affluence dietary pattern had a significantly increased risk of general obesity (prevalence ratio (PR): 1.06, 95% confidence interval (CI): 1.03–1.08) and central obesity (PR: 1.07, 95% CI: 1.06–1.08). The corresponding risks for the traditional northern dietary pattern were 1.05 (1.02–1.09) and 1.17 (1.25–1.18), respectively. In addition, the associations were modified by lifestyle behaviors, and the combined effects with alcohol drinking, tobacco smoking, and physical activity were analyzed. Further prospective studies are needed to elucidate the diet-obesity relationships. PMID:26184308
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Nystad, Tove; Melhus, Marita; Brustad, Magritt; Lund, Eiliv
To estimate the prevalence of general (body mass index) and central (waist circumference and waist/hip ratio) obesity in an area with a mixed Sami and Norwegian population. A cross-sectional population-based study carried out in 2003- 2004, the SAMINOR study. The attendance rate was 60.6%. A total of 7,301 men and 7,841 women, aged 36-79, were included in the analyses. Height, weight, waist and hip circumference were measured, body mass index (BMI) calculated and information concerning lifestyle was collected by questionnaire. The prevalence of general obesity (BMI > or = 30 kg/m(2)) in participants who had Sami as their home language for three generations (Sami I) and Norwegian participants was 38.7% and 24.3% for women respectively; and for men 26.9% and 23.4% respectively. More than 40% of the women had central obesity (waist circumference > or = 88 cm), and the highest prevalence was found in Sami I women (45%). The highest prevalence of central obesity (waist circumference > or = 102 cm) was found in Norwegian men (24.2%). The ethnic differences persisted after adjustment for age, education, physical activity in leisure time, and smoking habits. The prevalence of obesity was high in this population and central obesity was most pronounced in women, particularly in Sami women. Sami men were less obese than Norwegian men. Further studies are necessary to examine a possible explanation for these findings, especially to elaborate on the impact of diet.
Jiao, Jingjing; Watt, Gordon P; Lee, MinJae; Rahbar, Mohammad H; Vatcheva, Kristina P; Pan, Jen-Jung; McCormick, Joseph B; Fisher-Hoch, Susan P; Fallon, Michael B; Beretta, Laura
Liver cirrhosis is a leading cause of death in Hispanics and Hispanics who live in South Texas have the highest incidence of liver cancer in the United States. We aimed at determining the prevalence and associated risk factors of cirrhosis in this population. Clinical and demographic variables were extracted for 2466 participants in the community-based Cameron County Hispanic Cohort in South Texas. Aspartate transaminase to Platelet Ratio Index (APRI) was used to predict cirrhosis in Cameron County Hispanic Cohort. The prevalence of cirrhosis using APRI≥2 was 0.94%, which is nearly 4-fold higher than the national prevalence. Using APRI≥1, the overall prevalence of cirrhosis/advanced fibrosis was 3.54%. In both analyses, highest prevalence was observed in males, specifically in the 25-34 age group. Risk factors independently associated with APRI≥2 and APRI≥1 included hepatitis C, diabetes and central obesity with a remarkable population attributable fraction of 52.5% and 65.3% from central obesity, respectively. Excess alcohol consumption was also independently associated with APRI≥2. The presence of patatin-like phospholipase domain-containing-3 gene variants was independently associated with APRI≥1 in participants >50 years old. Males with both central obesity and excess alcohol consumption presented with cirrhosis/advanced fibrosis at a young age. Alarmingly high prevalence of cirrhosis and advanced fibrosis was identified in Hispanics in South Texas, affecting young males in particular. Central obesity was identified as the major risk factor. Public health efforts are urgently needed to increase awareness and diagnosis of advanced liver fibrosis in Hispanics.
Jiao, Jingjing; Watt, Gordon P.; Lee, MinJae; Rahbar, Mohammad H.; Vatcheva, Kristina P.; Pan, Jen-Jung; McCormick, Joseph B.; Fisher-Hoch, Susan P.; Fallon, Michael B.; Beretta, Laura
Liver cirrhosis is a leading cause of death in Hispanics and Hispanics who live in South Texas have the highest incidence of liver cancer in the United States. We aimed at determining the prevalence and associated risk factors of cirrhosis in this population. Clinical and demographic variables were extracted for 2466 participants in the community-based Cameron County Hispanic Cohort in South Texas. Aspartate transaminase to Platelet Ratio Index (APRI) was used to predict cirrhosis in Cameron County Hispanic Cohort. The prevalence of cirrhosis using APRI≥2 was 0.94%, which is nearly 4-fold higher than the national prevalence. Using APRI≥1, the overall prevalence of cirrhosis/advanced fibrosis was 3.54%. In both analyses, highest prevalence was observed in males, specifically in the 25–34 age group. Risk factors independently associated with APRI≥2 and APRI≥1 included hepatitis C, diabetes and central obesity with a remarkable population attributable fraction of 52.5% and 65.3% from central obesity, respectively. Excess alcohol consumption was also independently associated with APRI≥2. The presence of patatin-like phospholipase domain-containing-3 gene variants was independently associated with APRI≥1 in participants >50 years old. Males with both central obesity and excess alcohol consumption presented with cirrhosis/advanced fibrosis at a young age. Alarmingly high prevalence of cirrhosis and advanced fibrosis was identified in Hispanics in South Texas, affecting young males in particular. Central obesity was identified as the major risk factor. Public health efforts are urgently needed to increase awareness and diagnosis of advanced liver fibrosis in Hispanics. PMID:26950933
van de Sande-Lee, Simone; Velloso, Licio A
Obesity, defined as abnormal or excessive fat accumulation that may impair life quality, is one of the major public health problems worldwide. It results from an imbalance between food intake and energy expenditure. The control of energy balance in animals and humans is performed by the central nervous system (CNS) by means of neuroendocrine connections, in which circulating peripheral hormones, such as leptin and insulin, provide signals to specialized neurons of the hypothalamus reflecting body fat stores, and induce appropriate responses to maintain the stability of these stores. The majority of obesity cases are associated with central resistance to both leptin and insulin actions. In experimental animals, high-fat diets can induce an inflammatory process in the hypothalamus, which impairs leptin and insulin intracellular signaling pathways, and results in hyperphagia, decreased energy expenditure and, ultimately, obesity. Recent evidence obtained from neuroimaging studies and assessment of inflammatory markers in the cerebrospinal fluid of obese subjects suggests that similar alterations may be also present in humans. In this review, we briefly present the mechanisms involved with the loss of homeostatic control of energy balance in animal models of obesity, and the current evidence of hypothalamic dysfunction in obese humans.
Liu, Xin; Vitetta, Luis; Kostner, Karam; Crompton, David; Williams, Gail; Brown, Wendy J; Lopez, Alan; Xue, Charlie C; Oei, Tian P; Byrne, Gerard; Martin, Jennifer H; Whiteford, Harvey
This study examined the effects of Tai Chi, a low-impact mind-body movement therapy, on severity of depression, anxiety, and stress symptoms in centrally obese people with elevated depression symptoms. In total, 213 participants were randomized to a 24-week Tai Chi intervention program or a wait-list control group. Assessments were conducted at baseline and 12 and 24 weeks. Outcomes were severity of depression, anxiety, and stress symptoms, leg strength, central obesity, and other measures of metabolic symptom. There were statistically significant between-group differences in favor of the Tai Chi group in depression (mean difference = -5.6 units, P < 0.001), anxiety (-2.3 units, P < 0.01), and stress (-3.6 units, P < 0.001) symptom scores and leg strength (1.1 units, P < 0.001) at 12 weeks. These changes were further improved or maintained in the Tai Chi group relative to the control group during the second 12 weeks of follow-up. Tai Chi appears to be beneficial for reducing severity of depression, anxiety, and stress and leg strength in centrally obese people with depression symptoms. More studies with longer follow-up are needed to confirm the findings. This trial is registered with ACTRN12613000010796.
Lee, Jane J; Freeland-Graves, Jeanne H; Pepper, M Reese; Yao, Ming; Xu, Bugao
Objective Abdominal visceral adiposity is related to risks for insulin resistance and metabolic perturbations. Magnetic resonance imaging (MRI) and computed tomography are advanced instruments that quantify abdominal adiposity; yet field use is constrained by their bulkiness and costliness. The purpose of this study is to develop prediction equations for total abdominal, subcutaneous, and visceral adiposity via anthropometrics, stereovision body imaging (SBI), and MRI. Design and Methods Participants (67 men and 55 women) were measured for anthropometrics, and abdominal adiposity volumes evaluated by MRI umbilicus scans. Body circumferences and central obesity were obtained via SBI. Prediction models were developed via multiple linear regression analysis, utilizing body measurements and demographics as independent predictors, and abdominal adiposity as a dependent variable. Cross-validation was performed by the data-splitting method. Results The final total abdominal adiposity prediction equation was –470.28+7.10waist circumference–91.01gender+5.74sagittal diameter (R²=89.9%); subcutaneous adiposity was –172.37+8.57waist circumference–62.65gender–450.16stereovision waist-to-hip ratio (R²=90.4%); and visceral adiposity was –96.76+11.48central obesity depth–5.09 central obesity width+204.74stereovision waist-to-hip ratio–18.59gender (R²=71.7%). R² significantly improved for predicting visceral fat when SBI variables were included, but not for total abdominal or subcutaneous adiposity. Conclusions SBI is effective for predicting visceral adiposity and the prediction equations derived from SBI measurements can assess obesity. PMID:23613161
Zhang, Cui-yan; Yang, Li
To evaluate the efficacy of acupuncture therapy in decreasing visceral fat thickness(VFT) in patients with simple central obesity. Sixty patients with simple central obesity (syndrome of stomach and intestinal excessive heat) were randomly divided into control and acupuncture groups. Patients of the control group were treated with diet control and physical exercise procedure (basic treatment) for 6 months, and those of the acupuncture group treated with basic treatment combined with acupuncture stimulation of main acupoints Shuifen (CV 9), Yinjiao (CV 7), and bilateral Tianshu (ST 25), Huaroumen (ST 24) and bilateral Wailing (ST 26), etc., in combination with electroacupuncture (EA, 50- 100 Hz, 1- 5 mA) of bilateral ST 25, CV 9 and CV 7 for 30 min, once every other day for 3 months. The VFT (1 cm above the umbilicus) was detected by using an ultrasonic diagnosis instrument, and the body mass index (BMI, body weight/height(2)), and waist circumfe-rence (WC) were measured before treatment, 3 and 6 months after the treatment, respectively. Following 3 and 6 months' treatment, the VFT, BMI and WC of both groups were significantly decreased (P<0.01), and the effects of the acupuncture group were significantly superior to those of the control group in lowering VFT [(51.5 ± 6.5) mm vs (48.3 ± 4.7) mm)] and WC [(88.2 ± 3.6)cm vs (85.9 ± 4.3)cm] 6 months' after the treatment (P<0.05). There was no significant difference between the control and acupuncture groups in BMI fowllowing 6 months' treatment [(31.0 ± 4.3) vs (30.1 ± 3.2), P>0.05]. Acupuncture intervention combined with diet control and physical exercise can effectively decrease VFT and WC in simple central obesity patients. VFT is a sensitive and better parameter for evaluating the effect of obesity treatment.
Bray, George A
As Erwin Chargaff observed, "Scientific autobiography belongs to a most awkward literary genre," and mine is no exception. In reviewing my scientific life, I contrast the nutritional influences that would have existed had I been born 100 or 200 years earlier than I actually was. With this background, I trace the influences on my formative years in science beginning in high school and ending as a postdoctoral fellow in Professor E.B. Astwood's laboratory, when my directional sails were set and obesity was the compass heading. With this heading, the need for organized national and international meetings on obesity and the need for a scientific journal dealing with obesity as its subject matter became evident and occupied considerable energy over the next 30 years. The next section of this memoir traces the wanderings of an itinerant academic who moved from Boston to Los Angeles and finally to Baton Rouge. The influence of Sir William Osler's idea that there is a time for education, a time for scholarship, a time for teaching, and time to retire has always been a guide to allocating time ever since I was an intern at Johns Hopkins Hospital. It was in Baton Rouge that the final phase began: I agreed to become the first full-time executive director of the Pennington Biomedical Research Center, a decision that changed my life. The article ends with a quotation from Tennessee Williams that reflects the theater, which has given me so much pleasure over the years: "There is a time for departure even when there's no certain place to go."
Milbank, Edward; Martinez, M Carmen; Andriantsitohaina, Ramaroson
Obesity and its metabolic resultant dysfunctions such as insulin resistance, hyperglycemia, dyslipidemia and hypertension, grouped as the "metabolic syndrome", are chronic inflammatory disorders that represent one of the most severe epidemic health problems. The imbalance between energy intake and expenditure, leading to an excess of body fat and an increase of cardiovascular and diabetes risks, is regulated by the interaction between central nervous system (CNS) and peripheral signals in order to regulate behavior and finally, the metabolism of peripheral organs. At present, pharmacological treatment of obesity comprises actions in both CNS and peripheral organs. In the last decades, the extracellular vesicles have emerged as participants in many pathophysiological regulation processes. Whether used as biomarkers, targets or even tools, extracellular vesicles provided some promising effects in the treatment of a large variety of diseases. Extracellular vesicles are released by cells from the plasma membrane (microvesicles) or from multivesicular bodies (exosomes) and contain lipids, proteins and nucleic acids, such as DNA, protein coding, and non-coding RNAs. Owing to their composition, extracellular vesicles can (i) activate receptors at the target cell and then, the subsequent intracellular pathway associated to the specific receptor; (ii) transfer molecules to the target cells and thereby change their phenotype and (iii) be used as shuttle of drugs and, thus, to carry specific molecules towards specific cells. Herein, we review the impact of extracellular vesicles in modulating the central and peripheral signals governing obesity.
Heal, David J; Gosden, Jane; Smith, Sharon L
Obesity is a global problem that is predominantly caused by the increasing adoption of a low-cost, Westernised diet that is rich in fat and sugar and a more sedentary lifestyle. The costs of this epidemic are substantial increases in Type 2 diabetes, cardiovascular disease and some types of cancer that are certain to place a huge burden on individuals, healthcare providers and society. In this review, we provide an overview of the chequered history of pharmacotherapy for the treatment of obesity and an analysis of the regulatory and commercial challenges for developing new centrally-acting drugs in this metabolic indication. The efficacy and safety of the drug candidates that are currently at the pre-registration phase, i.e., lorcaserin, Qnexa and Contrave, are critically assessed. The main focus, however, is to provide a comprehensive review of the wide range of novel CNS compounds that are in the discovery phase or early clinical development. The profiles of various clinical candidates in animal models of obesity predict that several new CNS approaches in the clinic have the potential to deliver greater weight-loss than existing agents. This article is part of a Special Issue entitled 'Central Control of Food Intake'.
Schinzari, Francesca; Veneziani, Augusto; Mores, Nadia; Barini, Angela; Di Daniele, Nicola; Cardillo, Carmine; Tesauro, Manfredi
Patients with central obesity have impaired insulin-stimulated vasodilation and increased ET-1 (endothelin 1) vasoconstriction, which may contribute to insulin resistance and vascular damage. Apelin enhances insulin sensitivity and glucose disposal but also acts as a nitric oxide (NO)-dependent vasodilator and a counter-regulator of AT1 (angiotensin [Ang] II type 1) receptor-induced vasoconstriction. We, therefore, examined the effects of exogenous (Pyr(1))apelin on NO-mediated vasodilation and Ang II- or ET-1-dependent vasoconstrictor tone in obese patients. In the absence of hyperinsulinemia, forearm blood flow responses to graded doses of acetylcholine and sodium nitroprusside were not different during saline or apelin administration (both P>0.05). During intra-arterial infusion of regular insulin, however, apelin enhanced the vasodilation induced by both acetylcholine and nitroprusside (both P<0.05). Interestingly, the vasodilator effect of concurrent blockade of AT1 (telmisartan) and AT2 (PD 123,319) receptors was blunted by apelin (3±5% versus 32±9%; P<0.05). Similarly, during apelin administration, blockade of ETA receptors (BQ-123) resulted in lower vasodilator response than during saline (23±10% versus 65±12%; P<0.05). NO synthase inhibition by L-NMMA (l-N-monometylarginine) during the concurrent blockade of either Ang II or ETA receptors resulted in similar vasoconstriction in the absence or presence of apelin (P>0.05). In conclusion, in patients with central obesity, apelin has favorable effects not only to improve insulin-stimulated endothelium-dependent and endothelium-independent vasodilator responses but also to blunt Ang II- and ET-1-dependent vasoconstriction by a mechanism not involving NO. Taken together, our results suggest that targeting the apelin system might favorably impact some hemodynamic abnormalities of insulin-resistant states like obesity. © 2017 American Heart Association, Inc.
Ammar, Khawaja Afzal; Redfield, Margaret M.; Mahoney, Douglas W.; Johnson, Matthew; Jacobsen, Steven J; Rodeheffer, Richard J.
Objectives We sought to measure the strength of association between two indices of obesity, waist hip ratio (WHR) and body mass index (BMI), with left ventricular (LV) dysfunction and mortality in a community cohort. Background The distribution of body fat is thought to affect cardiovascular disease risk. The association of BMI (an index of overall obesity) and WHR (an index of central obesity) with LV systolic and diastolic dysfunction in a population-based cohort is unknown. Methods Results Anthropomorphic measurements and echocardiographic LV function were measured in a cross-sectional population-based sample of 2042 men and women >45 years old in the Olmsted County Heart Function Study. Five year prospective mortality was measured. Results Increased WHR had a stronger association than BMI with: 1) lower LV EF (r= -0.24, p<0.0001 versus r= -0.04, p=0.09), and 2) LV diastolic dysfunction (r = 0.18, p<0.0001 versus r = 0.05, p = 0.02). After adjustment for standard cardiovascular risk factors WHR continued to be significantly associated with diastolic dysfunction, but not with systolic dysfunction. WHR, but not BMI, was strongly predictive of all cause mortality independent of age and sex (HR 23.6, CI 4.0, 139.8; p = 0.0005). This relationship was attenuated on adjustment for diastolic dysfunction. Conclusions WHR is a stronger correlate of LV dysfunction and mortality than BMI. These cross-sectional data suggest that the increased risk of mortality from central obesity is mediated at least in part by LV dysfunction, especially diastolic dysfunction. PMID:19061715
Rafiei, M.; Ayatollahi, S. M. T.
To estimate the prevalence of low birth weight (LBW) and to document distribution of body mass index (BMI) at birth in Arak (central Iran) neonates of the 10,241 live neonates (5241 boys, 5000 girls, sex ratio 105) born in 2004 in Arak. A birth weight of less than 2500 g was classified as LBW. BMI based on the original supine length and weight…
Rafiei, M.; Ayatollahi, S. M. T.
To estimate the prevalence of low birth weight (LBW) and to document distribution of body mass index (BMI) at birth in Arak (central Iran) neonates of the 10,241 live neonates (5241 boys, 5000 girls, sex ratio 105) born in 2004 in Arak. A birth weight of less than 2500 g was classified as LBW. BMI based on the original supine length and weight…
Finkelstein, Eric A; Khavjou, Olga A; Thompson, Hope; Trogdon, Justin G; Pan, Liping; Sherry, Bettylou; Dietz, William
Previous efforts to forecast future trends in obesity applied linear forecasts assuming that the rise in obesity would continue unabated. However, evidence suggests that obesity prevalence may be leveling off. This study presents estimates of adult obesity and severe obesity prevalence through 2030 based on nonlinear regression models. The forecasted results are then used to simulate the savings that could be achieved through modestly successful obesity prevention efforts. The study was conducted in 2009-2010 and used data from the 1990 through 2008 Behavioral Risk Factor Surveillance System (BRFSS). The analysis sample included nonpregnant adults aged ≥ 18 years. The individual-level BRFSS variables were supplemented with state-level variables from the U.S. Bureau of Labor Statistics, the American Chamber of Commerce Research Association, and the Census of Retail Trade. Future obesity and severe obesity prevalence were estimated through regression modeling by projecting trends in explanatory variables expected to influence obesity prevalence. Linear time trend forecasts suggest that by 2030, 51% of the population will be obese. The model estimates a much lower obesity prevalence of 42% and severe obesity prevalence of 11%. If obesity were to remain at 2010 levels, the combined savings in medical expenditures over the next 2 decades would be $549.5 billion. The study estimates a 33% increase in obesity prevalence and a 130% increase in severe obesity prevalence over the next 2 decades. If these forecasts prove accurate, this will further hinder efforts for healthcare cost containment. Copyright © 2012 Elsevier Inc. All rights reserved.
Food is a potent natural reward and food intake is a complex process. Reward and gratification associated with food consumption leads to dopamine (DA) production, which in turn activates reward and pleasure centers in the brain. An individual will repeatedly eat a particular food to experience this positive feeling of gratification. This type of repetitive behavior of food intake leads to the activation of brain reward pathways that eventually overrides other signals of satiety and hunger. Thus, a gratification habit through a favorable food leads to overeating and morbid obesity. Overeating and obesity stems from many biological factors engaging both central and peripheral systems in a bi-directional manner involving mood and emotions. Emotional eating and altered mood can also lead to altered food choice and intake leading to overeating and obesity. Research findings from human and animal studies support a two-way link between three concepts, mood, food, and obesity. The focus of this article is to provide an overview of complex nature of food intake where various biological factors link mood, food intake, and brain signaling that engages both peripheral and central nervous system signaling pathways in a bi-directional manner in obesity. PMID:25225489
Food is a potent natural reward and food intake is a complex process. Reward and gratification associated with food consumption leads to dopamine (DA) production, which in turn activates reward and pleasure centers in the brain. An individual will repeatedly eat a particular food to experience this positive feeling of gratification. This type of repetitive behavior of food intake leads to the activation of brain reward pathways that eventually overrides other signals of satiety and hunger. Thus, a gratification habit through a favorable food leads to overeating and morbid obesity. Overeating and obesity stems from many biological factors engaging both central and peripheral systems in a bi-directional manner involving mood and emotions. Emotional eating and altered mood can also lead to altered food choice and intake leading to overeating and obesity. Research findings from human and animal studies support a two-way link between three concepts, mood, food, and obesity. The focus of this article is to provide an overview of complex nature of food intake where various biological factors link mood, food intake, and brain signaling that engages both peripheral and central nervous system signaling pathways in a bi-directional manner in obesity.
Bandini, L G; Dietz, W H
Childhood obesity is a multifactorial and complex disease. Myths such as those that we have described may distract our patients from the underlying behaviors that contribute to the disease or may deflect the blame perceived by obese patients and their parents. Myths that suggest that the obese are inactive, eat differently, or eat more junk food suggest that obese individuals are socially deviant and justifies the intense discrimination directed against them. The myth that obesity represents an untreatable disease helps free health-care professionals from the responsibility to understand and care for obese children. Dispelling the myths about childhood obesity represents a critical step in prevention and treatment.
Ahima, Rexford S.
The growing problem of obesity is associated with multiple morbidities, including increased risk of diabetes, hypertension, heart disease, sleep apnea, and cancer. Obesity promotes disability, decreases productivity, and shortens life span. Although much attention has been focused on diet and exercise, these strategies alone are not effective in preventing obesity and maintaining weight loss. Moreover, the development of pharmacological approaches for obesity treatment has been dogged by poor efficacy and serious side effects. The biology of obesity is very complex, and mechanisms linking obesity to various diseases are poorly understood. This issue of the JCI highlights important concepts in our understanding of the pathogenesis of obesity and its complications. PMID:21633174
Ferreira, Sandra R G; Lerario, Daniel D G; Gimeno, Suely G A; Sanudo, Adriana; Franco, Laércio J
We examined the association of nutritional factors with body fat deposition in a representative sample (n=530, aged 40-79 years) of first and second-generation Japanese-Brazilian population who was submitted to standardized questionnaires, including nutritional data, clinical examination and laboratory procedures. Dietary data were compared between groups of subjects defined by the presence of obesity or central adiposity. Associations of body mass index or waist circumference (dependent variables) with energy and nutrient intakes (main exposure of interest) were analyzed by multiple linear regression, with adjustment for gender, age, physical activity and generation. Groups of obese subjects and those with central adiposity consumed higher proportions of energy as fat and lower as carbohydrate than those without obesity and central adiposity (p<0.05). Stratifying by generation, second-generation was shown to take more energy as fat than the first-generation (p<0.05). In the regression models, protein intake was the only variable significantly associated with body mass index. Replacing body mass index by the waist circumference, male sex and protein intake were shown to be independent predictors of central adiposity. When second-generation was taken, total energy intake and all macronutrient intakes became significantly associated with body mass index (p<0.05) but only protein intake predicted waist circumference. We speculate that Japanese-Brazilians, genetically prone to insulin resistance, when exposed to unfavorable environment will express a number of metabolic disturbances. A deleterious dietary pattern may contribute to weight gain, was associated with abdominal fat deposition in particular a protein-rich diet, and reflected by their waist circumference. Intra-abdominal fat could be triggering insulin resistance, which would explain the increased prevalence rates of diabetes, dyslipidemia and hypertension seen in Japanese-Brazilians.
Rostás, I; Tenk, J; Mikó, A; Füredi, N; Soós, S; Solymár, M; Lengyel, A; Székely, M; Gaszner, B; Feller, D; Pétervári, E; Balaskó, M
Leptin is a key catabolic regulator of food intake (FI) and energy expenditure. Both aging and obesity have been shown to induce leptin-resistance. The present study aimed to analyze age-related changes in the anorexigenic and hypermetabolic responsiveness to acute intracerebroventricular leptin administration in different age-groups of normally fed male Wistar rats (adult and old rats from 3 to 24months of age, NF3 to NF24, respectively). The expressions of the long form of the leptin receptor (Ob-Rb) and inhibitory SOCS3 genes were also assessed by quantitative RT-PCR in the arcuate nucleus (ARC). The influence of high-fat diet-induced obesity (HF) on the anorexigenic leptin effects were also tested in younger and older middle-aged groups (HF6 and HF12). Leptin-induced anorexia varied with age: leptin suppressed re-feeding FI (following 48-h fasting) strongly in young adult (NF3), but not in younger or older middle-aged (NF6 or NF12) or in aging (NF18) rats. However, anorexigenic leptin effects reached statistical significance again in old NF24 rats. Leptin-induced hypermetabolism, on the other hand, showed monotonous age-related decline and disappeared by old age. Ob-Rb expression declined until 12months of age followed by a partial recovery in NF18 and NF24 groups. On the other hand, SOCS3 expression was high in NF6 and NF18 and to some extent in NF24 rats. Age-related alterations of Ob-Rb and SOCS3 expression in the ARC may partly contribute to the explanation of age-related variations in anorexigenic but not hypermetabolic leptin effects. High-fat diet-induced obesity was associated with resistance to leptin-induced anorexia in HF6, similar to that seen in NF6. However, instead of the expected leptin-resistance in HF12, a strong leptin-induced suppression of re-feeding was detected in these obese middle-aged rats. Our results suggest that acute central effects of leptin on anorexia and hypermetabolism change in disparate ways during aging, implying separate
Background Leptin, an adipocytokine produced by adipose tissue, along with the traditional cardiometabolic risk factors, contributes to the development of cardiovascular complications. At the same time, ethnic features of adipocytokines have been insufficiently investigated, especially among Asians, who have an increased risk of cardiovascular complications compared with Europeans. Aim of study was to investigate the relationship between leptin levels and age, gender, anthropometric parameters, lipid parameters, arterial hypertension (AH), and obesity in the adult population of ethnic Kyrgyz people living in Central Asia. Results In total, 322 ethnic Kyrgyz (145 men, 177 women) aged ≥ 30 years were studied. Waist and hip circumference, body mass index, blood glucose, lipids, leptin, and homeostatic model assessment were measured. Patients in the upper quartile of leptin levels had high values of BMI, WC, systolic and diastolic blood pressure, glucose, and HOMA index compared with patients with lower leptin levels. The prevalence of metabolic syndrome and AH increased with higher levels of leptin. Leptin positively correlated with BMI, WC, triglycerides, and glucose concentrations in patients of both sexes. According to the multivariate logistic regression analysis, elevated leptin levels increased by 30 times the risk of obesity in men, regardless of the presence of type 2 diabetes, and 17.7 times in women. Conclusion Leptin is associated with general and abdominal obesity, dyslipidemia, and insulin resistance in Kyrgyz patients. PMID:24981337
James, P T; Leach, R; Kalamara, E; Shayeghi, M
The recent World Health Organization (WHO) agreement on the standardized classification of overweight and obese, based on body mass index (BMI), allows a comparable analysis of prevalence rates worldwide for the first time. In Asia, however, there is a demand for a more limited range for normal BMIs (i.e., 18.5 to 22.9 kg/m(2) rather than 18.5 to 24.9 kg/m(2)) because of the high prevalence of comorbidities, particularly diabetes and hypertension. In children, the International Obesity Task-Force age-, sex-, and BMI-specific cutoff points are increasingly being used. We are currently evaluating BMI data globally as part of a new millennium analysis of the Global Burden of Disease. WHO is analyzing data in terms of 20 or more principal risk factors contributing to the primary causes of disability and lost lives in the 191 countries within the WHO. The prevalence rates for overweight and obese people are different in each region, with the Middle East, Central and Eastern Europe, and North America having higher prevalence rates. In most countries, women show a greater BMI distribution with higher obesity rates than do men. Obesity is usually now associated with poverty, even in developing countries. Relatively new data suggest that abdominal obesity in adults, with its associated enhanced morbidity, occurs particularly in those who had lower birth weights and early childhood stunting. Waist measurements in nationally representative studies are scarce but will now be needed to estimate the full impact of the worldwide obesity epidemic.
Alonso-Castro, Angel Josabad; Domínguez, Fabiola; Zapata-Morales, Juan Ramón; Carranza-Álvarez, Candy
Obesity is a worldwide medical concern. New ethnobotanical information regarding the antiobesity effect of medicinal plants has been obtained in the last 30 years in response to socio-demographic changes and high-fat diets became common. This review provides a summary of medicinal plants used in Mexico, Central America and the Caribbean for the empirical treatment of obesity in terms of ethnobotany, toxicity, pharmacology, conservation status, trade and chemistry. Bibliographic investigation was performed by analyzing recognized books, undergraduate and postgraduate theses and peer-reviewed scientific articles, consulting worldwide accepted scientific databases from the last four decades. Medicinal plants used for the treatment of obesity were classified in two categories: (1) plants with pharmacological evidence and (2) plants without pharmacological evidence. A total of 139 plant species, belonging to 61 families, native to Mexico, Central America and the Caribbean that are used for the empirical treatment of obesity were recorded. From these plants, 33 were investigated in scientific studies, and 106 plants lacked scientific investigation. Medicinal plants were experimentally studied in vitro (21 plants) and in vivo (16 plants). A total of 4 compounds isolated from medicinal plants used for the empirical treatment of obesity have been tested in vitro (2 compounds) and in vivo (4 compounds) studies. No clinical trials on obese subjects (BMI>30 kg/m(2)) have been performed using the medicinal plants cited in this review. There are no herbal-based products approved in Mexico for the treatment of obesity. There are a limited number of scientific studies published on medicinal plants from Mexico, Central America and the Caribbean used for the treatment of obesity. This review highlights the need to perform pharmacological, phytochemical, toxicological and ethnobotanical studies with medicinal flora to obtain new antiobesity agents. Copyright © 2015 Elsevier Ireland
Lenz, Anne; Diamond, Frank B
Obesity has reached epidemic proportions throughout the world and poses significant health and economic burdens to both developed and developing societies. Most recent data from the NHANES study (2003-2004) report that 17.1% of US children are overweight and 32.2% of adults are obese, a significant increase compared with data obtained only 6 years earlier. The neurohormonal control of appetite, body composition, and glucose homeostasis is mediated by hormones secreted from adipose tissue, endocrine glands, and enteroendocrine cells, which converge at the vagus nerve, brainstem and hypothalamus to modulate complex interactions of neurotransmitters and central appetite-regulating peptides. These hormonal signals are tightly regulated to maintain body weight/adiposity within a narrow, individually defined range that may be further impacted by variables such as ingested calories, meal composition, and lifestyle. Clinical manifestations of obesity, the metabolic syndrome and impaired glucose tolerance reflect biochemical alterations in a complex hormonal milieu. Elucidation of these hormonal perturbations in obese patients has already provided novel pharmacologic treatments to improve weight management and address the metabolic sequelae of obesity. The remarkable redundancy of these hormones, however, and their interactions make a monopharmaceutical approach unlikely to be successful.
Davis, Cynthia R; Dearing, Eric; Usher, Nicole; Trifiletti, Sarah; Zaichenko, Lesya; Ollen, Elizabeth; Brinkoetter, Mary T; Crowell-Doom, Cindy; Joung, Kyoung; Park, Kyung Hee; Mantzoros, Christos S; Crowell, Judith A
This study examined whether a novel indicator of overall childhood adversity, incorporating number of adversities, severity, and chronicity, predicted central obesity beyond contributions of "modifiable" risk factors including psychosocial characteristics and health behaviors in a diverse sample of midlife adults. The study also examined whether the overall adversity score (number of adversities × severity × chronicity) better predicted obesity compared to cumulative adversity (number of adversities), a more traditional assessment of childhood adversity. 210 Black/African Americans and White/European Americans, mean age=45.8; ±3.3 years, were studied cross-sectionally. Regression analysis examined overall childhood adversity as a direct, non-modifiable risk factor for central obesity (waist-hip ratio) and body mass index (BMI), with and without adjustment for established adult psychosocial risk factors (education, employment, social functioning) and heath behavior risk factors (smoking, drinking, diet, exercise). Overall childhood adversity was an independent significant predictor of central obesity, and the relations between psychosocial and health risk factors and central obesity were not significant when overall adversity was in the model. Overall adversity was not a statistically significant predictor of BMI. Overall childhood adversity, incorporating severity and chronicity and cumulative scores, predicts central obesity beyond more contemporaneous risk factors often considered modifiable. This is consistent with early dysregulation of metabolic functioning. Findings can inform practitioners interested in the impact of childhood adversity and personalizing treatment approaches of obesity within high-risk populations. Prevention/intervention research is necessary to discover and address the underlying causes and impact of childhood adversity on metabolic functioning. © 2013.
Objective: The variations in perilipin gene (PLIN) were previously associated with obesity and insulin sensitivity. We examined whether PLIN variability was associated with diabetes risk and whether obesity status modified such associations. Research Methods and Procedures: We conducted a nested cas...
Shcherbakova, M Iu; Poriagina, G I; Kovaleva, E A
In this article presented modern data on the definition of obesity in childhood and its prevalence. Were reflected the basic diagnostic criteria for obesity and metabolic syndrome. Were analyzed genetic changes, hormonal factors, influence lifestyle of modern man as the reasons of the obesity. Are also was considered data on the relation of obesity and its complications such as cardiovascular, metabolic syndromes, nonalcoholic fatty liver disease. Was reflected the views of various specialists (cardiologists, endocrinologists, gastroenterologists, pediatricians) to the problem of overweight and obesity in children and adolescents. Were presented modern data on the approaches to the treatment of obesity in children.
Diehl, Anna Mae
Obesity is associated with a spectrum of chronic liver disease. Because obesity increases the risk for advanced forms of liver disease (ie, cirrhosis and liver cancer), the obesity epidemic is emerging as a major factor underlying the burden of liver disease in the United States and many other countries. This article reviews mechanisms that mediate the pathogenesis of obesity-related liver disease, summarizes clinical evidence that demonstrates obesity-related liver disease can be life-threatening, and discusses whether or not treatments for obesity or related comorbidities impact liver disease outcomes. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Coveleskie, K; Gupta, A; Kilpatrick, L A; Mayer, E D; Ashe-McNalley, C; Stains, J; Labus, J S; Mayer, E A
Background/Objectives: Neuroimaging studies in obese subjects have identified abnormal activation of key regions of central reward circuits, including the nucleus accumbens (NAcc), in response to food-related stimuli. We aimed to examine whether women with elevated body mass index (BMI) show structural and resting state (RS) functional connectivity alterations within regions of the reward network. Subjects/Methods: Fifty healthy, premenopausal women, 19 overweight and obese (high BMI=26–38 kg m−2) and 31 lean (BMI=19–25 kg m−2) were selected from the University of California Los Angeles' Oppenheimer Center for Neurobiology of Stress database. Structural and RS functional scans were collected. Group differences in grey matter volume (GMV) of the NAcc, oscillation dynamics of intrinsic brain activity and functional connectivity of the NAcc to regions within the reward network were examined. Results: GMV of the left NAcc was significantly greater in the high BMI group than in the lean group (P=0.031). Altered frequency distributions were observed in women with high BMI compared with lean group in the left NAcc (P=0.009) in a medium-frequency (MF) band, and in bilateral anterior cingulate cortex (ACC) (P=0.014, <0.001) and ventro-medial prefrontal cortex (vmPFC) (P=0.034, <0.001) in a high-frequency band. Subjects with high BMI had greater connectivity of the left NAcc with bilateral ACC (P=0.024) and right vmPFC (P=0.032) in a MF band and with the left ACC (P=0.03) in a high frequency band. Conclusions: Overweight and obese women in the absence of food-related stimuli show significant structural and functional alterations within regions of reward-related brain networks, which may have a role in altered ingestive behaviors. PMID:25599560
Patsopoulou, Anna; Tsimtsiou, Zoi; Katsioulis, Antonios; Rachiotis, George; Malissiova, Eleni; Hadjichristodoulou, Christos
The increasing obesity trend in adolescence is a public health concern. The initial phase of Feeding Exercise Trial in Adolescents (FETA) aimed in investigating the prevalence of overweight and obesity in adolescents and their parents and in identifying associated factors among parents' and adolescents' demographics, eating habits, and parental style. The sample consisted of 816 adolescents, aged 12-18 years old, and their parents from 17 middle and high schools in Larissa, central Greece. During school visits, anthropometric measurements were performed along with examination of blood pressure. The students completed the study tool that comprised of demographics and the modified versions of Parental Authority Questionnaire (PAQ), the Parent-Initiated Motivational Climate Questionnaire-2 (PIMCQ-2) and the Family Eating and Activity Habits Questionnaire (FEAHQ). Their parents completed a questionnaire with demographics, anthropometrics and FEAHQ. Normal Body Mass Index was found in 75.2% of the adolescents, 2.6% of the adolescents were underweight, 18% overweight and 4.2% obese. Regarding the parents, 76.3% of the fathers and 39.2% of the mothers were overweight or obese. The logistic regression analysis revealed that, overweight or obesity in adolescence was associated with gender (boy), maternal overweight or obesity, lower maternal educational level, eating without feeling hungry, eating in rooms other than kitchen and having a father that motivates by worrying about failing. A significant proportion of adolescents and their parents are overweight or obese. Future interventions should focus both on the parents and children, taking into account the role of parental authority style, in preventing adolescents' obesity.
Patsopoulou, Anna; Tsimtsiou, Zoi; Katsioulis, Antonios; Rachiotis, George; Malissiova, Eleni; Hadjichristodoulou, Christos
The increasing obesity trend in adolescence is a public health concern. The initial phase of Feeding Exercise Trial in Adolescents (FETA) aimed in investigating the prevalence of overweight and obesity in adolescents and their parents and in identifying associated factors among parents’ and adolescents’ demographics, eating habits, and parental style. The sample consisted of 816 adolescents, aged 12–18 years old, and their parents from 17 middle and high schools in Larissa, central Greece. During school visits, anthropometric measurements were performed along with examination of blood pressure. The students completed the study tool that comprised of demographics and the modified versions of Parental Authority Questionnaire (PAQ), the Parent-Initiated Motivational Climate Questionnaire-2 (PIMCQ-2) and the Family Eating and Activity Habits Questionnaire (FEAHQ). Their parents completed a questionnaire with demographics, anthropometrics and FEAHQ. Normal Body Mass Index was found in 75.2% of the adolescents, 2.6% of the adolescents were underweight, 18% overweight and 4.2% obese. Regarding the parents, 76.3% of the fathers and 39.2% of the mothers were overweight or obese. The logistic regression analysis revealed that, overweight or obesity in adolescence was associated with gender (boy), maternal overweight or obesity, lower maternal educational level, eating without feeling hungry, eating in rooms other than kitchen and having a father that motivates by worrying about failing. A significant proportion of adolescents and their parents are overweight or obese. Future interventions should focus both on the parents and children, taking into account the role of parental authority style, in preventing adolescents’ obesity. PMID:26712779
... Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery Obesity and Anesthesia More than one-third of Americans ... Sleep Apnea, a chronic medical problem common with obesity, can present with serious breathing problems before, during, ...
... Bar Home Current Issue Past Issues Reducing Childhood Obesity Past Issues / Summer 2007 Table of Contents For ... Ga. were the first three We Can! cities. Obesity Research: A New Approach The percentage of children ...
The prevalence of child and adolescent overweight and obesity is rapidly increasing and is associated with morbidity, both medical and psychosocial. Obesity is unlikely to resolve spontaneously. It is important that health professionals can assess obesity and initiate an action plan. The evidence base for what works best in the management of child and adolescent overweight and obesity is limited. It is uncertain whether protocols from clinical research trials can be translated into primary care. Dietary change, with an emphasis on lower fat intake and smaller portion size, should be commenced. There should be an increase in physical activity and a decrease in sedentary behaviours, combined with behavioural change and parental involvement. These are the elements of a lifestyle intervention. In the severely obese adolescent with obesity-related co-morbidity, the use of very low-energy diets and anti-obesity agents could be considered. Bariatric surgery may be indicated in carefully selected, older, severely obese adolescents.
Powers, Mark Anthony
We only need to look around us to see that we are in an epidemic of obesity and obesity-related medical problems. The obesity hypoventilation syndrome is a disorder in which an obese person with normal lungs chronically hypoventilates. Obesity impairs ventilatory mechanics, increases the work of breathing and carbon dioxide production, results in respiratory muscle dysfunction, and reduces ventilatory response to hypercapnia. Sleep-disordered breathing is present in most patients with the obesity hypoventilation syndrome. When noninvasive ventilation can be successfully introduced, hypoventilation can usually be corrected. Weight loss is the desirable long-term treatment for the obesity hypoventilation syndrome. This paper concisely overviews the physiologic factors that lead to the obesity hypoventilation syndrome and discusses therapies for it.
In the GDR about 20% of the males and 40% of the females were estimated to be obese. In the country obesity is more spread than in the town. Increased disablement of obese persons leads to reduction of the national income. With higher expenses for nutrition the frequency of obestiy increases. Hypophages and hyperphages are differently distributed in persons with normal weight and obese ones, so that the average establishments do not reflect the differentiated situation in nutrition. Obesity correlates with the type of structure; with increasing obesity dominate pyknomorphous tendencies of growth. Also in normal weight pyknomorphous persons have a higher proportion of fat. We should speak of obesity in such a case, when, taking into consideration biological differentiations, the normal proportion of the fat in the body is increased by more than 1/3. For epidemiological serial examinations the degrees of relative weight basing on optimum weight are a favourable basis for the classification of obesity.
Li, Qiang; Zhang, Jun; Zhou, Yongning; Qiao, Liang
Obesity is an important public health problem worldwide. It increases the risk of many chronic diseases such as diabetes and cardiovascular diseases. Meanwhile, obesity is a major risk factor for several types of cancer including gastric cancer. Possible mechanisms linking obesity with gastric cancer may include obesity associated gastro-oesophageal reflux, insulin resistance, altered levels of adiponectin, leptin, ghrelin, and an abnormally increased blood level of insulin-like growth factor (IGF). Helicobacter pylori (H. pylori) infection is a well-recognized risk factor for peptic ulcer and gastric cancer. Recent studies have revealed an increased prevalence of H. pylori infection in obese patients, providing another clue for the increased incidence of gastric cancer in obese population. If this connection can be confirmed in animal models and a large cohort of patients, then eradicating H. pylori together with life style modification in obese individuals may help prevent the development of gastric cancer in the increasingly obese population.
Kahan, Scott; Zvenyach, Tracy
Despite much effort, obesity prevalence and disease severity continues to worsen. The purpose of this review is to describe the leading government supported food and nutrition interventions and policies to prevent and address obesity in the USA. The review also summarizes obesity interventions and policies that the government plays a role in, but further development is warranted. The government's role in obesity has largely focused on interventions and policies such as national surveillance, obesity education and awareness, grant-based food subsidy programs, zoning for food access, school-based nutrition programs, dietary guidelines, nutrition labeling, and food marketing and pricing policies. The government has played a lesser role in obesity interventions and policies that provide access to evidence-based obesity care to people affected by the disease. Given the magnitude of the obesity epidemic, the government should explore multiple evidence-based interventions and policies across prevention and clinical care.
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Obesity increases a person's risk of illness and death due to diabetes, stroke, heart disease, hypertension, high cholesterol, and kidney and gallbladder disease. Obesity may increase the risk for some types of ...
... this page: //medlineplus.gov/ency/article/007508.htm Obesity in children To use the sharing features on this page, ... food choices have led to the rise of obesity among children . Children are surrounded by many things that make ...
Kunej, Tanja; Jevsinek Skok, Dasa; Zorc, Minja; Ogrinc, Ana; Michal, Jennifer J.; Kovac, Milena; Jiang, Zhihua
Obesity in humans has increased at an alarming rate over the past two decades and has become one of the leading public health problems worldwide. Studies have revealed a large number of genes/markers that are associated with obesity and/or obesity-related phenotypes, indicating an urgent need to develop a central database for helping the community understand the genetic complexity of obesity. In the present study, we collected a total of 1,736 obesity associated loci and created a freely available obesity database, including 1,515 protein-coding genes and 221 microRNAs (miRNAs) collected from four mammalian species: human, cattle, rat, and mouse. These loci were integrated as orthologs on comparative genomic views in human, cattle, and mouse. The database and genomic views are freely available online at: http://www.integratomics-time.com/fat_deposition. Bioinformatics analyses of the collected data revealed some potential novel obesity related molecular markers which represent focal points for testing more targeted hypotheses and designing experiments for further studies. We believe that this centralized database on obesity and adipogenesis will facilitate development of comparative systems biology approaches to address this important health issue in human and their potential applications in animals. PMID:25031655
Lusk, J L
This paper elucidates the challenges surrounding the economics of some popular obesity-related policy proposals. Solid economic justifications for anti-obesity policies are often lacking, and evidence suggests policies like fat and soda taxes or restrictions on food stamp spending are unlikely to substantively affect obesity prevalence. In short, many of the same factors that make obesity such a complicated and multifaceted issue extend to the economic analysis of public health policies.
