Ethnic Differences in Prevalence of General Obesity and Abdominal Obesity among Low-Income Rural Kazakh and Uyghur Adults in Far Western China and Implications in Preventive Public Health Community pharmacy interventions for public health priorities: protocol for a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions The spread of the obesity epidemic in the United States, 1991-1998. A randomized trial of the clinical utility of genetic testing for obesity: Design and implementation considerations A community-based motivational personalised lifestyle intervention to reduce BMI in obese adolescents: results from the Healthy Eating and Lifestyle Programme (HELP) randomised controlled trial Effectiveness of a motivational intervention on overweight/obese patients in the primary healthcare: a cluster randomized trial Hip-Hop to Health Jr., an obesity prevention program for minority preschool children: baseline characteristics of participants. Relationship between weight status and delay discounting in a sample of adolescent cigarette smokers Assessing the efficacy of the healthy eating and lifestyle programme (HELP) compared with enhanced standard care of the obese adolescent in the community: study protocol for a randomized controlled trial The Lifestyle Challenge Program: A Multidisciplinary Approach to Weight Management Obesity management: attitudes and practices of French general practitioners in a region of France Overweight and obesity prevention for adolescents: a cluster randomized controlled trial in a school setting. A Community-Based Intervention to Prevent Obesity Beginning at Birth Among American Indian Children: Study Design and Rationale for the PTOTS Study Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health. Kids and adults now! Defeat Obesity (KAN-DO): rationale, design and baseline characteristics. PRALIMAP: study protocol for a high school-based, factorial cluster randomised interventional trial of three overweight and obesity prevention strategies The effect of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women: a systematic review protocol Implication of socio-economic status on the prevalence of overweight and obesity in Greek adults: the ATTICA study. Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study. The Lifestyle Intervention for the Treatment of Diabetes study (LIFT Diabetes): Design and baseline characteristics for a randomized translational trial to improve control of cardiovascular disease risk factors. Adapting Pediatric Obesity Treatment Delivery for Low-Income Families: A Public—Private Partnership Vitamin D Deficiency and Its Determinants in Adults: A Sample from Community-Based Settings in the United Arab Emirates Evaluation of weight reduction in a community intervention for cardiovascular disease risk: changes in body mass index in the Minnesota Heart Health Program.
Background The global p and emic of obesity has become a disastrous public health issue that needs urgent attention . Previous studies have concentrated in high-income urban setting s and few cover low-income rural setting s especially nomadic residents in mountain areas . This study focused on low-income rural and nomadic minority people residing in China ’s far west and investigated their prevalence and ethnic differences of obesity . Methods A question naire-based survey and physical examination of 8,036 individuals were conducted during 2009–2010 , using stratified cluster r and om sampling method in nomadic Kazakhs and rural Uyghur residents ( ≥18 years old ) in 18 villages , Xinjiang , China , about 4,407 km away from capital Beijing .  Obesity was defined by BMI and WC . Results The overall prevalence of general and abdominal obesity in Kazakh adults were 18.3 % and 60.0 % , respectively and in Uyghur , 7.6 % and 54.5 % , respectively . Female ’s prevalence of obesity was higher than male ’s for general obesity ( 45–54 age group in Uyghur , P = 0.041 ) and abdominal obesity ( ≥55 years in Kazakhs , P55∼ = 0.010 , P65∼ = 0.001 ; and ≥18 years in Uyghurs , P<0.001 ) . Kazakh ’s prevalence of obesity was higher than Uyghur ’s ( general obesity : ≥35 years , P<0.001 ; abdominal obesity : ≥25 years in males and ≥65 years in females , P<0.01 ) . The prevalence of obesity increased after 18 years old and subsequently decreased after 55 years old . Meat consumption , older age , and female gender had a higher risk of obesity in these two minorities . Conclusions Both general and abdominal obesity were common in rural ethnic Kazakhs and Uyghurs .  The prevalence rates were different in these two minorities depending on ethnicity , gender , and age . Kazakhs , females and elderly people may be prioritized in prevention of obesity in western China . Because of cost-effectiveness in measuring BMI and WC , we recommend that BMI and WC be integrated into local preventive policies in public health toward screening obesity and related diseases in low-income rural minorities Background Community pharmacists can deliver health care advice at an opportunistic level , related to prescription or non-prescription medicines and as part of focused services design ed to reduce specific risks to health . Obesity , smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK , and interventions led by community pharmacists , aim ed at these three risk factors , have been identified by the