Background Although children of lower socio-economic status (SES) in the United States have generally been found to be at greater risk for obesity, the SES-obesity association varies when stratified by racial/ethnic groups-with no consistent association found for African American and Hispanic children. Research on contextual and setting-related factors may provide further insights into ethnic and SES disparities in obesity. We examined whether obesity levels among central Texas 8th grade students (n=2682) vary by school-level economic disadvantage across individual-level family SES and racial/ethnicity groups. As a secondary aim, we compared the association of school-level economic disadvantage and obesity by language spoken with parents (English or Spanish) among Hispanic students. Methods Multilevel regression models stratified by family SES and ethnicity were run using cross-sectional baseline data from five school districts participating in the Central Texas CATCH Middle School project. For family SES, independent multi-level logistic regression models were run for total sample and by gender for each family SES stratum (poor/near poor/just getting by, living comfortably, and very well off), adjusting for age, ethnicity, and gender. Similarly, multi-level regression models were run by race/ethnic group (African American, Hispanic, and White), adjusting for age, family SES, and gender. Results Students attending highly economically disadvantaged (ED) schools were between 1.7 (95% CI: 1.1-2.6) and 2.4 (95% CI: 1.2-4.8) times more likely to be obese as students attending low ED schools across family SES groups (p<.05). African American (ORAdj =3.4, 95% CI: 1.1-11.4), Hispanic (ORAdj=1.8, 95% CI 1.1-3.0) and White (ORAdj=3.8, 95% CI: 1.6-8.9) students attending high ED schools were more likely to be obese as counterparts at low ED schools (p<.05). Gender-stratified findings were similar to findings for total sample, although fewer results reached significance. While
Springer, Andrew E; Li, Linlin; Ranjit, Nalini; Delk, Joanne; Mehta, Kajal; Kelder, Steven H
Although children of lower socio-economic status (SES) in the United States have generally been found to be at greater risk for obesity, the SES-obesity association varies when stratified by racial/ethnic groups-with no consistent association found for African American and Hispanic children. Research on contextual and setting-related factors may provide further insights into ethnic and SES disparities in obesity. We examined whether obesity levels among central Texas 8th grade students (n=2682) vary by school-level economic disadvantage across individual-level family SES and racial/ethnicity groups. As a secondary aim, we compared the association of school-level economic disadvantage and obesity by language spoken with parents (English or Spanish) among Hispanic students. Multilevel regression models stratified by family SES and ethnicity were run using cross-sectional baseline data from five school districts participating in the Central Texas CATCH Middle School project. For family SES, independent multi-level logistic regression models were run for total sample and by gender for each family SES stratum (poor/near poor/just getting by, living comfortably, and very well off), adjusting for age, ethnicity, and gender. Similarly, multi-level regression models were run by race/ethnic group (African American, Hispanic, and White), adjusting for age, family SES, and gender. Students attending highly economically disadvantaged (ED) schools were between 1.7 (95% CI: 1.1-2.6) and 2.4 (95% CI: 1.2-4.8) times more likely to be obese as students attending low ED schools across family SES groups (p<.05). African American (OR(Adj) =3.4, 95% CI: 1.1-11.4), Hispanic (OR(Adj)=1.8, 95% CI 1.1-3.0) and White (OR(Adj)=3.8, 95% CI: 1.6-8.9) students attending high ED schools were more likely to be obese as counterparts at low ED schools (p<.05). Gender-stratified findings were similar to findings for total sample, although fewer results reached significance. While no obesity
Álvarez-Castro, Paula; Sangiao-Alvarellos, Susana; Brandón-Sandá, Iria; Cordido, Fernando
Obesity is associated to significant disturbances in endocrine function. Hyper insulinemia and insulin resistance are the best known changes in obesity, but their mechanisms and clinical significance are not clearly established. Adipose tissue is considered to be a hormone-secreting endocrine organ; and increased leptin secretion from the adipocyte, a satiety signal, is a well-established endocrine change in obesity. In obesity there is a decreased GH secretion. Impairment of somatotropic function in obesity is functional and may be reversed in certain circumstances. The pathophysiological mechanism responsible for low GH secretion in obesity is probably multifactorial. There are many data suggesting that a chronic state of somatostatin hypersecretion results in inhibition of GH release. Increased FFA levels, as well as a deficient ghrelin secretion, probably contribute to the impaired GH secretion. In women, abdominal obesity is associated to hyperandrogenism and low sex hormone-binding globulin levels. Obese men, particularly those with morbid obesity, have decreased testosterone and gonadotropin levels. Obesity is associated to an increased cortisol production rate, which is compensated for by a higher cortisol clearance, resulting in plasma free cortisol levels that do not change when body weight increases. Ghrelin is the only known circulating orexigenic factor, and has been found to be decreased in obese people. In obesity there is also a trend to increased TSH and free T3 levels. Copyright © 2011 SEEN. Published by Elsevier Espana. All rights reserved.
Reilly, John J.
This article reviews recent research evidence, largely from systematic reviews, on a number of aspects of childhood obesity: its definition and prevalence; consequences; causes and prevention. The basis of the body mass index (BMI) as a means of defining obesity in children and adolescents is discussed: a high BMI for age constitutes obesity. In…
With Americans fatter and more malnourished than ever--almost two-thirds of the population is considered overweight or obese compared with 56 percent in the late 1980s and early 1990s, and people of color and the poor are the most obese of all--federal and university researchers and outreach workers from various anti-obesity organizations aim to…
Shore, Stephanie A.
Obesity currently affects about one third of the U.S. population, while another one third is overweight. The importance of obesity for certain conditions such as heart disease and type 2 diabetes is well appreciated. The effects of obesity on the respiratory system have received less attention and are the subject of this chapter. Obesity alters the static mechanic properties of the respiratory system leading to a reduction in the functional residual capacity (FRC) and the expiratory reserve volume (ERV). There is substantial variability in the effects of obesity on FRC and ERV, at least some of which is related to the location, rather than the total mass of adipose tissue. Obesity also results in airflow obstruction, which is only partially attributable to breathing at low lung volume, and can also promote airway hyperresponsiveness and asthma. Hypoxemia is common is obesity, and correlates well with FRC, as well as with measures of abdominal obesity. However, obese subjects are usually eucapnic, indicating that hypoventilation is not a common cause of their hypoxemia. Instead, hypoxemia results from ventilation perfusion mismatch caused by closure of dependent airways at FRC. Many obese subjects complain of dyspnea either at rest or during exertion, and the dyspnea score also correlates with reductions in FRC and ERV. Weight reduction should be encouraged in any symptomatic obese individual, since virtually all of the respiratory complications of obesity improve with even moderate weight loss. PMID:23737172
US children are at risk for developing childhood obesity. Currently, 23% of children ages 2–5 are overweight or obese, i.e., at or above the 85th percentile. This prevalence becomes even higher as children age, with 34% of children ages 6–11 being overweight or obese. Ethnic minority children are at...
Reilly, John J.
This article reviews recent research evidence, largely from systematic reviews, on a number of aspects of childhood obesity: its definition and prevalence; consequences; causes and prevention. The basis of the body mass index (BMI) as a means of defining obesity in children and adolescents is discussed: a high BMI for age constitutes obesity. In…
Rand, Colleen S.; Stunkard, Albert J.
This report describes a collaborative study undertaken by 72 psychoanalysts in an effort to (1) collect systematic data about obese patients in psychoanalysis and (2) assess the effect of psychoanalysis in the treatment of obesity. A total of 84 obese and 63 normal weight patients was studied. Each analyst completed a detailed questionnaire on his…
With Americans fatter and more malnourished than ever--almost two-thirds of the population is considered overweight or obese compared with 56 percent in the late 1980s and early 1990s, and people of color and the poor are the most obese of all--federal and university researchers and outreach workers from various anti-obesity organizations aim to…
... NCHS) data brief [PDF-705KB] The prevalence of obesity among children aged 2 to 5 years decreased significantly from ... 2292-9. Top of Page Prevalence of Childhood Obesity among Young Low-Income WIC Children in the United States, 2014 Obesity disproportionally affects ...
... 95th percentile on the CDC growth charts Extreme obesity Children grow at different rates at different times, so ... at: https://www.cdc.gov/nchs/data/hestat/obesity_child_13_14/obesity_child_13_14.htm . Accessed ...
Surwit, Richard S; Williams, Redford B; Lane, James D; Feinglos, Mark N; Kuhn, Cynthia M; Georgiades, Anastasia
The high prevalence of diabetes in African-American (AA) women has been widely assumed to be related to the greater prevalence of obesity in this group. Catecholamine release acting on central adipose tissue has been proposed to be a contributing factor. The aim of this article was to examine the interaction of plasma catecholamines and central adiposity on fasting and nonfasting glucose levels in two separate samples. In both studies, the women were healthy, nondiabetic of similar age. In addition, both studies assessed plasma epinephrine (EPI) and norepinephrine (NOREPI) levels collected at three time points. In study 1, catecholamines were measured during a standardized laboratory mental stress task and in study 2, they were measured during the initial phase (10 min) of an intravenous glucose tolerance test (IVGTT). Results from both studies revealed significant effects of EPI on fasting glucose in the obese women. In study 1, mean EPI levels were significantly related to fasting glucose in AA women with high trunk fat (beta = 0.60, P < 0.001). Because high BMI was associated with high trunk fat in women, we used BMI >30 as a proxy for high trunk fat (>32%) in study 2. In study 2, EPI response to the glucose bolus was a strong predictor of fasting glucose in AA women with BMI >30 (beta = 0.75, P < 0.003). We conclude that the effect of central adiposity on fasting glucose may be moderated by plasma EPI. This suggests that adrenal medullary activity could play a role in the pathophysiology of type 2 diabetes.
Schaefer, Sara E; Camacho-Gomez, Rosa; Sadeghi, Banefsheh; Kaiser, Lucia; German, J Bruce; de la Torre, Adela
In California's agricultural Central Valley, the rate of childhood obesity is higher than the national average. Adequate physical activity contributes to obesity prevention and its assessment is useful to evaluate the impact of interventions. Niños Sanos, Familia Sana (Healthy Children, Healthy Family [NSFS]) uses community-based participatory research to implement an intervention program to reduce childhood obesity among people of Mexican origin in the Central Valley. Anthropometric measurements were conducted on more than 650 children enrolled in NSFS. Physical activity data from a subgroup of children aged 4 to 7 years (n = 134) were collected via a wearable accelerometer. Children were classified on the basis of age and sex-adjusted body mass index as healthy weight (57.7%); overweight (19.3%), or obese (23%). Logistic regression showed that moderate to vigorous physical activity (MVPA) was associated with a child's likelihood of having a healthy BMI (odds ratio: 1.03; 95% CI, 1.01-1.05; P = .017). NSFS's community-based participatory approach resulted in successful use of a commercial electronic device to measure physical activity quantity and quality in this hard-to-reach population. Promotion of adequate daily MVPA is an appropriate and necessary component of NSFS's childhood obesity prevention strategy.
Mauricio, Maria Dolores; Aldasoro, Martin; Ortega, Joaquin; Vila, José María
Morbid obesity is a chronic multifunctional disease characterized by an accumulation of fat. Epidemiological studies have shown that obesity is associated with cardiovascular and metabolic disorders. Endothelial dysfunction, as defined by an imbalance between relaxing and contractile endothelial factors, plays a central role in the pathogenesis of these cardiometabolic diseases. Diminished bioavailability of nitric oxide (NO) contributes to endothelial dysfunction and impairs endothelium- dependent vasodilatation. But this is not the only mechanism that drives to endothelial dysfunction. Obesity has been associated with a chronic inflammatory process, atherosclerosis, and oxidative stress. Moreover levels of asymmetrical dimethyl-L-arginine (ADMA), an endogenous inhibitor of endothelial nitric oxide synthase (eNOS), are elevated in obesity. On the other hand, increasing prostanoid-dependent vasoconstriction and decreasing vasodilator prostanoids also lead to endothelial dysfunction in obesity. Other mechanisms related to endothelin-1 (ET-1) or endothelium derived hyperpolarizing factor (EDHF) have been proposed. Bariatric surgery (BS) is a safe and effective means to achieve significant weight loss, but its use is limited only to patients with severe obesity including morbid obesity. BS also proved efficient in endothelial dysfunction reduction improving cardiovascular and metabolic comorbidities associated with morbid obesity such as diabetes, coronary artery disease, nonalcoholic fatty liver disease and cancer. This review will provide a brief overview of the mechanisms that link obesity with endothelial dysfunction, and how weight loss is a cornerstone treatment for cardiovascular comorbidities obesity-related. A better understanding of the mechanisms of obesity-induced endothelial dysfunction may help develop new therapeutic strategies to reduce cardiovascular morbidity and mortality.
Gami, Apoor S; Caples, Sean M; Somers, Virend K
There is a very high prevalence of OSA in obese individuals and a high prevalence of obesity in patients with OSA. The pathophysiology of OSA is intimately linked to obesity. Anatomic and functional considerations of the pharyngeal airway, the CNS, central obesity, and leptin likely interact in the development of OSA in obese individuals. OSA may itself predispose individuals to worsening obesity because of sleep deprivation, daytime somnolence, and disrupted metabolism. The diagnosis of OSA requires the clinician's awareness of its potential to cause a spectrum of acute and chronic neurocognitive, psychiatric, and nonspecific symptoms in patients who may be unaware that their sleep is disturbed. Symptoms and examination findings help predict which obese individuals have OSA, and polysomnography is the gold standard by which to make the diagnosis and assess the effects of treatment. Numerous disease states are associated with both OSA and obesity, and it is becoming clear that the relationships are mediated by complex interrelated mechanisms. Common diseases and disease mechanisms in OSA and obesity suggest that conditions related to obesity may be better managed if patients, particularly those who are morbidly obese, are evaluated and treated for previously undiagnosed OSA. OSA is cured in only specific cases with craniofacial or upper airway surgery, and the general application of UVP is not efficacious. OSA also can be cured with sufficient lifestyle-mediated or surgical weight loss; however, in the absence of long-term weight maintenance, OSA returns with weight gain. Although not curative, nasal CPAP is the initial treatment of choice for most patients because of its noninvasive approach and technical efficacy. It is limited, however, by patient acceptance and long-term compliance. Advances in mask comfort and use of humidified air should increase its acceptance. Future management strategies include newer generations of positive airway devices that
Wosu, Adaeze C; Vélez, Juan Carlos; Barbosa, Clarita; Andrade, Asterio; Frye, Megan; Chen, Xiaoli; Gelaye, Bizu; Williams, Michelle A
This cross-sectional study evaluates the prevalence and extent to which high risk for obstructive sleep apnea (OSA) is associated with general obesity and central obesity among college students in Punta Arenas, Chile. Risk for OSA was assessed using the Berlin Questionnaire and trained research nurses measured anthropometric indices. Overweight was defined as body mass index (BMI) of 25-29.9 kg/m(2) and general obesity was defined as BMI ≥ 30 kg/m(2). Central obesity was defined as waist circumference ≥90 centimeters (cm) for males and ≥80 cm for females. Multivariate logistic regression models were fit to obtain adjusted odds ratios (OR) and 95% confidence intervals (CI). Prevalence of high risk for OSA, general obesity, and central obesity were 7.8%, 12.8%, and 42.7%, respectively. Students at high risk for OSA had greater odds of general obesity (OR 9.96; 95% CI: 4.42-22.45) and central obesity (OR 2.78; 95% CI 1.43-5.40). Findings support a strong positive association of high risk for OSA with obesity.
Barbosa, Clarita; Andrade, Asterio; Frye, Megan; Williams, Michelle A.
This cross-sectional study evaluates the prevalence and extent to which high risk for obstructive sleep apnea (OSA) is associated with general obesity and central obesity among college students in Punta Arenas, Chile. Risk for OSA was assessed using the Berlin Questionnaire and trained research nurses measured anthropometric indices. Overweight was defined as body mass index (BMI) of 25–29.9 kg/m2 and general obesity was defined as BMI ≥ 30 kg/m2. Central obesity was defined as waist circumference ≥90 centimeters (cm) for males and ≥80 cm for females. Multivariate logistic regression models were fit to obtain adjusted odds ratios (OR) and 95% confidence intervals (CI). Prevalence of high risk for OSA, general obesity, and central obesity were 7.8%, 12.8%, and 42.7%, respectively. Students at high risk for OSA had greater odds of general obesity (OR 9.96; 95% CI: 4.42–22.45) and central obesity (OR 2.78; 95% CI 1.43–5.40). Findings support a strong positive association of high risk for OSA with obesity. PMID:24944841
Zhu, Zhengbao; Zhang, Qiu; Peng, Hao; Zhong, Chongke; Liu, Yan; Huangfu, Xinfeng; Tian, Yunfan; Chao, Xiangqin; Wang, Aili; Jin, Jianhua; Zhang, Yonghong
Atrial natriuretic peptide (ANP) and its prohormone activating enzyme are associated with central obesity, suggesting there may be a potential relationship between proANP1-98 and central obesity. However, the association is still lack of population-based evidence. We explored the association in a general population of China. We measured plasma proANP1-98, waist circumference and other traditional biomarkers in 2203 participants aged≥30y. Multivariate logistic regression models were used to determine the association between plasma proANP1-98 and central obesity, and odds ratio (OR) and 95% confidence interval (CI) were calculated. High proANP1-98 was significantly associated with increased risk of central obesity in participants, and the multivariate adjusted OR (95% CI) of central obesity associated with the second, third and fourth quartiles of proANP1-98 were 1.33 (1.03-1.72), 1.69 (1.31-2.19) and 1.76 (1.35-2.29), respectively, compared with the lowest quartile of proANP1-98. There was a dose-response relationship between proANP1-98 and risk of central obesity among the participants (Ptrend<0.001). Sensitivity analyses further confirmed these associations. Adding proANP1-98 to a model containing conventional risk factors improved discriminatory power of central obesity (as shown by significant improvement in continuous NRI and IDI). Contrary to known reduced ANP levels in central obesity, we found that plasma proANP1-98 was positively associated with central obesity, suggesting that elevated plasma proANP1-98 may be a marker or a risk factor for central obesity. Copyright © 2017. Published by Elsevier B.V.
Yoshida, Yilin; Scribner, Richard; Chen, Liwei; Broyles, Stephanie; Phillippi, Stephen; Tseng, Tung-Sung
Using the Healthy Eating Index-2010 (HEI-2010), the present study aimed to examine diet quality and the impact of overall diet quality and its components on central obesity among Mexican-American men and women. Cross-sectional data from NHANES 1999-2012 were used. The HEI-2010 data, including twelve components for a total score of 100, were collected with a 24 h recall interview. Central obesity was defined as a waist circumference of ≥88 cm for women and ≥102 cm for men. Weighted logistic regressions were performed to assess associations between HEI-2010 scores and central obesity. National Health and Nutrition Examination Survey (NHANES) 1999-2012. A total of 6847 Mexican Americans aged ≥20 years with reliable dietary recall status and non-pregnancy status. Higher HEI-2010 total score was associated with lower odds of central obesity in Mexican-American men (OR; 95 % CI=0·98; 0·98, 1·00). Among all Mexican Americans, one-unit higher score of total fruit and sodium (i.e. lower level of intake) was associated with 4 % (0·96; 0·93, 0·99) and 2 % (0·98; 0·96, 0·99) lower odds of central obesity, respectively. However, a higher total proteins score was associated with higher odds of central obesity (1·08; 1·00, 1·16). In gender-specific analyses, a higher whole fruit or sodium score was inversely associated with central obesity in men but not in women. HEI-2010 scores of total fruit and sodium were inversely associated with central obesity among all Mexican Americans. However, total proteins score and central obesity was positively associated. In Mexican-American men, HEI-2010 total and whole fruit scores were inversely associated with central obesity.
Arroyo-Johnson, Cassandra; Mincey, Krista D
Obesity continues to be a public health concern across the globe. Obesity has a demonstrated association with health behaviors and health outcomes, such as diabetes, hypertension, and cancer. Over the past 2 decades, obesity has increased worldwide and remains highest in the United States. It is critical to understand the definition of obesity, using body mass index appropriately, recent estimates, and risk factors as a framework within which clinicians should work to help reduce the burden of obesity. This framework, including the Healthy People 2020 place-based approach to social determinants of health, is described in this article. Copyright © 2016 Elsevier Inc. All rights reserved.
Salaün, Hélène; Thariat, Juliette; Vignot, Marina; Merrouche, Yacine; Vignot, Stéphane
The proportion of people affected by obesity is increasing and this finding emphasizes several issues in oncology: obesity as a risk factor for cancer, prognostic value of obesity in cancer patients, nutritional assessment in overweight patients and impact of obesity on treatment management. It is important to remember the common underevaluation of malnutrition in overweight or obese patients. Every caregiver must be especially careful about the management of comorbidities in these patients. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.
Vázquez García, Juan Carlos
Obesity and asthma are two disorders of high and increasing worldwide prevalence. A consistent association between obesity and asthma has been recently found in case-control, cross-sectional and longitudinal studies. This association is more consistent in women after the puberty. Moreover, an improvement in the severity of asthma has been described after weight reduction in obese patients. A causal association between asthma and obesity may represent an additional respiratory work that could increase the morbidity and medical expenditures. The most striking studies which demonstrate association between obesity and asthma and the possible causal mechanisms are reviewed.
Catalano, Patrick M
Maternal pregravid obesity is a significant risk factor for adverse outcomes during pregnancy. In early pregnancy there is an increased risk of spontaneous abortion and congenital anomalies. In later gestation maternal metabolic manifestations of the metabolic syndrome, such as gestational hypertensive disorders and diabetes, become clinically recognized because of the increased insulin resistance in obese compared with nonobese women. In women with pregestational glucose intolerance, hypertension, central obesity, and lipid disorders, the physiologic changes in pregnancy increase the risk of problems previously not routinely encountered during pregnancy. These include chronic cardiac dysfunction, proteinuria, sleep apnea, and nonalcoholic fatty liver disease. At parturition the obese patient is at an increased risk of cesarean delivery and associated complications of anesthesia, wound disruption, infection, and deep venous thrombophlebitis. For the fetus there are short-term risks of fetal macrosomia, more specifically obesity, and long-term risks of adolescent components of the metabolic syndrome. Although preliminary results of bariatric surgery are encouraging, the procedure is expensive and not for all obese women, and we recognize that long-term follow-up data on offspring of obese women who have undergone bariatric surgery before pregnancy are lacking. In the interim, we need to encourage obese women to lose weight before conception, using lifestyle changes if possible. During pregnancy, weight gain should be limited to Institute of Medicine guidelines (currently under review) and encouragement given for physical activity.
This study assesses whether oxidative stress, using oxidized LDL (ox-LDL) as a proxy, is associated with metabolic syndrome (MS), whether ox-LDL mediates the association between central obesity and MS, and whether insulin resistance mediates the association between ox-LDL and MS. We examined baselin...
Jiang, Shu-Zhong; Lu, Wen; Zong, Xue-Feng; Ruan, Hong-Yun; Liu, Yi
The imbalance between energy intake and expenditure is the main cause of excessive overweight and obesity. Technically, obesity is defined as the abnormal accumulation of ≥20% of body fat, over the individual's ideal body weight. The latter constitutes the maximal healthful value for an individual that is calculated based chiefly on the height, age, build and degree of muscular development. However, obesity is diagnosed by measuring the weight in relation to the height of an individual, thereby determining or calculating the body mass index. The National Institutes of Health have defined 30 kg/m2 as the limit over which an individual is qualified as obese. Accordingly, the prevalence of obesity in on the increase in children and adults worldwide, despite World Health Organization warnings. The growth of obesity and the scale of associated health issues induce serious consequences for individuals and governmental health systems. Excessive overweight remains among the most neglected public health issues worldwide, while obesity is associated with increasing risks of disability, illness and death. Cardiovascular diseases, the leading cause of mortality worldwide, particularly hypertension and diabetes, are the main illnesses associated with obesity. Nevertheless, the mechanisms underlying obesity-associated hypertension or other associated metabolic diseases remains to be adequately investigated. In the present review, we addressed the association between obesity and cardiovascular disease, particularly the biological mechanisms linking obesity and hypertension. PMID:27703502
Turzyniecka, M; Wild, S H; Krentz, A J; Chipperfield, A J; Clough, G F; Byrne, C D
Cardiorespiratory fitness [maximal O2 consumption (VO2max)] is an independent risk factor for type 2 diabetes; but in individuals at risk, factors influencing VO2max are poorly understood. We tested the hypothesis that VO2max is associated with diastolic function [subendocardial variability ratio (SEVR), %], as diastolic function influences myocardial perfusion. We studied 47 men and women with central obesity without diabetes. We measured fitness (VO2max) by treadmill testing and diastolic function (SEVR%) by pulse-wave analysis. We measured other factors influencing this relationship: insulin sensitivity [whole body glucose uptake-to-insulin concentration ratio (M/I)] by hyperinsulinemic euglycemic clamp, fatness by MR imaging and dual-energy X-ray absorptiometry, physical activity energy expenditure (metabolic equivalents of tasks) by the Sensewear Pro2 device, and muscle microvascular exchange capacity (capillary filtration coefficient) by venous plethysmography. Mean age of the subjects was 51+/-9 (SD) yr. VO2max was associated with SEVR% (r=0.50, P=0.001), fatness (r=-0.39, P=0.008), and HbA1c (r=-0.35, P=0.018), but not with whole body glucose uptake-to-insulin concentration ratio, metabolic equivalents of tasks, or capillary filtration coefficient. In regression modeling with age, sex, fatness, and SEVR% as explanatory variables, only age, sex, and SEVR% were independently associated with VO2max (SEVR%--standardized B coefficient=0.37, 95% confidence interval=0.003-0.18, P=0.007). This model identified 46% of the variance in VO2max (R2=0.46, P=0.0001). There was a strong, independent association between VO2max and a measure of diastolic function in sedentary individuals with central obesity.
Tyrovolas, Stefanos; Koyanagi, Ai; Garin, Noe; Olaya, Beatriz; Ayuso-Mateos, Jose Luis; Miret, Marta; Chatterji, Somnath; Tobiasz-Adamczyk, Beata; Koskinen, Seppo; Leonardi, Matilde; Haro, Josep Maria
The aim of the study was to evaluate the association between various factors and diabetes type II (DM) with a particular emphasis on indicators of central obesity, and to compare the effect of DM on disability among elder populations (≥ 50 years old) in nine countries. Data were available for 52,946 people aged ≥ 18 years who participated in the WHO Study on global AGEing and adult health and the Collaborative Research on Ageing in Europe studies conducted between 2007 and 2012. DM was defined as self-report of physician diagnosis. Height, weight, and waist circumference were measured. Disability status was assessed with the WHODAS II questionnaire. The overall prevalence of DM was 7.9% and ranged from 3.8% (Ghana) to 17.6% (Mexico). A 10 cm increase in waist circumference and waist-to-height ratio of >0.5 were associated with a significant 1.26 (India) to 1.77 (Finland), and 1.68 (China, Spain) to 5.40 (Finland) times higher odds for DM respectively. No significant associations were observed in Mexico and South Africa. DM was associated with significantly higher disability status in all countries except Mexico in the model adjusted for demographics and smoking. The inclusion of chronic conditions associated with diabetes in the model attenuated the coefficients in varying degrees depending on the country. A considerable proportion of the studied older population had DM. Central obesity may be a key factor for the prevention of DM among older populations globally. Prevention of DM especially among the older population globally may contribute to reducing the burden of disability.
Hurtado-Roca, Yamilee; Bueno, Hector; Fernandez-Ortiz, Antonio; Ordovas, Jose Maria; Ibañez, Borja; Fuster, Valentin; Rodriguez-Artalejo, Fernando; Laclaustra, Martin
This study assesses whether oxidative stress, using oxidized LDL (ox-LDL) as a proxy, is associated with metabolic syndrome (MS), whether ox-LDL mediates the association between central obesity and MS, and whether insulin resistance mediates the association between ox-LDL and MS. We examined baseline data from 3,987 subjects without diabetes in the Progression of Early Subclinical Atherosclerosis (PESA) Study. For the second, third, and fourth ox-LDL quartiles versus the first, the odds ratios (95% CI) for MS were 0.84 (0.52, 1.36), 1.47 (0.95, 2.32), and 2.57 (1.66, 4.04) (P < 0.001 for trend) once adjusted for age, sex, smoking, LDL-cholesterol, BMI, waist circumference, and HOMA-insulin resistance (HOMA-IR). Results showing the same trend were found for all MS components except glucose concentration. Ox-LDL mediated 13.9% of the association of waist circumference with triglycerides and only 1-3% of the association with HDL-cholesterol, blood pressure, and insulin concentration. HOMA-IR did not mediate the association between ox-LDL and MS components. This study found higher ox-LDL concentrations were associated with MS and its components independently of central obesity and insulin resistance. Ox-LDL may reflect core mechanisms through which MS components develop and progress in parallel with insulin resistance and could be a clinically relevant predictor of MS development. © 2017 by the American Diabetes Association.
Strawbridge, Rona J.; Laumen, Helmut; Hamsten, Anders; Breier, Michaela; Grallert, Harald; Hauner, Hans; Arner, Peter; Dahlman, Ingrid
Objectives Numerous genetic loci have been associated with measures of central fat accumulation, such as waist-to-hip ratio adjusted for body mass index (WHRadjBMI). However the mechanisms by which genetic variations influence obesity remain largely elusive. Lipolysis is a key process for regulation of lipid storage in adipocytes, thus is implicated in obesity and its metabolic complications. Here, genetic variants at 36 WHRadjBMI-associated loci were examined for their influence on abdominal subcutaneous adipocyte lipolysis. Subjects and Methods Fasting subcutaneous adipose tissue biopsies were collected from 789 volunteers (587 women and 202 men, body mass index (BMI) range 17.7–62.3 kg/m2). We quantified subcutaneous adipocyte lipolysis, both spontaneous and stimulated by the catecholamine isoprenaline or a cyclic AMP analogue. DNA was extracted from peripheral blood mononuclear cells and genotyping of SNPs associated with WHRadjBMI conducted. The effects on adipocyte lipolysis measures were assessed for SNPs individually and combined in a SNP score. Results The WHRadjBMI-associated loci CMIP, PLXND1, VEGFA and ZNRF3-KREMEN1 demonstrated nominal associations with spontaneous and/or stimulated lipolysis. Candidate genes in these loci have been reported to influence NFκB-signaling, fat cell size and Wnt signalling, all of which may influence lipolysis. Significance This report provides evidence for specific WHRadjBMI-associated loci as candidates to modulate adipocyte lipolysis. Additionally, our data suggests that genetically increased central fat accumulation is unlikely to be a major cause of altered lipolysis in abdominal adipocytes. PMID:27104953
There is no single unifying theory to explain the aetiology of obesity but several environmental factors, such as decreased physical activity and increased fat intake may contribute to its development in genetically predisposed individuals. Dietary and pharmacological treatments of morbid obesity have been proven to be unsuccessful. Modern surgical treatments have been shown to be effective in achieving significant weight loss with consequent reduction in morbidity. Despite the fact that surgical treatment of morbid obesity is the only therapeutic form that has stood the test of time, it still remains a crisis-driven form of therapy in the UK. It is probable that a better understanding of the aetiology and physiology of obesity may lead to the development of an effective pharmacological treatment of obesity in the future. However, until then, surgical treatment of morbid obesity should be considered as an effective and efficient way of treatment in selected cases. Keywords: obesity PMID:10396579
Rice, Mary; Malhotra, Atul
Obesity prevalence continues to increase globally, with figures exceeding 30% of some populations. Patients who are obese experience alterations in baseline pulmonary mechanics, including airflow obstruction, decreased lung volumes, and impaired gas exchange. These physiologic changes have implications in many diseases, including ARDS. The unique physiology of patients who are obese affects the presentation and pathophysiology of ARDS, and patients who are obese who have respiratory failure present specific management challenges. Although more study is forthcoming, ventilator strategies that focus on transpulmonary pressure as a measure of lung stress show promise in pilot studies. Given the increasing prevalence of obesity and the variable effects of obesity on respiratory mechanics and ARDS pathophysiology, we recommend an individualized approach to the management of the obese patient with ARDS. PMID:22948584
Acosta, Andres; Camilleri, Michael
Obesity is a complex disease that results from increased energy intake and decreased energy expenditure. The gastrointestinal system plays a key role in the pathogenesis of obesity and facilitates caloric imbalance. Changes in gastrointestinal hormones and the inhibition of mechanisms that curtail caloric intake result in weight gain. It is not clear if the gastrointestinal role in obesity is a cause or an effect of this disease. Obesity is often associated with type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). Obesity is also associated with gastrointestinal disorders, which are more frequent and present earlier than T2DM and CVD. Diseases such as gastro-esophageal reflux disease, cholelithiasis or non-alcoholic steatohepatitis are directly related to body weight and abdominal adiposity. Our objective is to assess the role of each gastrointestinal organ in obesity and the gastrointestinal morbidity resulting in those organs from effects of obesity. PMID:24602085
Azarbad, Leila; Gonder-Frederick, Linda
Obesity carries a unique disease burden on women and is influenced by a variety of biological, hormonal, environmental, and cultural factors. Reproductive transitions, such as pregnancy and menopause, increase the risk for obesity. Psychologically, obese women experience greater weight-related stigma and discrimination and are at increased risk for depression than obese men. Women are also particularly susceptible to psychological stress, sleep debt, and lack of physical activity, all of which are risk factors for the development of excess weight. Obesity risk is increased among women with psychiatric disorders and those who use certain psychotropic medications. Obesity treatment should take into consideration degree of obesity, health risks, past weight loss attempts, and individual differences in motivation and readiness for treatment. Copyright 2010 Elsevier Inc. All rights reserved.
Leeners, Brigitte; Geary, Nori; Tobler, Philippe N; Asarian, Lori
Obesity is caused by an imbalance between energy intake, i.e. eating and energy expenditure (EE). Severe obesity is more prevalent in women than men worldwide, and obesity pathophysiology and the resultant obesity-related disease risks differ in women and men. The underlying mechanisms are largely unknown. Pre-clinical and clinical research indicate that ovarian hormones may play a major role. We systematically reviewed the clinical and pre-clinical literature on the effects of ovarian hormones on the physiology of adipose tissue (AT) and the regulation of AT mass by energy intake and EE. Articles in English indexed in PubMed through January 2016 were searched using keywords related to: (i) reproductive hormones, (ii) weight regulation and (iii) central nervous system. We sought to identify emerging research foci with clinical translational potential rather than to provide a comprehensive review. We find that estrogens play a leading role in the causes and consequences of female obesity. With respect to adiposity, estrogens synergize with AT genes to increase gluteofemoral subcutaneous AT mass and decrease central AT mass in reproductive-age women, which leads to protective cardiometabolic effects. Loss of estrogens after menopause, independent of aging, increases total AT mass and decreases lean body mass, so that there is little net effect on body weight. Menopause also partially reverses women's protective AT distribution. These effects can be counteracted by estrogen treatment. With respect to eating, increasing estrogen levels progressively decrease eating during the follicular and peri-ovulatory phases of the menstrual cycle. Progestin levels are associated with eating during the luteal phase, but there does not appear to be a causal relationship. Progestins may increase binge eating and eating stimulated by negative emotional states during the luteal phase. Pre-clinical research indicates that one mechanism for the pre-ovulatory decrease in eating is a
Obesity is a risk factor for asthma, but standard asthma drugs have reduced efficacy in the obese. Obesity alters the gastrointestinal microbial community structure. This change in structure contributes to some obesity-related conditions and also could be contributing to obesity-related asthma. Although currently unexplored, obesity may also be altering lung microbiota. Understanding the role of microbiota in obesity-related asthma could lead to novel treatments for these patients. PMID:26889016
Cho, Youngji; Shore, Stephanie A
Obesity is a risk factor for asthma, but standard asthma drugs have reduced efficacy in the obese. Obesity alters the gastrointestinal microbial community structure. This change in structure contributes to some obesity-related conditions and also could be contributing to obesity-related asthma. Although currently unexplored, obesity may also be altering lung microbiota. Understanding the role of microbiota in obesity-related asthma could lead to novel treatments for these patients. ©2016 Int. Union Physiol. Sci./Am. Physiol. Soc.
Zhang, Li-Dan; Li, Yan-Hong; Ke, Zhi-Yong; Huang, Li-Bin; Luo, Xue-Qun
A 6-year-old boy with acute lymphoblastic leukemia in remission experienced hyperphagia, obesity, and emotional disorders. Cytomorphologic examination of cerebral spinal fluid (CSF) and cranial MRI did not help in differentiating between central nervous system leukemia (CNSL) and other CNS diseases including tuberculosis in this boy. Flow cytometric CSF analysis on repeated lumber puncture detected lymphoblasts, while microscopic CSF examination did not definitively show relapse disease. The diagnosis of CNSL was thus made and confirmed by the response to leukemia treatment. Obesity can be the first manifestation of CNSL and the diagnosis can be challenging. A combination of CSF cytomorphology, CSF flow cytometry, and cranial MRI can be useful in the diagnosis of the disease. Two mechanisms of CNSL-related obesity are discussed based on the literature review.
Dong, Z; Chen, X; Li, L; Huang, J; Yin, Q; Yang, D
Women with polycystic ovary syndrome (PCOS) have increased risks of developing metabolic abnormalities compared with the women without PCOS. Hyperandrogenemia is one of the most important characteristics of PCOS. However, the correlations between hyperandrogenemia and metabolic disorders are uncertain. To elucidate the relationship between androgen indices and metabolic abnormalities in Chinese women with PCOS. A retrospective analysis of the anthropometric and biochemical records of 408 women with PCOS. The prevalence of metabolic syndrome (MetS) was 15.7% in women with PCOS. No association existed between total testosterone (TT) and metabolic profile. Free testosterone (FT) correlated with most of the metabolic variables by unadjusted correlation analyses. The women with elevated FT levels exhibited more unfavorable metabolic profiles compared with the women with normal FT levels. After adjusting for the confounding factors by multivariate logistic regression analysis, the women with elevated FT levels had higher prevalence of central obesity than the women with normal FT levels (odds ratio [OR] 2.346, p=0.042). Women with reduced sex hormone-binding globulin levels were more likely to have central obesity, overweight, raised fasting glucose, insulin resistance, and raised diastolic blood pressure. Raised dehydroepiandrosterone sulfate (DHEAS) level was associated with a lower probability of having central obesity (OR 0.293, p=0.001) and overweight (OR 0.47, p=0.023). FT has closer association with metabolic parameters than TT. FT can involve in the development of metabolic disorders dependent on central obesity. Raised DHEAS level can reduce the risks of central obesity and overweight. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.
Buckman, Laura B; Hasty, Alyssa H; Flaherty, David K; Buckman, Christopher T; Thompson, Misty M; Matlock, Brittany K; Weller, Kevin; Ellacott, Kate L J
Obesity is associated with chronic low-grade inflammation in peripheral tissues caused, in part, by the recruitment of inflammatory monocytes into adipose tissue. Studies in rodent models have also shown increased inflammation in the central nervous system (CNS) during obesity. The goal of this study was to determine whether obesity is associated with recruitment of peripheral immune cells into the CNS. To do this we used a bone marrow chimerism model to track the entry of green-fluorescent protein (GFP) labeled peripheral immune cells into the CNS. Flow cytometry was used to quantify the number of GFP(+) immune cells recruited into the CNS of mice fed a high-fat diet compared to standard chow fed controls. High-fat feeding resulted in obesity associated with a 30% increase in the number of GFP(+) cells in the CNS compared to control mice. Greater than 80% of the GFP(+) cells recruited to the CNS were also CD45(+) CD11b(+) indicating that the GFP(+) cells displayed characteristics of microglia/macrophages. Immunohistochemistry further confirmed the increase in GFP(+) cells in the CNS of the high-fat fed group and also indicated that 93% of the recruited cells were found in the parenchyma and had a stellate morphology. These findings indicate that peripheral immune cells can be recruited to the CNS in obesity and may contribute to the inflammatory response.
Bienertová-Vašků, Julie; Novák, Jan; Zlámal, Filip; Forejt, Martin; Havlenová, Soňa; Jackowská, Aneta; Tomandl, Josef; Tomandlová, Marie; Šplíchal, Zbyněk; Vašků, Anna
This study was designed to investigate the relationship between 8 selected adipokines (leptin, leptin receptor, adiponectin, agouti-related peptide, omentin, visfatin, adipsin and resistin), dietary composition and anthropometric parameters found in the Central European obese population. A total of 65 unrelated obese Central European Caucasian individuals were recruited for the study. Phenotypic measurements included weight, height, BMI, lean body mass, fat mass, body fat, waist and hip circumference, waist-hip ratio (WHR) and skinfold thickness. Participants completed standardized self-reported 7-day food records. Plasma levels of leptin, leptin receptor, adiponectin, agouti-related peptide (AgRP), resistin, adipsin, omentin and visfatin were examined using ELISA. Multiple associations (weight, height, percentage of body fat, waist circumference, hip circumference, WHR and sum of skinfold thickness) with the circulation levels of the investigated adipokines were identified. Leptin-Leptin receptor (L-LR) levels were found to correlate with total energy intake and macronutrients while adipsin was found to strongly correlate with multiple adipokines. Furthermore, the L-LR index was found to constitute a more accurate description of the relationship between BMI and body weight than individual measurements and the Ag-LR index was found to strongly correlate with both anthropometric and dietary characteristics. Following confirmation on larger population samples and on samples of different ethnicities, the reported adipokine indexes could become a useful tool for estimating nutritional status and predicting the body composition of specific patient groups. Copyright © 2014 Elsevier Ltd. All rights reserved.
Bournat, Juan C.; Brown, Chester W.
Purpose of the Review The review highlights recent findings regarding the functions of mitochondria in adipocytes, providing an understanding of their central roles in regulating substrate metabolism, energy expenditure, disposal of reactive oxygen species (ROS), and in the pathophysiology of obesity and insulin resistance, as well as roles in the mechanisms that affect adipogenesis and mature adipocyte function. Recent Findings Nutrient excess leads to mitochondrial dysfunction, which in turn leads to obesity-related pathologies, in part due to the harmful effects of ROS. The recent recognition of “ectopic” brown adipose in humans suggests that this tissue may play an underappreciated role in the control of energy expenditure. Transcription factors, PGC-1α and PRDM16, which regulate brown adipogenesis, and members of the TGF–β superfamily that modulate this process may be important new targets for anti-obesity drugs. Summary Mitochondria play central roles in ATP production, energy expenditure, and disposal of ROS. Excessive energy substrates lead to mitochondrial dysfunction with consequential effects on lipid and glucose metabolism. Adipocytes help to maintain the appropriate balance between energy storage and expenditure and maintaining this balance requires normal mitochondrial function. Many adipokines, including members of the TGF-beta superfamily, and transcriptional co-activators, PGC-1α and PRDM16, are important regulators of this process. PMID:20585248
How, Jackie M Y; Wardak, Suhail A; Ameer, Shaik I; Davey, Rachel A; Sartor, Daniela M
The gut hormone cholecystokinin (CCK) acts at subdiaphragmatic vagal afferents to induce renal and splanchnic sympathoinhibition and vasodilatation, via reflex inhibition of a subclass of cardiovascular-controlling neurons in the rostroventrolateral medulla (RVLM). These sympathoinhibitory and vasodilator responses are blunted in obese, hypertensive rats and our aim in the present study was to determine whether this is attributable to (i) altered sensitivity of presympathetic vasomotor RVLM neurons, and (ii) aberrant peripheral or central signalling mechanisms. Using a diet-induced obesity model, male Sprague–Dawley rats exhibited either an obesity-prone (OP) or obesity-resistant (OR) phenotype when placed on a medium high fat diet for 13–15 weeks; control animals were placed on a low fat diet. OP animals had elevated resting arterial pressure compared to OR/control animals (P < 0.05). Barosensitivity of RVLM neurons was significantly attenuated in OP animals (P < 0.05), suggesting altered baroreflex gain. CCK induced inhibitory responses in RVLM neurons of OR/control animals but not OP animals. Subdiaphragmatic vagal nerve responsiveness to CCK and CCK1 receptor mRNA expression in nodose ganglia did not differ between the groups, but CCK induced significantly less Fos-like immunoreactivity in both the nucleus of the solitary tract and the caudal ventrolateral medulla of OP animals compared to controls (P < 0.05). These results suggest that blunted sympathoinhibitory and vasodilator responses in obesity-related hypertension are due to alterations in RVLM neuronal responses, resulting from aberrant central but not peripheral signalling mechanisms. In obesity, blunted sympathoinhibitory mechanisms may lead to increased regional vascular resistance and contribute to the development of hypertension. PMID:24492842
Shen, Yue; Chandak, Giriraj R.; Zhao, Xiaoyuan; Hou, Dongqing; Wu, Lijun; Wang, Xingyu; Mi, Jie
Objective Recent genome-wide association studies have identified many single nucleotide polymorphisms (SNPs) associated with body mass index (BMI)/generalized obesity. In this study, we aimed to examine the associations of identified SNPs with risk of central obesity in a child population from China. Methods We genotyped 11 SNPs (FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397, BDNF rs6265, FAIM2 rs7138803, NPC1 rs1805081, SEC16B rs10913469, SH2B1 rs4788102, PCSK1rs6235, KCTD15 rs29941, BAT2 rs2844479) in the Chinese children (N = 3502, age range 6–18 years) from the Beijing Child and Adolescent Metabolic Syndrome (BCAMS). Based on the age- and sex- specific waist circumference (WC) standards generated in the BCAMS study, 1196 central obese cases and 2306 controls were identified. Results Of 11 studied SNPs, four SNPs and genetic risk score (GRS) based on them were statistically significantly associated with central obesity by WC criteria (FTO rs9939609: OR = 1.29, 95%CI = 1.10–1.50, p = 0.001; MC4R rs17782313: OR = 1.27, 95%CI = 1.12–1.44, p = 1.32×10−4; GNPDA2 rs10938397: OR = 1.22, 95%CI = 1.09–1.37, p = 4.09×10−4; BDNF rs6265: OR = 1.20, 95%CI = 1.08–1.34, p = 8.86×10−4; GRS: OR = 1.25, 95%CI 1.16–1.34, p = 2.58×10−9) after adjustment for sex, age, pubertal stage, physical activity and family history of obesity. Similar observations were made using weight-to-height ratio (WHtR) criterion. However, other SNPs were not associated with central obesity by WC as well as WHtR criterion. Conclusions Our study replicates the statistically significant association of four SNPs (FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397, BDNF rs6265) with risk of central obesity in the Chinese children. PMID:23424664
Ramos Salas, X; Forhan, M; Sharma, A M
Misinformation or myths about obesity can lead to weight bias and obesity stigma. Counteracting myths with facts and evidence has been shown to be effective educational tools to increase an individuals' knowledge about a certain condition and to reduce stigma.The purpose of this study was to identify common obesity myths within the healthcare and public domains and to develop evidence-based counterarguments to diffuse them. An online search of grey literature, media and public health information sources was conducted to identify common obesity myths. A list of 10 obesity myths was developed and reviewed by obesity experts and key opinion leaders. Counterarguments were developed using current research evidence and validated by obesity experts. A survey of obesity experts and health professionals was conducted to determine the usability and potential effectiveness of the myth-fact messages to reduce weight bias. A total of 754 individuals responded to the request to complete the survey. Of those who responded, 464 (61.5%) completed the survey. All 10 obesity myths were identified to be deeply pervasive within Canadian healthcare and public domains. Although the myth-fact messages were endorsed, respondents also indicated that they would likely not be sufficient to reduce weight bias. Diffusing deeply pervasive obesity myths will require multilevel approaches.