government as public health priorities . In 2008 , the Department of Health for Engl and stated that ‘ a sound evidence base that demonstrates how pharmacy delivers effective , high quality and value for money services is needed ’ ; this systematic review aims to respond to this requirement . Methods / design We will search the data bases MEDLINE , Embase , CINAHL , PsycINFO , Social Sciences Citation Index , ASSIA , IBSS , Sociological Abstract s , Scopus and NHS Economic Evaluation Data base for studies that have evaluated interventions based on community pharmacies that aim to target weight management , smoking cessation and alcohol misuse . We will include all r and omised controlled trials ( RCTs ) , non-r and omised controlled trials ( N RCTs ) , controlled before-after studies ( CBAs ) and interrupted time series ( ITS ) and repeated measures studies . Data from included studies will be extracted by two independent review ers and will include study details methods , results , intervention implementation/costs and method ological quality . Meta- analysis will be conducted if appropriate ; if not , the synthesis will be restricted to a narrative overview of individual studies looking at the same question . Discussion The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management , smoking cessation and alcohol misuse . It will also explore if , and how , socio-economic status , gender , ethnicity and age moderate the effect of the interventions and will describe how the interventions included in the review have been organised , implemented and delivered , since context is an important factor governing the success of public health interventions . The findings from this review will have an impact on the commissioning of public health services aim ing to promote healthy weight , smoking cessation and prevent excessive alcohol consumption . Systematic review registration The review has been registered with PROSPERO ( registration no. CRD42013005943 ) . Available at : http://www.crd.york.ac.uk/ prospero /display_record.asp?ID = CRD42013005943 CONTEXT The increasing prevalence of obesity is a major public health concern , since obesity is associated with several chronic diseases . OBJECTIVE To monitor trends in state-specific data and to examine changes in the prevalence of obesity among adults . DESIGN Cross-sectional r and om-digit telephone survey ( Behavioral Risk Factor Surveillance System ) of noninstitutionalized adults aged 18 years or older conducted by the Centers for Disease Control and Prevention and state health departments from 1991 to 1998 . SETTING States that participated in the Behavioral Risk Factor Surveillance System . MAIN OUTCOME MEASURES Body mass index calculated from self-reported weight and height . RESULTS The prevalence of obesity ( defined as a body mass index > or = 30 kg/m2 ) increased from 12.0 % in 1991 to 17.9 % in 1998 . A steady increase was observed in all states ; in both sexes ; across age groups , races , educational levels ; and occurred regardless of smoking status . The greatest magnitude of increase was found in the following groups : 18- to 29-year-olds ( 7.1 % to 12.1 % ) , those with some college education ( 10.6 % to 17.8 % ) , and those of Hispanic ethnicity ( 11.6 % to 20.8 % ) . The magnitude of the increased prevalence varied by region ( ranging from 31.9 % for mid Atlantic to 67.2 % for South Atlantic , the area with the greatest increases ) and by state ( ranging from 11.3 % for Delaware to 101.8 % for Georgia , the state with the greatest increases ) . CONCLUSIONS Obesity continues to increase rapidly in the United States . To alter this trend , strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority Background Obesity rates in the United States have escalated in recent decades and present a major challenge in public health prevention efforts . Currently , testing to identify genetic risk for obesity is readily available through several direct-to-consumer companies . Despite the availability of this type of testing , there is a paucity of evidence as to whether providing people with personal genetic information on obesity risk will facilitate or impede desired behavioral responses . Purpose We describe the key issues in the design and implementation of a r and omized controlled trial examining the clinical utility of providing genetic risk information for obesity . Methods Participants are being recruited from the Coriell Personalized Medicine Collaborative , an ongoing , longitudinal research cohort study design ed to determine the utility of personal genome information in health management and clinical decision making . The primary focus of the ancillary Obesity Risk Communication Study is to determine whether genetic risk information added value to traditional communication efforts for obesity , which are based on lifestyle risk factors . The trial employs a 2 × 2 factorial design in order to examine the effects of providing genetic risk information for obesity , alone or in combination with lifestyle risk information , on participants ’ psychological responses , behavioral intentions , health behaviors , and weight . Results The factorial design generated four experimental arms based on communication of estimated risk to participants : ( 1 ) no risk feedback ( control ) , ( 2 ) genetic risk only , ( 3 ) lifestyle