Kurukulasuriya, L Romayne; Stas, Sameer; Lastra, Guido; Manrique, Camila; Sowers, James R
Obesity and HTN are on the rise in the world. HTN seems to be the most common obesity-related health problem and visceral obesity seems to be the major culprit. Unfortunately, only 31% of hypertensives are treated to goal. This translates into an increased incidence of CVD and related morbidity and mortality. Several mechanisms have been postulated as the causes of obesity-related HTN. Activation of the RAAS, SNS, insulin resistance, leptin, adiponectin, dysfunctional fat, FFA, resistin, 11 Beta dehydrogenase, renal structural and hemodynamic changes, and OSA are some of the abnormalities in obesity-related HTN. Many of these factors are interrelated. Treatment of obesity should begin with weight loss via lifestyle modifications, medications, or bariatric surgery. According to the mechanisms of obesity-related HTN, it seems that drugs that blockade the RAAS and target the SNS should be ideal for treatment. There is not much evidence in the literature that one drug is better than another in controlling obesity-related HTN. There have only been a few studies specifically targeting the obese hypertensive patient, but recent trials that emphasize the importance of BP control have enrolled both overweight and obese subjects. Until we have further studies with more in-depth information about the mechanisms of obesity-related HTN and what the targeted treatment should be, the most important factor necessary to control the obesity-related HTN pandemic and its CVD and CKD consequences is to prevent and treat obesity and to treat HTN to goal. Copyright © 2011 Elsevier Inc. All rights reserved.
Bernardi, Juliana Rombaldi; Goldani, Marcelo Zubaran; Pinheiro, Tanara Vogel; Guimarães, Luciano Santos Pinto; Bettiol, Heloisa; da Silva, Antônio Augusto Moura; Barbieri, Marco Antônio
Little is known about the interaction between gender and low birth weight (LBW) and lifelong social mobility as an explanation of the etiology of obesity. The aim of the present study was to evaluate total and central obesity according to gender, LBW and social mobility, within the context of the epidemiological transition in middle-income countries. We hypothesize that there are more pronounced metabolic consequences of social mobility for women born with LBW. We used data from a birth cohort study conducted in Ribeirão Preto, São Paulo, Brazil. Data regarding anthropometric measurements, schooling and smoking status were collected at 23-25 years of age. Social mobility was determined based on maternal and adult offspring schooling and categorized as Low-Low, Low-High and High-High. Analysis of covariance was performed to assess the association between social mobility and body mass index (BMI) or waist circumference (WC) in adulthood, stratified by LBW and gender. Data on 6827 singleton pregnancies were collected at birth in 1978/79 and a sample was followed up in 2002/04. A total of 2063 subjects were included in the study. Mean age was 23.9 ± 0.7 years, 51.8% (n = 1068) were female and the LBW was 6.2% (n = 128). There was a triple interaction between social mobility, LBW and gender. Among women born without LBW, BMI and WC were higher in the Low-Low group compared to High-High schooling group. Among LBW women, BMI and WC were higher in the Low-Low group compared to the Low-High group. Women born with LBW belonging to the low schooling group in early adulthood had high BMI and WC, compared to the Low-High social mobility group.
Sáinz, Neira; Barrenetxe, Jaione; Moreno-Aliaga, María J; Martínez, José Alfredo
Obesity is a chronic disease that represents one of the most serious global health burdens associated to an excess of body fat resulting from an imbalance between energy intake and expenditure, which is regulated by environmental and genetic interactions. The adipose-derived hormone leptin acts via a specific receptor in the brain to regulate energy balance and body weight, although this protein can also elicit a myriad of actions in peripheral tissues. Obese individuals, rather than be leptin deficient, have in most cases, high levels of circulating leptin. The failure of these high levels to control body weight suggests the presence of a resistance process to the hormone that could be partly responsible of disturbances on body weight regulation. Furthermore, leptin resistance can impair physiological peripheral functions of leptin such as lipid and carbohydrate metabolism and nutrient intestinal utilization. The present document summarizes those findings regarding leptin resistance development and the role of this hormone in the development and maintenance of an obese state. Thus, we focused on the effect of the impaired leptin action on adipose tissue, liver, skeletal muscle and intestinal function and the accompanying relationships with diet-induced obesity. The involvement of some inflammatory mediators implicated in the development of obesity and their roles in leptin resistance development are also discussed.
Ochoa-Repáraz, Javier; Kasper, Lloyd H
The gut-brain axis is a bi-directional integrated system composed by immune, endocrine, and neuronal components by which the gap between the gut microbiota and the brain is significantly impacted. An increasing number of different gut microbial species are now postulated to regulate brain function in health and disease. The westernized diet is hypothesized to be the cause of the current obesity levels in many countries, a major socio-economical health problem. Experimental and epidemiological evidence suggest that the gut microbiota is responsible for significant immunologic, neuronal, and endocrine changes that lead to obesity. We hypothesize that the gut microbiota, and changes associated with diet, affect the gut-brain axis and may possibly contribute to the development of mental illness. In this review, we discuss the links between diet, gut dysbiosis, obesity, and immunologic and neurologic diseases that impact brain function and behavior.
Ochoa-Repáraz, Javier; Kasper, Lloyd H.
The gut-brain axis is a bi-directional integrated system composed by immune, endocrine and neuronal components by which the gap between the gut microbiota and the brain is significantly impacted. An increasing number of different gut microbial species are now postulated to regulate brain function in health and disease. The westernized diet is hypothesized to be the cause of the current obesity levels in many countries, a major socio-economical health problem. Experimental and epidemiological evidence suggest that the gut microbiota is responsible for significant immunologic, neuronal and endocrine changes that lead to obesity. We hypothesize that the gut microbiota, and changes associated with diet, affect the gut-brain axis and may possibly contribute to the development of mental illness. In this review, we discuss the links between diet, gut dysbiosis, obesity, and immunologic and neurologic diseases that impact brain function and behavior. PMID:26865085
Genné-Bacon, Elizabeth A.
Obesity, diabetes, and metabolic syndrome are growing worldwide health concerns, yet their causes are not fully understood. Research into the etiology of the obesity epidemic is highly influenced by our understanding of the evolutionary roots of metabolic control. For half a century, the thrifty gene hypothesis, which argues that obesity is an evolutionary adaptation for surviving periods of famine, has dominated the thinking on this topic. Obesity researchers are often not aware that there is, in fact, limited evidence to support the thrifty gene hypothesis and that alternative hypotheses have been suggested. This review presents evidence for and against the thrifty gene hypothesis and introduces readers to additional hypotheses for the evolutionary origins of the obesity epidemic. Because these alternate hypotheses imply significantly different strategies for research and clinical management of obesity, their consideration is critical to halting the spread of this epidemic. PMID:24910556
Genné-Bacon, Elizabeth A
Obesity, diabetes, and metabolic syndrome are growing worldwide health concerns, yet their causes are not fully understood. Research into the etiology of the obesity epidemic is highly influenced by our understanding of the evolutionary roots of metabolic control. For half a century, the thrifty gene hypothesis, which argues that obesity is an evolutionary adaptation for surviving periods of famine, has dominated the thinking on this topic. Obesity researchers are often not aware that there is, in fact, limited evidence to support the thrifty gene hypothesis and that alternative hypotheses have been suggested. This review presents evidence for and against the thrifty gene hypothesis and introduces readers to additional hypotheses for the evolutionary origins of the obesity epidemic. Because these alternate hypotheses imply significantly different strategies for research and clinical management of obesity, their consideration is critical to halting the spread of this epidemic.
Guerra-Segovia, Carolina; Ocampo-Candiani, Jorge
Obesity is a public health problem worldwide. It predominates in industrialized countries; however, it is prevalent in all nations. It is defined as a condition of excess adipose tissue and is the result of changes in lifestyle, excessive consumption of energy-dense foods with poor nutritional value, physical inactivity and the reduction of open space where one can practice a sport. Although obesity is associated with multiple diseases, it is important to stress that the metabolic changes caused by it affect skin physiology and play a predisposing factor for the development of skin diseases. Very little has been studied on the impact of obesity on the skin. The purpose of this article is to review the most frequently skin diseases in obesity. Some skin pathologies in obesity are caused by changes in skin physiology, others are related to insulin resistance or constitute an exacerbating factor for dermatitis. This article covers the clinical features of obesity related skin disease and its management.
Lim, Chu Chin; Mahmood, Tahir
The prevalence of obesity has reached alarming proportions globally, and continues to rise in both developed and developing countries. Maternal obesity has become one of the most commonly occurring risk factors in obstetric practice. The 2003-2005 report of the Confidential Enquiries into Maternal Deaths in the United Kingdom highlighted obesity as a significant risk for maternal death . More than half of all women who died from direct or indirect causes were either overweight or obese. For the mother, obesity increases the risk of obstetric complications during the antenatal, intrapartum and postnatal period, as well as contributing to technical difficulties with fetal assessment. The offspring of obese mothers also have a higher rate of perinatal morbidity and an increased risk of long-term health problems.
Olson, Amy L; Zwillich, Clifford
The obesity hypoventilation syndrome, which is defined as a combination of obesity and chronic hypoventilation, utimately results in pulmonary hypertension, cor pulmonale, and probable early mortality. Since the classical description of this syndrome nearly fifty years ago, research has led to a better understanding of the pathophysiologic mechanisms involved in this disease process, and to the development of effective treatment options. However, recent data indicate the obesity hypoventilation syndrome is under-recognized, and under-treated. Because obesity has become a national epidemic, it is critical that physicians are able to recognize and treat obesity-associated diseases. This article reviews current definitions of the obesity hypoventilation syndrome, clinical presentation and diagnosis, present understanding of the pathophysiology, and treatment options.
Talmor, Alon; Dunphy, Bruce
Infertility affects one in seven couples, and its rate is on the increase. Ovulatory defects and unexplained causes account for >50% of infertile aetiologies. It is postulated that a significant proportion of these cases are either directly or indirectly related to obesity. The prevalence of overweight and obese men and women has topped 50% in some developed countries. Obesity is on the increase worldwide; in turn, the consequences in terms of the associated morbidity and mortality have also been increasing. Obesity is associated with various reproductive sequelae including anovulation, subfertility and infertility, increased risk of miscarriage and poor neonatal and maternal pregnancy outcomes. Thus, the combination of infertility and obesity poses some very real challenges in terms of both the short- and long-term management of these patients. The mechanism with which obesity impacts female reproductive function is summarised in this review.
Jindal, Rahul M; Zawada, Edward T
There is a worldwide epidemic of obesity, and an increasing number of patients who are obese are presenting for solid-organ transplantation. Obesity increases the risk for delayed graft function and local wound complications after technically successful kidney transplantation. Obese patients are more likely to have comorbid factors leading to premature death with a functioning kidney transplant. We suggest the use of World Health Organization criteria when reporting the impact of obesity on recipients of solid-organ transplants. Prospective multicenter studies are indicated to evaluate long-term outcomes in obese patients who successfully receive a kidney transplant. Rigorous efforts should be made to optimize weight before and after solid-organ transplantation by a judicious combination of diet, exercise, minimization of steroid therapy, surgery, and psychological therapies.
Peer victimization of obese adolescents has been associated with low self-esteem, body dissatisfaction, social isolation, marginalization, poor psychosocial adjustment, depression, eating disorders, and suicidal ideation and attempts, not to mention poor academic performance. Weight-based peer victimization is defined as unsolicited bullying and teasing as a result of being overweight or obese. The victimization may be overt or relational. Obese adolescents are at risk of victimization, because their peers view them as different and undesirable. Although peer victimization occurs commonly among adolescents, obese adolescents are more susceptible than their average-weight peers. Because school nurses are often the first line of defense for obese adolescents, they are in an excellent position to identify forms of peer victimization and be prepared to intervene with the victims. School nurses can potentially preserve the psychosocial integrity of obese adolescents by promoting healthy peer interactions and experiences.
Yanovski, Jack A
The prevalence of child and adolescent obesity in the United States increased dramatically between 1970 and 2000, and there are few indications that the rates of childhood obesity are decreasing. Obesity is associated with myriad medical, psychological, and neurocognitive abnormalities that impact children's health and quality of life. Genotypic variation is important in determining the susceptibility of individual children to undue gains in adiposity; however, the rapid increase in pediatric obesity prevalence suggests that changes to children's environments and/or to their learned behaviors may dramatically affect body weight regulation. This paper presents an overview of the epidemiology, consequences, and etiopathogenesis of pediatric obesity, serving as a general introduction to the subsequent papers in this Special Issue that address aspects of childhood obesity and cognition in detail.
Camilleri, Michael; Malhi, Harmeet; Acosta, Andres
Obesity usually is associated with morbidity related to diabetes mellitus and cardiovascular diseases. However, there are many gastrointestinal and hepatic diseases for which obesity is the direct cause (eg, nonalcoholic fatty liver disease) or is a significant risk factor, such as reflux esophagitis and gallstones. When obesity is a risk factor, it may interact with other mechanisms and result in earlier presentation or complicated diseases. There are increased odds ratios or relative risks of several gastrointestinal complications of obesity: gastroesophageal reflux disease, erosive esophagitis, Barrett's esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer. Gastroenterologists are uniquely poised to participate in the multidisciplinary management of obesity as physicians caring for people with obesity-related diseases, in addition to their expertise in nutrition and endoscopic interventions. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.
Camilleri, Michael; Malhi, Harmeet; Acosta, Andres
Obesity usually is associated with morbidity related to diabetes mellitus and cardiovascular diseases. However, there are many gastrointestinal and hepatic diseases for which obesity is the direct cause (eg, nonalcoholic fatty liver disease) or is a significant risk factor, such as reflux esophagitis and gallstones. When obesity is a risk factor, it may interact with other mechanisms and result in earlier presentation or complicated diseases. There are increased odds ratios or relative risks of several gastrointestinal complications of obesity: gastroesophageal reflux disease, erosive esophagitis, Barrett’s esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer. Gastroenterologists are uniquely poised to participate in the multidisciplinary management of obesity as physicians caring for people with obesity-related diseases, in addition to their expertise in nutrition and endoscopic interventions. PMID:28192107
Campos, Gilberto; Fernández, Virginia; Fernández, Erika; Molero, Emperatriz; Morales, Luz Marina; Raleigh, Xiomara; Connell, Lissette; Ryder, Elena
Individuals with insulin resistance (IR) usually have upper body obesity phenotype, often accompanied by an increase in plasma free fatty acids (FFA). Since the Venezuelan population has a high frequency of IR and central obesity, the purpose of this work was to determine FFA levels in 47 Venezuelan individuals, men and women, 24-58 years old, and analyze their relationship with central obesity and parameters of carbohydrate and lipid metabolism. Basal concentrations of TG, total cholesterol, LDL-C, and HDL-C were measured, and FFA, glucose and insulin, at basal state and at different times after a glucose load. Eighteen individuals presented insulin resistance (HOMA-IR > 2.7) and 29 were non-insulin resistant (non-IR). Insulin resistant individuals (IR) had higher waist circumference, BMI and basal concentrations of FFA than the non-IR. No differences were observed in skin folds and other basal lipids studied. The increased FFA seemed to be related to the IR associated to BMI and not to central obesity, since the difference between IR and non-IR disappeared when they were matched for waist circumference. After a glucose load, FFA decreased in both groups, but remained significantly elevated in IR subjects. This effect disappeared after matching for BMI or waist circumference, inferring that it was independent of anthropometries. FFA were positively associated with HOMA-IR, glucose and TG levels; however, there was.no association with BMI or waist circumference. These findings, and the lack of elements to support the presence of hepatic IR, common to increased visceral lipolysis, might suggest that the IR present in the obese individuals studied, might be due to an increase in subcutaneous fat.
Tayem, Yasin I; Yaseen, Nagham A; Khader, Wiam T; Abu Rajab, Lama O; Ramahi, Ahmad B; Saleh, Mohammad H
We aimed to determine the prevalence and correlates of obesity and hypertension (HTN) among students at a central university in the West Bank. This cross-sectional study targeted a cohort of 553 students (59.5% males, 40.5% females) aged 17-26 years (median = 21) from Al-Quds University. Body mass index (BMI) and blood pressure (BP) were measured. Participants completed a questionnaire on physical activity, sedentary behavior, dietary factors, smoking and family history of obesity, HTN, and coronary artery disease. The magnitude of correlation was assessed by Spearman's rho (r(s)) and Chi-square tests. The prevalence of overweight was 25% (31.1% males, 15.6% females) and obesity 7.2% (9.4% males, 4% females). Obesity and overweight were associated with family history of obesity in both genders (p<0.001) and physical activity in males (r(s)= - 0.162, p<0.005). No correlation was demonstrated between participants' BMI and sedentary lifestyle or consumption of fast food. Pre-HTN was detected in 27.1% (38% males, 11.2% females) and HTN in 2.2% (3.3% males, 0.4% females). Pre-HTN and HTN were associated with obesity (r(s)=0.252, p<0.001) and smoking (p<0.05). No relationship was detected between students' BP and sedentary behavior, family history of HTN/CAD, or consumption of fast food. The prevalence of increased BMI and BP among males was significantly higher than females (p<0.001). We detected a high prevalence of elevated BP and excess weight gain among students at Al-Quds University. An interventional program is urgently needed to control these cardiovascular risk factors in this community.
Tayem, Yasin I.; Yaseen, Nagham A.; Khader, Wiam T.; Abu Rajab, Lama O.; Ramahi, Ahmad B.; Saleh, Mohammad H.
Objectives We aimed to determine the prevalence and correlates of obesity and hypertension (HTN) among students at a central university in the West Bank. Materials and methods This cross-sectional study targeted a cohort of 553 students (59.5% males, 40.5% females) aged 17–26 years (median = 21) from Al-Quds University. Body mass index (BMI) and blood pressure (BP) were measured. Participants completed a questionnaire on physical activity, sedentary behavior, dietary factors, smoking and family history of obesity, HTN, and coronary artery disease. The magnitude of correlation was assessed by Spearman's rho (r s) and Chi-square tests. Results The prevalence of overweight was 25% (31.1% males, 15.6% females) and obesity 7.2% (9.4% males, 4% females). Obesity and overweight were associated with family history of obesity in both genders (p<0.001) and physical activity in males (rs= − 0.162, p<0.005). No correlation was demonstrated between participants’ BMI and sedentary lifestyle or consumption of fast food. Pre-HTN was detected in 27.1% (38% males, 11.2% females) and HTN in 2.2% (3.3% males, 0.4% females). Pre-HTN and HTN were associated with obesity (rs=0.252, p<0.001) and smoking (p<0.05). No relationship was detected between students’ BP and sedentary behavior, family history of HTN/CAD, or consumption of fast food. The prevalence of increased BMI and BP among males was significantly higher than females (p<0.001). Conclusions We detected a high prevalence of elevated BP and excess weight gain among students at Al-Quds University. An interventional program is urgently needed to control these cardiovascular risk factors in this community. PMID:23077467
Ando, Katsuyuki; Fujita, Megumi
1. There are multiple and complex mechanisms of salt-induced hypertension; however, central sympathoexcitation plays an important role. In addition, the production of reactive oxygen species (ROS) is increased in salt-sensitive hypertensive humans and animals. Thus, we hypothesized that brain ROS overproduction may increase blood pressure (BP) by central sympathostimulation. 2. Recently, we demonstrated that ROS levels were elevated in the hypothalamus of salt-sensitive hypertensive animals. Moreover, intracerebroventricular anti-oxidants suppressed BP and renal sympathetic nerve activity more in salt-sensitive than non-salt-sensitive hypertensive rats. Thus, brain ROS overproduction increased BP through central sympathoexcitation in salt-sensitive hypertension. 3. Salt sensitivity of BP is enhanced in obesity and metabolic syndrome. Interestingly, it is also suggested that, in obesity-induced hypertension models, increases in BP are caused by brain ROS-induced central sympathoexcitation. 4. Recent studies suggest that increased ROS production in the brain and central sympathoexcitation may share a common pathway that increases BP in both salt- and obesity-induced hypertension.
Markt, P; Herdlinger, S; Schuster, D
The development of novel drugs against obesity is one of the top priorities of worldwide drug research. In recent years, it has been facilitated by the application of virtual screening methods. In this review, we give a short introduction into obesity-related protein targets and computer-aided drug design techniques. Furthermore, we highlight the most successful virtual screening studies, outline their results, and provide suggestions for future anti-obesity drug development.
Kim, Ho Gak; Han, Jimin
Obesity is defined as BMI (calculated as weight in kg divided by height in m2) more than 30, and overweight is defined as BMI of 25-29.9. Obesity has been considered as a risk factor for pancreatic diseases, including pancreatitis and pancreatic cancer. Severe acute pancreatitis is significantly more frequent in obese patients. Furthermore, obese patients develop systemic and local complications of acute pancreatitis more frequently. The underlying mechanisms are increased inflammation and necrosis from increased amount of intra- and peri-pancreatic fat. In addition, obesity is a poor prognostic factor in acute pancreatitis, and overweight before disease onset appears to be a risk factor for chronic pancreatitis. Overweight and/or obesity are associated with greater risk of pancreatic cancer and younger age of onset. Physical activity appears to decrease the risk of pancreatic cancer, especially among those who are overweight. Long-standing diabetes increases the risk of pancreatic cancer. The pathogenic mechanism is that obesity and physical inactivity increase insulin resistance. In a state of hypersinulinemia, increased circulating level of insulin-like growth factor-1 induces cellular proliferation of pancreatic cancer. Obesity is associated with negative prognostic factor and increased mortality in pancreatic cancer. However, there are controversies regarding the effects of obesity on long-term post-operative results in the patient with pancreatic cancer.
Wilson, Kathryn M; Cho, Eunyoung
Renal cell cancer (RCC) is the major type of kidney cancer with increasing incidence. Obesity is one of the well-established risk factors for RCC. Meta-analyses including multiple cohort and case-control studies have found a consistent positive association between obesity and RCC. The association appeared to be independent of other RCC risk factors including hypertension and has been often stronger in women, although a positive association has also been observed in men. Obesity has been largely measured as body mass index (BMI). Studies which evaluated other measures of obesity including waist circumference (WC), waist-to-hip ratio (WHR) as well as increase in weight have reported similar positive associations with RCC. Although the mechanisms by which obesity influences renal carcinogenesis have been under-explored, insulin resistance and certain growth factors including insulin-like growth factor (IGF-1), sex steroid hormones, and biochemical markers such as adiponectin may be involved. The positive association with obesity has been observed with the clear cell type of RCC, which is the major histological subtype. On the other hand, the association between obesity and RCC survival appears to be much more complex. An apparent inverse association between obesity at time of diagnosis and RCC survival has been observed in some studies' generating speculation of an "obesity paradox" hypothesis. However, this "paradox" may be due to reverse causation, selection bias, or other forms of bias rather than a true biological association.
Parsi, Mansour A
It is estimated that about half of the population in developed countries are either overweight or obese. In some developing nations obesity rates have increased to surpass those seen in Western countries. This rate increase in obesity has many implications as obesity has been associated with numerous negative health effects including increased risks of hypertension, diabetes, cardiovascular disease, stroke, liver disease, apnea, and some cancer types. Obesity is now considered to be one of the major public health concerns facing the society. Cholangiocarcinomas (bile duct cancers) are malignant tumors arising from cholangiocytes inside or outside of the liver. Although cholangiocarcinomas are relatively rare, they are highly lethal. The low survival rate associated with cholangiocarcinoma is due to the advanced stage of the disease at the time of diagnosis. Prevention is therefore especially important in this cancer type. Some data suggest that the incidence of cholangiocarcinoma in the western world is on the rise. Increasing rate of obesity may be one of the factors responsible for this increase. Determining whether obesity is a risk factor for cholangiocarcinoma has significant clinical and societal implications as obesity is both prevalent and modifiable. This paper seeks to provide a summary of the current knowledge linking obesity and cholangiocarcinoma, and encourage further research on this topic. PMID:23382624
Spieker, Elena A; Pyzocha, Natasha
Parallel to rising obesity rates is an increase in costs associated with excess weight. Estimates of future direct (medical) and indirect (nonmedical) costs related to obesity suggest rising expenditures that will impose a significant economic burden to individuals and society as a whole. This article reviews research on direct and indirect medical costs and future economic trends associated with obesity and associated comorbidities. Cost disparities associated with subsets of the population experiencing higher than average rates of obesity are explored. Finally, potential solutions with the highest estimated impact are offered, and future directions are proposed.
Van Grouw, Jacqueline M; Volpe, Stella L
To provide an overview of the current advances in childhood obesity physiology, intervention, and prevention. Structural and functional brain impairments are present in obese adolescents with metabolic syndrome (MetS). Aerobic training for 20 or 40 min per day produced similar affects on metabolic risk factors. Vitamin D supplementation has been shown to improve the metabolic risk factors in obese children; however, obese children require greater doses to treat vitamin D deficiency. A 10-week community-based exergaming weight management program significantly decreased the BMI in obese children. There is surmounting research on MetS and its associated risk factors in obese children. Gaining a comprehensive overview of the factors associated with obesity in children is crucial in developing the most effective intervention strategies. Community-based and family-centered interventions have generated positive results in reducing children's BMI and improving MetS risk factors. In addition to obesity intervention efforts, ongoing prevention initiatives are imperative to reduce the prevalence of childhood obesity.
Weismann, D; Wiedmann, S; Bala, M; Frantz, S; Fassnacht, M
Obesity is an important risk factor for the development of heart failure. In normotensive obese patients, a reduced peripheral resistance is typically observed and is accompanied by an increased fluid volume and an increase in cardiac work, resulting in hypertrophy and diastolic heart failure, which can be visualized with echocardiography. However, in the presence of arterial hypertension cardiac geometry is not different to hypertensive heart disease without obesity. Furthermore, the typical changes found with obesity, such as reduced peripheral resistance and increased blood volume, are no longer present. Obstructive sleep apnea (OSA) is very common in obesity and warrants screening but levels of the heart failure marker N-terminal pro-brain natriuretic peptide (NT-ProBNP) might be misleading as the values are lower in obesity than in normal weight controls. Body weight reduction is advisable but difficult to achieve and much more difficult to maintain. Furthermore, diet and exercise has not been proven to enhance life expectancy in obesity. However, with bariatric surgery, long-term weight reduction can be achieved and mortality can be reduced. With effective weight loss and improved clinical outcome after bariatric surgery, treatment of obesity has shifted much more into focus. Regardless of technical challenges in the work-up of obese patients, clinical symptoms suggestive of cardiac disorders warrant prompt investigation with standard techniques following recommendations as established for normal weight patients.
Herpertz, S; Saller, B
Overweight and obesity are widespread in industrial countries and are considered to be serious health problems in these countries. Population-based studies in Germany have shown that between 12 and 18 % of the adult population is obese. Overweight and obesity are accompanied by a large spectrum of health disorders and extreme psychosocial burdens. Besides the hereditary disposition, the life style including both intra- and inter-individual aspects determines the complex etiology of obesity. Within the collective sample of the obese, one sub-sample is the "psychogenic obese" i. e. in which psychiatric disorders lead to a change in both eating and exercise behavior, the result then being a continuous positive energy reserve in the form of overweight and obesity. The paper describes the psychosocial problems of obese persons; especially the controverse question with regard to psychiatric morbidity in general and eating disorders in particular are emphasized. The results of past, mainly behavioral oriented treatment concepts are presented and various concepts beyond single school orientation are discussed. Finally, the problems with psychiatric psychological diagnostics in those obese patients with the request for surgical weight reduction within the context of insurance coverage and the surgeons are presented.
Dávila-Torres, Javier; González-Izquierdo, José Jesús; Barrera-Cruz, Antonio
Excess body weight (overweight and obesity) is currently recognized as one of the most important challenges of public health in the world, given its size, speed of growth and the negative effect it has on the health of the population that suffers. Overweight and obesity significantly increases the risk of chronic no communicable diseases, premature mortality and the social cost of health. An estimated 90 % of cases of type 2 diabetes mellitus attributable to overweight and obesity. Today, Mexico is second global prevalence of obesity in the adult population, which is ten times higher than that of countries like Japan and Korea. With regard to children, Mexico ranks fourth worldwide obesity prevalence, behind Greece, USA and Italy. In our country, over 70 % of the adult population, between 30 and 60 years are overweight. The prevalence of overweight is higher in men than females, while the prevalence of obesity is higher in women than men. Until 2012, 26 million Mexican adults are overweight and 22 million obese, which represents a major challenge for the health sector in terms of promoting healthy lifestyles in the population and development of public policies to reverse this scenario epidemiology. Mexico needs to plan and implement strategies and action cost effective for the prevention and control of obesity of children, adolescents and adults. Global experience shows that proper care of obesity and overweight, required to formulate and coordinate multisectoral strategies and efficient for enhancing protective factors to health, particularly to modify individual behavior, family and community.
Finkelstein, Eric A; Strombotne, Kiersten L
The rise in obesity rates, both nationally and internationally, is a result of changes in the environment that have simultaneously lowered the cost of food production, lowered the time and monetary cost of food consumption, increased the real cost of being physically active at work and at home, and decreased the health consequences that result from obesity by bringing a host of new drugs and devices to the market to better manage the adverse health effects that obesity promotes. This changing environment is in response to consumers' demand for labor-saving technology and convenient, affordable food. To be successful, efforts to combat obesity therefore need to recognize and address these realities.
Franco, Ruth; Fonoff, Erich T.; Alvarenga, Pedro; Lopes, Antonio Carlos; Miguel, Euripides C.; Teixeira, Manoel J.; Damiani, Durval; Hamani, Clement
Obesity is a chronic, progressive and prevalent disorder. Morbid obesity, in particular, is associated with numerous comorbidities and early mortality. In patients with morbid obesity, pharmacological and behavioral approaches often have limited results. Bariatric surgery is quite effective but is associated with operative failures and a non-negligible incidence of side effects. In the last decades, deep brain stimulation (DBS) has been investigated as a neurosurgical modality to treat various neuropsychiatric disorders. In this article we review the rationale for selecting different brain targets, surgical results and future perspectives for the use of DBS in medically refractory obesity. PMID:27438859
ABEL, E. DALE; LITWIN, SHELDON E.; SWEENEY, GARY
The dramatic increase in the prevalence of obesity and its strong association with cardiovascular disease have resulted in unprecedented interest in understanding the effects of obesity on the cardiovascular system. A consistent, but puzzling clinical observation is that obesity confers an increased susceptibility to the development of cardiac disease, while at the same time affording protection against subsequent mortality (termed the obesity paradox). In this review we focus on evidence available from human and animal model studies and summarize the ways in which obesity can influence structure and function of the heart. We also review current hypotheses regarding mechanisms linking obesity and various aspects of cardiac remodeling. There is currently great interest in the role of adipokines, factors secreted from adipose tissue, and their role in the numerous cardiovascular complications of obesity. Here we focus on the role of leptin and the emerging promise of adiponectin as a cardioprotective agent. The challenge of understanding the association between obesity and heart failure is complicated by the multifaceted interplay between various hemodynamic, metabolic, and other physiological factors that ultimately impact the myocardium. Furthermore, the end result of obesity-associated changes in the myocardial structure and function may vary at distinct stages in the progression of remodeling, may depend on the individual pathophysiology of heart failure, and may even remain undetected for decades before clinical manifestation. Here we summarize our current knowledge of this complex yet intriguing topic. PMID:18391168
... a Healthy Heart Healthy Kids Our Kids Programs Childhood Obesity What is childhood obesity? Overweight in Children BMI in Children Is Childhood Obesity an Issue in Your Home? Addressing your Child's ...
Schwingel, Andiara; Nakata, Yoshio; Ito, Lucy S; Chodzko-Zajko, Wojtek J; Erb, Christopher T; Shigematsu, Ryosuke; Oba-Shinjo, Sueli M; Matsuo, Tomoaki; Shinjo, Samuel K; Uno, Miyuki; Marie, Suely K N; Tanaka, Kiyoji
The objective of this study was to investigate the influence of different cultural environments on the development of obesity by examining the association of central obesity, lifestyle, and selected coronary risk factors among people with identical Japanese genetic backgrounds living in Japan and Brazil. One hundred and four native Japanese and 286 Japanese-Brazilians residing in Brazil and Japan aged 35 years or over were studied. Obesity, metabolic risk factors for coronary disease, and history of regular sports activity, daily physical activity, and eating habits were assessed. The results showed Japanese-Brazilians residing in Brazil with significantly higher waist circumference values, and greater prevalence of central obesity compared to native Japanese and Japanese-Brazilians residing in Japan. The risk of developing central obesity was found to be 2.8 times higher among Japanese-Brazilians residing in Brazil. However, this association was no longer found to be significant after adjusting for lifestyle factors in the logistic model. Additionally, waist circumference was found to be significantly associated with metabolic risk factors for coronary disease. These findings suggest substantial variation in measures of central obesity among the three groups of Japanese ancestry, and underscore the heterogeneity of risk factors among communities of Japanese ancestry living in different cultural environments. The results also suggest that immigrant men exposed to the Brazilian cultural environment are more susceptible to the development of central obesity, and it seems to be associated with various lifestyle items and metabolic risk factors for coronary disease.
Chan, Wah-Kheong; Tan, Alexander Tong-Boon; Vethakkan, Shireene Ratna; Tah, Pei-Chien; Vijayananthan, Anushya; Goh, Khean-Lee
To study the dietary intake and level of physical activity (PA) of patients with diabetes mellitus and the association with non-alcoholic fatty liver disease (NAFLD). Consecutive adult patients with type 2 diabetes mellitus seen in our hospital diabetes clinic were enrolled. The Global Physical Activity Questionnaire and a semi-quantitative food-frequency questionnaire were used to assess PA and dietary intake, respectively. Diagnosis of NAFLD was ultrasound-based and following exclusion of significant alcohol intake and other causes of chronic liver disease. Data for 299 patients were analyzed (mean age 63.3±10.5 years old, 41.1% male). Prevalence of NAFLD was 49.2%. Patients with low PA were more likely to have NAFLD (OR=1.75, 95% CI=1.03-2.99, p=0.029). There was no significant difference in energy intake, intake of macronutrients and percentage energy intake from each macronutrient, high sugar food, high cholesterol food and high SFA food between patients with and without NAFLD. Among centrally obese patients, patients with low PA and in the highest quartile of percentage energy intake from fat (OR=4.03, 95% CI=1.12-15.0, p=0.015), high cholesterol food (OR=3.61, 95% CI=1.37-9.72, p=0.004) and high SFA food (OR=2.67, 95% CI=1.08-6.67, p=0.019) were most likely to have NAFLD. Among those who were not centrally obese, PA and percentage energy intake from fat, high cholesterol food and high SFA food was not associated with NAFLD. Low PA and high percentage energy intake from fat, high cholesterol food and high SFA food is associated with NAFLD in centrally obese but not in non-centrally obese patients with diabetes mellitus.
Magalhães, Elma Izze da Silva; Sant'Ana, Luciana Ferreira da Rocha; Priore, Silvia Eloiza; Franceschini, Sylvia do Carmo Castro
Objective: To analyze studies that assessed the anthropometric parameters waist circumference (WC), waist-to-height ratio (WHR) and neck circumference (NC) as indicators of central obesity in children. Data sources: We searched PubMed and SciELO databases using the combined descriptors: "Waist circumference", "Waist-to-height ratio", "Neck circumference", "Children" and "Abdominal fat" in Portuguese, English and Spanish. Inclusion criteria were original articles with information about the WC, WHR and NC in the assessment of central obesity in children. We excluded review articles, short communications, letters and editorials. Data synthesis: 1,525 abstracts were obtained in the search, and 68 articles were selected for analysis. Of these, 49 articles were included in the review. The WC was the parameter more used in studies, followed by the WHR. Regarding NC, there are few studies in children. The predictive ability of WC and WHR to indicate central adiposity in children was controversial. The cutoff points suggested for the parameters varied among studies, and some differences may be related to ethnicity and lack of standardization of anatomical site used for measurement. Conclusions: More studies are needed to evaluate these parameters for determination of central obesity children. Scientific literature about NC is especially scarce, mainly in the pediatric population. There is a need to standardize site measures and establish comparable cutoff points between different populations. PMID:25479861
Magalhães, Elma Izze da Silva; Sant'Ana, Luciana Ferreira da Rocha; Priore, Silvia Eloiza; Franceschini, Sylvia do Carmo Castro
To analyze studies that assessed the anthropometric parameters waist circumference (WC), waist-to-height ratio (WHR) and neck circumference (NC) as indicators of central obesity in children. We searched PubMed and SciELO databases using the combined descriptors: "Waist circumference", "Waist-to-height ratio", "Neck circumference", "Children" and "Abdominal fat" in Portuguese, English and Spanish. Inclusion criteria were original articles with information about the WC, WHR and NC in the assessment of central obesity in children. We excluded review articles, short communications, letters and editorials. 1,525 abstracts were obtained in the search, and 68 articles were selected for analysis. Of these, 49 articles were included in the review. The WC was the parameter more used in studies, followed by the WHR. Regarding NC, there are few studies in children. The predictive ability of WC and WHR to indicate central adiposity in children was controversial. The cutoff points suggested for the parameters varied among studies, and some differences may be related to ethnicity and lack of standardization of anatomical site used for measurement. More studies are needed to evaluate these parameters for determination of central obesity children. Scientific literature about NC is especially scarce, mainly in the pediatric population. There is a need to standardize site measures and establish comparable cutoff points between different populations. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.
Tyrovolas, S; Psaltopoulou, T; Pounis, G; Papairakleous, N; Bountziouka, V; Zeimbekis, A; Gotsis, E; Antonopoulou, M; Metallinos, G; Polychronopoulos, E; Lionis, C; Panagiotakos, D B
The aim of the present work was to evaluate the relationship between energy-generating nutrients and the presence of central and overall obesity after correcting for socio-demographic, lifestyle and clinical characteristics, among healthy elders. During 2005-2007, 553 elderly men and 637 elderly women (mean age 74±7years) from eight Mediterranean islands in Greece and Cyprus, were enrolled. The retrieved information included demographic, bio-clinical and dietary characteristics. MedDietScore assessed adherence to the Mediterranean dietary pattern. The prevalence of obesity was 27% in males and 39% in females (p<0.001), while 73% of males and 87% of females had central obesity. The prevalence of diabetes, hypercholesterolemia and hypertension was higher in the obese than in the non-obese participants (p<0.01). After adjusting for various confounders, a 1% increase in carbohydrate consumption was associated with a 12% (95% CI 0.78-0.99) lower likelihood of having central obesity, while a 1% increase in carbohydrate and protein consumption was associated with a 14% (95% CI 0.78-0.95) and 16% (95% CI 0.72-0.97) lower likelihood of being obese, respectively. Vegetable protein was found to be associated with a 15% (95% CI 0.77-0.93) lower likelihood of being obese while, only low glycemic index carbohydrates seem to be associated with a 6% (95% CI 0.90-0.98) lower likelihood of having central obesity. The presented findings suggest that a diet high in carbohydrates and vegetable protein is associated with a lower likelihood of being obese and may help elderly people to preserve normal weight. Copyright © 2009 Elsevier B.V. All rights reserved.
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Pagotto, Uberto; Vanuzzo, Diego; Vicennati, Valentina; Pasquali, Renato
Obesity is reaching epidemic proportions worldwide and it is correlated with various comorbidities, among which the most relevant are diabetes mellitus, arterial hypertension, and cardiovascular diseases. Obesity management is a modern challenge because of the rapid evolution of unfavorable lifestyles and unfortunately there are no effective treatments applicable to the large majority of obese/overweight people. The current medical attitude is to treat the complications of obesity (e.g. dyslipidemia, hypertension, diabetes, and cardiovascular diseases). However, the potential of treating obesity is enormous, bearing in mind that a volitional weight loss of 10 kg is associated with important risk factor improvement: blood pressure -10 mmHg, total cholesterol -10%, LDL cholesterol -15%, triglycerides -30%, fasting glucose -50%, HDL cholesterol +8%. Drug treatment for obesity is an evolving branch of pharmacology, burdened by severe side effects and consequences of the early drugs, withdrawn from the market, and challenged by the lack of long-term data on the effect of medications on obesity-related morbidity and mortality, first of all cardiovascular diseases. In Europe three antiobesity drugs are currently licensed: sibutramine, orlistat, and rimonabant; important trials with clinical endpoints are ongoing for sibutramine and rimonabant. While waiting for their results, it is convenient to evaluate these drugs for their effects on body weight and cardiometabolic risk factors. Sibutramine is a centrally acting serotonin/noradrenaline reuptake inhibitor that mainly increases satiety. At the level of brown adipose tissue, sibutramine can also facilitate energy expenditure by increasing thermogenesis. The long-term studies (five) documented a mean differential weight reduction of 4.45 kg for sibutramine vs placebo. Considering the principal studies, attrition rate was 43%. This drug not only reduces body weight and waist circumference, but it decreases triglycerides and
Stienstra, Rinke; van Diepen, Janna A; Tack, Cees J; Zaki, Md Hasan; van de Veerdonk, Frank L; Perera, Deshani; Neale, Geoffrey A; Hooiveld, Guido J; Hijmans, Anneke; Vroegrijk, Irene; van den Berg, Sjoerd; Romijn, Johannes; Rensen, Patrick C N; Joosten, Leo A B; Netea, Mihai G; Kanneganti, Thirumala-Devi
Inflammation plays a key role in the pathogenesis of obesity. Chronic overfeeding leads to macrophage infiltration in the adipose tissue, resulting in proinflammatory cytokine production. Both microbial and endogenous danger signals trigger assembly of the intracellular innate immune sensor Nlrp3, resulting in caspase-1 activation and production of proinflammatory cytokines IL-1β and IL-18. Here, we showed that mice deficient in Nlrp3, apoptosis-associated speck-like protein, and caspase-1 were resistant to the development of high-fat diet-induced obesity, which correlated with protection from obesity-induced insulin resistance. Furthermore, hepatic triglyceride content, adipocyte size, and macrophage infiltration in adipose tissue were all reduced in mice deficient in inflammasome components. Monocyte chemoattractant protein (MCP)-1 is a key molecule that mediates macrophage infiltration. Indeed, defective inflammasome activation was associated with reduced MCP-1 production in adipose tissue. Furthermore, plasma leptin and resistin that affect energy use and insulin sensitivity were also changed by inflammasome-deficiency. Detailed metabolic and molecular phenotyping demonstrated that the inflammasome controls energy expenditure and adipogenic gene expression during chronic overfeeding. These findings reveal a critical function of the inflammasome in obesity and insulin resistance, and suggest inhibition of the inflammasome as a potential therapeutic strategy.
Stienstra, Rinke; van Diepen, Janna A.; Tack, Cees J.; Zaki, Md. Hasan; van de Veerdonk, Frank L.; Perera, Deshani; Neale, Geoffrey A.; Hooiveld, Guido J.; Hijmans, Anneke; Vroegrijk, Irene; van den Berg, Sjoerd; Romijn, Johannes; Rensen, Patrick C. N.; Joosten, Leo A. B.; Netea, Mihai G.; Kanneganti, Thirumala-Devi
Inflammation plays a key role in the pathogenesis of obesity. Chronic overfeeding leads to macrophage infiltration in the adipose tissue, resulting in proinflammatory cytokine production. Both microbial and endogenous danger signals trigger assembly of the intracellular innate immune sensor Nlrp3, resulting in caspase-1 activation and production of proinflammatory cytokines IL-1β and IL-18. Here, we showed that mice deficient in Nlrp3, apoptosis-associated speck-like protein, and caspase-1 were resistant to the development of high-fat diet-induced obesity, which correlated with protection from obesity-induced insulin resistance. Furthermore, hepatic triglyceride content, adipocyte size, and macrophage infiltration in adipose tissue were all reduced in mice deficient in inflammasome components. Monocyte chemoattractant protein (MCP)-1 is a key molecule that mediates macrophage infiltration. Indeed, defective inflammasome activation was associated with reduced MCP-1 production in adipose tissue. Furthermore, plasma leptin and resistin that affect energy use and insulin sensitivity were also changed by inflammasome-deficiency. Detailed metabolic and molecular phenotyping demonstrated that the inflammasome controls energy expenditure and adipogenic gene expression during chronic overfeeding. These findings reveal a critical function of the inflammasome in obesity and insulin resistance, and suggest inhibition of the inflammasome as a potential therapeutic strategy. PMID:21876127
Ortega, Francisco B; Lavie, Carl J; Blair, Steven N
The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-size-fits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis. © 2016 American Heart Association, Inc.
van Dijk, S J; Molloy, P L; Varinli, H; Morrison, J L; Muhlhausler, B S
Recent technological advances in epigenome profiling have led to an increasing number of studies investigating the role of the epigenome in obesity. There is also evidence that environmental exposures during early life can induce persistent alterations in the epigenome, which may lead to an increased risk of obesity later in life. This paper provides a systematic review of studies investigating the association between obesity and either global, site-specific or genome-wide methylation of DNA. Studies on the impact of pre- and postnatal interventions on methylation and obesity are also reviewed. We discuss outstanding questions, and introduce EpiSCOPE, a multidisciplinary research program aimed at increasing the understanding of epigenetic changes in emergence of obesity. An electronic search for relevant articles, published between September 2008 and September 2013 was performed. From the 319 articles identified, 46 studies were included and reviewed. The studies provided no consistent evidence for a relationship between global methylation and obesity. The studies did identify multiple obesity-associated differentially methylated sites, mainly in blood cells. Extensive, but small, alterations in methylation at specific sites were observed in weight loss intervention studies, and several associations between methylation marks at birth and later life obesity were found. Overall, significant progress has been made in the field of epigenetics and obesity and the first potential epigenetic markers for obesity that could be detected at birth have been identified. Eventually this may help in predicting an individual's obesity risk at a young age and opens possibilities for introducing targeted prevention strategies. It has also become clear that several epigenetic marks are modifiable, by changing the exposure in utero, but also by lifestyle changes in adult life, which implies that there is the potential for interventions to be introduced in postnatal life to modify
Manco, Melania; Dallapiccola, Bruno
Onset of obesity has been anticipated at earlier ages, and prevalence has dramatically increased worldwide over the past decades. Epidemic obesity is mainly attributable to modern lifestyle, but family studies prove the significant role of genes in the individual's predisposition to obesity. Advances in genotyping technologies have raised great hope and expectations that genetic testing will pave the way to personalized medicine and that complex traits such as obesity will be prevented even before birth. In the presence of the pressing offer of direct-to-consumer genetic testing services from private companies to estimate the individual's risk for complex phenotypes including obesity, the present review offers pediatricians an update of the state of the art on genomics obesity in childhood. Discrepancies with respect to genomics of adult obesity are discussed. After an appraisal of findings from genome-wide association studies in pediatric populations, the rare variant-common disease hypothesis, the theoretical soil for next-generation sequencing techniques, is discussed as opposite to the common disease-common variant hypothesis. Next-generation sequencing techniques are expected to fill the gap of "missing heritability" of obesity, identifying rare variants associated with the trait and clarifying the role of epigenetics in its heritability. Pediatric obesity emerges as a complex phenotype, modulated by unique gene-environment interactions that occur in periods of life and are "permissive" for the programming of adult obesity. With the advent of next-generation sequencing techniques and advances in the field of exposomics, sensitive and specific tools to predict the obesity risk as early as possible are the challenge for the next decade.
Bardou, Marc; Barkun, Alan N; Martel, Myriam
Excess body weight, as defined by the body mass index (BMI), has been associated with several diseases and includes subjects who are overweight (BMI ≥ 25-29.9 kg/m(2)) or obese (BMI ≥ 30 kg/m(2)). Overweight and obesity constitute the fifth leading risk for overall mortality, accounting for at least 2.8 million adult deaths each year. In addition around 11% of colorectal cancer (CRC) cases have been attributed to overweight and obesity in Europe. Epidemiological data suggest that obesity is associated with a 30-70% increased risk of colon cancer in men, whereas the association is less consistent in women. Similar trends exist for colorectal adenoma, although the risk appears lower. Visceral fat, or abdominal obesity, seems to be of greater concern than subcutaneous fat obesity, and any 1 kg/m(2) increase in BMI confers additional risk (HR 1.03). Obesity might be associated with worse cancer outcomes, such as recurrence of the primary cancer or mortality. Several factors, including reduced sensitivity to antiangiogenic-therapeutic regimens, might explain these differences. Except for wound infection, obesity has no significant impact on surgical procedures. The underlying mechanisms linking obesity to CRC are still a matter of debate, but metabolic syndrome, insulin resistance and modifications in levels of adipocytokines seem to be of great importance. Other biological factors such as the gut microbiota or bile acids are emerging. Many questions still remain unanswered: should preventive strategies specifically target obese patients? Is the risk of cancer great enough to propose prophylactic bariatric surgery in certain patients with obesity?
Lee, Mi-Jeong; Pramyothin, Pornpoj; Karastergiou, Kalypso; Fried, Susan K.
Central obesity is associated with insulin resistance and dyslipidemia. Thus, the mechanisms that control fat distribution and its impact on systemic metabolism have importance for understanding risk for diabetes and cardiovascular disease. Hypercortisolemia at the systemic (Cushing’s syndrome) or local levels (due to adipose-specific overproduction via 11β-Hydroxysteroid dehydrogenase 1) results in the preferential expansion of central, especially visceral fat depots. At the same time, peripheral subcutaneous depots can become depleted. The biochemical and molecular mechanisms underlying the depot-specific actions of glucocorticoids (GCs) on adipose tissue function remain poorly understood. GCs exert pleiotropic effects on adipocyte metabolic, endocrine and immune function, and dampen adipose tissue inflammation. GCs also regulate multiple steps in the process of adipogenesis. Acting synergistically with insulin, GCs increase the expression of numerous genes involved in fat deposition. Variable effects of GC on lipolysis are reported, and GC can improve or impair insulin action depending on the experimental conditions. Thus, the net effect of GC on fat storage appears to depend on the physiologic context. The preferential effects of GC on visceral adipose tissue have been linked to higher cortisol production and glucocorticoid receptor expression, but the molecular details of the depot-dependent actions of GCs are only beginning to be understood. In addition, increasing evidence underlines the importance of circadian variations in GCs in relationship to the timing of meals for determining their anabolic actions on the adipocyte. In summary, although the molecular mechanisms remain to be fully elucidated, there is increasing evidence that GCs have multiple, depot-dependent effects on adipocyte gene expression and metabolism that promote central fat deposition. PMID:23735216
Lee, Mi-Jeong; Pramyothin, Pornpoj; Karastergiou, Kalypso; Fried, Susan K
Central obesity is associated with insulin resistance and dyslipidemia. Thus, the mechanisms that control fat distribution and its impact on systemic metabolism have importance for understanding the risk for diabetes and cardiovascular disease. Hypercortisolemia at the systemic (Cushing's syndrome) or local levels (due to adipose-specific overproduction via 11β-hydroxysteroid dehydrogenase 1) results in the preferential expansion of central, especially visceral fat depots. At the same time, peripheral subcutaneous depots can become depleted. The biochemical and molecular mechanisms underlying the depot-specific actions of glucocorticoids (GCs) on adipose tissue function remain poorly understood. GCs exert pleiotropic effects on adipocyte metabolic, endocrine and immune functions, and dampen adipose tissue inflammation. GCs also regulate multiple steps in the process of adipogenesis. Acting synergistically with insulin, GCs increase the expression of numerous genes involved in fat deposition. Variable effects of GC on lipolysis are reported, and GC can improve or impair insulin action depending on the experimental conditions. Thus, the net effect of GC on fat storage appears to depend on the physiologic context. The preferential effects of GC on visceral adipose tissue have been linked to higher cortisol production and glucocorticoid receptor expression, but the molecular details of the depot-dependent actions of GCs are only beginning to be understood. In addition, increasing evidence underlines the importance of circadian variations in GCs in relationship to the timing of meals for determining their anabolic actions on the adipocyte. In summary, although the molecular mechanisms remain to be fully elucidated, there is increasing evidence that GCs have multiple, depot-dependent effects on adipocyte gene expression and metabolism that promote central fat deposition. This article is part of a Special Issue entitled: Modulation of Adipose Tissue in Health and Disease
For a long time the assumption has been that, although weight reduction was necessary and desirable, comorbidities were far more important and needed treatment even if weight loss was not a treatment goal, preferably with medication. This controversy leads to postponement of treatment, and later on causes very intensive medical treatment, thus, raising the health care costs to unacceptable levels, leading to the medicalization of individuals, and a declining of the responsibility of patients for their health, leaving the question of when to regard their own weight as a problem that should be dealt with up to individuals. The central problem is insulin resistance, which leads to a cascade of health problems. This condition should be diagnosed in primary practice and obesity clinics to ensure a better, tailor-made treatment for patients. Treatment should start at the earliest stage possible, when comorbidities are still reversible and includes a personalized dietary advice and counseling, preferably by a dietitian, to tackle insulin resistance. An exercise program is part of the treatment.
For a long time the assumption has been that, although weight reduction was necessary and desirable, comorbidities were far more important and needed treatment even if weight loss was not a treatment goal, preferably with medication. This controversy leads to postponement of treatment, and later on causes very intensive medical treatment, thus, raising the health care costs to unacceptable levels, leading to the medicalization of individuals, and a declining of the responsibility of patients for their health, leaving the question of when to regard their own weight as a problem that should be dealt with up to individuals. The central problem is insulin resistance, which leads to a cascade of health problems. This condition should be diagnosed in primary practice and obesity clinics to ensure a better, tailor-made treatment for patients. Treatment should start at the earliest stage possible, when comorbidities are still reversible and includes a personalized dietary advice and counseling, preferably by a dietitian, to tackle insulin resistance. An exercise program is part of the treatment. PMID:27417770
Licata, G; Corrao, S; Parrinello, G; Scaglione, R
Obesity and overweight have great clinical and social significance and are associated with a number of medical and surgical complications. We attempt here to summarize current knowledge on the subject and describe the research we are presently carrying out in this field. After a brief introduction, definition, and discussion of etiopathogenesis, the indexes of ponderal excess and epidemiology are illustrated. The cardiovascular adjustments and the relationships between obesity and hypertension, ischemic heart disease and congestive heart failure are then treated. One aim of our investigation was to study the modifications of an entire set of biological and clinical parameters which could concretely formulate and/or identify some pathophysiological links between obesity and heart disease. We thus studied obese subjects with hypertension, diabetes and multiple cardiovascular risk factors. We also studied a group of asymptomatic obese subjects, whom we define as "the healthy obese". Our results, supported by the medical literature, led to the conclusion that obesity is an important and/or independent cardiovascular risk factor. We think, however, that it would be prudent to await for the results of interventional trials and follow-up studies involving a large number of young, healthy obese subjects in order to monitor the most important biological variables over the long term.
Kelly, Mark; Moag-Stahlberg, Alicia
Describes causes of overweight and obesity in children; cites research linking good nutrition and a child's capacity to learn; includes six Web-based links to resources to help principals and teachers reduce the serious problem of overweight and obese children. (PKP)
Chandra, Aravind; Biersmith, Michael; Tolouian, Ramin
Obesity, both directly and indirectly, increases the risk for a variety of disease conditions including diabetes, hypertension, liver disease, and certain cancers, which in turn, decreases the overall lifespan in both men and women. Though the cardiovascular risks of obesity are widely acknowledged, less often identified is the relationship between obesity and renal function. Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched. The concept of the "Metabolic Syndrome" helps us to understand this close link between obesity, diabetes, hypertension, and renal dysfunction. An elevated body mass index has shown to be one of the major determinants of glomerular hyperfiltration that lead to the development of chronic kidney disease. Interestingly, weight loss can lead to attenuation of hyperfiltration in severely obese patients suggesting a possible therapeutic option to combat obesity-related hyperfiltration. Various treatment strategies had been suggested to decrease impact of obesity on kidneys. These are blood pressure controling, inhibition of the renin-angiotensinaldosterone axis, improving glycemic control, improving dyslipidemia, improving protein uriaand lifestyle modifications. Regardless of the numerous pharmacotherapies, the focus should be on the root cause: obesity.
Chandra, Aravind; Biersmith, Michael; Tolouian, Ramin
Context: Obesity, both directly and indirectly, increases the risk for a variety of disease conditions including diabetes, hypertension, liver disease, and certain cancers, which in turn, decreases the overall lifespan in both men and women. Though the cardiovascular risks of obesity are widely acknowledged, less often identified is the relationship between obesity and renal function. Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched. Results: The concept of the “Metabolic Syndrome“ helps us to understand this close link between obesity, diabetes, hypertension, and renal dysfunction. An elevated body mass index has shown to be one of the major determinants of glomerular hyperfiltration that lead to the development of chronic kidney disease. Interestingly, weight loss can lead to attenuation of hyperfiltration in severely obese patients suggesting a possible therapeutic option to combat obesity-related hyperfiltration. Conclusions: Various treatment strategies had been suggested to decrease impact of obesity on kidneys. These are blood pressure controling, inhibition of the renin-angiotensinaldosterone axis, improving glycemic control, improving dyslipidemia, improving protein uriaand lifestyle modifications. Regardless of the numerous pharmacotherapies, the focus should be on the root cause: obesity. PMID:25093156
All definitions of the metabolic syndrome include some form of obesity as one of the possible features. Body mass index (BMI) has a known genetic component, currently estimated to account for about 70% of the population variance in weight status for non-syndromal obesity. Much research effort has be...
Sarfati, J; Young, J; Christin-Maitre, S
Weight, fat mass and obesity have been shown to play a major role in female reproduction. Obese women have a greater risk than nonobese women of infertility and they fail to become pregnant in both natural and assisted conception cycles. This cannot be explained only by their lack of ovulation. There are several potential mechanisms. On one hand, the endometrium seems to be partially responsible for this low fecundity in obese women. On the other hand, the oocyte seems to be implied. In a model of obese mouse, maternal obesity prior to conception is associated with altered mitochondria in mouse oocytes and an increased generation of reactive oxygen species (ROS). Furthermore, compared with controls, obese mice have significantly more decreased embryonic IGF-IR staining, smaller fetuses and smaller pups. In this model, all weaned pups have been fed with a regular diet. At 13 weeks, pups delivered from obese mice were significantly larger, and these pups demonstrated early development of a metabolic-type syndrome. These findings suggest that maternal obesity has adverse effects as early as the oocyte and preimplantation embryo stages and that these effects may contribute to lasting morbidity in offspring, underscoring the importance of optimal maternal weight and nutrition before conception. Copyright Â© 2010 Elsevier Masson SAS. All rights reserved.
The study of obesity is a relatively new interdisciplinary academic field. The community college library shelves should contain two types of resources. First, several kinds of reference materials, and second, a host of broader materials that place the discussion of obesity within a cultural framework. This overview is divided into two major…
Farooqi, I Sadaf
We and others have identified several single gene defects that disrupt the molecules in the leptinmelanocortin pathway causing severe obesity in humans. In this review, we consider these human monogenic obesity syndromes and discuss how far the characterisation of these patients has informed our understanding of the physiological role of leptin and the melanocortins in the regulation of human body weight and neuroendocrine function.
Velazquez, Amanda; Apovian, Caroline M
Current management of obesity includes three main arms: behavioral modification, pharmacologic therapy, and bariatric surgery. Decades prior, the only pharmacological agents available to treat obesity were approved only for short-term use (≤ 12 weeks) by the Food and Drug Administration (FDA). However, in the last several years, the FDA has approved several medications for longer term treatment of obesity. This highlights the important progression that we, as a society, better appreciate now the chronicity and complexity of obesity as a disease. Also, availability of more medication options gives healthcare providers more possibilities to consider in the management of obesity. Medications for obesity can be simply categorized as FDA approved short-term use (diethylproprion, phendimetrazine, benzphetamine, and phentermine) and long-term use (orlistat, phentermine/topiramate ER, lorcaserin, naltrexone/bupropion ER and liraglutide). Additionally, type 2 diabetes (T2DM) is commonly seen in patients with obesity and necessitates consideration of pharmacological options that do not hinder patients' weight loss. Finally, weight-centric prescribing is also an important component to pharmacological management of obesity. It warrants that healthcare providers thoroughly review their patients' medication lists to determine if any of these agents could be contributing to weight gain.
Ashburn, Doyle D; Reed, Mary Jane
Obesity is associated with significant alterations in endocrine function. An association with type 2 diabetes mellitus and dyslipidemia has been well documented. This article highlights the complexities of treating endocrine system disorders in obese patients. Copyright © 2010. Published by Elsevier Inc.
A University of California at Los Angeles study in the Journal of Health Politics, Policy and Law suggests that the proportion of obese Americans has risen 20% since 1980, but the so-called obesity epidemic is at best a metaphor and not a very effective one at that. However, recent research finds no appreciable difference in mortality rates among…
Summerfield, Liane M.
In this discussion of childhood obesity, the medical and psychological problems associated with the condition are noted. Childhood obesity most likely results from an interaction of nutritional, psychological, familial, and physiological factors. Three factors--the family, low-energy expenditure, and heredity--are briefly examined. Early…
Drummond, Elaine M; Gibney, Eileen R
Research suggests that 65% of variation in obesity is genetic. However, much of the known genetic associations have little known function and their effect size small, thus the gene-environment interaction, including epigenetic influences on gene expression, is suggested to be an important factor in the susceptibilty to obesity. This review will explore the potential of epigenetic markers to influence expression of genes associated with obesity. Epigenetic changes in utero are known to have direct implications on the phenotype of the offspring. More recently work has focused on how such epigenetic changes continue to regulate risk of obesity from infancy through to adulthood. Work has shown that, for example, hypomethylation of the MC4 gene causes an increase in expression, and has a direct impact on appetite and intake, and thus influences risk of obesity. Similar influences are also seen in other aspects of obesity including inflammation and adiposity. Maternal diet during foetal development has many epigenetic implications, which affect the offspring's risk factors for obesity during childhood and adulthood, and even in subsequent generations. Genes associated with risk of obesity, are susceptible to epigenetic mutations, which have subsequent effects on disease mechanisms, such as appetite and impaired glucose and insulin tolerance.
Na, Soo-Young; Myung, Seung-Jae
Obesity worldwide is constantly increasing. Obesity acts as an independent significant risk factor for malignant tumors of various organs including colorectal cancer. Visceral adipose tissue is physiologically more important than subcutaneous adipose tissue. The relative risk of colorectal cancer of obese patients is about 1.5 times higher than the normal-weight individuals, and obesity is also associated with premalignant colorectal adenoma. The colorectal cancer incidence of obese patients has gender-specific and site-specific characteristics that it is higher in men than women and in the colon than rectum. Obesity acts as a risk factor of colorectal carcinogenesis by several mechanisms. Isulin, insulin-like growth factor, leptin, adiponectin, microbiome, and cytokines of chronic inflammation etc. have been understood as its potential mechanisms. In addition, obesity in patients with colorectal cancer negatively affects the disease progression and response of chemotherapy. Although the evidence is not clear yet, there are some reports that weight loss as well as life-modification such as dietary change and physical activity can reduce the risk of colorectal cancer. It is very important knowledge in the point that obesity is a potentially modifiable risk factor that can alter the incidence and outcome of the colorectal cancer.
Powell, Lynda H.; Calvin, James E., III; Calvin, James E., Jr.
To curb the epidemic of obesity in the United States, revised Medicare policy allows support for efficacious obesity treatments. This review summarizes the evidence from rigorous randomized trials (9 lifestyle trials, 5 drug trials, and 2 surgical trials) on the efficacy and risk-benefit profile of lifestyle, drug, and surgical interventions aimed…
Obesity is a chronic disease, and it requires chronic therapy. Hypertension, dyslipidemia, diabetes and cardiovascular diseases are leading causes of mortality in the modern world. All of them are strongly linked to obesity. While treating obesity, those conditions are also managed. Obese patients should always be treated through lifestyle interventions, though the results of such interventions are modest. Pharmacotherapy is a second step in the treatment of obesity, approved only when weight loss targets were not reached through lifestyle intervention. During the history of antiobesity drugs, many of them were withdrawn because of their side effects. Various guidelines recommend prescribing drug therapy for obesity through consideration of the potential benefits and limitations. Orlistat deactivates intestinal lipase and inhibits intestinal fat lipolysis. It is actually the only drug on the European market approved for the treatment of obesity. Orlistat therapy reduces weight to a modest extent, but it reduces the incidence of diabetes beyond the result achieved with lifestyle changes. Recently, some effective antiobesity drugs like sibutramine and rimonabant have been removed from the market due to their side effects. The new combination of topimarate and fentermine is approved in the US but not in Europe. The cost effectiveness of long-term pharmacotherapy of obesity is still an unresolved question.
Kelly, Mark; Moag-Stahlberg, Alicia
Describes causes of overweight and obesity in children; cites research linking good nutrition and a child's capacity to learn; includes six Web-based links to resources to help principals and teachers reduce the serious problem of overweight and obese children. (PKP)
Peralta-Romero, José de Jesús; Gómez-Zamudio, Jaime Héctor; Estrada-Velasco, Bárbara; Karam-Araujo, Roberto; Cruz-López, Miguel
Obesity is a major health problem around the globe. The statistics of overweight and obesity at early ages have reached alarming levels and placed our country in the first place in regard to childhood obesity. In the development of obesity two major factors take part, one genetic and the other one environmental. From the perspective of environmental changes both overweight and obesity result from the imbalance in the energy balance: people ingest more energy than they expend. Despite people live in the same obesogenic environment not all of them develop obesity; it requires genetic factors for this to happen. This review focuses on the description of the main methodologies to find genetic markers, as well as the main loci in candidate genes, whose single nucleotide polymorphisms (SNPs) are associated with obesity and its comorbidities in children, highlighting the association of these genes in the Mexican population. Knowledge of the genetic markers associated with obesity will help to understand the molecular and physiological mechanisms, the genetic background and changes in body mass index in the Mexican population. This information is useful for the planning of new hypotheses in the search for new biomarkers that can be used in a predictive and preventive way, as well as for the development of new therapeutic strategies.
The study of obesity is a relatively new interdisciplinary academic field. The community college library shelves should contain two types of resources. First, several kinds of reference materials, and second, a host of broader materials that place the discussion of obesity within a cultural framework. This overview is divided into two major…
Mauro, Marina; Taylor, Valerie; Wharton, Sean; Sharma, Arya M
Obesity, one of the most prevalent health problems in the Western world, is a chronic and progressive condition. Therefore, as with other chronic diseases, patients with obesity require lifelong treatment. Long-term efficacy and effectiveness of obesity treatments is notoriously poor. This may in part be attributable to the substantial barriers that undermine long-term obesity management strategies. These can include lack of recognition of obesity as a chronic condition, low socioeconomic status, time constraints, intimate saboteurs, and a wide range of comorbidities including mental health, sleep, chronic pain, musculoskeletal, cardiovascular, respiratory, digestive and endocrine disorders. Furthermore, medications used to treat some of these disorders may further undermine weight-loss efforts. Lack of specific obesity training of health professionals, attitudes and beliefs as well as coverage and availability of obesity treatments can likewise pose important barriers. Health professionals need to take care to identify, acknowledge and address these barriers where possible to increase patient success as well as compliance and adherence with treatments. Failure to do so may further undermine the sense of failure, low self esteem and self efficacy already common among obese individuals. Addressing treatment barriers can save resources and increase the prospect of long-term success.
Obesity is a health condition, but its consequences extend far beyond the realm of health. To illuminate an important route by which the experience of obesity can filter into the status attainment process, this study drew on nationally representative data from the National Longitudinal Study of Adolescent Health to test a social psychological…
... no one is to blame for your child’s obesity. Children gain excess weight for a variety of reasons. ... uncommon, they account for very few cases of obesity. More likely, your child’s excess weight is associated with poor eating and ...
Park, Jongwon; Chang, Jae Hyuck; Park, Sang Hi; Lee, Hee Jin; Lim, Yeon Soo; Kim, Tae Ho; Kim, Chang Whan; Han, Sok Won
Acute pancreatitis (AP) is a systemic inflammatory disease, and cytokines are suggested to be related to the course of AP. Obesity and central fat distribution are considered to have been associated with severe AP. This study investigated the profile of inflammatory cytokines in AP to determine how they are related to obesity, central fat distribution, and AP severity. Fifty-nine patients with AP were prospectively enrolled in the study. Body mass index and waist circumference were obtained at admission. Serum levels of inflammatory cytokines, IL-Iβ, IL-1ra, IL-6, TNF-α, sTNFR-I, and sTNFR-II, were measured on day 1 and 2 of AP. Of the patients included in the study, 19 (32%) were overweight, 23 (39%) had central fat distribution, and 23 (39%) had moderate AP. IL-1ra and IL-6 were significantly higher in overweight patients compared with non-overweight patients. IL-1ra, IL-6, TNF-α, and sTNFR-I were significantly higher in patients with central fat distribution compared with patients with non-central fat distribution. IL-6, sTNFR-I, and sTNFR-II were significantly higher in patients with moderate pancreatitis compared to those with mild pancreatitis. Among the six cytokines, IL-6 was commonly elevated in patients with central fat distribution, overweight, and moderate AP. The areas under the receiver operating characteristic curves of IL-6 for predicting the association with overweight, central fat distribution, and AP severity were 0.678, 0.716, and 0.801, respectively (P < 0.05). IL-6 is a good marker for AP severity and is associated with obesity and central fat distribution in AP patients. Copyright © 2014 IAP and EPC. Published by Elsevier B.V. All rights reserved.
The past few decades have witnessed a rapid rise in nutrition-related disorders such as obesity in the United States and over the world. Traditional nutrition research has associated various foods and nutrients with obesity. Recent advances in genomics have led to identification of the genetic variants determining body weight and related dietary factors such as intakes of energy and macronutrients. In addition, compelling evidence has lent support to interactions between genetic variations and dietary factors in relation to obesity and weight change. Moreover, recently emerging data from other 'omics' studies such as epigenomics and metabolomics suggest that more complex interplays between the global features of human body and dietary factors may exist at multiple tiers in affecting individuals' susceptibility to obesity; and a concept of 'personalized nutrition' has been proposed to integrate this novel knowledge with traditional nutrition research, with the hope ultimately to endorse person-centric diet intervention to mitigate obesity and related disorders.
Dizdar, Omer; Alyamaç, Evrim
Obesity is one of the most common disorders in clinical practice. The prevalance of obesity has increased by more than 60% since 1990. Adipose tissue acts as an endocrine organ secreting many factors into the blood, known as adipokines, including leptin, adipsin, acylation-stimulating protein, adiponectin, etc. This article examines the hypothesis that obesity may be evaluated as an endocrine tumor, regarding its genetic basis, hyperplasia and hypertrophy of adipocytes, neovascularisation within the adipose tissue associated with growth, and beneficisal metabolic effects of surgical removal of excess adipose tissue by liposuction. Assuming obesity as an endocrine tumor may bring out new treatment modalities. Liposuction as "cytoreductive surgery", antiangiogenic teraphy or anti-neoplastic drugs may be important components of obesity treatment in future.
Farooqi, I S; O'Rahilly, S
Over the past decade, we have witnessed a major increase in the scale of scientific activity devoted to the study of energy balance and obesity. This explosion of interest has, to a large extent, been driven by the identification of genes responsible for murine obesity syndromes and the novel physiological pathways revealed by those genetic discoveries. We and others recently have identified several single-gene defects causing severe human obesity. Many of these defects have occurred in molecules identical or similar to those identified as a cause of obesity in rodents. This chapter will consider the human monogenic obesity syndromes that have been characterized to date and discuss how far such observations support the physiological role of these molecules in the regulation of human body weight and neuroendocrine function.
Farooqi, I S
Over the past decade we have witnessed a major increase in the scale of scientific activity devoted to the study of energy balance and obesity. This explosion of interest has, to a large extent, been driven by the identification of genes responsible for murine obesity syndromes, and the novel physiological pathways revealed by those genetic discoveries. Others and we have also recently identified several single gene defects causing severe human obesity. Many of these defects have been in molecules identical or similar to those identified as a cause of obesity in rodents. I will review the human monogenic obesity syndromes that have been characterised to date and discuss how far such observations support the physiological role of these molecules in the regulation of human body weight and neuroendocrine function.
Michaud, Dominique S
Pancreatic cancer has few known risk factors, providing little in the way of prevention, and is the most rapidly fatal cancer with 7 % survival rate at 5 years. Obesity has surfaced as an important risk factor for pancreatic cancer as epidemiological studies with strong methodological designs have removed important biases and solidified the obesity associations. Moreover, studies indicate that obesity early in adulthood is strongly associated with future risk of pancreatic cancer and that abdominal obesity is an independent risk factor. There is increasing evidence suggesting long-standing diabetes type 2 and insulin resistance are important etiological factors of this disease, providing a strong mechanistic link to obesity. The challenge remains to determine whether intended weight loss in midlife will reduce risk of pancreatic cancer and to elucidate the complex underlying pathways directly involved with risk.
Al-Safi, Zain A; Polotsky, Alex J
Over the recent decades, the prevalence of obesity in the United States has increased to epidemic proportions to more than 35% of adults, along with an increased risk of a number of health conditions, including hypertension, adverse lipid concentrations, and type 2 diabetes. The relationships between menopausal transition, weight gain, and obesity are reported but incompletely understood. The association between menopause and these measures has been the subject of many studies, along with examining their effect on reproductive hormones and menopausal symptoms. The purpose of this review is to summarize what is published in the literature on this subject and examine it through: (1) the possible impact of obesity on the timing of menopause; (2) the effect of obesity on menopausal symptoms and reproductive hormones around the time of menopause; and (3) the effect of menopause on obesity, weight gain, and body composition. Copyright © 2014 Elsevier Ltd. All rights reserved.
Lee, Hae Sang; Yoon, Jong Seo; Hwang, Jin Soon
Objective: Girls with precocious puberty have high luteinizing hormone (LH) levels and advanced bone age. Obese children enter puberty at earlier ages than do non-obese children. We analyzed the effects of obesity on LH secretion during gonadotropin-releasing hormone (GnRH) tests in girls with precocious puberty. Methods: A total of 981 subjects with idiopathic precocious puberty who had undergone a GnRH stimulation testing between 2008 and 2014 were included in the study. Subjects were divided into three groups based on body mass index (BMI). Auxological data and gonadotropin levels after the GnRH stimulation test were compared. Results: In Tanner stage 2 girls, peak stimulated LH levels on GnRH test were 11.9±7.5, 10.4±6.4, and 9.1±6.1 IU/L among normal-weight, overweight, and obese subjects, respectively (p=0.035 for all comparisons). In Tanner stage 3 girls, peak stimulated LH levels were 14.9±10.9, 12.8±7.9, and 9.6±6.0 IU/L, respectively (p=0.022 for all comparisons). However, in Tanner stage 4 girls, peak stimulated LH levels were not significantly different among normal, overweight, and obese children. On multivariate analysis, BMI standard deviation score was significantly and negatively associated with peak LH (β=-1.178, p=0.001). Conclusion: In girls with central precocious puberty, increased BMI was associated with slightly lower peak stimulated LH levels at early pubertal stages (Tanner stages 2 and 3). This association was not valid in Tanner stage 4 girls. PMID:27215137
Ford, Earl S; Mokdad, Ali H
Obesity has emerged as a global public health challenge. The objective of this review was to examine epidemiological aspects of obesity in the Western Hemisphere. Using PubMed, we searched for publications about obesity (prevalence, trends, correlates, economic costs) in countries in North America, Central America, South America, and the Caribbean. To the extent possible, we focused on studies that were primarily population based in design and on four countries in the Western Hemisphere: Brazil, Canada, Mexico, and the United States. Data compiled by the International Obesity Task Force show a substantial level of obesity in all of or selected areas of the Bahamas, Barbados, Canada, Chile, Guyana, Mexico, Panama, Paraguay, Peru, St. Lucia, Trinidad and Tobago, the United States, and Venezuela. Furthermore, countries such as Brazil, Canada, Mexico, and the United States have experienced increases in the prevalence of obesity. In many countries, the prevalence of obesity is higher among women than men and in urban areas than in rural areas. The relationship between socioeconomic status and obesity depends on the stage of economic transition. Early in the transition, the prevalence of obesity is positively related to income whereas at some point during the transition the prevalence becomes inversely related to income. Like other countries in the Western Hemisphere, the four countries that we focused on have experienced a rising tide of obesity. The high and increasing prevalence of obesity and its attendant comorbidities are likely to pose a serious challenge to the public health and medical care systems in these countries.
Clement, Karine; Boutin, Philippe; Froguel, Philippe
Obesity is a typical common multifactorial disease in which environmental and genetic factors interact. In rare cases of severe obesity with childhood onset, a single gene has a major effect in determining the occurrence of obesity, with the environment having only a permissive role in the severity of the phenotype. Exceptional mutations of the leptin gene and its receptor, pro-opiomelanocortine (POMC), prohormone convertase 1 (PC1) and more frequently, mutations in the melanocortin receptor 4 (1 to 4% of very obese cases) have been described. All these obesity genes encode proteins that are strongly connected as part of the same loop of the regulation of food intake. They all involve the leptin axis and one of its hypothalamic targets; the melanocortin pathway. Pathways of bodyweight regulation involved in monogenic forms of obesity might represent targets for future drug development. Successful leptin protein replacement in a leptin-deficient child has contributed to the validation of the usefulness of gene screening in humans. However, the individual variability in response to leptin treatment might be related to genetic variability. The efficiency of leptin itself or of small-molecule agonists of the leptin receptor should be studied in relation with genetic variations in the leptin gene promoter. The most common forms of obesity are polygenic. Two general approaches have been used to date in the search for genes underlying common polygenic obesity in humans. The first approach focuses on selected genes having some plausible role in obesity on the basis of their known or presumed biological role. This approach yielded putative susceptibility genes with only small or uncertain effects. The second approach attempts to map genes purely by position and requires no presumptions on the function of genes. Genome-wide scans identify chromosomal regions showing linkage with obesity in large collections of nuclear families. Genome-wide scans in different ethnic
Jochem, Carmen; Leitzmann, Michael
There is strong evidence that modifiable lifestyle factors such as obesity play a key role in colorectal carcinogenesis. Epidemiologic data have consistently reported a positive association between obesity and colorectal cancer. The relative risk associated with general obesity (as assessed by BMI) is higher in men than in women and for cancer of the colon than for cancer of the rectum. Abdominal obesity (as assessed by waist circumference (WC) or waist-to-hip ratio) is associated with an increased risk of colorectal cancer in both sexes, with stronger associations for cancer of the colon than for cancer of the rectum. Plausible biological mechanisms include insulin resistance, hyperinsulinemia, chronic inflammation, altered levels of growth factors, adipocytokines and steroid hormones. In addition to its effect on colorectal cancer incidence, obesity may play a role in colorectal cancer recurrence, treatment outcomes and survival. Understanding the effects of childhood and adolescent obesity and weight change over the life course in relation to future risk of colorectal cancer is incomplete but essential for targeted preventive recommendations. This chapter summarizes the current evidence on the relationship between obesity and colorectal cancer and colorectal adenoma, a common precursor lesion.
Zhang, Xin; Lerman, Lilach O
Obesity remains a prominent public health concern. Obesity not only contributes greatly to cardiovascular events but has also been identified to initiate and affect the progression of preexisting chronic kidney disease. The prevalence of renal artery stenosis is growing world-wide, especially in the elderly population and in individuals with atherosclerotic risk factors such as obesity. Prolonged renovascular disease causes inflammation and microvascular remodeling within the post-stenotic kidney, which promote tissue scarring and may account for irreversible renal damage. Obesity has been shown to aggravate kidney damage via several pathways, including exacerbation of microvascular regression and renal cell injury mediated by adipocytes and insulin resistance, thereby worsening the structural and functional outcomes of the kidney in renovascular disease. Dietary modification and inhibition of the renin-angiotensin-aldosterone system have been shown to alleviate obesity-induced tissue injury and remodeling. Possibly, angiogenic factors may boost microvascular repair in the ischemic kidney in the obesity milieu. Novel therapeutic interventions targeting deleterious pathways that are activated by obesity and responsible for kidney damage need to be explored in future studies. Copyright © 2015 the American Physiological Society.
Raj, Manu; Kumar, R Krishna
Worldwide, obesity trends are causing serious public health concern and in many countries threatening the viability of basic health care delivery. It is an independent risk factor for cardiovascular diseases and significantly increases the risk of morbidity and mortality. The last two decades have witnessed an increase in health care costs due to obesity and related issues among children and adolescents. Childhood obesity is a global phenomenon affecting all socio-economic groups, irrespective of age, sex or ethnicity. Aetiopathogenesis of childhood obesity is multi-factorial and includes genetic, neuroendocrine, metabolic, psychological, environmental and socio-cultural factors. Many co-morbid conditions like metabolic, cardiovascular, psychological, orthopaedic, neurological, hepatic, pulmonary and renal disorders are seen in association with childhood obesity. The treatment of overweight and obesity in children and adolescents requires a multidisciplinary, multi-phase approach, which includes dietary management, physical activity enhancement, restriction of sedentary behaviour, pharmacotherapy and bariatric surgery. A holistic approach to tackle the childhood obesity epidemic needs a collection of activities including influencing policy makers and legislation, mobilizing communities, restructuring organizational practices, establishing coalitions and networks, empowering providers, imparting community education as well as enriching and reinforcing individual awareness and skills. The implications of this global phenomenon on future generations will be serious unless appropriate action is taken.
Sturm, Roland; An, Ruopeng
This review summarizes our understanding of economic factors during the obesity epidemic and dispels some widely held, but incorrect, beliefs: Rising obesity rates coincided with increases in leisure time (rather than increased work hours), increased fruit and vegetable availability (rather than a decline of healthier foods), and increased exercise uptake. As a share of disposable income, Americans now have the cheapest food available in history, which fueled the obesity epidemic. Weight gain was surprisingly similar across sociodemographic groups or geographic areas, rather than specific to some groups (at every point in time, however, there are clear disparities). It suggests that if we want to understand the role of the environment in the obesity epidemic, we need to understand changes over time affecting all groups, not differences between subgroups at a given time. Although economic and technological changes in the environment drove the obesity epidemic, the evidence for effective economic policies to prevent obesity remains limited. Taxes on foods with low nutritional value could nudge behavior towards healthier diets, as could subsidies/discounts for healthier foods. However, even a large price change for healthy foods could only close a part of the gap between dietary guidelines and actual food consumption. Political support has been lacking for even moderate price interventions in the US and this may continue until the role of environment factors is accepted more widely. As opinion leaders, clinicians play an important role to shape the understanding of the causes of obesity. PMID:24853237
Lopomo, A; Burgio, E; Migliore, L
Obesity is a metabolic disease, which is becoming an epidemic health problem: it has been recently defined in terms of Global Pandemic. Over the years, the approaches through family, twins and adoption studies led to the identification of some causal genes in monogenic forms of obesity but the origins of the pandemic of obesity cannot be considered essentially due to genetic factors, because human genome is not likely to change in just a few years. Epigenetic studies have offered in recent years valuable tools for the understanding of the worldwide spread of the pandemic of obesity. The involvement of epigenetic modifications-DNA methylation, histone tails, and miRNAs modifications-in the development of obesity is more and more evident. In the epigenetic literature, there are evidences that the entire embryo-fetal and perinatal period of development plays a key role in the programming of all human organs and tissues. Therefore, the molecular mechanisms involved in the epigenetic programming require a new and general pathogenic paradigm, the Developmental Origins of Health and Disease theory, to explain the current epidemiological transition, that is, the worldwide increase of chronic, degenerative, and inflammatory diseases such as obesity, diabetes, cardiovascular diseases, neurodegenerative diseases, and cancer. Obesity and its related complications are more and more associated with environmental pollutants (obesogens), gut microbiota modifications and unbalanced food intake, which can induce, through epigenetic mechanisms, weight gain, and altered metabolic consequences. Copyright © 2016 Elsevier Inc. All rights reserved.
Khan, Naiman A.; Baym, Carol L.; Monti, Jim M.; Raine, Lauren B.; Drollette, Eric S.; Scudder, Mark R.; Moore, R. Davis; Kramer, Arthur F.; Hillman, Charles H.; Cohen, Neal J.
Objective To assess associations between adiposity and hippocampal-dependent and hippocampal-independent memory forms among prepubertal children. Study design Prepubertal children (7–9-year-olds, n = 126), classified as non-overweight (<85th %tile BMI-for-age [n = 73]) or overweight/obese (≥85th %tile BMI-for-age [n = 53]), completed relational (hippocampal-dependent) and item (hippocampal-independent) memory tasks, and performance was assessed with both direct (behavioral accuracy) and indirect (preferential disproportionate viewing [PDV]) measures. Adiposity (%whole body fat mass, subcutaneous abdominal adipose tissue, visceral adipose tissue, and total abdominal adipose tissue) was assessed using DXA. Backward regressions identified significant (P <0.05) predictive models of memory performance. Covariates included age, sex, pubertal timing, socioeconomic status, IQ, oxygen consumption (VO2max), and body mass index (BMI) z-score. Results Among overweight/obese children, total abdominal adipose tissue was a significant negative predictor of relational memory behavioral accuracy, and pubertal timing together with socioeconomic status jointly predicted the PDV measure of relational memory. In contrast, among non-overweight children, male sex predicted item memory behavioral accuracy, and a model consisting of socioeconomic status and BMI z-score jointly predicted the PDV measure of relational memory. Conclusions Regional, and not whole body, fat deposition was selectively and negatively associated with hippocampal-dependent relational memory among overweight/obese prepubertal children. PMID:25454939
Khan, Naiman A; Baym, Carol L; Monti, Jim M; Raine, Lauren B; Drollette, Eric S; Scudder, Mark R; Moore, R Davis; Kramer, Arthur F; Hillman, Charles H; Cohen, Neal J
To assess associations between adiposity and hippocampal-dependent and hippocampal-independent memory forms among prepubertal children. Prepubertal children (age 7-9 years; n = 126), classified as non-overweight (<85th percentile body mass index [BMI]-for-age [n = 73]) or overweight/obese (≥85th percentile BMI-for-age [n = 53]), completed relational (hippocampal-dependent) and item (hippocampal-independent) memory tasks. Performance was assessed with both direct (behavioral accuracy) and indirect (preferential disproportionate viewing [PDV]) measures. Adiposity (ie, percent whole-body fat mass, subcutaneous abdominal adipose tissue, visceral adipose tissue, and total abdominal adipose tissue) was assessed by dual-energy X-ray absorptiometry. Backward regression identified significant (P < .05) predictive models of memory performance. Covariates included age, sex, pubertal timing, socioeconomic status (SES), IQ, oxygen consumption, and BMI z-score. Among overweight/obese children, total abdominal adipose tissue was a significant negative predictor of relational memory behavioral accuracy, and pubertal timing together with SES jointly predicted the PDV measure of relational memory. In contrast, among non-overweight children, male sex predicted item memory behavioral accuracy, and a model consisting of SES and BMI z-score jointly predicted the PDV measure of relational memory. Regional, but not whole-body, fat deposition was selectively and negatively associated with hippocampal-dependent relational memory among overweight/obese prepubertal children. Copyright © 2015 Elsevier Inc. All rights reserved.
Pimentel, Gustavo D; Lira, Fábio S; Rosa, José C; Caris, Aline V; Pinheiro, Fernanda; Ribeiro, Eliane B; Oller do Nascimento, Cláudia M; Oyama, Lila M
To clarify the effects of natural dietary components on the metabolic consequences of obesity, we examined the effects of yerba mate extract Ilex paraguariensis on both central and peripheral inflammatory effects of diet-induced obesity and correlated the hypothalamic tumor necrosis factor (TNF)-α level with adipose depot weight. Wistar rats were divided into four groups: a control group (CTL) fed with chow diet, a second group fed with chow diet plus yerba mate extract (CTL+E), a third group fed with a high-fat diet rich in saturated fatty acids (HFD) and a fourth group fed with HFD plus yerba mate extract (HFD+E). Enzyme-linked immunosorbent assay, Western blotting, colorimetric method and treatment by gavage were utilized as materials and methods. The HFD groups showed a significant increase in food intake (kcal), body weight, adipose tissue and leptin level in comparison to CTL and CTL+E. HFD leads to increase of both central and peripheral inflammatory effects, and deregulation of insulin pathway. In addition, yerba mate extract intake blunted the proinflammatory effects of diet-induced obesity in rats by reducing the phosphorylation of hypothalamic IKK and NFκBp65 expression and increasing the phosphorylation of IκBα, the expression of adiponectin receptor-1 and consequently the amount of IRS-2. Moreover, the increase in interleukin (IL)-6 levels in the liver and muscle and of the IL-10/TNF-α ratio in groups that received yerba mate extract showed the anti-inflammatory effects of this natural substance. Taken together, our data suggest that the use of yerba mate extract may be useful for reducing low-grade obesity-associated inflammation.
Nagrani, R; Mhatre, S; Rajaraman, P; Soerjomataram, I; Boffetta, P; Gupta, S; Parmar, V; Badwe, R; Dikshit, R
Current evidence suggests that the relationship between obesity and breast cancer (BC) risk may vary between ethnic groups. A total of 1633 BC cases and 1504 controls were enrolled in hospital-based case-control study in Mumbai, India, from 2009 to 2013. Along with detailed questionnaire, we collected anthropometric measurements on all participants. We used unconditional logistic regression models to estimate odds ratios (ORs) and 95% confidence interval (CI) for BC risk associated with anthropometry measurements, stratified on tumour subtype and menopausal status. Waist-to-hip ratio (WHR) of ≥0.95 was strongly associated with risk of BC compared to WHR ≤0.84 in both premenopausal (OR = 4.3; 95% CI: 2.9-6.3) and postmenopausal women (OR = 3.4; 95% CI: 2.4-4.8) after adjustment for body mass index (BMI). Premenopausal women with a BMI ≥30 were at lower risk compared to women with normal BMI (OR = 0.5; 95% CI: 0.4-0.8). A similar protective effect was observed in women who were postmenopausal for <10 years (OR = 0.6; 95% CI: 0.4-0.9) but not in women who were postmenopausal for ≥10 years (OR = 1.8; 95% CI: 1.1-3.3). Overweight and obese women (BMI: 25-29.9 and ≥ 30 kg/m(2), respectively) were at increased BC risk irrespective of menopausal status if their WHR ≥0.95. Central obesity (measured in terms of WC and WHR) increased the risk of both premenopausal and postmenopausal BCs irrespective of hormone receptor (HR) status. Central obesity appears to be a key risk factor for BC irrespective of menopausal or HR status in Indian women with no history of hormone replacement therapy. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Casanello, Paola; Krause, Bernardo J; Castro-Rodríguez, José A; Uauy, Ricardo
Current evidence supports the notion that exposure to various environmental conditions in early life may induce permanent changes in the epigenome that persist throughout the life-course. This article focuses on early changes associated with obesity in adult life. A review is presented on the factors that induce changes in whole genome (DNA) methylation in early life that are associated with adult onset obesity and related disorders. In contrast, reversal of epigenetic changes associated with weight loss in obese subjects has not been demonstrated. This contrasts with well-established associations found between obesity related DNA methylation patterns at birth and adult onset obesity and diabetes. Epigenetic markers may serve to screen indivuals at risk for obesity and assess the effects of interventions in early life that may delay or prevent obesity in early life. This might contribute to lower the obesity-related burden of death and disability at the population level. The available evidence indicates that epigenetic marks are in fact modifiable, based on modifications in the intrauterine environment and changes in food intake, physical activity and dietary patterns patterns during pregnancy and early years of adult life. This offers the opportunity to intervene before conception, during pregnancy, infancy, childhood, and also in later life. There must be documentation on the best preventive actions in terms of diet and physical activity that will modify or revert the adverse epigenetic markers, thus preventing obesity and diabetes in suceptible individuals and populations. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.