risk only , and ( 4 ) both genetic and lifestyle risk ( combined ) . Key issues in study design pertained to the selection of algorithms to estimate lifestyle risk and determination of information to be provided to participants assigned to each experimental arm to achieve a balance between clinical st and ards and method ological rigor . Following the launch of the trial in September 2011 , implementation challenges pertaining to low enrollment and differential attrition became apparent and required immediate attention and modifications to the study protocol . Although monitoring of these efforts is ongoing , initial observations show a doubling of enrollment and reduced attrition . Limitations The trial is evaluating the short-term impact of providing obesity risk information as participants are followed for only 3 months . This study is built upon the structure of an existing personalized medicine study wherein participants have been provided with genetic information for other diseases . This nesting in a larger study may attenuate the effects of obesity risk information and has implication s for the generalizability of study findings . Conclusions This r and omized trial examines value of obesity genetic information , both when provided independently and when combined with lifestyle risk assessment , to motivate individuals to engage in healthy lifestyle behaviors . Study findings will guide future intervention efforts to effectively communicate genetic risk information Objective Approximately 7 % of children and young people aged 5–15 years in the UK have obesity at a level likely to be associated with comorbidities . The majority of multicomponent lifestyle programmes have limited applicability and generalisability for British adolescents . The Healthy Eating and Lifestyle Programme ( HELP ) was a specific adolescent-focused intervention , design ed for obese 12 to 18-year-olds seeking help to manage their weight . Participants were r and omised to the 12-session HELP intervention or st and ard care . The primary outcome was difference in mean body mass index ( BMI ) ( kg/m2 ) between groups at week 26 adjusted for baseline BMI , age and sex . Subjects 174 subjects were r and omised ( 87 in each arm ) , of whom 145 ( 83 % ) provided primary outcome data at week 26 . Results At week 26 there were no significant effects of the intervention on BMI ( mean change in BMI 0.18 kg/m2 for the intervention arm , 0.25 kg/m2 for the control arm ; adjusted difference between groups : −0.11 kg/m2 ( 95 % CI −0.62 to 0.40 ) , p=0.7 ) . At weeks 26 and 52 there were no significant differences between groups in any secondary outcomes . Conclusion At minimum this study reinforces the need for higher level , structured interventions to tackle the growing public health burden of obesity in the UK and internationally . The HELP intervention was no more effective than a single educational session for reducing BMI in a community sample of obese adolescents . Further work is needed to underst and how weight management programmes can be delivered effectively to young people from diverse and deprived background s in which childhood obesity is common . The study has significant implication s in terms of informing public health interventions to tackle childhood obesity . Trial registration number IS RCT N : IS RCT N99840111 Background Overweight and obesity are common health problems which increase the risk of developing several serious health conditions . The main difficulty in the management of weight-loss lies in its maintenance , once it is achieved . The aim of this study was to investigate whether a motivational intervention , together with current clinical practice , was more efficient than a traditional intervention , in the treatment of overweight and obesity and whether this intervention reduces cardiovascular risk factors associated with overweight and obesity . Methods Multi-centre cluster r and omized trial with a 24-month follow-up included 864 overweight/obese patients r and omly assigned .  Motivational intervention group ( 400 patients ) , delivered by a nurse trained by an expert psychologist , in 32 sessions , 1 to 12 fortnightly , and 13 to 32 , monthly , on top of their st and ard programmed diet and exercise . The control group ( 446 patients ) , received the usual follow-up . Results Weight reduction was statistically significant in the second year with a mean reduction of 1.0 Kg in the control group and 2.5 Kg in the intervention group ( p = 0 . 02 ) . While 18.1 % of patients in the control group reduced their weight by more than 5 % , this percentage rose to 26.9 % in the intervention group , which is statistically significant ( p = 0.04 ) . Patients in the motivational intervention group had significantly greater improvements in triglycerides and APOB/APOA1ratio . Conclusions The results highlight the importance of the group motivational interview in the treatment of overweight /obese patients in primary care , and in the improvement of their associated cardiovascular risks factors . Trial registration Clinical Trials.gov Identifier : NCT01006213 October 30 , 2009 BACKGROUND The prevalence of obesity in the United States is a significant public health problem . Many obesity-related risk factors are more prevalent in minority population s. Given the recalcitrant nature of weight loss