Pischon, Tobias; Nöthlings, Ute; Boeing, Heiner
The prevalence of obesity, defined as a BMI of > or =30.0 kg/m2, has increased substantially over previous decades to about 20% in industrialized countries, and a further increase is expected in the future. Epidemiological studies have shown that obesity is a risk factor for: post-menopausal breast cancer; cancers of the endometrium, colon and kidney; malignant adenomas of the oesophagus. Obese subjects have an approximately 1.5-3.5-fold increased risk of developing these cancers compared with normal-weight subjects, and it has been estimated that between 15 and 45% of these cancers can be attributed to overweight (BMI 25.0-29.9 kg/m2) and obesity in Europe. More recent studies suggest that obesity may also increase the risk of other types of cancer, including pancreatic, hepatic and gallbladder cancer. The underlying mechanisms for the increased cancer risk as a result of obesity are unclear and may vary by cancer site and also depend on the distribution of body fat. Thus, abdominal obesity as defined by waist circumference or waist:hip ratio has been shown to be more strongly related to certain cancer types than obesity as defined by BMI. Possible mechanisms that relate obesity to cancer risk include insulin resistance and resultant chronic hyperinsulinaemia, increased production of insulin-like growth factors or increased bioavailability of steroid hormones. Recent research also suggests that adipose tissue-derived hormones and cytokines (adipokines), such as leptin, adiponectin and inflammatory markers, may reflect mechanisms linked to tumourigenesis.
Aleksandrova, Krasimira; Stelmach-Mardas, Marta; Schlesinger, Sabrina
Obesity and related metabolic disorders have become globally prevalent posing a challenge for the chronically damaged liver and predisposing the development and progression of cancer. The rising phenomenon of "obesity epidemic" may provide means for understanding why liver cancer is one of the few malignancies with rising incidence in developed countries over the last decades. Non-alcoholic fatty liver disease associated with obesity, insulin resistance, and type 2 diabetes is an increasingly recognized trigger for liver cancer in Western populations characterized by low prevalence of established risk factors for liver cancer such as viral hepatitis and hepatotoxin exposure. Accumulating evidence has established an association between higher body mass index as an indicator of general obesity and higher risk of primary liver cancer. The associations are stronger in men, in patients with underlying liver disease and in white ethnic groups. Abdominal obesity, weight gain in adult life and metabolic factors related to visceral fat accumulation were also suggested as important risk factors for liver cancer; however, more studies are needed to evaluate these associations. The association of obesity and metabolic parameters with liver cancer survival remains controversial. It is unclear which exact mechanisms could provide links between obesity and liver cancer risk. Recent evidence has implicated several molecular pathways in obesity-associated liver cancer. These include insulin resistance leading to increased levels of insulin and insulin-like growth factors, chronic inflammation, adipose tissue remodeling, pro-inflammatory cytokine and adipokine secretion, and altered gut microbiota. These mechanisms coincide with inflammatory and metabolic processes occurring in non-alcoholic fatty liver disease predisposing cancer development and progression. In the context of the current evidence, better understanding of the role of obesity and related metabolic factors may help in
Mathus-Vliegen, Elisabeth M H
The prevalence of obesity is rising progressively, even among older age groups. By the year 2030 to 2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years or older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20% and 30% dependent on the model used. This means 20.9 million obese 60 years or older people in the United States in 2010 and 32 million obese elders in 2015 in EU. Although cutoff values of body mass index, waist circumference, and percentages of fat mass have not been defined for the elderly, it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a body mass index >30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who have functional impairments, metabolic complications, or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should minimize muscle and bone loss and vigilance as regards the development of sarcopenic obesity--a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone--is important. Lifestyle intervention should be the first step and consists of a diet with a 500 kcal energy deficit and an adequate intake of protein of high biological quality, together with calcium and vitamin D, behavioral therapy, and multicomponent exercise. Multicomponent exercise includes flexibility training, balance training, aerobic exercise, and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older were excluded.
Duchečková, Petra; Forejt, Martin
The purpose of this study was to examine the relation between daily steps and aerobic steps, and anthropometric variables, using the waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). The participants in this cross-sectional study were taken the measurements of by a trained anthropologist and then instructed to wear an Omron pedometer for seven consecutive days. A series of statistical tests (Mann-Whitney U test, Kruskal-Wallis ANOVA, multiple comparisons of z' values and contingency tables) was performed in order to assess the relation between daily steps and aerobic steps, and anthropometric variables. A total of 507 individuals (380 females and 127 males) participated in the study. The average daily number of steps and aerobic steps was significantly lower in the individuals with risky WHR and WHtR as compared to the individuals with normal WHR (P=0.005) and WHtR (P=0.000). A comparison of age and anthropometric variables across aerobic steps activity categories was statistically significant for all the studied parameters. According to the contingency tables for normal steps, there is a 5.75x higher risk in the low-activity category of having WHtR>0.50 as compared to the high-activity category. Both normal and aerobic steps are significantly associated with central obesity and other body composition variables. This result is important for older people, who are more likely to perform low-intensity activities rather than moderate- or high-intensity activities. Our results also indicate that risk of having WHtR>0.50 can be reduced by almost 6x by increasing daily steps over 8985 steps per day.
Obesity hypoventilation syndrome is a respiratory consequence of morbid obesity that is characterized by alveolar hypoventilation during sleep and wakefulness. The disorder involves a complex interaction between impaired respiratory mechanics, ventilatory drive and sleep-disordered breathing. Early diagnosis and treatment is important, because delay in treatment is associated with significant mortality and morbidity. Available treatment options include non-invasive positive airway pressure (PAP) therapies and weight loss. There is limited long-term data regarding the effectiveness of such therapies. This review outlines the current concepts of clinical presentation, diagnostic and management strategies to help identify and treat patients with obesity-hypoventilation syndromes. PMID:26029497
Shetty, Safal; Parthasarathy, Sairam
Obesity hypoventilation syndrome is a respiratory consequence of morbid obesity that is characterized by alveolar hypoventilation during sleep and wakefulness. The disorder involves a complex interaction between impaired respiratory mechanics, ventilatory drive and sleep-disordered breathing. Early diagnosis and treatment is important, because delay in treatment is associated with significant mortality and morbidity. Available treatment options include non-invasive positive airway pressure (PAP) therapies and weight loss. There is limited long-term data regarding the effectiveness of such therapies. This review outlines the current concepts of clinical presentation, diagnostic and management strategies to help identify and treat patients with obesity-hypoventilation syndromes.
Carr, Katelyn A; Daniel, Tinuke Oluyomi; Lin, Henry; Epstein, Leonard H
Obesity is, in part, a result of positive energy balance or energy intake exceeding physiological needs. Excess energy intake is determined by a series of food choices over time. These choices involve both motivational and executive function processes. Problems arise when there is excessive motivation to eat and low impulse control, a situation we have termed reinforcement pathology. Motivational and executive function processes have also been implicated in the development of drug dependence and addiction. In this review we discuss the application of reinforcement pathology to obesity, and implications of this approach for obesity treatment.
Ryan, Donna H; Braverman-Panza, Jill
Obesity is a common disorder affecting approximately 1 in 3 women. Assessment should consist of measuring BMI and waist circumference, a thorough history regarding nutrition, physical activity, and prior attempts at weight loss, and identification of obesity-related comorbidities. As a chronic disease, obesity requires management using a chronic care model employing multimodal therapy. Behavioral therapy to bring about changes in nutrition and physical activity can be supplemented with long-term use of medications (lorcaserin, orlistat, phentermine/topiramate) to help patients both achieve and maintain meaningful weight loss.
Berger, Nathan A.
Overweight and obesity have reached pandemic levels on a worldwide basis and are associated with increased risk and worse prognosis for many but not all malignancies. Pathophysiologic processes that affect this association are reviewed, with a focus on the relation of type 2 diabetes mellitus with cancer, lessons learned from the use of murine models to study the association, the impact of obesity on pancreatic cancer, the effect of dietary fats and cholesterol as cancer promoters, and the mechanisms by which the intestinal microbiome affects obesity and cancer. PMID:24725147
Pavlik, V; Fajfrova, J
Obesity has become the most frequent metabolic disease as a result of life conditions and lifestyle which have resulted in a positive energetic balance. However, at the end of the 20th century it reached the dimension of the global epidemic as a result of constantly increasing energy intake without an adequate increase in energy expenditure. The article describes the 11th International Congress on Obesity which took place in Stockholm in July 2010. The delegates discussed recommended diagnostics and treatments in obesitology. A large number of presentations were focused on nutrition and dietary management. The Congress showed that it is necessary to keep paying obesity due attention.
Riobó Serván, Pilar
Type 2 diabetes mellitus is characterized by hyperglycemia, insulin resistance, and relative impairment in insulin secretion and its possible long term complications. Its pathogenesis is poorly understood, but both genetic and environmental factors, such as obesity and aging, play a key role. "Diabesity" is a new term which refers to diabetes occurring in the context of obesity. In this article, we will discuss the epidemiology and impact of diabetes and obesity and will also outline the components of the metabolic syndrome and the studies that demonstrate that screening and prevention are possible in an attempt to control this epidemic.
Vanni, Ester; Bugianesi, Elisabetta
Obesity is an established risk factor for many types of cancers, particularly for hepatocellular carcinoma (HCC), owing to its carcinogenic potential and the association with nonalcoholic fatty liver disease (NAFLD). HCC may develop in cirrhotic and noncirrhotic livers with NAFLD, particularly in the presence of multiple metabolic risk factors such as obesity and diabetes. This issue is alarming because the population potentially at higher risk is greatly increasing. This review summarizes current evidence linking obesity and liver cancer, and discusses recent advances on the mechanisms underlying this relationship. Copyright © 2014 Elsevier Inc. All rights reserved.
Stunkard, Albert J
In conclusion, 2 types of disordered eating behaviors affect some overweight and obese persons. BED and NES present an excellent opportunity to recognize, treat, and prevent these disorders that, at the least, maintain, and at worst, promote, overweight and obesity. Articles in this volume by Wilson and co-workers and Allison and colleagues discuss current treatment options for BED and NES, respectively. Clinicians are encouraged to evaluate the presence of BED and NES in all patients who seek treatment for their obesity. Although the prevalence of these 2 eating disorders is relatively low, both are associated with significant distress and dysfunction that can be ameliorated with effective treatment.
Berger, Nathan A
Overweight and obesity have reached pandemic levels on a worldwide basis and are associated with increased risk and worse prognosis for many but not all malignancies. Pathophysiologic processes that affect this association are reviewed, with a focus on the relationship between type 2 diabetes mellitus and cancer, lessons learned from the use of murine models to study the association, the impact of obesity on pancreatic cancer, the effects of dietary fats and cholesterol on cancer promotion, and the mechanisms by which the intestinal microbiome affects obesity and cancer. © 2014 New York Academy of Sciences.
Kalish, Virginia B
The percentage of older obese adults is on the rise. Many clinicians underestimate the health consequences of obesity in the elderly, citing scarce evidence and concerns that weight loss might be detrimental to the health of older adults. Although overweight and obese elders are not at the same risk for morbidity and mortality as younger individuals, quality of life and function are adversely impacted. Weight loss plans in the elderly should include aerobic activities as well as balance and resistance activities to maintain optimal physical function. Published by Elsevier Inc.
García Álvarez, Alicia; Serra-Majem, Lluís; Castell, Conxa; Ribas-Barba, Lourdes; Méndez, Michelle A
To examine trends in the relationship between smoking history and both general and central fatness in adults from a Mediterranean setting. Materials and methods: The ENCAT 1992-1993 and 2002-2003 surveys were used; samples consisted of 482 men, 589 women from 1992-1993, and 515 men, 613 women from 2002-2003, aged 25-60 years. Measured anthropometry and self-reported data on smoking habits, diet, lifestyle and SES were collected. General fatness was defined as WHO's BMI overweight and obesity, and central fatness was defined as WHO's Increased-Risk-for-metabolic-complications Waist Circumference (IR WC) and Substantially-Increased-Risk WC (SIR WC). Simple logistic regression was used to estimate multivariate-adjusted associations between general/central fatness and smoking history. By 2002-2003, most associations observed in 1992-1993 had been strongly attenuated: only male current-heavy-smoking remained associated with IR/SIR WC (three-fold) and female current-moderate-smokers were 0.57 times less likely to have an IR/SIR WC (p < 0.10). Although causality cannot be established, results suggest a positive association between heavy smoking and central fatness among men, but no association between former smoking and general/central fatness; findings strengthen arguments for promoting smoking cessation to reduce smoking -and obesity- associated morbidity and mortality.
Cheung, Wai W.; Mao, Peizhong
The prevalence of obesity, which is a heritable trait that arises from the interactions of multiple genes and lifestyle factors, continues to increase worldwide, causing serious health problems and imposing a substantial economic burden on societies. For the past several years, various genetic epidemiological approaches have been utilized to identify genetic loci for obesity. Recent evidence suggests that development of obesity involves hormones and neurotransmitters (such as leptin, cocaine- and amphetamine-regulated transcript (CART), and ghrelin) that regulate appetite and energy expenditure. These hormones act on specific centers in the brain that regulate the sensations of satiety. Mutations in these hormones or their receptors can lead to obesity. Aberrant circadian rhythms and biochemical pathways in peripheral organs or tissues have also been implicated in the pathology of obesity. More interestingly, increasing evidence indicates a potential relation between obesity and central nervous system disorders (such as cognitive deficits). This paper discusses recent advances in the field of genetics of obesity with an emphasis on several established loci that influence obesity. These recently identified loci may hold the promise to substantially improve our insights into the pathophysiology of obesity and open up new therapeutic strategies to combat growing obesity epidemic facing the human population today. PMID:22474595
Després, Jean-Pierre; Lemieux, Isabelle
Metabolic syndrome is associated with abdominal obesity, blood lipid disorders, inflammation, insulin resistance or full-blown diabetes, and increased risk of developing cardiovascular disease. Proposed criteria for identifying patients with metabolic syndrome have contributed greatly to preventive medicine, but the value of metabolic syndrome as a scientific concept remains controversial. The presence of metabolic syndrome alone cannot predict global cardiovascular disease risk. But abdominal obesity - the most prevalent manifestation of metabolic syndrome - is a marker of 'dysfunctional adipose tissue', and is of central importance in clinical diagnosis. Better risk assessment algorithms are needed to quantify diabetes and cardiovascular disease risk on a global scale.
Pataky, Zoltan; Bobbioni-Harsch, Elisabetta; Carpentier, Anne; Golay, Alain
The endocannabinoid system is involved in the regulation of energy balance and metabolism. Endocannabinoids have central effects with raising appetite and hunger. On the other hand, different components of the endocannabinoid system are also found in peripheral organs and tissues and they could impact the lipid and glucose metabolism. Obesity is associated with an overactivity of the endocannabinoid system with increased both plasmatic and visceral adipose tissue levels. The amount of the intra-abdominal fat mass is an indicator of the peripheral endocannabinoid system dysregulation. Endocannabinoids-like molecules with more pronounced peripheral effects on lipids and glucose metabolism could be a new target of obesity treatment.
Globally obesity has reached to epidemic proportions, and the people of the Gulf countries have also affected, especially high-income, oil-producing countries. The prevalence of obesity in Gulf Countries among children and adolescents ranges from 5% to 14% in males and from 3% to 18% in females. In adult females there is a significant increase of obesity with a prevalence of 2%–55% and in adult males 1%–30% in countries of gulf region. Over the last two decades there is increased consumption of fast foods and sugar-dense beverages (e.g., sodas). Simultaneously, technological advances – cars, elevators, escalators, and remotes have lead to a decrease in level of activity. Traditional dependence on locally grown natural products such as dates, vegetables, wheat and has also shifted. Changes in food consumption, socioeconomic and demographic factors, physical activity, and urbanization are being important factors that contribute to the increased prevalence of obesity in the region. PMID:24899882
... groups. For example, in 2011–2012 among adults, non-Hispanic blacks had the highest prevalence of obesity (47.8%) followed by Hispanics (42.0%), non-Hispanic whites (33.4%), and non-Hispanic Asians ( ...
... Data Articles & Key Findings Disability-Related Documents Materials & Multimedia Fact Sheets Infographics Disability Impacts All of Us ... and adults with mobility limitations and intellectual or learning disabilities are at greatest risk for obesity. 1, ...
Health is regulated by homeostasis, a property of all living things. Homeostasis maintains equilibrium at set-points using feedback loops for optimum functioning of the organism. Imbalances in homeostasis causing overweight and obesity are evident in more than 1 billion people. In a new theory, homeostatic obesity imbalance is attributed to a hypothesized ‘Circle of Discontent’, a system of feedback loops linking weight gain, body dissatisfaction, negative affect and over-consumption. The Circle of Discontent theory is consistent with an extensive evidence base. A four-armed strategy to halt the obesity epidemic consists of (1) putting a stop to victim-blaming, stigma and discrimination; (2) devalorizing the thin-ideal; (3) reducing consumption of energy-dense, low-nutrient foods and drinks; and (4) improving access to plant-based diets. If fully implemented, interventions designed to restore homeostasis have the potential to halt the obesity epidemic. PMID:28070357
Martos-Moreno, Gabriel Ángel; Barrios, Vicente; Chowen, Julie A; Argente, Jesús
The worldwide increase in the prevalence of obesity in children and adolescents during the past decades, in addition to mounting evidence indicating that obesity is associated with an increased incidence of comorbidities and the risk of premature death, resulting in a high economical impact, has stimulated obesity-focused research. These studies have highlightened the prominent endocrine activity of adipose tissue, which is exerted through the synthesis and secretion of a wide variety of peptides and cytokines, called adipokines. In the present review, we have summarized the current knowledge and most relevant studies of adipokine dynamics and actions in children, focusing on the control of energy homeostasis, metabolic regulation (particularly, carbohydrate metabolism), and inflammation. The particularities of adipose secretion and actions in healthy children, from birth to adolescence, and the modifications induced by early-onset obesity are highlighted.
VanItallie, T B
Average body mass index values and prevalence data for overweight show complex patterns varying with sex, age, socioeconomic circumstances, race, geography, and over time. Differences in the predominant lifestyles and developmental status of nations and regions also influence weight patterns. Estimates of the prevalence of obesity in developed countries vary depending on the definitions used. For example, one recent survey has reported that the prevalence of obesity in the US is 15%, while another survey has found it to be 26%. It appears that overweight and obesity are becoming more prevalent worldwide, not only in developed nations, but also in the populations of developing countries, possibly as a result of urbanisation, migration, new eating habits and recent affluence. Since modernisation appears to be an inevitable process throughout the world, there is every reason to expect that the epidemic of overweight and obesity will extend globally in the future.
... page: //medlineplus.gov/ency/patientinstructions/000348.htm Health risks of obesity To use the sharing features on ... also have an increased risk of these conditions. Risk Factors Having a risk factor does not mean ...
Bray, Molly S; Young, Martin E
The development of obesity is the consequence of a multitude of complex interactions between both genetic and environmental factors. It has been suggested that the dramatic increase in the prevalence of obesity over the past 30 years has been the result of environmental changes that have enabled the full realization of genetic susceptibility present in the population. Among the many environmental alterations that have occurred in our recent history is the ever-increasing dyssynchrony between natural cycles of light/dark and altered patterns of sleep/wake and eating behavior associated with our "24-hour" lifestyle. An extensive research literature has established clear links between increased risk for obesity and both sleep deprivation and shift work, and our understanding of the consequences of such dyssynchrony at the molecular level is beginning to emerge. Studies linking alterations in cellular circadian clocks to metabolic dysfunction point to the increasing importance of chronobiology in obesity etiology.
Globally obesity has reached to epidemic proportions, and the people of the Gulf countries have also affected, especially high-income, oil-producing countries. The prevalence of obesity in Gulf Countries among children and adolescents ranges from 5% to 14% in males and from 3% to 18% in females. In adult females there is a significant increase of obesity with a prevalence of 2%-55% and in adult males 1%-30% in countries of gulf region. Over the last two decades there is increased consumption of fast foods and sugar-dense beverages (e.g., sodas). Simultaneously, technological advances - cars, elevators, escalators, and remotes have lead to a decrease in level of activity. Traditional dependence on locally grown natural products such as dates, vegetables, wheat and has also shifted. Changes in food consumption, socioeconomic and demographic factors, physical activity, and urbanization are being important factors that contribute to the increased prevalence of obesity in the region.
... January 27, 2012 NHLBI Research Featured in HBO Documentary Series on Obesity Hear people talk about their ... and maintaining a healthy weight on the HBO Documentary Films series, “The Weight of the Nation,” which ...
Ong, Ken K
High rates of overweight and obesity even in very young children argue the case for strategies to prevent overweight from very young ages. Historical studies, prospective birth cohorts, and more recently genetic studies all indicate that the rapid weight gain trajectory to later obesity starts in the first months of life, even from birth. Early puberty and age at menarche are consequences of rapid infant weight gain and childhood overweight, and in turn these adolescent traits are predictive for obesity, diabetes, hypertension and cardiovascular disease events in later life. Understanding of the nutritional, parental and wider determinants of rapid infant weight gain are informing the development of obesity prevention strategies starting in early life. Such strategies could be further refined by future studies that address the specific regulation of infant adiposity, and also by studies that explore whether these life-course trajectories are modifiable during adolescence.
da Silva, Inês Vieira; Soveral, Graça
Obesity is one of the most important metabolic disorders of this century and is associated with a cluster of the most dangerous cardiovascular disease risk factors, such as insulin resistance and diabetes , dyslipidemia and hypertension , collectively named Metabolic Syndrome. The role of aquaporins in glycerol metabolism facilitating glycerol release from the adipose tissue and distribution to various tissues and organs, unveils these membrane channels as important players in lipid balance and energy homeostasis and points to their involvement in a variety of pathophysiological mechanisms including insulin resistance, obesity and diabetes.This review summarizes the physiologic role of aquaglyceroporins in glycerol metabolism and lipid homeostasis, describing their specific tissue distribution, their involvement in glycerol balance and their implication in obesity and fat-related metabolic complications. The development of specify pharmacologic modulators able to regulate aquaglyceroporins expression and function , in particular AQP7 in adipose tissue, might constitute a novel approach for controlling obesity and other metabolic disorders.
Wyatt, Holly R
During the past several decades, obesity has increased substantially, making it a true epidemic and a public health crisis that both health care providers and the public are going to have to face. Currently, 61% of the US population is overweight or obese and therefore at increased risk for a number of diseases that are associated with increased body fat. Indeed, the obesity epidemic already is leading to dramatic increases in type 2 diabetes and the metabolic syndrome. Almost a quarter of the population currently has metabolic syndrome, which places them at high risk for the development of coronary heart disease. The future of the general health of the US population depends on identifying and providing the best treatment and prevention strategies for obesity in the years ahead.
Marks, David F
Health is regulated by homeostasis, a property of all living things. Homeostasis maintains equilibrium at set-points using feedback loops for optimum functioning of the organism. Imbalances in homeostasis causing overweight and obesity are evident in more than 1 billion people. In a new theory, homeostatic obesity imbalance is attributed to a hypothesized 'Circle of Discontent', a system of feedback loops linking weight gain, body dissatisfaction, negative affect and over-consumption. The Circle of Discontent theory is consistent with an extensive evidence base. A four-armed strategy to halt the obesity epidemic consists of (1) putting a stop to victim-blaming, stigma and discrimination; (2) devalorizing the thin-ideal; (3) reducing consumption of energy-dense, low-nutrient foods and drinks; and (4) improving access to plant-based diets. If fully implemented, interventions designed to restore homeostasis have the potential to halt the obesity epidemic.
Ingrande, Jerry; Lemmens, Hendrikus Jm
Anesthesiologists are increasingly being faced with treating obese patients. Physiologic and anthropometric associated with obesity-most notably increases in cardiac output, changes in tissue perfusion and increases in total body weight (TBW), lean body weight (LBW), and fat mass affect the pharmacokinetics (PK) of anesthetic agents. In addition, redundancy of airway tissue, obstructive and central sleep apnea and CO2 retention affect the pharmacodynamics (PD) of anesthetics and narrow the therapeutic window of numerous anesthetic drugs. Safe and effective pharmacologic management of the obese patient requires a thorough understanding of how obesity affects the PK and PD of anesthetics.
Seidell, J C
Obesity, defined as a body mass index (BMI) of 30 kg/m2 or more, is common in many parts of the world, especially in the established market economies, the former socialist economies of Europe, Latin America, the Caribbean and the Middle Eastern Crescent. As many as 250 million people worldwide may be obese (7% of the adult population) and two to three times as many may be considered overweight. The prevalence of obesity seems to be increasing in most parts of the world, even where it used to be rare. Increased fatness, measured by a high BMI, a large waist circumference or a high waist/hip circumference ratio, is associated with many chronic diseases as well as with poor physical functioning. Assessments of the prevalence of obesity, and trends in this prevalence over time, are more difficult in children than adults, due to the lack of international criteria for classifying individuals as overweight or obese. The World Health Organization has now recommended the use of BMI-for-age percentiles, but the reference curves are still under development. France. The Netherlands, the UK and the USA are among the countries that have reported recent increases in the prevalence of obesity in children and adolescents. Although there are no accurate estimates of the components of energy balance and their changes over time, the available evidence suggests that the trends in obesity rates are related more to a reduction in energy expenditure than to an increase in caloric intake. Prevention of obesity through the promotion of a healthy lifestyle is among the important challenges for the new millennium, and should start in childhood.
O'Rahilly, Stephen; Farooqi, I Sadaf
Considerable attention is currently being paid to the secular changes in food intake and physical activity that underlie the increase in the prevalence of obesity that is apparent in many societies. While this is laudable it would be unwise to view these environmental factors in isolation from the biological factors that normally control body weight and composition and the compelling evidence that inter-individual differences in susceptibility to obesity have strong genetic determinants. This is particularly important, as it is only in the past decade that we have begun to obtain substantive information regarding the molecular constituents of pathways controlling mammalian energy balance and therefore, for the first time, are in a position to achieve a better mechanistic understanding of this disease. Population-based association and linkage studies have highlighted a number of loci at which genetic variation is associated with obesity and related phenotypes and the identification and characterization of monogenic obesity syndromes has been particularly fruitful. While there is widespread acceptance that hereditary factors might predispose to human obesity, it is frequently assumed that such factors would influence metabolic rate or the selective partitioning of excess calories into fat. However, it is notable that, thus far, all monogenic defects causing human obesity actually disrupt hypothalamic pathways and have a profound effect on satiety and food intake. To conclude, the evidence we have to date suggests that the major impact of genes on human obesity is just as likely (or perhaps more likely) to directly impact on hunger, satiety and food intake rather than metabolic rate or nutrient partitioning. At the risk of oversimplification, it seems that from an aetiological/genetic standpoint, human obesity appears less a metabolic than a neuro-behavioural disease.
O'Rahilly, Stephen; Farooqi, I.Sadaf
Considerable attention is currently being paid to the secular changes in food intake and physical activity that underlie the increase in the prevalence of obesity that is apparent in many societies. While this is laudable it would be unwise to view these environmental factors in isolation from the biological factors that normally control body weight and composition and the compelling evidence that inter-individual differences in susceptibility to obesity have strong genetic determinants. This is particularly important, as it is only in the past decade that we have begun to obtain substantive information regarding the molecular constituents of pathways controlling mammalian energy balance and therefore, for the first time, are in a position to achieve a better mechanistic understanding of this disease. Population-based association and linkage studies have highlighted a number of loci at which genetic variation is associated with obesity and related phenotypes and the identification and characterization of monogenic obesity syndromes has been particularly fruitful. While there is widespread acceptance that hereditary factors might predispose to human obesity, it is frequently assumed that such factors would influence metabolic rate or the selective partitioning of excess calories into fat. However, it is notable that, thus far, all monogenic defects causing human obesity actually disrupt hypothalamic pathways and have a profound effect on satiety and food intake. To conclude, the evidence we have to date suggests that the major impact of genes on human obesity is just as likely (or perhaps more likely) to directly impact on hunger, satiety and food intake rather than metabolic rate or nutrient partitioning. At the risk of oversimplification, it seems that from an aetiological/genetic standpoint, human obesity appears less a metabolic than a neuro-behavioural disease. PMID:16815794
Nihiser, Allison; Merlo, Caitlin; Lee, Sarah
PRÉCIS This paper describes highlights from the Weight of the Nation™ 2012 Schools Track. Included is a summary of 16 presentations. Presenters shared key actions for obesity prevention through schools. The information provided at the Weight of the Nation™ can help school health practitioners access tools, apply evidence-based strategies, and model real-world examples to successfully start obesity prevention initiatives in their jurisdiction. PMID:24446995
Martini, Ana C; Molina, Rosa I; Ruiz, Rubén D; Fiol de Cuneo, Marta
Obesity and male infertility have increased in the last decades; therefore, a possible association between these pathologies has been explored. Studies inform that obesity may affect fertility through different mechanisms, which alltogether could exert erectile dysfunction and/or sperm quality impairment. These include: 1) hypothalamic-pituitary-testicular (HPG) axis malfunction: obese hormonal profile is characterized by reduction of testosterone, gonadotrophins, SHBG and/or inhibin B concentrations (marker of Sertoli cells function) and hyperestrogenemy (consequence of aromatase overactivity ascribed to adipose tissue increase); 2) increased release of adipose-derived hormones: leptin increase could be responsible for some of the alterations on the HPG axis and could also exert direct deleterious effects on Leydig cells physiology, spermatogenesis and sperm function; 3) proinflammatory adipokines augmentation, higher scrotal temperature (due to fat accumulation in areas surrounding testes) and endocrine disruptors accumulation in adiposites, all of these responsible for the increase in testes oxidative stress and 4) sleep apnea, frequent in obese patients, suppresses the nocturnal testosterone rise needed for normal spermatogenesis. Finally, although controversial, all the above mentioned factors could comprise gametes quality; i.e. decrease sperm density and motility and increase DNA fragmentation, probably disturbing spermatogenesis and/or epididymal function. In summary, although obesity may impair male fertility by some/all of the described mechanisms, the fact is that only a small proportion of obese men are infertile, probably those genetically predisposed or morbidly obese. Nevertheless, it is likely that because the incidence of obesity is growing, the number of men with reduced fertility will increase as well.
Liu, Ying; Warren Andersen, Shaneda; Wen, Wanqing; Gao, Yu-Tang; Lan, Qing; Rothman, Nathaniel; Ji, Bu-Tian; Yang, Gong; Xiang, Yong-Bing; Shu, Xiao-Ou; Zheng, Wei
General obesity, typically measured using body mass index (BMI), has been associated with an increased risk of several cancers. However, few prospective studies have been conducted in Asian populations. Although central obesity, often measured using waist-hip ratio (WHR), is more predictive for type 2 diabetes and cardiovascular diseases (CVD) risk than BMI, knowledge of its association with cancer incidence is limited. In a cohort of 68,253 eligible Chinese women, we prospectively investigated the association of BMI, WHR and weight change during adulthood with risk of overall cancer and major site-specific cancers using multivariate Cox proportional hazard models. Compared to the BMI group of 18.5-22.9 kg/m(2) , obese (BMI ≥ 30 kg/m(2) ) women were at an increased risk of developing overall cancer (hazard ratio = 1.36, 95% confidence interval = 1.21-1.52), postmenopausal breast cancer (HR: 2.43, 95% CI: 1.73-3.40), endometrial cancer (HR: 5.34, 95% CI: 3.48-8.18), liver cancer (HR: 1.93, 95% CI: 1.14-3.27) and epithelial ovarian cancer (HR: 2.44, 95% CI: 1.37-4.35). Weight gain during adulthood (per 5 kg gain) was associated with increased risk of all cancers combined (HR: 1.05, 95% CI: 1.03-1.08), postmenopausal breast cancer (HR: 1.17, 95% CI: 1.10-1.24) and endometrial cancer (HR: 1.37, 95% CI: 1.27-1.48). On the other hand, WHR was not associated with cancer risk after adjustment for baseline BMI. These findings suggest that obesity may be associated with cancer risk through different mechanisms from those for type 2 diabetes and CVD and support measures of maintaining health body weight to reduce cancer risk in Chinese women. © 2016 UICC.
Yao, Fayi; MacKenzie, Robert George
The growing worldwide obesity epidemic and obesity-related disorders present a huge unmet medical need for safe and effective anti-obesity medications. The discovery of leptin in 1994 was rapidly succeeded by a wave of related discoveries leading to the elaboration of a hypothalamic melanocortinergic neuronal circuit regulated by leptin and other central and peripheral signaling molecules to control energy homeostasis. The identification of specific neuronal subtypes along with their unique connections and expression products generated a rich target menu for anti-obesity drug discovery programs. Over the course of the last decade, several new chemical entities aimed at these targets have reached various stages or successfully completed the drug discovery/regulatory process only to be dropped or taken off the market. There are now in fact fewer options for anti-obesity drug therapies in late 2010 than were available in 2000. The challenge to discover safe and effective anti-obesity drugs is alive and well.
Guillemot-Legris, Owein; Muccioli, Giulio G
Obesity is now a worldwide health issue. Far from being limited to weight gain, obesity is generally associated with low-grade inflammation and with a cluster of disorders collectively known as the 'metabolic syndrome'. When considering obesity and the subsequent neuroinflammation, the focus was long set on the hypothalamus. More recently, obesity-derived neuroinflammation has been shown to affect other brain structures such as the hippocampus, cortex, brainstem, or amygdala. Furthermore, obesity has been associated with increased occurrence of central disorders such as depression and impaired cognitive function. We discuss here the effects and mechanisms of obesity-derived neuroinflammation, with a specific emphasis on extra-hypothalamic structures, as well as the repercussions of neuroinflammation for some cerebral functions.
Larder, Rachel; Lim, Chung Thong; Coll, Anthony P
Obesity and its related metabolic consequences represent a major public health problem. Huge changes within the environment have undoubtedly contributed to the increased prevalence of obesity but genetic factors are also critical in determining an individual's predisposition to gain weight. The last two decades have seen a huge increase in the understanding of the mechanisms controlling appetitive behavior, body composition, and energy expenditure. Many regions throughout the central nervous system play critical roles in these processes but the hypothalamus, in particular, receives and orchestrates a variety of signals to bring about coordinated changes in energy balance. Reviewing data from human genetic and model organism studies, we consider how disruptions of hypothalamic pathways evolved to maintain energy homeostasis and go on to cause obesity. We highlight ongoing technological developments which continue to lead to novel insights and discuss how this increased knowledge may lead to effective therapeutic interventions in the future.
Carnahan, S; Balzer, A; Panchal, S K; Brown, L
Obesity was probably rare in ancient times, with the current increase starting in the Industrial Revolution of the eighteenth century, and becoming much more widespread from about 1950, so concurrent with the increased consumption of carbohydrates from cereals in the Green Revolution. However, dietary components such as oligosaccharides from plants including cereals may improve health following fermentation to short-chain carboxylic acids in the intestine by bacteria which constitute of the microbiome. Such non-digestible and fermentable components of diet, called prebiotics, have been part of the human diet since at least Palaeolithic times, and include components of the cereals domesticated in the Neolithic Revolution. If consumption of these cereals has now increased, why is obesity increasing? One reason could be lowered prebiotic intake combined with increased intake of simple sugars, thus changing the bacteria in the microbiome. Processing of food has played an important role in this change of diet composition. Since obesity is a low-grade inflammation, changing the microbiome by increased consumption of simple carbohydrates and saturated fats may lead to obesity via increased systemic inflammation. Conversely, there is now reasonable evidence that increased dietary prebiotic intake decreases inflammation, improves glucose metabolism and decreases obesity. Would widespread increases in prebiotics in the modern diet, so mimicking Palaeolithic or Neolithic nutrition, decrease the incidence and morbidity of obesity in our communities?
Ferreira, Vanessa Alves; Silva, Aline Elizabeth; Rodrigues, Chrystiellen Ayana Aparecida; Nunes, Nádia Lúcia Almeida; Vigato, Tássia Cassimiro; Magalhães, Rosana
National studies have been demonstrating the positive relationship among inequality, poverty and obesity revealing the singularities and complexity of the nutritional transition in Brazil. In this direction, the women constitute a vulnerable group to the dynamics of the obesity in the poverty context. Such fact imposes the theoretical deepening and the accomplishment of researches that make possible a larger approach with the phenomenon in subject. In this perspective, the study analyzed the daily life of poor and obese women, users of basic units of health of the city of Diamantina, Vale do Jequitinhonha, Minas Gerais State. The results revealed the complex relationship between feminine obesity and poverty. The cultural and material aspects of life, as well as the different feeding and body conceptions that demonstrated to be fundamental elements for the analysis of the multiple faces of the obesity among the investigated group. Facing these results it is appropriate to encourage public policies that promote equity widening the access of those groups to the main resources for the prevention and combat of obesity.
Berger, Kenneth I; Goldring, Roberta M; Rapoport, David M
The term obesity hypoventilation syndrome (OHS) refers to the combination of obesity and chronic hypercapnia that cannot be directly attributed to underlying cardiorespiratory disease. Despite a plethora of potential pathophysiological mechanisms for gas exchange and respiratory control abnormalities that have been described in the obese, the etiology of hypercapnia in OHS has been only partially elucidated. Of particular note, obesity and coincident hypercapnia are often associated with some form of sleep disordered breathing (apnea/hypopnea or sustained periods of hypoventilation). From a conceptual point of view, even transient reductions of ventilation from individual sleep disordered breathing events must produce acute hypercapnia during the period of low ventilation. What is less clear, however, is the link between these transient episodes of acute hypercapnia and the development of chronic sustained hypercapnia persisting into wakefulness. A unifying view of how this comes about is presented in the following review. In brief, our concept is that chronic sustained hypercapnia (as in obesity hypoventilation) occurs when the disorder of ventilation that produces acute hypercapnia interacts with inadequate compensation (both during sleep and during the periods of wakefulness); neither alone is sufficient to fully explain the final result. The following discussion will amplify on both the potential reasons for acute hypercapnia in the obese and on what is known about the failure of compensation that must occur in these subjects.
Choi, Kyung Mook
Sarcopenia is an age-associated loss of muscle mass and decline in muscle strength; it is common in older adults and is associated with significant morbidity and mortality. Despite its prevalence, there is currently no universally adopted definition of sarcopenia. In addition to low muscle mass measurements, recent research has recognized the importance of muscle strength and physical performance. Aging induces changes in body composition, such as an increase in visceral fat and reduced muscle mass. Recently, the new concept of sarcopenic obesity has emerged, reflecting a combination of sarcopenia and obesity. The rapidly increasing prevalence and serious consequences of sarcopenic obesity are recognized as a critical public health risk in the aging society. Sarcopenia and obesity share several pathophysiological mechanisms, and they may potentiate each other. The present paper reviews the definitions and techniques used to measure sarcopenia, as well as the health outcomes of sarcopenic obesity. It also highlights the role of diminished muscle mass and strength in cardiometabolic disease mortality. Additional research may be needed to promote the identification and management of sarcopenia and sarcopenic obesity in the elderly population. PMID:27809450
Menifield, Charles E; Doty, Nicole; Fletcher, Audwin
Recent data indicate that Americans are gaining weight at an alarming rate. In fact, data from the CDC indicate that the U.S. obesity average was 12% in 1990 and had grown to 23% by 2005. In recent years, this problem appears to be more prominent in some southern states than in other states. The purpose of this study was to determine what factors were associated with increased levels of obesity. Do demographic, educational, healthcare, or economic factors correlate with this trend? Using state level data in a fixed effects regression model we examined obesity rates for the period 1990-2003. We also used cross tabulation tables to compare obesity rates to several independent variables. Our analysis revealed that obesity was related to several health, demographic, and economic factors. As a result, we argue that policy makers as well as health officials should take a comprehensive look at obesity as well as other social ills, health care conditions, and related issues prior to creating a plan to improve health in this country.
Esposito, Paul W; Caskey, Paul; Heaton, Lisa E; Otsuka, Norman
The goal of this publication is to raise awareness of the impact of childhood obesity on the musculoskeletal health of children and its potential long-term implications. Relevant articles dealing with musculoskeletal disorders either caused by or worsened by childhood obesity were reviewed through a Pub Med search. Efforts to recognize and combat the childhood obesity epidemic were also identified through Internet search engines. This case statement was then reviewed by the members of the pediatric specialty group of the US Bone and Joint Initiative, which represents an extensive number of organizations dealing with musculoskeletal health. Multiple musculoskeletal disorders are clearly caused by or worsened by childhood obesity. The review of the literature clearly demonstrates the increased frequency and severity of many childhood musculoskeletal disorders. Concerns about the long-term implications of these childhood onset disorders such as pain and degenerative changes into adulthood are clearly recognized by all the member organizations of the US Bone and Joint Initiative. It is imperative to recognize the long-term implications of musculoskeletal disorders caused by or worsened by childhood obesity. It is also important to recognize that the ability to exercise comfortably is a key factor to developing a healthy lifestyle and maintaining a healthy body weight. Efforts to develop reasonable and acceptable programs to increase physical activity by all facets of society should be supported. Further research into the long-term implications of childhood musculoskeletal disorders related to childhood obesity is necessary.
Esposito, Paul W; Caskey, Paul; Heaton, Lisa E; Otsuka, Norman
The goal of this publication is to raise awareness of the impact of childhood obesity on the musculoskeletal health of children and its potential long-term implications. Relevant articles dealing with musculoskeletal disorders either caused by or worsened by childhood obesity were reviewed through a Pub Med search. Efforts to recognize and combat the childhood obesity epidemic were also identified through Internet search engines. This case statement was then reviewed by the members of the pediatric specialty group of the US Bone and Joint Initiative, which represents an extensive number of organizations dealing with musculoskeletal health. Multiple musculoskeletal disorders are clearly caused by or worsened by childhood obesity. The review of the literature clearly demonstrates the increased frequency and severity of many childhood musculoskeletal disorders. Concerns about the long-term implications of these childhood onset disorders such as pain and degenerative changes into adulthood are clearly recognized by all the member organizations of the US Bone and Joint Initiative. It is imperative to recognize the long-term implications of musculoskeletal disorders caused by or worsened by childhood obesity. It is also important to recognize that the ability to exercise comfortably is a key factor to developing a healthy lifestyle and maintaining a healthy body weight. Efforts to develop reasonable and acceptable programs to increase physical activity by all facets of society should be supported. Further research into the long-term implications of childhood musculoskeletal disorders related to childhood obesity is necessary. Copyright © 2013 Elsevier Inc. All rights reserved.
Lee, Yung Seng
Common obesity is widely regarded as a complex, multifactorial trait influenced by the 'obesogenic' environment, sedentary behavior, and genetic susceptibility contributed by common and rare genetic variants. This review describes the recent advances in understanding the role of genetics in obesity. New susceptibility loci and genetic variants are being uncovered, but the collective effect is relatively small and could not explain most of the BMI heritability. Yet-to-be identified common and rare variants, epistasis, and heritable epigenetic changes may account for part of the 'missing heritability'. Evidence is emerging about the role of epigenetics in determining obesity susceptibility, mediating developmental plasticity, which confers obesity risk from early life experiences. Genetic prediction scores derived from selected genetic variants, and also differential DNA methylation levels and methylation scores, have been shown to correlate with measures of obesity and response to weight loss intervention. Genetic variants, which confer susceptibility to obesity-related morbidities like nonalcoholic fatty liver disease, were also discovered recently. We can expect discovery of more rare genetic variants with the advent of whole exome and genome sequencing, and also greater understanding of epigenetic mechanisms by which environment influences genetic expression and which mediate the gene-environment interaction.
Choi, Kyung Mook
Sarcopenia is an age-associated loss of muscle mass and decline in muscle strength; it is common in older adults and is associated with significant morbidity and mortality. Despite its prevalence, there is currently no universally adopted definition of sarcopenia. In addition to low muscle mass measurements, recent research has recognized the importance of muscle strength and physical performance. Aging induces changes in body composition, such as an increase in visceral fat and reduced muscle mass. Recently, the new concept of sarcopenic obesity has emerged, reflecting a combination of sarcopenia and obesity. The rapidly increasing prevalence and serious consequences of sarcopenic obesity are recognized as a critical public health risk in the aging society. Sarcopenia and obesity share several pathophysiological mechanisms, and they may potentiate each other. The present paper reviews the definitions and techniques used to measure sarcopenia, as well as the health outcomes of sarcopenic obesity. It also highlights the role of diminished muscle mass and strength in cardiometabolic disease mortality. Additional research may be needed to promote the identification and management of sarcopenia and sarcopenic obesity in the elderly population.
Lobert, M; Pigeyre, M; Gronier, H; Catteau-Jonard, S; Robin, G
The prevalence of obesity is increasing massively over several decades in industrialized countries. Obese women are sexually active but they use fewer contraceptive methods and are at high risk of unintended pregnancy. In addition, obesity is an important risk factor for venous thromboembolism events and arterial thrombosis (myocardial infarction and ischemic stroke). All of these data are to be considered in choosing a contraceptive method for obese women. Except depot medroxyprogesterone acetate injection, the progestin-only contraceptives (progestin only pills and etonogestrel subdermal implant) and the intra-uterine devices are the preferred contraceptive methods in obese women. The combined estrogen-progestin contraceptives (pill, patch and vaginal ring) may be proposed in very strict conditions (no other associated vascular risk factor). Obesity does not increase the risk of failure of most contraceptive methods. Bariatric surgery is a complex situation. It requires to program a possible pregnancy and contraception is needed for several months. Some bariatric surgical techniques such as by-pass can induce gastrointestinal malabsorption. In this situation, all oral contraceptives are not recommended because of a higher risk of failure.
Koch, Felix-Sebastian; Sepa, Anneli; Ludvigsson, Johnny
To examine whether there is a relationship between psychological stress in the family and obesity in 5- to 6-year-old children. A total of 7443 Swedish families reported on psychological stress across 4 domains as part of the prospective All Babies in Southeast Sweden-project (ABIS). Domains assessed included serious life events, parenting stress, lack of social support, and parental worries. These variables were summarized in cross-sectional and longitudinal composite measures of psychological stress. Logistic regression models were used to calculate odds ratios for childhood obesity for psychological stress. A total of 4.2% of the children were obese according to age-adjusted international standards. Children from families that reported stress in at least 2 of the 4 domains assessed had significantly higher adjusted odds ratios (OR) for obesity, both cross-sectionally (OR, 2.1; 95% CI, 1.3-3.5; P < .01) and longitudinally (OR, 2.6; 95% CI, 1.3-5.4, P < .01). Psychological stress in the family may be a contributing factor for childhood obesity. This finding underscores how important it is to give children with obesity and their families psychological and social support in addition to recommendations about changing life style.
Li, Mingfang; Cheung, Bernard M Y
Obesity is associated with increased risk of conditions such as hypertension, dyslipidaemia, diabetes mellitus, and obstructive sleep apnoea. Pharmacotherapy for obesity should be considered in combination with lifestyle changes in obese patients, or overweight patients with other conditions that put them at risk of developing heart disease. Sibutramine and orlistat are the only two anti-obesity medications approved for long-term use. Sibutramine is a serotonergic and adrenergic drug that reduces food intake. Orlistat is a gastrointestinal lipase inhibitor that interferes with fat absorption. However, it commonly causes flatulence and diarrhoea. Rimonabant is the first of a series of endocannabinoid receptor antagonists. It was approved by the Committee for Medicinal Products for Human Use of the European Medicines Agency (EMEA) as an adjunct to diet and exercise in treating obesity in 2006. However, despite the extensive clinical trial data, EMEA announced in 2008 that it has recommended suspension of rimonabant because of its psychiatric side effects. Studies evaluating the long-term safety and efficacy of anti-obesity agents are needed. PMID:20002075
Buttenheim, Alison M; Goldman, Noreen; Pebley, Anne R
Previous studies assessing the validity of adolescent self-reported height and weight for estimating obesity prevalence have not accounted for, potential bias due to nonresponse in self-reports. The aim of this study was to assess the implications of selective nonresponse in self-reports of height and weight for estimates of adolescent obesity. The authors analyzed 613 adolescents ages 12-17 years from the 2006-2008 Los Angeles Family and Neighborhood Survey, a longitudinal study of Los Angeles County households with an oversample of poor neighborhoods. Obesity prevalence estimates were compared based on (a) self-report, (b) measured height and weight for those who did report, and (c) measured height and weight for those who did report. Among younger teens, measured obesity prevalence was higher for those who did not report height and weight compared with those who did (40% vs. 30%). Consequently, obesity prevalence based on self-reported height and weight underestimated measured prevalence by 12 percentage points (when accounting for nonresponse) versus 9 percentage points (when nonresponse was not accounted for). Results were robust to the choice of difference child growth references. Adolescent obesity surveillance and prevention efforts must take into account selective nonresponse for self-reported height and weight, particularly for younger teens. Results should be replicated in a nationally representative sample.
Moreno, Luis A; Bel-Serrat, Silvia; Santaliestra-Pasías, Alba M; Rodríguez, Gerardo
The prevalence of childhood overweight and obesity continues to be unacceptably high and of public health concern in Europe. During childhood and adolescence, environmental factors are the main drivers of obesity development. Obesity is caused by a chronic energy imbalance involving both dietary intake and physical activity patterns. Several risk factors are influencing obesity development, even starting in the prenatal period. From birth, along life, mainly diet and physical activity/inactivity are the most important drivers on top of genetic susceptibility. The first years of life can therefore be crucial to start preventive interventions that can have an impact on lifestyle and on later overweight and obesity. Schools are an attractive and popular setting for implementing interventions for children. Interventions including a community component are considered to be the most effective. Obesity control will require policy interventions to improve the environments that promote poor dietary intake and physical inactivity rather than individually focused interventions. More solid institutional and health policies are needed together with more effective interventions to obtain evident changes for the prevention of excess adiposity among children.
Leite, Fernanda; Lima, Margarida; Marino, Franca; Cosentino, Marco; Ribeiro, Laura
Background: Central obesity (CO) is an inflammatory disease. Because immune cells and adipocytes are catecholamines(CA)-producing cells, we studied the expression of adrenoceptors (AR) in peripheral blood mononuclear cells (PBMCs) hypothesizing a distinct adrenergic pattern in inflammatory obesity. Methods: AR expression was assessed in blood donors categorized by waist circumference (WC) (CO: WC≥0.80 m in women and ≥0.94 m in men). Following a pilot study for all AR subtypes, we measured β2AR expression in fifty-seven individuals and correlated this result with anthropometric, metabolic and inflammatory parameters. A ratio (R) between AR mRNA of CO and non-CO<0.5 was considered under and >2.0 over expression. Results: The pilot study revealed no differences between groups, except for β2AR mRNA. CO individuals showed underexpression of β2AR relatively to those without CO (R=0.08; p=0.009). β2AR expression inversely correlated with triacylglycerol (r=-0.271; p=0.041), very low-density lipoprotein-cholesterol (r=-0.313; p=0.018) and leptin (r=-0.392; p=0.012) and positively with high-density lipoprotein-cholesterol (r=0.310: p=0.045) plasma levels. Multiple logistic regression analysis showed a protective effect of β2AR expression (≥2x10-6) [odds ratio (OR) 0.177 with respective confidence interval of 95% (95% CI) (0.040- 0.796)] for the occurrence of CO. A higher association was found for women as compared to men (Ξ9:1) [OR 8.972 (95% CI) (1.679-47.949)]. Conclusion: PBMCs β2AR, underexpressed in centrally obese, are associated with a better metabolic profile and showed a protective role for the development of CO. The discovery of β2AR as a new molecular marker of obesity subphenotypes in PBMCs might contribute to clarify the adrenergic immunomodulation of inflammatory obesity.
Murakami, Kentaro; McCaffrey, Tracy A; Livingstone, M Barbara E
Inconsistent associations between dietary glycaemic index (GI) and glycaemic load (GL) and body fatness may be partly due to differences in the underlying dietary patterns or energy under-reporting. In the present study, we examined the cross-sectional associations of dietary GI and GL with food and nutrient intake and general and central obesity, accounting for energy under-reporting. The subjects were 1487 British adults aged 19-64 years. Dietary intake was assessed using a 7 d weighed dietary record. Breads and potatoes were the positive predictive foods for dietary GI, while fruit, other cereals and dairy products were the negative predictors. These foods were similarly identified in the analysis of only acceptable reporters (AR; ratio of reported energy intake:estimated energy requirement within 0·665-1·335) and under-reporters (UR; ratio < 0·665). Dietary GL was closely correlated with carbohydrate intake. Multiple linear regression analyses showed that dietary GI was independently associated with a higher risk of general obesity (BMI ≥ 30 kg/m²) and central obesity (waist circumference ≥ 102 cm in men and ≥ 88 cm in women). Dietary GL was also associated with general (only women) and central obesity. Similarly, in the analysis of AR, the GI showed positive associations with general and central obesity, and, only in women, the GL showed positive associations with general and central obesity. Conversely, in the analysis of UR, the associations were generally weaker and many of them failed to reach statistical significance. In conclusion, we found independent positive associations of dietary GI and GL with general and central obesity in British adults.
Macia, Enguerran; Gueye, Lamine; Duboz, Priscilla
Background Cardiovascular disease is a major public health problem in many sub-Saharan African countries, but data on the main cardiovascular risk factors–hypertension and obesity–are almost nonexistent in Senegal. The aims of this study were therefore (i) to report the prevalence, awareness, treatment and control of hypertension among adults in Dakar, (ii) to assess the prevalence of general and central obesity, and (iii) to analyze the association between hypertension and general and central obesity. Methods A cross-sectional survey was carried out in 2015 on a representative sample of 1000 dwellers of the Senegalese capital aged 20–90. Results The overall prevalence of hypertension was 24.7%. Among hypertensive respondents, 28.4% were aware of their condition; 16.0% were on antihypertensive medication; 4.9% had controlled blood pressure. The frequency of doctor visits was a significant predictor of awareness (OR = 2.16; p<0.05) and treatment (OR = 2.57; p<0.05) of hypertension. The prevalence of underweight, overweight and general obesity were 12.6%, 19.2% and 9.7% respectively. The prevalence of central obesity was 26% by WC and 39.8% by WHtR. General obesity and central obesity by WHtR significantly predicted HTN among men and women, but not central obesity by WC. Conclusions This study has demonstrated a high prevalence of hypertension in Dakar and a high prevalence of obesity among women–particularly among older women. The awareness, treatment, and effective control of hypertension are unacceptably low. The blood pressure of women with general obesity, and men with central obesity, in the community should be monitored regularly to limit the burden of cardiovascular disease in Senegal. PMID:27622534
Huang, Jia-Yi; Qi, Sui-Jian
The prevalence of obesity among children is growing in China at present. Childhood obesity reflects complex interactions of genetic, environmental, social and behavioral factors. Foods, nutritional components, and food intake patterns may be associated with the increasing obesity rate in children. Articles about the relationship between childhood obesity and food intake were collected from the databases including Web of Knowledge, PubMed, Elsevier and Google Scholar. Foods and nutritional components such as calcium, dietary fiber are inversely related to obesity, whereas others such as vitamin B and sugar-sweeten beverages play a positive role in obesity development. The differences in food intake pattern also influence the risk of obesity. Food intake is an important factor influencing childhood obesity. One strategy to prevent childhood obesity is to take foods of moderate amount in a proper pattern.
Karam, Basil S; Chavez-Moreno, Alejandro; Koh, Wonjoon; Akar, Joseph G; Akar, Fadi G
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in humans. Several risk factors promote AF, among which diabetes mellitus has emerged as one of the most important. The growing recognition that obesity, diabetes and AF are closely intertwined disorders has spurred major interest in uncovering their mechanistic links. In this article we provide an update on the growing evidence linking oxidative stress and inflammation to adverse atrial structural and electrical remodeling that leads to the onset and maintenance of AF in the diabetic heart. We then discuss several therapeutic strategies to improve atrial excitability by targeting pathways that control oxidative stress and inflammation.
Chen, Chih-Cheng; Hsu, Yao-Chun; Lee, Ching-Tai; Hsu, Chia-Chang; Tai, Chi-Ming; Wang, Wen-Lun; Tseng, Cheng-Hao; Hsu, Chao-Tien; Lin, Jaw-Town
Background and Aim The prevalence rates of Barrett’s esophagus (BE) in western countries are higher than Asian ones, but little is known about their difference among risk factors of BE. The aim of this study is to investigate the associations of various risk factors including central obesity, body mass index (BMI), metabolic syndrome and H. pylori infection, with BE. Methods A total of 161 subjects with BE were enrolled and compared to age- and gender-matched controls randomly sampled (1:4) from check-up center in same hospital. Central obesity was defined by waist circumference (female>80cm; male>90cm), metabolic syndrome by the modified National Cholesterol Education Program Adult Treatment Panel III criteria in Taiwan. Independent risk factors for BE were identified by multiple logistic regression analyses. Results The mean age for BE was 53.8±13.7 years and 75.8% was male. H. pylori infection status was detected by the rapid urease test with the prevalence of 28.4% and 44.4% in the BE patients and controls, respectively. The univariate logistic regression analyses showed the risk was associated with higher waist circumference (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.78–3.60), metabolic syndrome (OR, 2.02; 95% CI, 1.38–2.96) and negative H. pylori infection (OR, 0.50; 95% CI, 0.34–0.74). However, multivariate logistic regression analyses revealed that BE associated with higher waist circumference (adjusted OR, 2.79; 95% CI, 1.89–4.12) and negative H. pylori infection (adjusted OR, 0.46; 95% CI, 0.30–0.70). Conclusions Central obesity is associated with a higher risk of BE whereas H. pylori infection with a lower risk in an ethnic Chinese population. PMID:27936223
Jennings, Amy; Cassidy, Aedín; van Sluijs, Esther M F; Griffin, Simon J; Welch, Ailsa A
The rising prevalence of childhood obesity is a key public health issue worldwide. Increased eating frequency (EF) is one aspect of diet that has been beneficially associated with obesity, although the mechanisms are unclear. The aims of the current study were to determine whether increased EF was associated with improved adiposity in children, and if this was due to differences in dietary and activity behaviors. Cross-sectional data from 1,700 children aged 9-10 year were analyzed to examine the associations between EF, as estimated from diet diaries, measures of adiposity, and activity measured by accelerometer. Analyses were stratified by obesity status using waist-to-height ratio to define obesity as it has been shown to be a good predictor of adverse health outcomes. Mean EF was 4.3 occasions/day and after adjustment for underreporting, energy intake (EI), and activity significant relative mean differences of -2.4% for body weight (P = 0.001), -1.0% for BMI (P = 0.020), -33% for BMI z-score (P = 0.014), and -0.6% for waist circumference (P = 0.031) per increase in eating occasion were found in healthy-weight but not centrally obese children. Differences between the extreme quartiles of EF were observed for total fat intake at breakfast (-18%, P < 0.001), fruit and vegetables from snacks (201% healthy-weight and 209% centrally obese children, P < 0.01), and for healthy-weight children, vigorous activity (4%, P = 0.003). Increased EF was favorably associated with adiposity, diet quality, and activity behaviors in healthy-weight but not centrally obese children. Future obesity interventions should consider the mediating role of diet quality and activity in the relationship between EF and adiposity in children.
Naznin, Farhana; Toshinai, Koji; Waise, T M Zaved; NamKoong, Cherl; Md Moin, Abu Saleh; Sakoda, Hideyuki; Nakazato, Masamitsu
Ghrelin, a stomach-derived orexigenic peptide, transmits starvation signals to the hypothalamus via the vagus afferent nerve. Peripheral administration of ghrelin does not induce food intake in high fat diet (HFD)-induced obese mice. We investigated whether this ghrelin resistance was caused by dysfunction of the vagus afferent pathway. Administration (s.c.) of ghrelin did not induce food intake, suppression of oxygen consumption, electrical activity of the vagal afferent nerve, phosphorylation of ERK2 and AMP-activated protein kinase alpha in the nodose ganglion, or Fos expression in hypothalamic arcuate nucleus of mice fed a HFD for 12 weeks. Administration of anti-ghrelin IgG did not induce suppression of food intake in HFD-fed mice. Expression levels of ghrelin receptor mRNA in the nodose ganglion and hypothalamus of HFD-fed mice were reduced. Inflammatory responses, including upregulation of macrophage/microglia markers and inflammatory cytokines, occurred in the nodose ganglion and hypothalamus of HFD-fed mice. A HFD blunted ghrelin signaling in the nodose ganglion via a mechanism involving in situ activation of inflammation. These results indicate that ghrelin resistance in the obese state may be caused by dysregulation of ghrelin signaling via the vagal afferent. © 2015 The authors.
Kirk, Shona L; Samuelsson, Anne-Maj; Argenton, Marco; Dhonye, Hannah; Kalamatianos, Theodosis; Poston, Lucilla; Taylor, Paul D; Coen, Clive W
Hypothalamic systems which regulate appetite may be permanently modified during early development. We have previously reported hyperphagia and increased adiposity in the adult offspring of rodents fed an obesogenic diet prior to and throughout pregnancy and lactation. We now report that offspring of obese (OffOb) rats display an amplified and prolonged neonatal leptin surge, which is accompanied by elevated leptin mRNA expression in their abdominal white adipose tissue. At postnatal Day 30, before the onset of hyperphagia in these animals, serum leptin is normal, but leptin-induced appetite suppression and phosphorylation of STAT3 in the arcuate nucleus (ARC) are attenuated; the level of AgRP-immunoreactivity in the hypothalamic paraventricular nucleus (PVH), which derives from neurones in the ARC and is developmentally dependent on leptin, is also diminished. We hypothesise that prolonged release of abnormally high levels of leptin by neonatal OffOb rats leads to leptin resistance and permanently affects hypothalamic functions involving the ARC and PVH. Such effects may underlie the developmental programming of hyperphagia and obesity in these rats.
Mattes, Richard; Foster, Gary D
The food environment plays an important and often dominant role in food choice, eating patterns, and ultimately, energy intake. The Obesity Society and the American Society for Nutrition jointly sponsored a series of reviews on topics of interest to both memberships. The goal was to consider the state of understanding on selected issues related to the food environment and obesity and to identify key knowledge gaps. The first article (not necessarily of importance) targeted energy density (ED) and focuses on the role of ED in the regulation of energy intake and body weight. It offers recommendations for prioritizing research. The second article addresses economic factors and examines food and beverage purchases as a function of price changes. It concludes that targeted food taxes and subsidies alone are unlikely to substantially affect obesity. The third article concerns sweetened beverages and points out the difficulty in establishing the strength of the association between intake of sugar-sweetened beverages and weight gain and obesity. In the fourth article, the contributions of palatability and variety to eating behavior and weight are reviewed. Article five explores the influence of portion size on energy intake and weight management. It finds that consumers generally tend to eat proportionally more as portion size increases. The sixth article focuses on the efficacy and effectiveness of eating frequency manipulations for body weight management and finds that such manipulations have consistently yielded null results. Finally, article seven identifies several limitations of the existing literature regarding neighborhood access to healthy foods. This series of reviews addresses important questions regarding the contribution of the food environment to obesity. Independent of physiological/genetic determinants, factors such as ED, cost, food form, palatability, variety, portion size, eating frequency, and access to healthy food are each evaluated for their role in
The current epidemic of human obesity implies that whilst energy balance appears to be regulated, the extent of this regulatory process is being overwhelmed in large numbers of the population by environmental changes. Clearly, the shift towards positive energy balance reflects both alterations in energy intake and decreases in physical activity. Increased energy intake and, in particular, the rising proportion of energy from fat is linked with obesity. However, on a population level reduced levels of activity probably play the predominant role. It is apparent that individual susceptibility to weight gain varies enormously. The factors underlying this susceptibility are an area of intense research interest. Variations in BMR from that predicted appear to be linked to the propensity to gain weight. The genes responsible for this variation may include uncoupling proteins-2 and -3, with a number of studies showing a link with obesity. However, in vivo studies of these proteins have not yet demonstrated a physiological role for them that would explain the link with obesity. Non-exercise activity thermogenesis may also protect from weight gain, but the regulation of this type of thermogenesis is unclear, although the sympathetic nervous system may be important. A profusion of hormones, cytokines and neurotransmitters is involved in regulating energy intake, but whilst mutations in leptin and the melanocortin-3 receptor are responsible for rare monogenic forms of obesity, their wider role in common polygenic obesity is not known. Much current work is directed at examining the interplay between genetic background and environmental factors, in particular diet, that both lead to positive energy balance and seem to make it so hard for many obese subjects to lose weight.
Mladenova, Silviya; Andreenko, Emiliya
The objective of this work is to investigate the distribution of underweight, overweight, the general and central obesity in 8-15-year-old Bulgarian children and adolescents, through the use of the anthropometric indices BMI and WHtR. Subject of this study are 878 children and adolescents (437 boys and 441 girls) of Smolyan region, Bulgaria, at the age of 8 to 15 years. The study is cross-sectional and was conducted in the period 2012-2014. The body height, weight and waist circumference were measured. In addition, the body mass index (BMI) and waist to height ratio (WHtR) were calculated. Overweight and obesity were defined according to the cut-off points of BMI, recommended of IOTF and developed by Cole et al. (2000; 2007). The central obesity was defined according to the discriminatory values of 0.500 of WHtR. The collected data were analysed by statistical software packages STATISTICA 10.0 and SPSS 16. Overweight occurs among 18.8% of the boys and 17.0% of the girls, and obesity occurs among 7.6% of boys and 3.7% of the girls. The underweight are 8.0% of the boys and 10.4% of the girls. Central obesity (WHtR ≥ 0.500) occur among average 12.75% of all investigated children independently of their nutritional status (16.2% of boys and 9.3% of girls). With central obesity (WHtR ≥ 0.500) are on average 2.7% of all boys and girls with normal weight (n = 96) and an average 46.82% of all participants with overweight and with obesity (n = 205). With increased health risk (WHtR ≥ 0.500) are total of 2.01% (n=16) of all surveyed children (n = 793) from categories normal weight. There has been an increase in prevalence of overweight and obesity among Bulgarian children and adolescents from Smolyan region during the over one last decade. The relatively high percentage of underweight children, especially among in group of the girls alter puberty. The central obesity, as well as its combination with overweight or general obesity is more frequent in boys than in girls
Genkinger, J M; Kitahara, C M; Bernstein, L; Berrington de Gonzalez, A; Brotzman, M; Elena, J W; Giles, G G; Hartge, P; Singh, P N; Stolzenberg-Solomon, R Z; Weiderpass, E; Adami, H-O; Anderson, K E; Beane-Freeman, L E; Buring, J E; Fraser, G E; Fuchs, C S; Gapstur, S M; Gaziano, J M; Helzlsouer, K J; Lacey, J V; Linet, M S; Liu, J J; Park, Y; Peters, U; Purdue, M P; Robien, K; Schairer, C; Sesso, H D; Visvanathan, K; White, E; Wolk, A; Wolpin, B M; Zeleniuch-Jacquotte, A; Jacobs, E J
Body mass index (BMI), a measure of obesity typically assessed in middle age or later, is known to be positively associated with pancreatic cancer. However, little evidence exists regarding the influence of central adiposity, a high BMI during early adulthood, and weight gain after early adulthood on pancreatic cancer risk. We conducted a pooled analysis of individual-level data from 20 prospective cohort studies in the National Cancer Institute BMI and Mortality Cohort Consortium to examine the association of pancreatic cancer mortality with measures of central adiposity (e.g. waist circumference; n = 647 478; 1947 pancreatic cancer deaths), BMI during early adulthood (ages 18-21 years) and BMI change between early adulthood and cohort enrollment, mostly in middle age or later (n = 1 096 492; 3223 pancreatic cancer deaths). Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. Higher waist-to-hip ratio (HR = 1.09, 95% CI 1.02-1.17 per 0.1 increment) and waist circumference (HR = 1.07, 95% CI 1.00-1.14 per 10 cm) were associated with increased risk of pancreatic cancer mortality, even when adjusted for BMI at baseline. BMI during early adulthood was associated with increased pancreatic cancer mortality (HR = 1.18, 95% CI 1.11-1.25 per 5 kg/m(2)), with increased risk observed in both overweight and obese individuals (compared with BMI of 21.0 to <23 kg/m(2), HR = 1.36, 95% CI 1.20-1.55 for BMI 25.0 < 27.5 kg/m(2), HR = 1.48, 95% CI 1.20-1.84 for BMI 27.5 to <30 kg/m(2), HR = 1.43, 95% CI 1.11-1.85 for BMI ≥30 kg/m(2)). BMI gain after early adulthood, adjusted for early adult BMI, was less strongly associated with pancreatic cancer mortality (HR = 1.05, 95% CI 1.01-1.10 per 5 kg/m(2)). Our results support an association between pancreatic cancer mortality and central obesity, independent of BMI, and also suggest that being overweight or obese during early adulthood may be important in
Genkinger, J. M.; Kitahara, C. M.; Bernstein, L.; Berrington de Gonzalez, A.; Brotzman, M.; Elena, J. W.; Giles, G. G.; Hartge, P.; Singh, P. N.; Stolzenberg-Solomon, R. Z.; Weiderpass, E.; Adami, H.-O.; Anderson, K. E.; Beane-Freeman, L. E.; Buring, J. E.; Fraser, G. E.; Fuchs, C. S.; Gapstur, S. M.; Gaziano, J. M.; Helzlsouer, K. J.; Lacey, J. V.; Linet, M. S.; Liu, J. J.; Park, Y.; Peters, U.; Purdue, M. P.; Robien, K.; Schairer, C.; Sesso, H. D.; Visvanathan, K.; White, E.; Wolk, A.; Wolpin, B. M.; Zeleniuch-Jacquotte, A.; Jacobs, E. J.
Background Body mass index (BMI), a measure of obesity typically assessed in middle age or later, is known to be positively associated with pancreatic cancer. However, little evidence exists regarding the influence of central adiposity, a high BMI during early adulthood, and weight gain after early adulthood on pancreatic cancer risk. Design We conducted a pooled analysis of individual-level data from 20 prospective cohort studies in the National Cancer Institute BMI and Mortality Cohort Consortium to examine the association of pancreatic cancer mortality with measures of central adiposity (e.g. waist circumference; n = 647 478; 1947 pancreatic cancer deaths), BMI during early adulthood (ages 18–21 years) and BMI change between early adulthood and cohort enrollment, mostly in middle age or later (n = 1 096 492; 3223 pancreatic cancer deaths). Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. Results Higher waist-to-hip ratio (HR = 1.09, 95% CI 1.02–1.17 per 0.1 increment) and waist circumference (HR = 1.07, 95% CI 1.00–1.14 per 10 cm) were associated with increased risk of pancreatic cancer mortality, even when adjusted for BMI at baseline. BMI during early adulthood was associated with increased pancreatic cancer mortality (HR = 1.18, 95% CI 1.11–1.25 per 5 kg/m2), with increased risk observed in both overweight and obese individuals (compared with BMI of 21.0 to <23 kg/m2, HR = 1.36, 95% CI 1.20–1.55 for BMI 25.0 < 27.5 kg/m2, HR = 1.48, 95% CI 1.20–1.84 for BMI 27.5 to <30 kg/m2, HR = 1.43, 95% CI 1.11–1.85 for BMI ≥30 kg/m2). BMI gain after early adulthood, adjusted for early adult BMI, was less strongly associated with pancreatic cancer mortality (HR = 1.05, 95% CI 1.01–1.10 per 5 kg/m2). Conclusions Our results support an association between pancreatic cancer mortality and central obesity, independent of BMI, and also suggest that being overweight or obese
Wu, Yizhen; Yu, Yinghua; Szabo, Alexander; Han, Mei; Huang, Xu-Feng
A low-grade pro-inflammatory state is at the pathogenic core of obesity and type 2 diabetes. We tested the hypothesis that the plant terpenoid compound ginsenoside Rb1 (Rb1), known to exert anti-inflammatory effects, would ameliorate obesity, obesity-associated inflammation and glucose intolerance in the high-fat diet-induced obese mouse model. Furthermore, we examined the effect of Rb1 treatment on central leptin sensitivity and the leptin signaling pathway in the hypothalamus. We found that intraperitoneal injections of Rb1 (14 mg/kg, daily) for 21 days significantly reduced body weight gain, fat mass accumulation, and improved glucose tolerance in obese mice on a HF diet compared to vehicle treatment. Importantly, Rb1 treatment also reduced levels of pro-inflammatory cytokines (TNF-α, IL-6 and/or IL-1β) and NF-κB pathway molecules (p-IKK and p-IκBα) in adipose tissue and liver. In the hypothalamus, Rb1 treatment decreased the expression of inflammatory markers (IL-6, IL-1β and p-IKK) and negative regulators of leptin signaling (SOCS3 and PTP1B). Furthermore, Rb1 treatment also restored the anorexic effect of leptin in high-fat fed mice as well as leptin pSTAT3 signaling in the hypothalamus. Ginsenoside Rb1 has potential for use as an anti-obesity therapeutic agent that modulates obesity-induced inflammation and improves central leptin sensitivity in HF diet-induced obesity.
Holben, David H; Taylor, Christopher A
Food insecurity is a preventable health threat and may precipitate central obesity and metabolic syndrome in children and adolescents in the United States. To examine (1) health by household food security status; and (2) differences and prevalence of central obesity among persons aged 12 to 18 years in the United States. The National Health and Nutrition Examination Survey was administered to a cross-sectional sample of persons aged 12 to 18 years in 1999 to 2006. Controlling for age, race/ethnicity, and sex differences in mean obesity and chronic disease factors across levels of food insecurity (analysis of covariance [Bonferroni post hoc] and ORs [logistic regression analyses]) were examined, as were differences in the rates of risk factors (χ(2) statistics). A total of 7435 participants were analyzed. Those from marginally food secure (n=751) and low-food secure (n=1206) (population size estimate, 26,714,182) households were significantly more likely than their high-food secure counterparts (n=4831) to be overweight (P=.036) (OR, 1.44), and those from marginally food secure households were 1.3-times more likely to be obese (P=.036). Nearly 25% of respondents from marginally food secure, low-food secure, and very low-food secure (n=647) households reported central obesity (P=.002), which was 1.4 to 1.5 times more likely than those from high-food secure households. Participants from high-food secure households had significantly higher mean high-density lipoprotein values (P=.019). Risk factors indicative of metabolic syndrome were present in 3.1%. Household food insecurity was associated with an increased likelihood of being overweight and having central obesity. Limitations included the use of cross-sectional data and some self-reported data and the inability to control for all moderating variables in obesity and overall health status.
CASTRO, Adham do Amaral e; SKARE, Thelma Larocca; NASSIF, Paulo Afonso Nunes; SAKUMA, Alexandre Kaue; BARROS, Wagner Haese
ABSTRACT Introduction: Tendinopathies and tendon tears account for over 30% of all musculoskeletal consultations. Obesity, which is becoming one of the world´s most prevalent public health issues, may be associated with this condition. Objective: To review the literature about tendinopathies and obesity association. Methods: This is a descriptive exploratory study using the portal Medline. Literature in English language from 2006 to 2014 were reviewed. Results: The pathogenesis of tendinopathies includes inflammatory, regenerative and degenerative processes that happen simultaneously from early to late phases of the disease. Mechanical stress upon tendons seems to be one of the most important factors to initiate the inflammatory response, but it´s not the only one that can deflagrate it: there are other extrinsic, genetic and metabolic factors that may be involved. Therefore, tendinopathies in obese patients can be due to tendon overload because of the excess of weight, but also because of increased production of pro-inflammatory mediators related to fat tissue such as adipokines. This pro-inflammatory state that obese people can suffer is known as adiposopathy, or sick fat syndrome. Weight loss is associated with decrease in adipokines and improvement of musculoskeletal symptoms. Conclusion: The relation of obesity and tendinopathies is supported by evidences of recent studies, exemplified in this review of literature. PMID:27683789
Walsh, Jennifer S; Bowles, Simon; Evans, Amy L
Vitamin D is essential for bone health, and may also have important functions in immunity and other systems. Vitamin D deficiency is common, and testing and supplementation is increasing. Serum vitamin D is lower in obese people; it is important to understand the mechanism of this effect and whether it indicates clinically significant deficiency. Vitamin D is fat soluble, and distributed into fat, muscle, liver, and serum. All of these compartments are increased in volume in obesity, so the lower vitamin D likely reflects a volumetric dilution effect and whole body stores of vitamin D may be adequate. Despite lower serum vitamin D, obese adults do not have higher bone turnover or lower bone mineral density. Patients undergoing bariatric surgery do have bone loss, and ensuring vitamin D sufficiency in these patients may help to attenuate bone loss. Lower vitamin D in obese people is a consistent finding across age, ethnicity, and geography. This may not always reflect a clinical problem. Obese people need higher loading doses of vitamin D to achieve the same serum 25-hydroxyvitamin D as normal weight.
Benedetto, Chiara; Salvagno, Francesca; Canuto, Emilie Marion; Gennarelli, Gianluca
Obesity increases the risk of endometrial and ovarian cancer, and oestrogen receptor (ER)-progesterone receptor (PR)-positive postmenopausal breast cancer. A modest positive association between body mass index (BMI) and cervical cancer has also been found. By contrast, an inverse correlation between BMI and premenopausal breast cancer exists. Endogenous sex hormones, insulin resistance/hyperinsulinaemia, adipokines, cytokines and chronic inflammation, among other factors, may be involved in the promotion of cancer in obese patients. Obesity is also associated with an increased risk of cancer recurrence and mortality most likely due to suboptimal treatment and/or co-morbidities. It is recommended that chemotherapy doses be calculated on the actual body weight and that radical surgery be performed as in non-obese patients. The high risk of peri-operative complications may be reduced by optimizing preoperative clinical conditions. As part of cancer prevention, obese women should be encouraged to adopt healthy lifestyles leading to weight loss and to undergo regular cancer screening. Copyright © 2015. Published by Elsevier Ltd.
Kaushik, Prashant; Anderson, James T
Epigenetics, defined as inheritable and reversible phenomena that affect gene expression without altering the underlying base pair sequence has been shown to play an important role in the etiopathogenesis of obesity. Obesity is associated with extensive gene expression changes in tissues throughout the body. Epigenetics is emerging as perhaps the most important mechanism through which the lifestyle-choices we make can directly influence the genome. Considerable epidemiological, experimental and clinical data have been amassed showing that the risk of developing disease in later life is dependent on early life conditions, mainly operating within the normative range of developmental exposures. In addition to the 'maternal' interactions, there has been increasing interest in the epigenetic mechanisms through which 'paternal' influences on offspring development can be achieved. Nutrition, among many other environmental factors, is a key player that can induce epigenetic changes not only in the directly exposed organisms but also in subsequent generations through the transgenerational inheritance of epigenetic traits. Overall, significant progress has been made in the field of epigenetics and obesity and the first potential epigenetic markers for obesity that could be detected at birth have been identified. Fortunately, epigenetic phenomena are dynamic and rather quickly reversible with intensive lifestyle changes. This is a very promising and sustainable resolution to the obesity pandemic.
Gómez-Díaz, Rita Angélica; Wacher-Rodarte, Niels H
Screening and treatment of plasma lipid abnormalities secondary to obesity are among the interventions that should be implemented in children who are overweight or obese, in order to prevent a cardiovascular event. Dyslipidemias are a group of asymptomatic diseases that are commonly caused by abnormal levels of lipoproteins in blood; they are a comorbidity that is commonly related to obesity, without considering the age of the patient. Among dyslipidemias, hypertriglyceridemia has the highest prevalence. The etiology of the dyslipidemia should be identified; it allows the proper selection of therapy for the patients and their family. The goal is the prevention of cardiovascular complications. Reduced caloric intake and a structured physical activity plan should be considered for initial treatment for all the overweight and obese patients. For adherence to treatment to be successful, the participation of the primary care physician and a multidisciplinary team is required. With treatment, the risks and complications can be reduced. The participation of a specialist in handling the pediatric obese patient with dyslipidemia should be limited to severe cases or those at risk for having pancreatitis.
The past few decades have witnessed a rapid rise in nutrition-related disorders such as obesity in the United States and over the world. Traditional nutrition research has associated various foods and nutrients with obesity. Recent advances in genomics have led to identification of the genetic variants determining body weight and related dietary factors such as intakes of energy and macronutrients. In addition, compelling evidence has lent support to interactions between genetic variations and dietary factors in relation to obesity and weight change. Moreover, recently emerging data from other ‘omics’ studies such as epigenomics and metabolomics suggest that more complex interplays between the global features of human body and dietary factors may exist at multiple tiers in affecting individuals’ susceptibility to obesity; and a concept of ‘personalized nutrition’ has been proposed to integrate this novel knowledge with traditional nutrition research, with the hope ultimately to endorse person-centric diet intervention to mitigate obesity and related disorders. PMID:24716734
Obesity is globally the most prevalent nutritional disorder. Multifaceted therapeutic approaches are called for to halt the cascade from neonatal adiposity/high birth weight to childhood excessive weight gain/adult obesity with comorbidities. Recent experimental and clinical data provide one new target for interventions aiming to close this vicious circle: the microbiota. An aberrant gut microbiota, dysbiosis, induces immune and metabolic disturbances both locally and, consequent upon impaired gut barrier function, also systemic low-grade inflammation, which is causally linked to insulin resistance. The gut microecology could thus fill the gap between energy intake and expenditure by processing nutrients and regulating their access to and storage in the body, producing chemicals of hormonal nature and controlling the secretion of proinflammatory mediators locally and systemically. Conversely, being highly sensitive to environmental impacts, particularly to early feeding, the compositional development of the gut microbiota may prove the target of choice in efforts to reduce the risk of obesity. It has been demonstrated that a lower number of bifidobacteria precedes the development of obesity, and a dearth of butyrate-producing bacteria and an overall richness of bacteria increase the risk of metabolic disease; moreover, recognition that practices known to disrupt the early gut microbiota, e.g., cesarean section delivery and antibiotic exposure, contribute to obesity, encourages to pursue this line of research.
Carson, Kenneth; Colditz, Graham A.
Weight, weight gain, and obesity account for approximately 20% of all cancer cases. Evidence on the relation of each to cancer is summarized, including esophageal, thyroid, colon, renal, liver, melanoma, multiple myeloma, rectum, gallbladder, leukemia, lymphoma, and prostate in men; and postmenopausal breast and endometrium in women. Different mechanisms drive etiologic pathways for these cancers. Weight loss, particularly among postmenopausal women, reduces risk for breast cancer. Among cancer patients, data are less robust, but we note a long history of poor outcomes after breast cancer among obese women. While evidence on obesity and outcomes for other cancers is mixed, growing evidence points to benefits of physical activity for breast and colon cancers. Dosing of chemotherapy and radiation therapy among obese patients is discussed and the impact on therapy-related toxicity is noted. Guidelines for counseling patients for weight loss and increased physical activity are presented and supported by strong evidence that increased physical activity leads to improved quality of life among cancer survivors. The “Five A's” model guides clinicians through a counseling session: assess, advise, agree, assist, arrange. The burden of obesity on society continues to increase and warrants closer attention by clinicians for both cancer prevention and improved outcomes after diagnosis. PMID:20507889
McInnis, K J
The prevalence of obesity has increased dramatically during the past decade in the USA. This is despite an estimated 50 million Americans who try to lose weight each year. The increasing prevalence of obesity is particularly alarming due to the numerous health implications associated with this condition, including coronary artery disease, hypertension, diabetes, hyperlipidemia, cancer, and various musculoskeletal conditions. The economic impact of treating illnesses associated with obesity has been estimated to be US$40 billion in the USA. Dieting is largely ineffective in maintaining initial weight loss as numerous studies suggest the majority of dieters regain all lost weight with 3-5 years. On, the other hand, regular exercise has been shown to be one of the best predictors of successful weight maintenance. Moreover, studies indicate that improved fitness through regular physical activity reduces cardiovascular morbidity and mortality for overweight individuals even if they remain overweight. Providing advice about exercise to overweight or obese individuals requires explicit information about the frequency, intensity, duration, and type of physical activity that should be performed. The ultimate goal for the exercising obese patient is to make a life-long commitment to achieving reasonable energy expenditure through routine physical activity.
Blaut, Michael; Klaus, Susanne
The human gut harbors a highly diverse microbial ecosystem of approximately 400 different species, which is characterized by a high interindividual variability. The intestinal microbiota has recently been suggested to contribute to the development of obesity and the metabolic syndrome. Transplantation of gut microbiota from obese mice to nonobese, germ-free mice resulted in transfer of metabolic syndrome-associated features from the donor to the recipient. Proposed mechanisms for the role of gut microbiota include the provision of additional energy by the conversion of dietary fiber to short-chain fatty acids, effects on gut-hormone production, and increased intestinal permeability causing elevated systemic levels of lipopolysaccharides (LPS). This metabolic endotoxemia is suggested to contribute to low-grade inflammation, a characteristic trait of obesity and the metabolic syndrome. Finally, activation of the endocannabinoid system by LPS and/or high-fat diets is discussed as another causal factor. In conclusion, there is ample evidence for a role of gut microbiota in the development of obesity in rodents. However, the magnitude of its contribution to human obesity is still unknown.
Hill, James O.; Wyatt, Holly R.; Peters, John C.
This paper describes the interplay among energy intake, energy expenditure and body energy stores and illustrates how an understanding of energy balance can help develop strategies to reduce obesity. First, reducing obesity will require modifying both energy intake and energy expenditure and not simply focusing on either alone. Food restriction alone will not be effective in reducing obesity if human physiology is biased toward achieving energy balance at a high energy flux (i.e. at a high level of energy intake and expenditure). In previous environments a high energy flux was achieved with a high level of physical activity but in today's sedentary environment it is increasingly achieved through weight gain. Matching energy intake to a high level of energy expenditure will likely be more a more feasible strategy for most people to maintain a healthy weight than restricting food intake to meet a low level of energy expenditure. Second, from an energy balance point of view we are likely to be more successful in preventing excessive weight gain than in treating obesity. This is because the energy balance system shows much stronger opposition to weight loss than to weight gain. While large behavior changes are needed to produce and maintain reductions in body weight, small behavior changes may be sufficient to prevent excessive weight gain. In conclusion, the concept of energy balance combined with an understanding of how the body achieves balance may be a useful framework in helping develop strategies to reduce obesity rates. PMID:22753534
Huang, Jeannie S; Barlow, Sarah E; Quiros-Tejeira, Ruben E; Scheimann, Ann; Skelton, Joseph; Suskind, David; Tsai, Patrika; Uko, Victor; Warolin, Joshua P; Xanthakos, Stavra A
Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology.
Huang, Jeannie S.; Barlow, Sarah E.; Quiros-Tejeira, Ruben E.; Scheimann, Ann; Skelton, Joseph; Suskind, David; Tsai, Patrika; Uko, Victor; Warolin, Joshua P.; Xanthakos, Stavra A.
Obesity in childhood is one of the major health issues in pediatric health care today. As expected, the prevalence of obesity-related comorbidities has risen in parallel with that of obesity. Consultation regarding these concomitant diseases and subsequent management by subspecialists, including pediatric gastroenterologists, is now common and has resulted in obesity being recognized as a chronic disease requiring coordination of care. Although medications and even surgery may provide effective, though often temporary, treatments for obesity and its comorbidities, behavioral interventions addressing healthy dietary and physical activity habits remain a mainstay in the obesity treatment paradigm. Therefore, the issue of weight management must be addressed by both general practitioner and subspecialist alike. In this report, we review select aspects of pediatric obesity and obesity-related management issues because it relates in particular to the field of pediatric gastroenterology and hepatology. PMID:23282941
Mitchell, Nia; Catenacci, Vicki; Wyatt, Holly R.; Hill, James O.
SYNOPSIS Despite growing recognition of the problem, the obesity epidemic continues in the U.S., and obesity rates are increasing around the world. The latest estimates are that approximately 34% of adults and 15–20% of children and adolescents in the U.S. are obese. Obesity affects every segment of the U.S. population. Obesity increases the risk of many chronic diseases in children and adults. The epidemic of obesity arose gradually over time, apparently from a small, consistent degree of positive energy balance. Substantial public health efforts are being directed toward addressing obesity, but there is not yet clear evidence of success. Because of the complexity of obesity, it is likely to be one of the most difficult public health issues our society has faced. PMID:22098799
Jakicic, John M; Davis, Kelliann K
Physical activity seems to be an important component of lifestyle interventions for weight loss and maintenance. Although the effects of physical activity on weight loss may seem to be modest, there seems to be a dose-response relationship between physical activity and weight loss. Physical activity also seems to be a critically important behavior to promote long-term weight loss and the prevention of weight regain. The benefits of physical activity on weight loss are also observed in patients with severe obesity (BMI ≥ 35 kg/m²) and in patients who have undergone bariatric surgery. Moreover, independent of the effect of physical activity on body weight, engagement in physical activity that results in improved cardiorespiratory fitness can contribute to reductions in health risk in overweight and obese adults. Thus, progression of overweight and obese patients to an adequate dose of physical activity needs to be incorporated into clinical interventions for weight control.
Wright, Suzanne M; Aronne, Louis J
The prevalence of obesity has been rising steadily over the last several decades and is currently at unprecedented levels: more than 68% of US adults are considered overweight, and 35% are obese (Flegal et al., JAMA 303:235-241, 2010). This increase has occurred across every age, sex, race, and smoking status, and data indicate that segments of individuals in the highest weight categories (i.e., BMI > 40 kg/m(2)) have increased proportionately more than those in lower BMI categories (BMI < 35 kg/m(2)). The dramatic rise in obesity has also occurred in many other countries, and the causes of this increase are not fully understood (Hill and Melanson, Med Sci Sports Exerc 31:S515-S521, 1999).
Al Dabal, Laila; BaHammam, Ahmed S.
Obesity is becoming a major medical concern in several parts of the world, with huge economic impacts on health- care systems, resulting mainly from increased cardiovascular risks. At the same time, obesity leads to a number of sleep-disordered breathing patterns like obstructive sleep apnea and obesity hypoventilation syndrome (OHS), leading to increased morbidity and mortality with reduced quality of life. OHS is distinct from other sleep- related breathing disorders although overlap may exist. OHS patients may have obstructive sleep apnea/hypopnea with hypercapnia and sleep hypoventilation, or an isolated sleep hypoventilation. Despite its major impact on health, this disorder is under-recognized and under-diagnosed. Available management options include aggressive weight reduction, oxygen therapy and using positive airway pressure techniques. In this review, we will go over the epidemiology, pathophysiology, presentation and diagnosis and management of OHS. PMID:19561923
Best, Damian; Bhattacharya, Siladitya
The prevalence of overweight and obesity in women of reproductive age has increased over the past 30 years. Infertility affects 1 in 7 couples, and female obesity is associated with anovulation. The mechanisms by which excessive fat delays time to pregnancy (TTP) appear rooted in ovulatory problems and direct effects on oocytes, causing poorer embryo development, as well as in effects on the endometrium. Weight loss in women has been shown to improve conception, but not necessarily live birth rates following fertility treatment, and further research in this area is needed. The obesity epidemic has been accompanied by a potential rise in male infertility, which has been attributed to hormonal disturbances and compromised semen parameters.
Simonyi, Gábor; Kollár, Réka
The frequency of hypertension and obesity is gradually growing in Hungary. At present 68.5% of men and 78% of women are obese. Hypertension and obesity are the most important risk factors of morbidity and mortality from cardiovascular disease. The relationship between increased sympathetic activity and hypertension is well known. Waist circumference and body fat mass correlate significantly with sympathetic activity, in which hyperlipidemia plays also a role. The increased activity of renin-angiotensin-aldosterone system via its vascular and renal effects also contributes to an increase of blood pressure. Increased sympathetic activity with decreasing vagal tone accompanying the imbalance of the autonomous nervous system is independent and significant risk factor of cardiovascular events including sudden cardiac death.
The formation of skeletal muscle from the epithelial somites involves a series of events triggered by temporally and spatially discrete signals resulting in the generation of muscle fibers which vary in their contractile and metabolic nature. The fiber type composition of muscles varies between individuals and it has now been found that there are differences in fiber type proportions between lean and obese animals and humans. Amongst the possible causes of obesity, it has been suggested that inappropriate prenatal environments may ‘program’ the fetus and may lead to increased risks for disease in adult life. The characteristics of muscle are both heritable and plastic, giving the tissue some ability to adapt to signals and stimuli both pre and postnatally. Given that muscle is a site of fatty acid oxidation and carbohydrate metabolism and that its development can be changed by prenatal events, it is interesting to examine the possible relationship between muscle development and the risk of obesity. PMID:19279728
Parekh, Niyati; Chandran, Urmila; Bandera, Elisa V.