interventions for adults , prevention of overweight and obesity has become a high priority . The present study reports baseline data from an obesity prevention intervention developed for minority preschool children . METHODS Hip-Hop to Health Jr. is a 5-year r and omized controlled intervention that targets 3- to 5-year-old minority children enrolled in 24 Head Start programs . Our primary aim is to test the effect of the intervention on change in body mass index . Data were collected on sociodemographic , anthropometric , behavioral , and cognitive variables for the children and parents at baseline . RESULTS Participants included 416 black children , 337 black parents , 362 Latino children , and 309 Latino parents . Using body mass index for age and sex > or = the 95th percentile as the definition of overweight , 15 % of the black children and 28 % of the Latino children were overweight . More than 75 % of the parents were either overweight or obese . DISCUSSION The development of interventions to effectively prevent or control obesity early in life is crucial . These data highlight the escalating problem of weight control in minority population Obesity and cigarette smoking are often cited separately as the top two preventable causes of death in the United States ; however , little research has explored the factors associated with being both obese and a smoker . Delay discounting is a behavioral characteristic that may underlie both of these conditions/behaviors . Delay discounting describes the extent to which an individual discounts the value of an outcome because of a delay in its occurrence . Higher rates of discounting are often considered as an index of impulsivity and have been linked with obesity and cigarette smoking . No research to date has explored  delay discounting  in a sample of obese smokers . For this study , adolescent smokers classified as obese ( body mass index > 95th percentile ) and healthy weight ( body mass index between the 5th and 85th percentiles ) were compared on a laboratory assessment of delay discounting .  Obese smokers  discounted significantly more by delay than healthy weight smokers . This difference remained statistically significant even after controlling for demographic variables that differed across groups . These findings suggest that the relationships between  delay discounting and obesity and cigarette smoking may be additive , such that extreme discounting might proportionally increase the risk of becoming an obese smoker . However , future prospect i ve study is needed to fully determine the veracity of this hypothesis Background The childhood obesity epidemic is one of the foremost UK health priorities . Childhood obesity tracks into adult life and places individuals at considerable risk for diabetes , cardiovascular disease , liver disease and other morbidities . There is widespread need for paediatric lifestyle programmes as change may be easier to accomplish in childhood than later in life . Study Design / Method The study will evaluate the management of adolescent obesity by conducting a Medical Research Council complex intervention phase III efficacy r and omised clinical trial of the Healthy Eating Lifestyle Programme within primary care . The study tests a community delivered multi-component intervention design ed for adolescents developed from best practice as identified by National Institute for Health and Clinical Excellence . The hospital based pilot reduced body mass index and improved health-related quality of life . Subjects will be individually r and omised to receiving either the Healthy Eating Lifestyle Programme ( 12 fortnightly family sessions ) or enhanced st and ard care . Baseline and follow up assessment s will be undertaken blind to allocation status . A health economic evaluation is also being conducted.200 obese young people ( 13 - 17 years , body mass index > 98th centile for age and sex ) will be recruited from primary care within the greater London area . The primary hypothesis is that a motivational and solution-focused family-based weight management programme delivered over 6 months is more efficacious in reducing body mass index in obese adolescents identified in the community than enhanced st and ard care . The primary outcome will be body mass index at the end of the intervention , adjusted for baseline body mass index , age and sex . The secondary hypothesis is that the Healthy Eating Lifestyle Programme is more efficacious in improving quality of life and psychological function and reducing waist circumference and cardiovascular risk factors in obese adolescents than enhanced st and ard care assessed at 6 and 12 months post baseline assessment .Improvement in quality of life predicts on-going lifestyle change and maximises the chances of long-term weight reduction . We will explore whether improvement in QOL may be intermediate on the pathway between the intervention and body mass index change . Trial registration IS RCT N : IS RCT BACKGROUND The increasing prevalence of overweight and obesity in the US has received widespread attention and is highlighted in recent government-issued health priorities . While there are many weight loss programs in different setting s , few include pharmacist involvement in spite of pharmacists ’ recognized easy accessibility to the public . OBJECTIVE To provide