Although obesity is a well known risk factor for several cancers, its role on cancer survival is poorly understood. We conducted a systematic literature review to assess the current evidence evaluating the impact of body adiposity on the prognosis of the three most common obesity-related cancers: prostate, colorectal, and breast. We included 33 studies of breast cancer, six studies of prostate cancer, and eight studies of colorectal cancer. We note that the evidence over-represents breast cancer survivorship research and is sparse for prostate and colorectal cancers. Overall, most studies support a relationship between body adiposity and site-specific mortality or cancer progression. However, most of the research was not specifically designed to study these outcomes and, therefore, several methodological issues should be considered before integrating their results to draw conclusions. Further research is urgently warranted to assess the long-term impact of obesity among the growing population of cancer survivors. PMID:22540252
Puhl, R; Brownell, K D
This article reviews information on discriminatory attitudes and behaviors against obese individuals, integrates this to show whether systematic discrimination occurs and why, and discusses needed work in the field. Clear and consistent stigmatization, and in some cases discrimination, can be documented in three important areas of living: employment, education, and health care. Among the findings are that 28% of teachers in one study said that becoming obese is the worst thing that can happen to a person; 24% of nurses said that they are "repulsed" by obese persons; and, controlling for income and grades, parents provide less college support for their overweight than for their thin children. There are also suggestions but not yet documentation of discrimination occurring in adoption proceedings, jury selection, housing, and other areas. Given the vast numbers of people potentially affected, it is important to consider the research-related, educational, and social policy implications of these findings.
Bayon, Virginie; Leger, Damien; Gomez-Merino, Danielle; Vecchierini, Marie-Françoise; Chennaoui, Mounir
Short sleep duration has been shown to be associated with elevated body mass index (BMI) in many epidemiological studies. Several pathways could link sleep deprivation to weight gain and obesity, including increased food intake, decreased energy expenditure, and changes in levels of appetite-regulating hormones, such as leptin and ghrelin. A relatively new factor that is contributing to sleep deprivation is the use of multimedia (e.g. television viewing, computer, and internet), which may aggravate sedentary behavior and increase caloric intake. In addition, shift-work, long working hours, and increased time commuting to and from work have also been hypothesized to favor weight gain and obesity-related metabolic disorders, because of their strong link to shorter sleep times. This article reviews the epidemiological, biological, and behavioral evidence linking sleep debt and obesity.
Moellering, Douglas R.; Smith, Daniel L.
Homeotherms maintain an optimal body temperature that is most often above their environment or ambient temperature. As ambient temperature decreases, energy expenditure (and energy intake) must increase to maintain thermal homeostasis. With the wide spread adoption of climate control, humans in modern society are buffered from temperature extremes and spend an increasing amount of time in a thermally comfortable state where energetic demands are minimized. This is hypothesized to contribute to the contemporary increase in obesity rates. Studies reporting exposures of animals and humans to different ambient temperatures are discussed. Additional consideration is given to the potentially altered metabolic and physiologic responses in obese versus lean subjects at a given temperature. The data suggest that ambient temperature is a significant contributor to both energy intake and energy expenditure, and that this variable should be more thoroughly explored in future studies as a potential contributor to obesity susceptibility. PMID:24707450
The human intestine harbors a complex bacterial community called the gut microbiota. This microbiota is specific to each individual despite the existence of several bacterial species shared by the majority of adults. The influence of the gut microbiota in human health and disease has been revealed in the recent years. Particularly, the use of germ-free animals and microbiota transplant showed that the gut microbiota may play a causal role in the development of obesity and associated metabolic disorders, and lead to identification of several mechanisms. In humans, differences in microbiota composition, functional genes and metabolic activities are observed between obese and lean individuals suggesting a contribution of the gut microbiota to these phenotypes. Finally, the evidence linking gut bacteria to host metabolism could allow the development of new therapeutic strategies based on gut microbiota modulation to treat or prevent obesity.
Al Dabal, Laila; Bahammam, Ahmed S
Obesity is becoming a major medical concern in several parts of the world, with huge economic impacts on health- care systems, resulting mainly from increased cardiovascular risks. At the same time, obesity leads to a number of sleep-disordered breathing patterns like obstructive sleep apnea and obesity hypoventilation syndrome (OHS), leading to increased morbidity and mortality with reduced quality of life. OHS is distinct from other sleep- related breathing disorders although overlap may exist. OHS patients may have obstructive sleep apnea/hypopnea with hypercapnia and sleep hypoventilation, or an isolated sleep hypoventilation. Despite its major impact on health, this disorder is under-recognized and under-diagnosed. Available management options include aggressive weight reduction, oxygen therapy and using positive airway pressure techniques. In this review, we will go over the epidemiology, pathophysiology, presentation and diagnosis and management of OHS.
Campión, Javier; Milagro, Fermin; Martínez, J Alfredo
The etiology of obesity is multifactorial, involving complex interactions among the genetic makeup, neuroendocrine status, fetal programming, and different unhealthy environmental factors, such as sedentarism or inadequate dietary habits. Among the different mechanisms causing obesity, epigenetics, defined as the study of heritable changes in gene expression that occur without a change in the DNA sequence, has emerged as a very important determinant. Experimental evidence concerning dietary factors influencing obesity development through epigenetic mechanisms has been described. Thus, identification of those individuals who present with changes in DNA methylation profiles, certain histone modifications, or other epigenetically related processes could help to predict their susceptibility to gain or lose weight. Indeed, research concerning epigenetic mechanisms affecting weight homeostasis may play a role in the prevention of excessive fat deposition, the prediction of the most appropriate weight reduction plan, and the implementation of newer therapeutic approaches.
Duke, Meredith C; Farrell, Timothy M
The prevalence of gastroesophageal reflux disease (GERD) has mirrored the increase in obesity, and GERD is now recognized as an obesity-related comorbidity. There is growing evidence that obesity, specifically central obesity, is associated with the complications of chronic reflux, including erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. While fundoplication is effective in creating a competent gastroesophageal junction and controlling reflux in most patients, it is less effective in morbidly obese patients. In these patients a bariatric operation has the ability to correct both the obesity and the abnormal reflux. The Roux-en-Y gastric bypass is the preferred procedure.
Zuckerman, Katharine E.; Fombonne, Eric
OBJECTIVE: Overweight and obesity are increasingly prevalent in the general pediatric population. Evidence suggests that children with autism spectrum disorders (ASDs) may be at elevated risk for unhealthy weight. We identify the prevalence of overweight and obesity in a multisite clinical sample of children with ASDs and explore concurrent associations with variables identified as risk factors for unhealthy weight in the general population. METHODS: Participants were 5053 children with confirmed diagnosis of ASD in the Autism Speaks Autism Treatment Network. Measured values for weight and height were used to calculate BMI percentiles; Centers for Disease Control and Prevention criteria for BMI for gender and age were used to define overweight and obesity (≥85th and ≥95th percentiles, respectively). RESULTS: In children age 2 to 17 years, 33.6% were overweight and 18% were obese. Compared with a general US population sample, rates of unhealthy weight were significantly higher among children with ASDs ages 2 to 5 years and among those of non-Hispanic white origin. Multivariate analyses revealed that older age, Hispanic or Latino ethnicity, lower parent education levels, and sleep and affective problems were all significant predictors of obesity. CONCLUSIONS: Our results indicate that the prevalence of unhealthy weight is significantly greater among children with ASD compared with the general population, with differences present as early as ages 2 to 5 years. Because obesity is more prevalent among older children in the general population, these findings raise the question of whether there are different trajectories of weight gain among children with ASDs, possibly beginning in early childhood. PMID:26527551
Bratsis, Michael E.
U.S. health experts declared obesity an epidemic over a decade ago. Schools have tried to implement prevention programs for students, but as budgets shrink, educating students about obesity is increasingly falling to classroom instructors, including science teachers. The good news is that obesity-related classroom activities can be engaging, and…
Miller, Michael D.
Obesity in children is a problem both insidious and acute. Childhood obesity has been indicated as a forerunner of adult obesity; it is also an immediate problem for the child. Given the lack of evidence for long term maintenance of any weight loss, this paper investigates the etiology of the disorder as a prelude to prevention. Upon review of the…
Describes the role caregivers play in helping young children dealing with obesity. Examines: (1) causes of childhood obesity; (2) caregiver's position; (3) learning nutrition concepts; (4) preparing and serving healthy foods; (5) encouraging physical activity; (6) working with parents; and (7) assisting an obese child. (SD)
Obesity is one of the leading public health problems in the United States. It is associated with drug abuse and increased mortality. In seeking to differentiate between overweight and obese individuals, it may be said that obesity exists in those individuals who are 40% or more above normal weight as determined on commonly used height and weight…
Bratsis, Michael E.
U.S. health experts declared obesity an epidemic over a decade ago. Schools have tried to implement prevention programs for students, but as budgets shrink, educating students about obesity is increasingly falling to classroom instructors, including science teachers. The good news is that obesity-related classroom activities can be engaging, and…
This reference brief deals with the problem of childhood obesity and how it can lead to obesity in the adult. Eighty-four abstracts are presented of studies on the identification, prevention, and treatment of obesity in children, focusing on diet and psychological attitudes. Subjects of the studies were children ranging in age from infancy through…
Obesity is one of the leading public health problems in the United States. It is associated with drug abuse and increased mortality. In seeking to differentiate between overweight and obese individuals, it may be said that obesity exists in those individuals who are 40% or more above normal weight as determined on commonly used height and weight…
Describes the role caregivers play in helping young children dealing with obesity. Examines: (1) causes of childhood obesity; (2) caregiver's position; (3) learning nutrition concepts; (4) preparing and serving healthy foods; (5) encouraging physical activity; (6) working with parents; and (7) assisting an obese child. (SD)
Miller, Michael D.
Obesity in children is a problem both insidious and acute. Childhood obesity has been indicated as a forerunner of adult obesity; it is also an immediate problem for the child. Given the lack of evidence for long term maintenance of any weight loss, this paper investigates the etiology of the disorder as a prelude to prevention. Upon review of the…
Cai, Y; Dong, H; Weng, M
5 cases with obesity-hypoventilaion syndrome were reported. The clinical manifestations were obesity, palpitation, dyspnea, lethargy, cyanosis, distention of cervical vein, edema, enlargement of liver and hypertension. All of them were initially diagnosed as chronic bronchitis or heart diseases. Pulmonary function test showed restrictive ventilative defect and hypercapnia with hypoxemia. Mouth oclusion pressure at 0.1 second was higher than the normal value. The response to CO2 was decreased. Hypertrophy of right heart was shown in ECG and X-ray film improvement in symptoms and blood gases analyses were found to be associated with body weight decrease in a follow up period of one year.
Ard, Jamy D; Miller, Gary; Kahan, Scott
Obesity is a common disorder with complex causes. The epidemic has spurred significant advances in the understanding of nutritional approaches to treating obesity. Although the primary challenge is to introduce a dietary intake that creates an energy deficit, clinicians should also consider targeted risk factor modification with manipulation of the nutrient profile of the weight-reducing diet. These strategies produce significant weight loss and improvements in cardiometabolic risk factors. Future research is needed to better understand how to personalize nutrient prescriptions further to promote optimal risk modification and maintenance of long-term energy balance in the weight-reduced state.
Common DNA sequence variants inadequately explain variability in fat mass among individuals. Abnormal body weights are characteristic of specific imprinted-gene disorders. However, the relevance of imprinted genes to our understanding of obesity among the general population is uncertain. Hitherto unidentified imprinted genes and epigenetic mosaicism are two of the challenges for this emerging field of epigenetics. Subtle epigenetic differences in imprinted genes and gene networks are likely to be present among cells, tissues and individuals. In order to advance obesity research it will be necessary to use genome-wide, next-generation sequencing approaches that allow the detection of such epigenetic differences.
Lamm, Steven; Chidakel, Aaron; Bansal, Rohan
The relationship between obesity and hypogonadism is complicated. The relationship is bidirectional and there are numerous causative and correlative factors on both sides of the equation. Obesity is increasing in prevalence in epidemic proportions. Likewise, we are beginning to see the rapid increase in the incidence of male hypogonadism. It is only recently that we are learning the ways in which these 2 conditions exacerbate each other, and we are only beginning to understand how by treating one of these conditions, we can help to treat the other as well. Copyright © 2016 Elsevier Inc. All rights reserved.
Lavallard, Vanessa J; Meijer, Alfred J; Codogno, Patrice; Gual, Philippe
Autophagy is a cellular pathway crucial for development, differentiation, survival and homeostasis. Autophagy can provide protection against aging and a number of pathologies such as cancer, neurodegeneration, cardiac disease and infection. Recent studies have reported new functions of autophagy in the regulation of cellular processes such as lipid metabolism and insulin sensitivity. Important links between the regulation of autophagy and obesity including food intake, adipose tissue development, β cell function, insulin sensitivity and hepatic steatosis exist. This review will provide insight into the current understanding of autophagy, its regulation, and its role in the complications associated with obesity. Copyright © 2012 Elsevier Ltd. All rights reserved.
Gati, Asma; Kouidhi, Soumaya; Marrakchi, Raja; El Gaaied, Amel; Kourda, Nadia; Derouiche, Amine; Chebil, Mohamed; Caignard, Anne; Perier, Aurélie
Epidemiological studies link obesity, as measured by increased body mass index (BMI) to the incidence of renal cell carcinoma (RCC) as well as to the cancer-related mortality of RCC patients. RCC is the third cancer most robustly associated with increased BMI. Understanding the role of the adipose tissue in renal carcinogenesis is therefore of major importance for the development of novel paradigms of RCC prevention and treatment. Here, we discuss the current knowledge on the impact of obesity on the development and progression of RCC as well as the role of adipose tissue-derived hormones (adipokines) in the conflict between growing tumors and the immune system. PMID:24804162
Ayloo, Subhashini; Armstrong, John; Hurton, Scott; Molinari, Michele
The percentage of overweight and obese patients (OPs) waiting for a liver transplant continues to increase. Despite the significant advances occurred in bariatric medicine, obesity is still considered a relative contraindication to liver transplantation (LT). The main aim of this review is to appraise the literature on the outcomes of OPs undergoing LT, treatments that might reduce their weight before, during or after surgery, and discuss some of the controversies and limitations of the current knowledge with the intent of highlighting areas where future research is needed. PMID:26421262
Sales-Peres, Sílvia Helena de Carvalho; Goya, Suzana; Sant'Anna, Rute Moreira de Freitas; Silva, Henrique Mendes; Sales-Peres, André de Carvalho; Silva, Ricardo Pianta Rodrigues da; Lauris, José Roberto Pereira; Bastos, José Roberto de Magalhães
The aim of the study was to evaluate the relationship between the Body Mass Index (BMI) and the DMFT index, in 207 adolescents aged 12 years old, from 8 public and private schools of the central west area of São Paulo State. From a sample of 380 12 year-old adolescents, both genders, 207 were examined. We used the index DMFT, CBI for weight, measured of stature and applied a questionnaire about alimentary habits, characteristic anthropometrics and physical activity. Regarding body weight, 55.93% was normal, 35.59% had low weight, and 8.47% were pre-obese in private schools. In the public schools, 52.03% had normal weight, 41.22% had low weight, 4.73% were pre-obese and 2.03% were obese, without significant difference (p=0.45). The DMFT of public schools was 2.16, compared to 0.23 in private schools (p<0.05), with 39.2% of caries-free individuals in public schools and 88.1% in private schools. There was no correlation between the increase in BMI and the increase in DMFT. There was negative correlation between socioeconomic conditions and dental caries. It was concluded that, even though the pre-obese and obese groups presented a higher frequency of food ingestion, obesity was not correlated with the increase in dental caries. However, the socioeconomic conditions were determinant for this occurrence.
Montazerifar, Farzaneh; Bakhshipour, Ali Reza; Karajibani, Mansour; Torki, Zahra; Dashipour, Ali Reza
Omentin-1, vaspin, and apelin are novel adipokines which closely associate with obesity, nonalcoholic fatty liver disease (NAFLD), and inflammation. The aim of this study was to investigate the circulating levels of omentin-1, vaspin, and apelin in NAFLD patients and to clarify their relationship with biochemical parameters, abdominal obesity, and high sensitive C-reactive protein. In a case-control study, serum levels of omentin-1, vaspin, and apelin were measured in 41 NAFLD patients and 41 healthy volunteers. The study was performed in the outpatients' clinic of Imam-Ali Hospital in Zahedan, Iran, during February to July 2015. Fatty liver was confirmed by ultrasonography. The association of the adipokines with lipid profile and anthropometric parameters was assessed using multivariable linear regression models. In this model, those variables that showed P < 0.05 were included in the study. NAFLD patients presented a significantly higher apelin levels compared to the controls (P < 0.01), whereas serum omentin-1 and vaspin levels did not differ between two groups (both P > 0.05). Multiple regression analysis showed that the serum levels of apelin and vaspin correlated positively with waist circumference (WC) (P < 0.01 and P < 0.05, respectively) and low-density lipoprotein (P < 0.05 and P < 0.01, respectively) while serum omentin-1 was inversely correlated with WC (P < 0.01) and positively corrected with high-density lipoprotein (P < 0.05). The findings showed that among the analyzed adipokines only apelin was different in patients with NAFLD when compared to controls. Considering the multivariate regression analysis, apelin seems be more suitable diagnostic marker in predicting of NAFLD and omentin might be considered as a protective factor in occurrence of NAFLD, particularly in those with central obesity.
van den Berg, Sjoerd A A; Heemskerk, Mattijs M; Geerling, Janine J; van Klinken, Jan-Bert; Schaap, Frank G; Bijland, Silvia; Berbée, Jimmy F P; van Harmelen, Vanessa J A; Pronk, Amanda C M; Schreurs, Marijke; Havekes, Louis M; Rensen, Patrick C N; van Dijk, Ko Willems
Mutations in apolipoprotein A5 (APOA5) have been associated with hypertriglyceridemia in humans and mice. This has been attributed to a stimulating role for APOA5 in lipoprotein lipase-mediated triglyceride hydrolysis and hepatic clearance of lipoprotein remnant particles. However, because of the low APOA5 plasma abundance, we investigated an additional signaling role for APOA5 in high-fat diet (HFD)-induced obesity. Wild-type (WT) and Apoa5(-/-) mice fed a chow diet showed no difference in body weight or 24-h food intake (Apoa5(-/-), 4.5±0.6 g; WT, 4.2±0.5 g), while Apoa5(-/-) mice fed an HFD ate more in 24 h (Apoa5(-/-), 2.8±0.4 g; WT, 2.5±0.3 g, P<0.05) and became more obese than WT mice. Also, intravenous injection of APOA5-loaded VLDL-like particles lowered food intake (VLDL control, 0.26±0.04 g; VLDL+APOA5, 0.11±0.07 g, P<0.01). In addition, the HFD-induced hyperphagia of Apoa5(-/-) mice was prevented by adenovirus-mediated hepatic overexpression of APOA5. Finally, intracerebroventricular injection of APOA5 reduced food intake compared to injection of the same mouse with artificial cerebral spinal fluid (0.40±0.11 g; APOA5, 0.23±0.08 g, P<0.01). These data indicate that the increased HFD-induced obesity of Apoa5(-/-) mice as compared to WT mice is at least partly explained by hyperphagia and that APOA5 plays a role in the central regulation of food intake.
In recent years, the world has seen an alarming increase in obesity and closely associated with insulin resistance which is a state of low-grade inflammation, the latter characterized by elevated levels of proinflammatory cytokines in blood and tissues. A shift in energy balance alters systemic metabolic regulation and the important role that chronic inflammation, endoplasmic reticulum (ER) dysfunction, and activation of the unfolded protein response (UPR) play in this process.Why obesity is so closely associated with insulin resistance and inflammation is not understood well. This suggests that there are probably other causes for obesity-related insulin resistance and inflammation. One of these appears to be endoplasmic reticulum (ER) stress.The ER is a vast membranous network responsible for the trafficking of a wide range of proteins and plays a central role in integrating multiple metabolic signals critical in cellular homeostasis. Conditions that may trigger unfolded protein response activation include increased protein synthesis, the presence of mutant or misfolded proteins, inhibition of protein glycosylation, imbalance of ER calcium levels, glucose and energy deprivation, hypoxia, pathogens or pathogen-associated components and toxins. Thus, characterizing the mechanisms contributing to obesity and identifying potential targets for its prevention and treatment will have a great impact on the control of associated conditions, particularly T2D.
The hypothalamic disorders of obesity include hyperphagia, a low central orthosympathetic tone (with reduced thermogenesis), vagal hyperinsulinism, low serotonin efficacy, a hyperactive hypothalamo-hypophyseal-adrenal axis, a hypoactive GHRH-GH-IGF axis and hypogonadism of central origin. Hyperlipogenesis, glucose intolerance and excessive gluconeogenesis are secondary features. Most frequently the hypothalamic ARC reacts poorly to the leptin hypersecreted by adipose tissue, so that the local synthesis of NPY is unchecked. Fortunately, two prostaglandins derived from dietary arachidonic acid bind fat cell PPAR gamma and hepatic PPAR alpha. Both nuclear proteins are phosphorylated through an insulin pathway, thereby inhibiting the expression of genes favoring obesity and stimulating that of genes accelerating fatty acid oxidation. The array of dietetic and pharmacologic tools considered today is analyzed.
Thomas, Diana M.; Weedermann, Marion; Fuemmeler, Bernard F.; Martin, Corby K.; Dhurandhar, Nikhil V.; Bredlau, Carl; Heymsfield, Steven B.; Ravussin, Eric; Bouchard, Claude
Objective Obesity prevalence in the United States (US) appears to be leveling, but the reasons behind the plateau remain unknown. Mechanistic insights can be provided from a mathematical model. The objective of this study is to model known multiple population parameters associated with changes in body mass index (BMI) classes and to establish conditions under which obesity prevalence will plateau. Design and Methods A differential equation system was developed that predicts population-wide obesity prevalence trends. The model considers both social and non-social influences on weight gain, incorporates other known parameters affecting obesity trends, and allows for country specific population growth. Results The dynamic model predicts that: obesity prevalence is a function of birth rate and the probability of being born in an obesogenic environment; obesity prevalence will plateau independent of current prevention strategies; and the US prevalence of obesity, overweight, and extreme obesity will plateau by about 2030 at 28%, 32%, and 9%, respectively. Conclusions The US prevalence of obesity is stabilizing and will plateau, independent of current preventative strategies. This trend has important implications in accurately evaluating the impact of various anti-obesity strategies aimed at reducing obesity prevalence. PMID:23804487
Acosta, Andres; Abu Dayyeh, Barham K.; Port, John D.; Camilleri, Michael
Despite advances in understanding the roles of adiposity, food intake, gastrointestinal and adipocyte-related hormones, inflammatory mediators, the gut-brain axis, and the hypothalamic nervous system in the pathophysiology of obesity, the effects of different therapeutic interventions on those pathophysiological mechanisms are controversial. There are still no low cost, safe, effective treatments for obesity and its complications. Currently, bariatric surgical approaches targeting the gastrointestinal tract are more effective than non-surgical approaches in inducing weight reduction and resolving obesity-related comorbidities. However, current guidelines emphasize non-surgical approaches through life-style modification and medications to achieve slow weight loss, which is not usually sustained and may be associated with medication-related side effects. This review analyzes current central, peripheral, or hormonal targets to treat obesity, and addresses challenges and opportunities to develop novel approaches for obesity. PMID:24402654
Gunatilake, Ravindu P; Perlow, Jordan H
In recent years, the prevalence of obesity in the United States has risen dramatically, especially among women of reproductive age. Research that has specifically evaluated pregnancy outcomes among obese parturients has allowed for a better understanding of the myriad adverse perinatal complications that are observed with significantly greater frequency in the obese pregnant population. The antepartum, intrapartum, intraoperative, postoperative, and postpartum periods are all times in which the obese pregnant woman is at greater risk for adverse maternal-fetal outcomes, compared with her ideal bodyweight counterpart. Comorbid medical conditions that commonly are associated with obesity further accentuate perinatal risks. All obese pregnant women should be counseled regarding these risks, and strategies should be used to improve perinatal outcome whenever possible. Obese women of reproductive age ideally should be counseled before conception and advised to achieve ideal bodyweight before pregnancy. Copyright © 2011 Mosby, Inc. All rights reserved.
Lee, Yeong Yeh; Wirz, Angela A; Whiting, James G H; Robertson, Elaine V; Smith, Donald; Weir, Alexander; Kelman, Andrew W; Derakhshan, Mohammad H; McColl, Kenneth E L
There is a high incidence of inflammation and metaplasia at the gastro-oesophageal junction (GOJ) in asymptomatic volunteers. Additionally, the majority of patients with GOJ adenocarcinomas have no history of reflux symptoms. We report the effects of waist belt and increased waist circumference (WC) on the physiology of the GOJ in asymptomatic volunteers. 12 subjects with normal and 12 with increased WC, matched for age and gender were examined fasted and following a meal and with waist belts on and off. A magnet was clipped to the squamo-columnar junction (SCJ). Combined assembly of magnet-locator probe, 12-channel pH catheter and 36-channel manometer was passed. The waist belt and increased WC were each associated with proximal displacement of SCJ within the diaphragmatic hiatus (relative to upper border of lower oesophageal sphincter (LOS), peak LOS pressure point and pressure inversion point, and PIP (all p<0.05). The magnitude of proximal migration of SCJ during transient LOS relaxations was reduced by 1.6-2.6 cm with belt on versus off (p=0.01) and in obese versus non-obese (p=0.04), consistent with its resting position being already proximally displaced. The waist belt, but not increased WC, was associated with increased LOS pressure (vs intragastric pressure) and movement of pH transition point closer to SCJ. At 5 cm above upper border LOS, the mean % time pH <4 was <4% in all studied groups. Acid exposure 0.5-1.5 cm above SCJ was increased, with versus without, belt (p=0.02) and was most marked in obese subjects with belt. Our findings indicate that in asymptomatic volunteers, waist belt and central obesity cause partial hiatus herniation and short-segment acid reflux. This provides a plausible explanation for the high incidence of inflammation and metaplasia and occurrence of neoplasia at the GOJ in subjects without a history of reflux symptoms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a
Kim, Jongwan; Yun, Eun-Young; Quan, Fu-Shi
The α-glucosidase inhibitor, 1-deoxynojirimycin (DNJ), is widely used for its antiobesity and antidiabetic effects. Researchers have demonstrated that DNJ regulates body weight by increasing adiponectin levels, which affects energy intake and prevents diet-induced obesity. However, the mechanism by which centrally administered DNJ exerts anorexigenic effects has not been studied until now. We investigated the effect of DNJ in the hypothalamus of mice with high-fat diet-induced obesity. Results showed that intracerebroventricular (ICV) administration of DNJ reduced hypothalamic ER stress, which activated the leptin-induced Janus-activated kinase 2 (JAK2)/signal transducers and activators of transcription 3 (STAT3) signaling pathway to cause appetite suppression. We conclude that DNJ may reduce obesity by moderating feeding behavior and ER stress in the hypothalamic portion of the central nervous system (CNS). PMID:28798799
Kim, Jongwan; Yun, Eun-Young; Quan, Fu-Shi; Park, Seung-Won; Goo, Tae-Won
The α-glucosidase inhibitor, 1-deoxynojirimycin (DNJ), is widely used for its antiobesity and antidiabetic effects. Researchers have demonstrated that DNJ regulates body weight by increasing adiponectin levels, which affects energy intake and prevents diet-induced obesity. However, the mechanism by which centrally administered DNJ exerts anorexigenic effects has not been studied until now. We investigated the effect of DNJ in the hypothalamus of mice with high-fat diet-induced obesity. Results showed that intracerebroventricular (ICV) administration of DNJ reduced hypothalamic ER stress, which activated the leptin-induced Janus-activated kinase 2 (JAK2)/signal transducers and activators of transcription 3 (STAT3) signaling pathway to cause appetite suppression. We conclude that DNJ may reduce obesity by moderating feeding behavior and ER stress in the hypothalamic portion of the central nervous system (CNS).
Jayawardana, N W I A; Jayalath, W A T A; Madhujith, W M T; Ralapanawa, U; Jayasekera, R S; Alagiyawanna, S A S B; Bandara, A M K R; Kalupahana, N S
Obesity has become a global epidemic. The prevalence of obesity has also increased in the South Asian region in the last decade. However, dietary and lifestyle factors associated with obesity in Sri Lankan adults are unclear. The objective of the current study was to investigate the association of dietary and lifestyle patterns with overweight and obesity in a cohort of males from the Central Province of Sri Lanka. A total of 2469 males aged between 16 and 72 years ([Formula: see text]) were included in the study. The sample comprised individuals who presented for a routine medical examination at the National Transport Medical Institute, Kandy, Sri Lanka. The Body Mass Index (BMI) cutoff values for Asians were used to categorize the participants into four groups as underweight, normal weight, overweight or obese. The data on dietary and lifestyle patterns such as level of physical activity, smoking, alcohol consumption, sleeping hours and other socio demographic data were obtained using validated self-administered questionnaires. Multinomial logistic regression model was fitted to assess the associations of individual lifestyle patterns with overweight and obesity. The mean BMI of the study group was 22.7 kg m(-2) and prevalence rates of overweight and obesity were 31.8 and 12.3%, respectively. Mean waist circumference of the participants was 78.6 cm with 17.1% of them being centrally obese. After adjusting for potential confounders, weight status was associated with older age (P < 0.0001), ethnicity (P = 0.0033) and higher income (P = 0.0006). While higher physical activity showed a trend for being associated with lower odds of being obese (odds ratio: 0.898 - confidence interval: 0.744-1.084), alcohol intake, consumption of fruits, level of education, sleeping hours, smoking, consumption of fish, meat, dairy, sweets or fried snacks were not significantly associated with the weight status. The high prevalence rates of overweight and obesity in
Cottone, Pietro; Sabino, Valentina; Nagy, Tim R.; Coscina, Donald V.; Levin, Barry E.; Zorrilla, Eric P.
Objective Obesity is a costly, deadly public health problem for which new treatments are needed. Individual differences in meal pattern have been proposed to play a role in obesity risk. The present study tested the hypothesis that i) the microstructure of chronic high-fat diet intake differs between genetically selected Diet-Induced Obesity (DIO) and Diet Resistant (DR) rats, and ii) central administration of urocortin 2 (Ucn 2), a corticotropin-releasing factor type 2 (CRF2) agonist, decreases high-fat diet intake not only in lean DR rats, but also in obese DIO rats. Design Male, selectively bred DIO and DR rats (n=10/genotype) were chronically fed a high-fat diet. Food and water intake as well as ingestion microstructure were then compared under baseline conditions and following third intracerebroventricular injection of Ucn 2 (0, 0.1, 0.3, 1, 3 µg). Results Irrespective of genotype, Ucn 2 reduced nocturnal food intake with a minimum effective dose of 0.3 µg, suppressing high-fat diet intake by ~40% at the 3 µg dose. Ucn 2 also made rats of both genotypes eat smaller and briefer meals, including at doses that did not reduce drinking. Obese DIO rats ate fewer but larger meals than DR rats, which they ate more quickly and consumed with 2/3rd less water. Conclusions Unlike leptin and insulin, Ucn 2 retains its full central anorectic efficacy to reduce high-fat diet intake even in obese, genetically-prone DIO rats, which otherwise show a “gorging” meal pattern. These results open new opportunities of investigation towards treating some forms of diet-induced obesity. PMID:23478425
Lek, Ngee; Yan, Weili; Zhang, Yi; Wang, Qian; Cheung, Yin Bun
'A Body Shape Index-Adolescents' (ABSI-Adolescents) and waist-to-height ratio are recently proposed indices that quantify central obesity in adolescents. To investigate the scaling exponents to standardise waist circumference (WC) for body mass index (BMI) and height and to investigate the association between BMI, WC-based indices and cardiometabolic outcomes in adolescents of three ethnic groups. A cross-sectional study of 1755 adolescents (516 Hans, 565 Uygurs, 674 Kazakhs) was conducted in north-west China. Correlation between indices of obesity and blood pressure (BP) and fasting blood glucose (FBG) were estimated and compared. Two ethnic groups (Han and Kazakh) had WC-BMI-height profiles different from the previously proposed ABSI-Adolescents and, therefore, required different scaling exponents for WC standardization. After adjustment for age and gender, WC and BMI have similar associations with BP and FBG. After further adjustment for BMI, WC remained significantly associated with FBG in all three ethnic groups (each p < 0.01) and with BP in Han and Kazakh adolescents (each p < 0.05). Body proportionality varied between the ethnic groups. WC and WC-based indices were associated with blood pressure and fasting blood glucose in adolescents of three ethnicities. The WC-based indices did not out-perform WC per se.
Hutchinson, Jeff; Emerick, Jill; Saxena, Harshita
The National Health and Nutrition Examination Survey from the Centers for Disease Control and Prevention reports a steady increase in obesity over the last 30 years. The greatest increase was seen in 15 to 19 year olds, whose obesity prevalence almost doubled from 10.5% to 19.4%. The solution to pediatric obesity requires a multidisciplinary approach addressing cultural norms, technologic advances, and family engagement. Future treatment strategies to combat the obesity epidemic will have to extend beyond the health care provider's office. Behavior modification remains the key component to pediatric obesity prevention and treatment.
Aronne, Louis J
Over the past decade, treatment for obesity has been limited because of an incomplete understanding of the pathophysiology of obesity, lack of recognition of it as a disease, and limited efficacy of treatment options. Safety concerns related to medical and surgical approaches for obesity have also been a major barrier. The challenging nature of obesity management is reflected in a survey of primary care physicians which indicated that treating patients with obesity can be as difficult as treating patients with nicotine or alcohol dependence.
Elmehdawi, Rafik R.; Albarsha, Abdulwahab M.
Obesity is a global epidemic resulting in major morbidity and premature death. About 64% of Libyan adults are either overweight or obese, obesity progressively increasing with age, and two times more common among Libyan women than men. Cases of obesity and overweight are increasing in Libya as well as all over the world, with genetic and environmental factors playing a contributory role. With its known significant morbidity and mortality, obesity should draw the attention of the healthcare community, researchers, and policy makers in Libya. PMID:22899968
Costa-Font, Joan; Gil, Joan
Can the rise in obesity among children be attributed to the intergenerational transmission of parental influences? Does this trend affect the influence of parent's socioeconomic status on obesity? This paper documents evidence of an emerging social gradient of obesity in pre-school children resulting from a combination of both socio-economic status and less intensive childcare associated with maternal employment, when different forms of intergenerational transmission are controlled for. We also estimate and decompose income related inequalities in child obesity. We take advantage of a uniquely constructed dataset from Spain that contains records form 13,358 individuals for a time period (years 2003-2006) in which a significant spike in the growth of child obesity was observed. Our results suggest robust evidence of both socioeconomic and intergenerational gradients. Results are suggestive of a high income effect in child obesity, alongside evidence that income inequalities have doubled in just three years with a pure income effect accounting for as much as 72-66% of these income inequality estimates, even when intergenerational transmission is accounted for. Although, intergenerational transmission does not appear to be gender specific, when accounted for, mother's labour market participation only explains obesity among boys but not among girls. Hence, it appears income and parental influences are the central determinants of obesity among children.
The behavioral management of obesity is an approach designed to provide individuals with a set of skills that promote a healthier weight. A number of strategies are used to assist individuals in making gradual changes that can realistically be incorporated into their lives. Evidence is promising f...
Averett, Susan L; Smith, Julie K
There is a substantial correlation between household debt and health. Individuals with less healthy lifestyles are more likely to hold debt, yet there is little evidence as to whether this is merely a correlation or if financial hardship actually causes obesity. In this paper, we use data from the National Longitudinal Survey of Adolescent Health to test whether financial hardship affects body weight. We divide our sample into two groups: men and women, explore two different types of financial hardship: holding credit card debt and having trouble paying bills, and three outcomes: overweight, obese and body mass index (BMI). We use a variety of econometric techniques: Ordinary Least Squares, Propensity Score Matching, Sibling Fixed Effects, and Instrumental Variables to investigate the relationship that exists between financial hardship and body weight. In addition, we conduct several robustness checks. Although our OLS and PSM results indicate a correlation between financial hardship and body weight these results appear to be largely driven by unobservables. Our IV results suggest that there is no causal relationship between credit card debt and overweight or obesity for either men or women. However, we find suggestive evidence that having trouble paying bills may be a cause of obesity for women. Copyright © 2014 Elsevier B.V. All rights reserved.
Hoiberg, Anne; And Others
Results lend support to the other research findings and point to the difficulties that many overweight individuals have during a weight-reduction endeavor because they also must deal with the numerous psychological and physiological problems involved in overcoming a history of being obese. (Author)
Meldrum, David R
Women bear the predominant burden of our obesogenic environment, with a higher incidence of obesity than men, more impact on their fertility and success with treatment, and significant maternal and perinatal morbidity and mortality. In this series, the causes, consequences, and solutions regarding the obesity pandemic, the mechanisms of the effect of obesity on the female and male, the epigenetic consequences of male obesity, the marked effects on perinatal outcomes, and the effects of weight loss before conception and during pregnancy are explored. Lifestyle modifications, in particular a healthy diet and exercise during the 3-6 months before conception and during treatment, should result in better outcomes than requiring weight loss before fertility treatments. Such fundamental changes toward a healthier lifestyle will achieve steady and sustainable weight loss and long-term benefits for general health. The role of bariatric surgery before pregnancy requires careful consideration. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Aleksandrova, Krasimira; Nimptsch, Katharina; Pischon, Tobias
This review outlines the association of obesity with risk of colorectal cancer and the potential underlying mechanisms from an epidemiological perspective. Current research indicates that there is a moderate but consistently reported association between general obesity (as determined by BMI) and colorectal cancer incidence and mortality. The relative risk associated with obesity is higher for cancer of the colon than for cancer of the rectum and it is higher in men than in women. By contrast, abdominal adiposity (as determined by waist circumference or waist-to-hip ratio) is similarly strongly associated with colon cancer in men and women, suggesting that abdominal adiposity is a more important risk factor for colon cancer than general adiposity, at least in women. Putative mechanisms that may account for the link between adiposity and colorectal cancer risk include hyperinsulinemia, insulin resistance, inflammation, altered immune response, oxidative stress, as well as disturbances in insulin-like growth factors, adipokines, and sex steroids. Understanding the link between obesity and colorectal cancer may pave the way for targeted prevention of colorectal cancer morbidity and mortality.
Peer victimization of obese adolescents has been associated with low self-esteem, body dissatisfaction, social isolation, marginalization, poor psychosocial adjustment, depression, eating disorders, and suicidal ideation and attempts, not to mention poor academic performance. Weight-based peer victimization is defined as unsolicited bullying and…
Izaola, Olatz; de Luis, Daniel; Sajoux, Ignacio; Domingo, Joan Carles; Vidal, Montse
Obesity is a chronic disease with multiple origins. It is a widespread global phenomenon carrying potentially serious complications which requires a multidisciplinary approach due to the significant clinical repercussions and elevated health costs associated with the disease. The most recent evidence indicates that it shares a common characteristic with other prevalent, difficult-to-treat pathologies: chronic, low-grade inflammation which perpetuates the disease and is associated with multiple complications. The current interest in lipoinflammation or chronic inflammation associated with obesity derives from an understanding of the alterations and remodelling that occurs in the adipose tissue, with the participation of multiple factors and elements throughout the process. Recent research highlights the importance of some of these molecules, called pro-resolving mediators, as possible therapeutic targets in the treatment of obesity. This article reviews the evidence published on the mechanisms that regulate the adipose tissue remodelling process and lipoinflammation both in obesity and in the mediators that are directly involved in the appearance and resolution of the inflammatory process. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Kao, Yung-Hsi; Chang, Hsin-Huei; Lee, Meng-Jung; Chen, Chia-Lin
Tea has been found to possess widespread biological functions based on a variety of laboratory data. The effects of tea on obesity and diabetes have received increasing attention. This paper reviews the evidence for the connections among tea catechins, and obesity and diabetes. Tea catechins, especially (-)-epigallocatechin gallate (EGCG), appear to have antiobesity and antidiabetic effects. While few epidemiological and clinical studies show the health benefits of EGCG on obesity and diabetes, the mechanisms of its actions are emerging based on the various laboratory data. These mechanisms may be related to certain pathways, such as through the modulations of energy balance, endocrine systems, food intake, lipid and carbohydrate metabolism, the redox status, and activities of different types of cells (i. e., fat, liver, muscle, and beta-pancreatic cells). Because the EGCG receptor, the so-called 67-kDa laminin receptor (LR), has been discovered with colocalization of other types of LR and cytoskeleton in both cancer cells and normal cells, this may explain that EGCG possesses numerous actions. The mechanistic results of this review may possibly be utilized in the treatment of obesity, diabetes, and other related diseases using tea- and EGCG-based folk medicines.
Peer victimization of obese adolescents has been associated with low self-esteem, body dissatisfaction, social isolation, marginalization, poor psychosocial adjustment, depression, eating disorders, and suicidal ideation and attempts, not to mention poor academic performance. Weight-based peer victimization is defined as unsolicited bullying and…
Maternal nutrition at the time of conception and during pregnancy is considered a factor for individual differences in having obesity. The mechanisms underlying this association are likely partially epigenetic in nature, but pinning down the exact nature, location, and timing of these changes remain...
Braillon, A; Capron, J P; Hervé, M A; Degott, C; Quenum, C
We report on clinical, nutritional, and hepatic histological findings in 50 non-selected obese subjects (mean overweight +74%; range +21-138%). The pathogenesis of the liver damage was assessed with the help of multidimensional analysis of a number of clinical variables. According to the severity of the hepatic lesions, the patients have been ranged in five groups: O (normal liver) 10%; I (fatty liver) 48%; II (fatty hepatitis) 26%; III (fatty fibrosis) 8%; IV (fatty cirrhosis) 8%. The more severe changes (groups III and IV) were constantly associated with excessive alcohol intake. The multidimensional analysis was unable to find a relationship between obesity and the development of fibrosis and cirrhosis whereas it showed that: (a) there was a highly significant correlation between the daily ethanol intake and the degree of overweight, (b) severe fatty metamorphosis was significantly associated with the degree of overweight, the existence of diabetes mellitus, and the amount of alcohol and fat intake, (c) nutritional factors, in particular deficient protein intake, have only an accessory effect in the development of mild inflammation and fibrosis, (d) the consumption of potentially hepatotoxic drugs, very high in the obese (about five drugs per day) could have a role in the development of cirrhosis. In conclusion in our study, there was no evidence that obesity per se could result in severe liver damage. PMID:3967830
Lee, Hansongyi; Lee, In Seok
Obesity is a state in which there is an over-accumulation of subcutaneous and/or abdominal adipose tissue. This adipose tissue is no longer considered inert and mainly devoted to storing energy; it is emerging as an active tissue in the regulation of physiological and pathological processes, including immunity and inflammation. Adipose tissue produces and releases a variety of adipokines (leptin, adiponectin, resistin, and visfatin), as well as pro- and anti-inflammatory cytokines (tumor necrosis factor-α, interleukin [IL]-4, IL-6, and others). Adipose tissue is also implicated in the development of chronic metabolic diseases such as type 2 diabetes mellitus or cardiovascular disease. Obesity is thus an underlying condition for inflammatory and metabolic diseases. Diet or dietary patterns play critical roles in obesity and other pathophysiological conditions. A healthy diet and some nutrients are generally considered beneficial; however, some dietary nutrients are still considered controversial. In this article, dietary factors that influence inflammation associated with obesity are discussed. PMID:24224147
Over the past two decades, inflammation has been recognized as a major driver in the pathogenesis of several common diseases, including atherosclerosis, diabetes, cancer, and asthma. Over the same period, there has been a steep rise in the incidence of obesity, a major risk factor for these disorders. Inflammation of adipose tissue is now recognized to accompany obesity and contribute to its sequelae. Thus, whereas obesity is primarily a disorder of energy balance, it may be helpful to consider it also as a form of epidemic inflammation that predisposes to other forms of epidemic inflammation. It is a fundamental biologic challenge to understand how a positive energy balance and inflammation are linked. This work reviews evidence that reactive oxygen and nitrogen intermediates (ROI and RNI) help drive chronic inflammation in the obese. This is proposed to be a maladaptive instance of our evolved dependence on ROI and RNI for both homeostatic signaling and host defense. ROI and RNI are well suited for these seemingly contradictory dual functions by their metabolic origin, high diffusibility in water and lipid, atomic specificity, and large number of molecular targets. When we eat so much and work so little that we repeatedly generate reactive compounds at levels normally reserved for emergencies, we treat our own cells like invading microbes.
Videogames can be used to help children change their obesity-related diet and physical activity behaviors. A review of the relevant literature in this special issue of the Games for Health Journal indicated that video games did influence children's adiposity, but only among children who were alread...
Legendre, G; Fritel, X; Capmas, P; Pourcelot, A-G; Fernandez, H
Obesity, defined as a body mass index (BMI) more than or equal to 30kg/m(2), promotes pelvic floor disorders such as urinary incontinence (UI) and genital prolapse. Datas from cohort studies found an association between high BMI and the onset of UI. This association seems to be predominant with for mixed UI and stress UI. For the urge UI and overactive bladder syndrome, the analysis of the literature found a weaker association. The weight is therefore the only modifiable risk factor. Thus, the weight loss by a hypocaloric diet associated with pelvic floor muscle training should be the front line treatment in the obese patient suffering from UI. Bariatric surgery can be discussed in the most obese patient, even if the risk/benefit balance should be weighed because of significant morbidity of this surgery. The results of sub urethral sling (by retropubic tension-free vaginal tape or transobturator sling) in obese patients appear to be equivalent to those obtained in patients of normal weight. Datas on per- and postoperative complications for suburethral slings are reassuring.
Lewis, Anne C.
Headlines recently were full of studies about the obesity problem of America's children and young people, as if kids became overweight without anyone noticing. An accumulation of both school and family habits, however, have been contributing to the fact that at least 13% of children ages 7 to 11 are overweight, double those of the 1970s (and…
Lewis, Anne C.
Headlines recently were full of studies about the obesity problem of America's children and young people, as if kids became overweight without anyone noticing. An accumulation of both school and family habits, however, have been contributing to the fact that at least 13% of children ages 7 to 11 are overweight, double those of the 1970s (and…
Gomis Barbará, R
The pharmacological treatment of obesity should be considered when cannot be achieved a 10% weight loss with diet therapy and physical activity. The drugs effective in obesity treatment may act by different mechanisms such as reduction in food intake, inhibition of fat absorption, increase of thermogenesis and stimulation of adipocyte apoptosis. At present, we only have two marketed drugs for obesity treatment. Sibutramine is an inhibitor of norepinephrine, dopamine and serotonina reuptake which inhibits food intake and increases thermogenesis. Sibutramine administration for a year can induce a weight loss of 4-7%. Its main side effects are hypertension, headache, insomnia and constipation. Orlistat is an inhibitor of pancreatic lipase which is able to block the absorption of 30% of ingested fat. Its administration induces weight loss and reduction of ulterior weight regain. Also, this drug improves hypertension dyslipdaemia and helps to prevent diabetes in 52% of cases when administered over four years. The increase in frequency of stools and interference with vitamin absorption are its main side effects. Glucagon-like peptide 1, which increases insulin sensitivity and satiety, adiponectin and PPAR-gamma agonists which reduce insulin resistance and modulates adipocyte generation are the basis for future therapeutic approaches of obesity. Phosphatase inhibitors induce PPAR-gamma phosphorylation and UCP-1 expression leading to an increase in thermogenesis and reduction in appetite.
Ungefroren, H; Gieseler, F; Lehnert, H
The incidence of obesity in the western world has increased dramatically during recent decades. Epidemiological data suggest that obesity is associated with an increased risk of several but not all types of cancers, with clear sex-specific differences. The underlying mechanisms are still a matter of debate. This review focuses on the potential factors linking obesity to cancer. Current experimental evidence suggests that insulin resistance and a chronic, subclinical inflammation in the visceral fat are the major metabolic events causing alterations in the levels of insulin, glucose, free fatty acids, insulin-like growth factor 1 (IGF-1) and 2, adipose tissue-derived proinflammatory cytokines and other bioactive molecules, such as adipokines (e.g. leptin and adiponectin), vascular endothelial growth factor (VEGF), sex hormones, gut microbiota and secondary bile acids. All these factors may act directly or indirectly on the tumor microenvironment to drive tumor progression via stimulation of cell survival/antiapoptosis, cell proliferation, angiogenesis and invasion/metastasis of the cancer cells. Therapeutic strategies that target dysfunctional or inflamed fat and have been shown to benefit patients include bariatric surgery, while other cell or hormone-directed interventions, such as conversion of visceral fat macrophages to an anti-inflammatory M2 phenotype or the pharmacological modulation of serum adipokine levels are still theoretical and need to be clinically evaluated for their ability to successfully treat or prevent obesity-related cancers.
Witt, Cordelie E; Arbabi, Saman; Nathens, Avery B; Vavilala, Monica S; Rivara, Frederick P
The implications of childhood obesity on pediatric trauma outcomes are not clearly established. Anthropomorphic data were recently added to the National Trauma Data Bank (NTDB) Research Datasets, enabling a large, multicenter evaluation of the effect of obesity on pediatric trauma patients. Children ages 2 to 19years who required hospitalization for traumatic injury were identified in the 2013-2014 NTDB Research Datasets. Age and gender-specific body mass indices (BMI) were calculated. Outcomes included injury patterns, operative procedures, complications, and hospital utilization parameters. Data from 149,817 pediatric patients were analyzed; higher BMI percentiles were associated with significantly more extremity injuries, and fewer injuries to the head, abdomen, thorax and spine (p values <0.001). On multivariable analysis, higher BMI percentiles were associated with significantly increased likelihood of death, deep venous thrombosis, pulmonary embolus and pneumonia; although there was no difference in risk of overall complications. Obese children also had significantly longer lengths of stay and more frequent ventilator requirement. Among children admitted after trauma, increased BMI percentile is associated with increased risk of death and potentially preventable complications. These findings suggest that obese children may require different management than nonobese counterparts to prevent complications. Level III; prognosis study. Copyright © 2017 Elsevier Inc. All rights reserved.
Swencionis, Charles; Rendell, Sarah Litman
G. Stanley Hall, the first person to earn a Ph.D. in psychology in the United States, did research on eating behaviors in the nineteenth century (Lepore in The New Yorker, 2011). Research on psychological aspects of obesity accelerated in the 1950s and there has been a great deal done at this point. We review areas of considerable activity and relevance.
Marcello, Marjory Alana; Cunha, Lucas Leite; Batista, Fernando Assis; Ward, Laura Sterian
Many studies have provided observational data on the association of obesity and thyroid cancers, but only few of them propose mechanisms that would permit a better understanding of the causal molecular mechanisms of this association. Considering that there is an increasing incidence of both obesity and thyroid cancers, we need to summarize and link recent studies in order to characterize and understand the contribution of obesity-related factors that might affect thyroid cancer development and progression. Adipose tissue is involved in many vital processes, including insulin sensitivity, angiogenesis, regulation of energy balance, activation of the complement system, and responses such as inflammation. Although these processes have their own molecular pathways, they involve the same molecules through which obesity and adipose tissue might exert their roles in carcinogenesis, not only affecting MAPK and PI3K or even insulin pathways, but also recruiting local inflammatory responses that could result in disease formation and progression. This review describes five important issues that might explain the link between excessive weight and thyroid cancer: thyroid hormones, insulin resistance, adipokines, inflammation, and sexual hormones. © 2014 Society for Endocrinology.
The prevalence of overweight and obesity and their associated metabolic disorders are considered a major threat to the public’s health. While several diet and exercise programs are available for weight loss and prevention of weight regain, progresses often slow and disappointing. Recently, natural b...
García Hidalgo, Linda
Obesity is a health problem of considerable magnitude in the Western world. Dermatological changes have been reported in patients with obesity, including: acanthosis nigricans and skin tags (due to insulin resistance); hyperandrogenism; striae due to over extension; stasis pigmentation due to peripheral vascular disease; lymphedema; pathologies associated with augmented folds; morphologic changes in the foot anatomy due to excess load; and complications that may arise from hospitalization. Acanthosis nigricans plaques can be managed by improved control of hyperinsulinemia; the vitamin D3 analog calcipitriol has also been shown to be effective. Skin tags can be removed by snipping with curved scissors, by cryotherapy or by electrodesiccation. Hyperandrogenism, a result of increased production of endogenous androgens due to increased volumes of adipose tissue (which synthesizes testosterone) and hyperinsulinemia (which increases the production of ovarian androgens) needs to be carefully assessed to ensure disorders such as virilizing tumors and congenital adrenal hyperplasia are treated appropriately. Treatment of hyperandrogenism should be centred on controlling insulin levels; weight loss, oral contraceptive and antiandrogenic therapies are also possible treatment options. The etiology of striae distensae, also known as stretch marks, is yet to be defined and treatment options are unsatisfactory at present; striae rubra and alba have been treated with a pulsed dye laser with marginal success. The relationship between obesity and varicose veins is controversial; symptoms are best prevented by the use of elastic stockings. Itching and inflammation associated with stasis pigmentation, the result of red blood cells escaping into the tissues, can be treated with corticosteroids. Lymphedema is associated with dilatation of tissue channels, reduced tissue oxygenation and provides a culture medium for bacterial growth. Lymphedema treatment is directed towards reducing the
Cameron, Adrian J; Boyko, Edward J; Sicree, Richard A; Zimmet, Paul Z; Söderberg, Stefan; Alberti, K George M M; Tuomilehto, Jaakko; Chitson, Pierrot; Shaw, Jonathan E
Evidence from epidemiologic studies that central obesity precedes future metabolic change and does not occur concurrently with the appearance of the blood pressure, glucose, and lipid abnormalities that characterize the metabolic syndrome (MetS) has been lacking. Longitudinal surveys were conducted in Mauritius in 1987, 1992, and 1998, and in Australia in 2000 and 2005 (AusDiab). This analysis included men and women (aged > or = 25 years) in three cohorts: AusDiab 2000-2005 (n = 5,039), Mauritius 1987-1992 (n = 2,849), and Mauritius 1987-1998 (n = 1,999). MetS components included waist circumference, systolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein (HDL) cholesterol, triglycerides, and homeostasis model assessment of insulin sensitivity (HOMA-S) (representing insulin sensitivity). Linear regression was used to determine which baseline components predicted deterioration in other MetS components over 5 years in AusDiab and 5 and 11 years in Mauritius, adjusted for age, sex, and ethnic group. Baseline waist circumference predicted deterioration (P < 0.01) in four of the other six MetS variables tested in AusDiab, five of six in Mauritius 1987-1992, and four of six in Mauritius 1987-1998. In contrast, an increase in waist circumference between baseline and follow-up was only predicted by insulin sensitivity (HOMA-S) at baseline, and only in one of the three cohorts. These results suggest that central obesity plays a central role in the development of the MetS and appears to precede the appearance of the other MetS components.
Camacho-Gomez, Rosa; Sadeghi, Banefsheh; Kaiser, Lucia; German, J. Bruce; de la Torre, Adela
Introduction In California’s agricultural Central Valley, the rate of childhood obesity is higher than the national average. Adequate physical activity contributes to obesity prevention and its assessment is useful to evaluate the impact of interventions. Methods Niños Sanos, Familia Sana (Healthy Children, Healthy Family [NSFS]) uses community-based participatory research to implement an intervention program to reduce childhood obesity among people of Mexican origin in the Central Valley. Anthropometric measurements were conducted on more than 650 children enrolled in NSFS. Physical activity data from a subgroup of children aged 4 to 7 years (n = 134) were collected via a wearable accelerometer. Results Children were classified on the basis of age and sex-adjusted body mass index as healthy weight (57.7%); overweight (19.3%), or obese (23%). Logistic regression showed that moderate to vigorous physical activity (MVPA) was associated with a child’s likelihood of having a healthy BMI (odds ratio: 1.03; 95% CI, 1.01–1.05; P = .017). Conclusion NSFS’s community-based participatory approach resulted in successful use of a commercial electronic device to measure physical activity quantity and quality in this hard-to-reach population. Promotion of adequate daily MVPA is an appropriate and necessary component of NSFS’s childhood obesity prevention strategy. PMID:26203815
Hainer, V; Zamrazilová, H; Kunešová, M; Bendlová, B; Aldhoon-Hainerová, I
Associations between different infectious agents and obesity have been reported in humans for over thirty years. In many cases, as in nosocomial infections, this relationship reflects the greater susceptibility of obese individuals to infection due to impaired immunity. In such cases, the infection is not related to obesity as a causal factor but represents a complication of obesity. In contrast, several infections have been suggested as potential causal factors in human obesity. However, evidence of a causal linkage to human obesity has only been provided for adenovirus 36 (Adv36). This virus activates lipogenic and proinflammatory pathways in adipose tissue, improves insulin sensitivity, lipid profile and hepatic steatosis. The E4orf1 gene of Adv36 exerts insulin senzitizing effects, but is devoid of its pro-inflammatory modalities. The development of a vaccine to prevent Adv36-induced obesity or the use of E4orf1 as a ligand for novel antidiabetic drugs could open new horizons in the prophylaxis and treatment of obesity and diabetes. More experimental and clinical studies are needed to elucidate the mutual relations between infection and obesity, identify additional infectious agents causing human obesity, as well as define the conditions that predispose obese individuals to specific infections.
de Oliveira Otto, Marcia C.; Padhye, Nikhil S.; Bertoni, Alain G.; Jacobs, David R.; Mozaffarian, Dariush
Diet guidelines recommend increasing dietary diversity. Yet, metrics for dietary diversity have neither been well-defined nor evaluated for impact on metabolic health. Also, whether diversity has effects independent of diet quality is unknown. We characterized and evaluated associations of diet diversity and quality with abdominal obesity and type II diabetes (T2D) in the Multi-Ethnic Study of Atherosclerosis. At baseline (2000–02), diet was assessed among 5,160 Whites, Hispanic, Blacks, and Chinese age 45–84 y and free of T2D, using a validated questionnaire. Three different aspects of diet diversity were characterized including count (number of different food items eaten more than once/week, a broad measure of diversity), evenness (Berry index, a measure of the spread of the diversity), and dissimilarity (Jaccard distance, a measure of the diversity of the attributes of the foods consumed). Diet quality was characterized using aHEI, DASH, and a priori pattern. Count and evenness were weakly positively correlated with diet quality (r with AHEI: 0.20, 0.04), while dissimilarity was moderately inversely correlated (r = -0.34). In multivariate models, neither count nor evenness was associated with change in waist circumference (WC) or incident T2D. Greater food dissimilarity was associated with higher gain in WC (p-trend<0.01), with 120% higher gain in participants in the highest quintile of dissimilarity scores. Diet diversity was not associated with incident T2D. Also, none of the diversity metrics were associated with change in WC or incident T2D when restricted to only healthier or less healthy foods. Higher diet quality was associated with lower risk of T2D. Our findings provide little evidence for benefits of diet diversity for either abdominal obesity or diabetes. Greater dissimilarity among foods was actually associated with gain in WC. These results do not support the notion that “eating everything in moderation” leads to greater diet quality or
Otto, Marcia C de Oliveira; Padhye, Nikhil S; Bertoni, Alain G; Jacobs, David R; Mozaffarian, Dariush
Diet guidelines recommend increasing dietary diversity. Yet, metrics for dietary diversity have neither been well-defined nor evaluated for impact on metabolic health. Also, whether diversity has effects independent of diet quality is unknown. We characterized and evaluated associations of diet diversity and quality with abdominal obesity and type II diabetes (T2D) in the Multi-Ethnic Study of Atherosclerosis. At baseline (2000-02), diet was assessed among 5,160 Whites, Hispanic, Blacks, and Chinese age 45-84 y and free of T2D, using a validated questionnaire. Three different aspects of diet diversity were characterized including count (number of different food items eaten more than once/week, a broad measure of diversity), evenness (Berry index, a measure of the spread of the diversity), and dissimilarity (Jaccard distance, a measure of the diversity of the attributes of the foods consumed). Diet quality was characterized using aHEI, DASH, and a priori pattern. Count and evenness were weakly positively correlated with diet quality (r with AHEI: 0.20, 0.04), while dissimilarity was moderately inversely correlated (r = -0.34). In multivariate models, neither count nor evenness was associated with change in waist circumference (WC) or incident T2D. Greater food dissimilarity was associated with higher gain in WC (p-trend<0.01), with 120% higher gain in participants in the highest quintile of dissimilarity scores. Diet diversity was not associated with incident T2D. Also, none of the diversity metrics were associated with change in WC or incident T2D when restricted to only healthier or less healthy foods. Higher diet quality was associated with lower risk of T2D. Our findings provide little evidence for benefits of diet diversity for either abdominal obesity or diabetes. Greater dissimilarity among foods was actually associated with gain in WC. These results do not support the notion that "eating everything in moderation" leads to greater diet quality or better
Grantham, James P.; Henneberg, Maciej
The explanation of obesity as a simple result of positive energy balance fails to account for the scope of variable responses to diets and lifestyles. It is postulated that individual physiological and anatomical variation may be responsible for developing obesity. Girls in poor families develop greater adiposity than their male siblings, a trend not present in richer environments. This indicates strong influence of estrogen on fat accumulation irrespective of poor socioeconomic conditions. Obesity rates in males and females of developed nations are similar, while in poorer nations obesity is much more prevalent in females. Female to male ratio of obesity correlates inversely with gross domestic product. Therefore, the parity of male and female obesity in developed countries may result from male exposure to environmental estrogen-like substances associated with affluence. These hormonally driven mechanisms may be equally active within both sexes in more developed areas, thereby increasing overall obesity. PMID:24915457
Crocker, Melissa K.; Yanovski, Jack A.
Synopsis This paper reviews factors that contribute to excessive weight gain in children and outlines current knowledge regarding approaches for treating pediatric obesity. Virtually all of the known genetic causes of obesity primarily increase energy intake. Genes regulating the leptin signaling pathway are particularly important for human energy homeostasis. Obesity is a chronic disorder that requires long-term strategies for management. The foundation for all treatments for pediatric obesity remains restriction of energy intake with lifestyle modification. There are few long-term studies of pharmacotherapeutic interventions for pediatric obesity. Bariatric surgical approaches are the most efficacious obesity treatments but, because of their potential risks, are reserved for those with the most significant complications of obesity. PMID:19717003
Plourde, Benoit; Sarrazin, Jean-François; Nault, Isabelle; Poirier, Paul
For individuals and the society as a whole, the increased risk of sudden cardiac death in obese patients is becoming a major challenge, especially since obesity prevalence has been increasing steadily around the globe. Traditional risk factors and obesity often coexist. Hypertension, diabetes, obstructive sleep apnea and metabolic syndrome are well-known risk factors for CV disease and are often present in the obese patient. Although the bulk of evidence is circumstantial, sudden cardiac death and obesity share common traditional CV risk factors. Structural, functional and metabolic factors modulate and influence the risk of sudden cardiac death in the obese population. Other risk factors such as left ventricular hypertrophy, increased number of premature ventricular complexes, altered QT interval and reduced heart rate variability are all documented in both obese and sudden cardiac death populations. The present review focuses on out-of-hospital sudden cardiac death and potential mechanisms leading to sudden cardiac death in this population.
El-Sayed Moustafa, Julia S; Froguel, Philippe
Obesity is a disorder characterized by an excess accumulation of body fat resulting from a mismatch between energy intake and expenditure. Incidence of obesity has increased dramatically in the past few years, almost certainly fuelled by a shift in dietary habits owing to the widespread availability of low-cost, hypercaloric foods. However, clear differences exist in obesity susceptibility among individuals exposed to the same obesogenic environment, implicating genetic risk factors. Numerous genes have been shown to be involved in the development of monofactorial forms of obesity. In genome-wide association studies, a large number of common variants have been associated with adiposity levels, each accounting for only a small proportion of the predicted heritability. Although the small effect sizes of obesity variants identified in genome-wide association studies currently preclude their utility in clinical settings, screening for a number of monogenic obesity variants is now possible. Such regular screening will provide more informed prognoses and help in the identification of at-risk individuals who could benefit from early intervention, in evaluation of the outcomes of current obesity treatments, and in personalization of the clinical management of obesity. This Review summarizes current advances in obesity genetics and discusses the future of research in this field and the potential relevance to personalized obesity therapy.
O'Rahilly, S; Farooqi, I S
In the spirit of celebration associated with the 20th anniversary of the Pennington Biomedical Research Center, we have seized the opportunity of taking a highly personal and not at all comprehensive 'whistle-stop tour' of a large body of evidence that, we feel, supports the following conclusions: (1) that body fat stores are regulated by biological control processes in humans as they are in lower animals; (2) that there are major inherited influences on the efficiency whereby such control processes operate in humans; (3) that the precise nature of those genetic and biological influences and how they interact with environmental factors are beginning to be understood; (4) that most of the genes discovered thus far have their principal impact on hunger, satiety and food intake; (5) that while there is understandable resistance to the notion that genes can influence a human behavior such as the habitual ingestion of food, the implications of these discoveries are essentially benign. Indeed, we hope that they may eventually lead to improved treatment for patients and, in addition, help to inculcate a more enlightened attitude to the obese with a reduction in their experience of social and economic discrimination.
Nasreddine, Lara; Naja, Farah; Akl, Christelle; Chamieh, Marie Claire; Karam, Sabine; Sibai, Abla-Mehio; Hwalla, Nahla
The Eastern Mediterranean region is characterized by one of the highest burdens of paediatric obesity worldwide. This study aims at examining dietary, lifestyle, and socio-economic correlates of overweight, obesity, and abdominal adiposity amongst children and adolescents in Lebanon, a country of the Eastern Mediterranean basin. A nationally representative cross-sectional survey was conducted on 6–19-year-old subjects (n = 868). Socio-demographic, lifestyle, dietary, and anthropometric data (weight, height, waist circumference) were collected. Overweight and obesity were defined based on BMI z-scores. Elevated waist circumference (WC) and elevated waist to height ratio (WHtR) were used as indices of abdominal obesity. Of the study sample, 34.8% were overweight, 13.2% were obese, 14.0% had elevated WC, and 21.3% had elevated WHtR. Multivariate logistic regression analyses showed that male gender, maternal employment, residence in the capital Beirut, sedentarity, and higher consumption of fast food and sugar sweetened beverages were associated with increased risk of obesity, overweight, and abdominal adiposity, while regular breakfast consumption, higher intakes of milk/dairies and added fats/oils were amongst the factors associated with decreased risk. The study’s findings call for culture-specific intervention strategies for the promotion of physical activity, healthy lifestyle, and dietary practices amongst Lebanese children and adolescents. PMID:24618510
Nasreddine, Lara; Naja, Farah; Akl, Christelle; Chamieh, Marie Claire; Karam, Sabine; Sibai, Abla-Mehio; Hwalla, Nahla
The Eastern Mediterranean region is characterized by one of the highest burdens of paediatric obesity worldwide. This study aims at examining dietary, lifestyle, and socio-economic correlates of overweight, obesity, and abdominal adiposity amongst children and adolescents in Lebanon, a country of the Eastern Mediterranean basin. A nationally representative cross-sectional survey was conducted on 6-19-year-old subjects (n = 868). Socio-demographic, lifestyle, dietary, and anthropometric data (weight, height, waist circumference) were collected. Overweight and obesity were defined based on BMI z-scores. Elevated waist circumference (WC) and elevated waist to height ratio (WHtR) were used as indices of abdominal obesity. Of the study sample, 34.8% were overweight, 13.2% were obese, 14.0% had elevated WC, and 21.3% had elevated WHtR. Multivariate logistic regression analyses showed that male gender, maternal employment, residence in the capital Beirut, sedentarity, and higher consumption of fast food and sugar sweetened beverages were associated with increased risk of obesity, overweight, and abdominal adiposity, while regular breakfast consumption, higher intakes of milk/dairies and added fats/oils were amongst the factors associated with decreased risk. The study's findings call for culture-specific intervention strategies for the promotion of physical activity, healthy lifestyle, and dietary practices amongst Lebanese children and adolescents.
Oliveros, Estefania; Somers, Virend K; Sochor, Ondrej; Goel, Kashish; Lopez-Jimenez, Francisco
Individuals with normal body weight by body mass index (BMI) and high body fat percentage show a high degree of metabolic dysregulation. This phenomenon, defined as normal weight obesity, is associated with a significantly higher risk of developing metabolic syndrome, cardiometabolic dysfunction and with higher mortality. Recently, we have also shown that coronary artery disease patients with normal BMI and central obesity have the highest mortality risk as compared to other adiposity patterns. Therefore, it is important to recognize these high-risk groups for better adiposity-based risk stratification. There is a need for an updated definition of obesity based on adiposity, not on body weight.
Differences in meal patterns and timing with regard to central obesity in the ANIBES ('Anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain') Study.
Aparicio, Aránzazu; Rodríguez-Rodríguez, Elena E; Aranceta-Bartrina, Javier; Gil, Ángel; González-Gross, Marcela; Serra-Majem, Lluis; Varela-Moreiras, Gregorio; Ortega, Rosa Maria
To study the association of meal patterns and timing with central obesity to identify the best dietary strategies to deal with the increasing obesity prevalence. A cross-sectional study performed on data from a representative sample of the Spanish population. Height and waist circumference were measured using standardized procedures and waist-to-height ratio (WHtR) was calculated. The sample was divided into those without central obesity (WHtR<0·5) and those with central obesity (WHtR≥0·5). ANIBES ('Anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain') Study. Adults aged 18-64 years (n 1655; 798 men and 857 women). A higher percentage of people ate more than four meals daily in the group without central obesity and those with central obesity more frequently skipped the mid-afternoon snack than those without. Breakfasts containing >25 % of total energy intake and lunches containing >35 % of total energy intake were associated with increased likelihood of central obesity (OR=1·874, 95 % CI 1·019, 3·448; P15 % of total energy were associated with decreased likelihood of central obesity (OR=0·477, 95 % CI 0·313, 0·727; P<0·001 and OR=0·650, 95 % CI 0·453, 0·932; P<0·05, respectively). The variety of cereals, wholegrain cereals and dairy was higher in the population without central obesity. Our results suggest that 'what and when we eat' should be considered dietary strategies to reduce central obesity.
Hughes, K; Aw, T C; Kuperan, P; Choo, M
To examine the hypothesis that the higher rates of coronary heart disease (CHD) in Indians (South Asians) compared with Malays and Chinese is at least partly explained by central obesity, insulin resistance, and syndrome X (including possible components). Cross sectional study of the general population. Singapore. Random sample of 961 men and women (Indians, Malays, and Chinese) aged 30 to 69 years. Fasting serum insulin concentration was correlated directly and strongly with body mass index (BMI), waist-hip ratio (WHR), and abdominal diameter. The fasting insulin concentration was correlated inversely with HDL cholesterol and directly with the fasting triglyceride concentration, blood pressures, plasminogen activator inhibitor 1 (PAI-1), and tissue plasminogen activator (tPA), but it was not correlated with LDL cholesterol, apolipoproteins B and A1, lipoprotein(a), (Lp(a)), fibrinogen, factor VIIc, or prothrombin fragment (F)1 + 2. This indicates that the former but not the latter are part of syndrome X. While Malays had the highest BMI, Indians had a higher WHR (men 0.93 and women 0.84) than Malays (men 0.91 and women 0.82) and Chinese (men 0.91 and women 0.82). In addition, Indians had higher fasting insulin values and more glucose intolerance than Malays and Chinese. Indians had lower HDL cholesterol, and higher PAI-1, tPA, and Lp(a), but not higher LDL cholesterol, fasting triglyceride, blood pressures, fibrinogen, factor VIIc, or prothrombin F1 + 2. Indians are more prone than Malays or Chinese to central obesity with insulin resistance and glucose intolerance and there are no apparent environmental reasons for this in Singapore. As a consequence, Indians develop some but not all of the features of syndrome X. They also have higher Lp(a) values. All this puts Indians at increased risk of atherosclerosis and thrombosis and must be at least part of the explanation for their higher rates of CHD.
Nogueiras, Ruben; Veyrat-Durebex, Christelle; Suchanek, Paula M.; Klein, Marcella; Tschöp, Johannes; Caldwell, Charles; Woods, Stephen C.; Wittmann, Gabor; Watanabe, Masahiko; Liposits, Zsolt; Fekete, Csaba; Reizes, Ofer; Rohner-Jeanrenaud, Francoise; Tschöp, Matthias H.
OBJECTIVE—Blockade of the CB1 receptor is one of the promising strategies for the treatment of obesity. Although antagonists suppress food intake and reduce body weight, the role of central versus peripheral CB1 activation on weight loss and related metabolic parameters remains to be elucidated. We therefore specifically assessed and compared the respective potential relevance of central nervous system (CNS) versus peripheral CB1 receptors in the regulation of energy homeostasis and lipid and glucose metabolism in diet-induced obese (DIO) rats. RESEARCH DESIGN AND METHODS—Both lean and DIO rats were used for our experiments. The expression of key enzymes involved in lipid metabolism was measured by real-time PCR, and euglycemic-hyperinsulinemic clamps were used for insulin sensitivity and glucose metabolism studies. RESULTS—Specific CNS-CB1 blockade decreased body weight and food intake but, independent of those effects, had no beneficial influence on peripheral lipid and glucose metabolism. Peripheral treatment with CB1 antagonist (Rimonabant) also reduced food intake and body weight but, in addition, independently triggered lipid mobilization pathways in white adipose tissue and cellular glucose uptake. Insulin sensitivity and skeletal muscle glucose uptake were enhanced, while hepatic glucose production was decreased during peripheral infusion of the CB1 antagonist. However, these effects depended on the antagonist-elicited reduction of food intake. CONCLUSIONS—Several relevant metabolic processes appear to independently benefit from peripheral blockade of CB1, while CNS-CB1 blockade alone predominantly affects food intake and body weight. PMID:18716045
Sahoo, Krushnapriya; Sahoo, Bishnupriya; Choudhury, Ashok Kumar; Sofi, Nighat Yasin; Kumar, Raman; Bhadoria, Ajeet Singh
Childhood obesity has reached epidemic levels in developed as well as in developing countries. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. Childhood obesity can profoundly affect children's physical health, social, and emotional well-being, and self esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child. Many co-morbid conditions like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity.
The incidence of obesity has increased dramatically during recent decades. Obesity will cause a decline in life expectancy for the first time in recent history due to numerous co-morbid disorders. Adipocyte and adipose tissue dysfunction belong to the primary defects in obesity and may link obesity to several health problems including increased risk of insulin resistance, type 2 diabetes, fatty liver disease, hypertension, dyslipidemia, atherosclerosis, dementia, airway disease and some cancers. However, not all obese individuals develop obesity related metabolic or cardiovascular disorders potentially due to a preserved normal adipose tissue architecture and function. The majority of patients with obesity have an impaired adipose tissue function caused by the interaction of genetic and environmental factors which lead to adipocyte hypertrophy, hypoxia, a variety of stresses and inflammatory processes within adipose tissue. Ectopic fat accumulation including visceral obesity may be considered as a consequence of adipose tissue dysfunction, which is further characterized by changes in the cellular composition, increased lipid storage and impaired insulin sensitivity in adipocytes, and secretion of a proinflammatory, atherogenic, and diabetogenic adipokine pattern. This review focuses on the discussion of mechanisms causing or maintaining impaired adipose tissue function in obesity and potentially linking obesity to its associated disorders. A model is proposed how different pathogenic factors and mechanisms may cause dysfunction of adipose tissue.
Sahoo, Krushnapriya; Sahoo, Bishnupriya; Choudhury, Ashok Kumar; Sofi, Nighat Yasin; Kumar, Raman; Bhadoria, Ajeet Singh
Childhood obesity has reached epidemic levels in developed as well as in developing countries. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. Childhood obesity can profoundly affect children's physical health, social, and emotional well-being, and self esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child. Many co-morbid conditions like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity. PMID:25949965
Bilge, Yildiz Dallar; Alioglu, Bulent; Simşek, Enver; Tapci, Ayse Esra; Ozen, Cınar
This study aims to explore the relation between childhood obesity and procoagulant and anticoagulant systems. Fifty-one obese children and 32 normal-weighted children with similar age and gender distribution and between ages of 5 and 16 years were recruited to the study. Antropometric measures of all subjects, existence of any accompanying disease, and medication histories had been recorded. Full blood count, procoagulant, and anticoagulant coagulation tests were run for all subjects. When hematologic variables of obese children were compared with those of healthy controls, it was found that average erythrocyte hemoglobin concentration, erythrocyte distribution width, and platelet count of obese children are significantly higher than healthy control group. It was also found that fibrinogen, thrombin time, factor (F) VIII, FIX, FX, and von Willebrand factor levels of obese children are higher than healthy control group. By contrast, antithrombin levels of obese children are found to be lower. In our study, we found that there is a procoagulant increase in the coagulation system activity of obese children compared to non-obese healthy children, whereas there is a significant decrease in anticoagulant system. These changes occurred in obese patients, especially higher levels of plasma procoagulant factors such as fibrinogen, FVIII, FIX, and von Willebrand factor, lead us to think that there is an activity in these patients at endothelial level. Further studies are needed on endothelial activity of obese children.
Dhurandhar, N V; Kulkarni, P R
Obesity has been reported in developed as well as developing countries. However, data on a large sample of the Indian population are lacking. This study analysed the prevalence of obesity among 1,784 adults in Bombay from various sections of society. Since the prevalence of obesity depends upon the criteria used, prevalence was judged by three criteria viz. percentage excess of body weight, body mass index, and body fat content. The data were classified and analysed according to occupation, age group, income, diet type, and also with respect to family history of obesity. The three methods gave a different prevalence of obesity. In general, the criterion of body mass index under-estimated, and body fat content over-estimated the prevalence as compared to that obtained by percentage excess body weight. An extremely high prevalence of obesity was found in all sub-groups of the sample. As judged by a body mass index of 25 and above, male students had the lowest (10.7%) and male medical doctors had the highest (53.1%) prevalence of obesity. Prevalence was highest for the age group 31-50 years for males and females, and declined on either side of this age range. Prevalence was directly proportional to financial income, and subjects with a family history of obesity had a greater prevalence of obesity compared to those without. This study indicates the gravity of the problem of obesity in Bombay, and provides directions for nutritional planning in the future.
Pietrobelli, Angelo; Rugolotto, Simone; Cristofaro, Paolo De; Malavolti, Marcella
Prevalence of pediatric obesity continues to rise worldwide. Increasing the number of health care practitioners as well as pediatricians with expertise in obesity treatment is necessary. Because many obese patients suffer obesity-associated cardiovascular, metabolic and other health complications that could increase the severity of obesity, it is fundamental not only to identify the child prone to obesity as early as possible, but to recognize, treat and monitor obesity-related diseases during adolescence. This short review outlines the treatment of pediatric obesity that may have applications in the primary care setting. It examines current information on eating behavior, sedentary behavior, and details studies of multidisciplinary, behavior-based, obesity treatment programs. We also report the less common and more aggressive forms of treatment, such as medication and bariatric surgery. We emphasize that health care providers have the potential to improve outcomes by performing early identification, helping families create the best possible home environment, and by providing structured guidance to obese children and their families. PMID:22253978
Clark, Adrienne L; Fonarow, Gregg C; Horwich, Tamara B
Obesity is a growing public health problem in the general population, and significantly increases the risk for the development of new-onset heart failure (HF). However, in the setting of chronic HF, overweight and mild to moderate obesity is associated with substantially improved survival compared to normal-weight patients. Evidence exists for an "obesity paradox" in HF, with the majority of data measuring obesity by body mass index, but also across various less-frequently used measures of body fat (BF) and body composition including waist circumference, waist-hip ratio, skinfold estimates of percent BF, and bioelectrical impedance analysis of body composition. Other emerging areas of investigation such as the relationship of the obesity paradox to cardiorespiratory fitness are also discussed. Finally, this review explores various explanations for the obesity paradox, and summarizes the current evidence for intentional weight loss treatments for HF in context. © 2014.
Chen, Hubert C; Roth, Jonathan D; Schroeder, Brock E; Weyer, Christian
Contrary to its historical epithet as a lifestyle disorder, obesity is now widely recognized as having a neurobiological basis. This progress is due to our knowledge not only about energy homoeostatic pathways within the central nervous system (CNS), but also about the role of peripheral peptide hormones acting upon the CNS. These hormones include long-term adiposity signals, such as leptin, that inform the CNS primarily of changes in the body's overall fat and energy reserves, and short-term signals such as amylin, peptide YY (PYY) and ghrelin, that primarily reflect changes in the immediate nutritive state (energy intake). The limited weight loss effects achieved with current monotherapy approaches to obesity have been attributed, at least in part, to the redundancies and potent counter-regulatory responses within the neurohormonal feedback loop governing energy balance. Recently, we reported that combinations of amylin, leptin and PYY(3-36) resulted in additive and/or synergistic interactions and caused marked weight loss in the diet-induced obese rat model, which to date has reasonably predicted the clinical effects of several hormones in obese humans. If confirmed in ongoing translational clinical research studies, these findings may provide a physiological rationale for a novel, integrated neurohormonal approach to pharmacotherapy for obesity.
Because many obese children become obese adults, the recent rapid increase in juvenile obesity poses a major public health challenge. Enhanced physical activity is a cornerstone in a multidisciplinary approach to preventing and treating juvenile obesity. Giving exercise recommendations focused for obese youth is critical. Cutting down on sedentary…
Because many obese children become obese adults, the recent rapid increase in juvenile obesity poses a major public health challenge. Enhanced physical activity is a cornerstone in a multidisciplinary approach to preventing and treating juvenile obesity. Giving exercise recommendations focused for obese youth is critical. Cutting down on sedentary…
Diseases and Conditions Obesity Can you be considered obese if you have a normal body weight? Answers from Katherine Zeratsky, R.D., L. ... considered obese — a condition known as normal weight obesity. Normal weight obesity means you may have the ...
This article is a narrative overview of the role of hypertension on the relationships between obesity, morbidity, and mortality. We used as sources MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library, from inception to March 2016. Key words include overweight, obesity, visceral obesity, obesity paradox, and hypertension. In addition, we hand-searched references from the retrieved articles. This work is one of the works of the topical collection "Obesity Paradox". The positive association between overweight, obesity, and cardiovascular diseases is well established, though this relation is typically U shaped with an increased risk in low-weight subjects or even a beneficial effect of overweight and obesity, the so-called "obesity paradox". In addition, the relationship between obesity and arterial hypertension has been demonstrated in both children and adults by many epidemiological studies. Moreover, weight reduction is followed by a decrease in blood pressure in many patients and ameliorates the cardiovascular risk profile. Recent studies using more appropriate obesity indices raise some doubt about the real significance of obesity paradox and there are several studies that central obesity shows either no protective or even a worse effect. These observations raise the question: what kind of obesity is protective and what kind of obesity is harmful? The studies of obesity paradox suffer from several methodological limitations: most of these are retrospective analyses or were not specifically designed to study obesity paradox as a primary goal; a few studies have data on preceding unintentional weight loss and on some particular confounding variables. In conclusion, more prospective and accurate studies are necessary to better elucidate the clinical importance of obesity paradox. When weight loss is functional to reduce hypertension and cardiovascular risk, it should be encouraged, while an unintentional weight in a patient with chronic diseases may indicate an
Stanton, Rosemary A
We live in an 'obesogenic environment' where we are constantly bombarded with choices that encourage us to move less and eat more. Many factors influence our dietary choices, including the expert marketers who advise manufacturers on ways to encourage the population to buy more, especially profitable, palatable 'ultra-processed' foods. Supermarkets themselves have become skilled in manipulating buying behaviour, using their layout and specific product placement as well as advertising to maximise purchases of particular foods. Increasingly, supermarkets push their own 'house' brands. Those marketing fast foods also use persuasive tactics to attract customers, especially children who they entice with non-food items such as promotional or collectable toys. There is no mystery to the increase in obesity: our energy intake from foods and drinks has increased over the same period that energy output has decreased. Obesity has a range of relevant factors, but there is little doubt that marketing from supermarkets and fast food retailers has played a role.
Fortner, Renée T; Katzke, Verena; Kühn, Tilman; Kaaks, Rudolf
The relationship between adiposity and breast cancer risk and prognosis is complex, with associations that differ depending on when body size is assessed (e.g., pre- vs. postmenopausal obesity) and when breast cancer is diagnosed (i.e., pre- vs. postmenopausal disease). Further, the impact of obesity on risk differs by tumor hormone receptor status (e.g., estrogen (ER) and progesterone (PR) receptor) and, among postmenopausal women, use of exogenous hormones (i.e., hormone replacement therapy (HRT)). In the context of these complexities, this review focuses on associations between childhood and adolescent adiposity, general adiposity, weight changes (i.e., loss and gain), abdominal adiposity, and breast cancer risk and survival. Finally, we discuss potential mechanisms linking adiposity to breast cancer.
Chen, Guoxun; Pang, Zhen
A safe and effective antiobesity drug is needed to combat the global obesity epidemic. The discovery of cannabinoids from medicinal herbs has revealed the endocannabinoid system (ECS) in animals and humans, which regulates various physiological activities such as feeding, thermogenesis, and body weight (BW). Although cannabinoid receptors 1 (CB1) antagonists have shown antiobesity efficacies in animal models and in the clinic, they failed to establish as a treatment due to their psychological side effects. Recent studies indicate that CB1 in various peripheral tissues may mediate some of the therapeutic effects of CB1 antagonists, such as improved lipid and glucose homeostasis. It rationalizes the development of compounds with limited brain penetration, for minimizing the side effects while retaining the therapeutic efficacies. A survey of the literature has revealed some controversies about how the ECS affects obesity. This review summarizes the research progresses and discusses some future perspectives.
Nourissat, G; Ciais, G; Coudane, H
Obesity is a major public health issue, as incidence is rising in all developed countries, although the proportion is lower in Europe than in the U.S. Over and above the metabolic consequences and increased risk of diabetes, cardiovascular pathology and certain forms of cancer, the present study focuses on osteoarticular risk, and in particular on pathologies manageable by arthroscopy. It also analyzes results and complications specific to arthroscopy in these indications. Meniscal and ligamentous pathologies of the knee, rotator-cuff pathology in the shoulder and tendon pathology in the elbow were not significantly elevated, although a trend emerged. In contrast, there was significant elevation of Achilles and plantar aponeurosis pathology. In terms of postoperative complications, thromboembolic risk was elevated, but there were not significantly more complications specific to arthroscopy. Finally, subjective results were comparable to those for non-obese patients. Review. Copyright © 2015. Published by Elsevier Masson SAS.
Cottone, P; Sabino, V; Nagy, T R; Coscina, D V; Levin, B E; Zorrilla, E P
Obesity is a costly, deadly public health problem for which new treatments are needed. Individual differences in meal pattern have been proposed to have a role in obesity risk. The present study tested the hypothesis that (i) the microstructure of chronic high-fat diet intake differs between genetically selected diet-induced obesity (DIO) and diet-resistant (DR) rats, and (ii) central administration of urocortin 2 (Ucn 2), a corticotropin-releasing factor type 2 agonist, decreases high-fat diet intake not only in lean DR rats, but also in obese DIO rats. Male, selectively bred DIO and DR rats (n=10/genotype) were chronically fed a high-fat diet. Food and water intake as well as ingestion microstructure were then compared under baseline conditions and following third intracerebroventricular injection of Ucn 2 (0, 0.1, 0.3, 1, 3 μg). Irrespective of genotype, Ucn 2 reduced nocturnal food intake with a minimum effective dose of 0.3 μg, suppressing high-fat diet intake by ∼40% at the 3 μg dose. Ucn 2 also made rats of both genotypes eat smaller and briefer meals, including at doses that did not reduce drinking. Obese DIO rats ate fewer but larger meals than DR rats, which they ate more quickly and consumed with two-third less water. Unlike leptin and insulin, Ucn 2 retains its full central anorectic efficacy to reduce high-fat diet intake even in obese, genetically prone DIO rats, which otherwise show a 'gorging' meal pattern. These results open new opportunities of investigation toward treating some forms of DIO.
Ray, Indrani; Mahata, Sushil K.; De, Rajat K.
Obesity, characterized by chronic activation of inflammatory pathways, is a critical factor contributing to insulin resistance (IR) and type 2 diabetes (T2D). Free fatty acids (FFAs) are increased in obesity and are implicated as proximate causes of IR and induction of inflammatory signaling in adipose, liver, muscle, and pancreas. Cells of the innate immune system produce cytokines, and other factors that affect insulin signaling and result in the development of IR. In the lean state, adipose tissue is populated by adipose tissue macrophage of the anti-inflammatory M2 type (ATM2) and natural killer (NK) cells; this maintains the insulin-sensitive phenotype because ATM2 cells secrete IL10. In contrast, obesity induces lipolysis and release of pro-inflammatory FFAs and factors, such as chemokine (C–C motif) ligand 2 (CCL2) and tumor necrosis factor alpha (TNF-α), which recruit blood monocytes in adipose tissue, where they are converted to macrophages of the highly pro-inflammatory M1-type (ATM1). Activated ATM1 produce large amounts of pro-inflammatory mediators such as TNF-α, interleukin-1β, IL-6, leukotriene B4, nitric oxide (NO), and resistin that work in a paracrine fashion and cause IR in adipose tissue. In the liver, both pro-inflammatory Kupffer cells (M1-KCs) and recruited hepatic macrophages (Ly6Chigh) contribute to decreased hepatic insulin sensitivity. The present mini-review will update the bidirectional interaction between the immune system and obesity-induced changes in metabolism in adipose tissue and liver and the metabolic consequences thereof. PMID:28018292
Bergouignan, Audrey; Blanc, Stéphane
Although there is little argument about the state of energy imbalance that produces weight gain, there is considerable argument about the respective role of genetics, diet and physical activity in achieving obesity. In the USA, obesity has increased in the last decades despite a concomitant decrease in total energy and fat intake suggesting that there has been a dramatic drop in total energy expenditure. In this review, we investigated the respective role of resting metabolic rate, post-prandial thermogenesis, and activity energy expenditure in this lower energy output, and provided evidence that physical inactivity is the major contributor. Based on Jean Mayer original observation (Mayer et al., 1954), we hypothesize that there is a level of physical activity below which mechanisms of body mass regulation are impaired. The increasing prevalence of obesity may reflect the fact the majority of the population has fallen below such a level of physical activity. However, a causal relation between physical inactivity and obesity is still difficult to prove, probably because of the lack of longitudinal models to investigate the physiological consequences of inactivity and because the deleterious consequences of sedentary behaviors are essentially deduced from the benefits of exercise training. By using long term strict bed rest as a unique model of inactivity, we provide evidence that inactivity per se indeed disrupts fuel homeostasis and partitions post-absorptive and post-prandial fat use towards storage, thus promoting weight gain in the long term. More research is needed to investigate mechanisms and to determine the minimal physical activity our body has been engineered for by evolution.
Garaulet, Marta; Gómez-Abellán, Purificación
Chronobiology is a word derived from three Greek stems: kronos for time, bios for life and logos for study. From microarrays studies, now it is accepted that 10-30% of the human genome is under the control of circadian molecular clocks. This implies that most behavioral, physiological and biochemical variables display circadian rhythms in their expression. In its simplest form, circadian clocks are composed of a set of proteins that generate self-sustained circadian oscillations. The molecular clock comprises two transcription factors, CLOCK and BMAL1, whereas PERs and CRYs are responsible for the negative limb. One of the most important questions related to the circadian system and obesity, was to elucidate if adipose tissue displayed circadian rhythmicity or whether it had an internal peripheral clock. Our group of research has provided an overall view of the internal temporal order of circadian rhythms in human adipose tissue. A new concept related to illness is Chronodisruption (CD). It is defined as a relevant disturbance of the internal temporal order of physiological and behavioral circadian rhythms. In our modern society, CD may be common in several conditions such as jet lag, shift work, light at night, or social jet lag. In addition clock gene polymorphisms and aging may have also chronodisruptive effects. Our group has also demonstrated that Obesity and CD are also highly interconnected. With the help of chronobiology we can reach a new view of obesity considering not only "what" are the factors involved in obesity, but also "when" these factors are produced. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.
Donini, L M; Donini, M L; Savina, C; Castellaneta, E; Coletti, C; Paolini, M; Scavone, L; Civale, C; Ceccarelli, P; Zaninotto, S; Tineri, M; Grossi, G; De Felice, M R; Cannella, C
Obesity, associated with morbidity and mortality, is a complex disorder, characterised by an increase in fat mass (FM). Most authors agree in considering essential an integrated treatment made up of nutritional intervention, physical reconditioning programme and cognitive-behavioural psychotherapy. However, the feasibility is problematic and data in literature confirming the validity of this approach are poor. To verify the efficacy of a multidimensional approach (Nutritional Psycho-Physical Reconditioning - NPPR) in obesity treatment. All patients admitted from June 2002 to June 2004 (464 subjects) ranged from 18 to 65 years old, with a body mass index (BMI) >30 kg/m2