insight into a successful , collaborative , multidisciplinary approach to weight management and to encourage pharmacists and other healthcare professionals to adopt a similar approach to patient management . METHODS Adult patients > 18 years of age were recruited from an outpatient university-based setting to participate in a weight management program . The principles of the program included diet , exercise , and behavior modification . The program was conducted through weekly one-hour group sessions held over a 20-week period . Faculty involved in the program included an attending physician specializing in nutrition , a pharmacist , and a behavioral psychologist . All data are expressed as mean ± SD unless otherwise specified . RESULTS Ninety participants ( 74 female , mean age 48 ± 10 y ) entered the program between April 2001 and April 2004 . Participants had multiple obesity-related comorbid diseases . The weight of completers ( n = 59 ) decreased from 100.9 ± 20 kg at baseline to 97.3 ± 19.5 kg at 10 weeks and 95.9 ± 20 kg at 20 weeks . Thirty-nine patients completed both baseline and final assessment s , which showed improvement in health-related quality of life , binge-eating behavior , and depressive symptoms ( p < 0.05 ) . CONCLUSIONS This program is a successful multidisciplinary model for the management of overweight and obese patients in an outpatient-based hospital setting OBJECTIVES : To document the attitudes and practice s of French general practitioners ( GPs ) regarding  obesity management .  RESEARCH METHODS AND PROCEDURES : A cross-sectional survey of a r and omly selected sample of 744 French GPs was conducted , of which 607 question naires were returned . The measures included views on weight management , definitions of success , approaches to and strategies recommended for weight management and prevention , problems , frustrations , and expectations in managing obesity . RESULTS : GPs have a high awareness of obesity as a medically relevant issue , with 90 % of them considering it to be a disease . However , they are only 42 % to consider themselves well prepared to manage obesity and 51 % to find obesity management professionally rewarding . They are 66 % to believe that only a small percentage of patients can lose weight and maintain that loss but have unrealistic goals , with only 20 % of them considering weight maintenance as a success . They do not consider collaboration with other health professionals like dietitians as a priority . Only 34 % of the GPs believe that the currently available drugs are effective . Their views regarding bariatric surgery are in agreement with the recommendations of international experts . Their main expectations regarding obesity management are to improve their professional intervention through formation , education and easy-to-use tools , rather than improving their collaboration with other health professionals . DISCUSSION : There remains considerable opportunity to improve GPs ' practice in obesity management . Medical education , increased cooperation with dietitians , improved long-term follow-up , and implementing better use of the available documents are key issues BACKGROUND Given the increasing prevalence of obesity among youth over the past decade , prevention has become an international public health priority . PURPOSE To evaluate the 2-year effectiveness of three strategies aim ed at preventing overweight and obesity among adolescents in a high school setting . DESIGN PRomotion de l'ALIMentation et de l'Activité Physique ( PRALIMAP ) is a school-based RCT . Each study high school was assigned to receive or not , over a 2-year period ( Grade s 10 and 11 ) , each of three prevention strategies according to a 2 × 2 × 2 factorial school r and omization . Data were collected in 2006 - 2009 and analyzed in 2009 - 2011 . SETTING / PARTICIPANTS A total of 3538 adolescents ( aged 15.6±0.7 years at baseline ) in 24 public high schools in Lorraine ( northeastern France ) completed the PRALIMAP trial . INTERVENTIONS The prevention strategies were education ( development of nutritional knowledge and skills ) ; environment ( creation of a favorable environment by improving availability of " healthy " dietary items and physical activity ) ; and screening and care ( detection of overweight/obesity and , if necessary , adapted care management ) . MAIN OUTCOMES MEASURES The main outcome of interest was BMI ; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes . RESULTS Adolescents who completed the PRALIMAP trial were younger , less often suspected of having eating  disorders and depression , and came from a higher socioeconomic class than those who did not . The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones : a 0.11 lower increase in BMI ( p=0.0303 ) ; a 0.04 greater decrease in BMI z-score ( p=0.0173 ) ; and a 1.71 % greater decrease in overweight/obesity prevalence ( p=0.0386 ) . Education and environment strategies were not more effective than no strategy intervention . CONCLUSIONS Although the screening and care strategy is an effective way to prevent , at 2 years , overweight and obesity among adolescents in a high school setting , its effects over and above no strategy intervention were small . TRIAL REGISTRATION This study is registered at www . clinical trials.govNCT00814554 Eating and physical activity behaviors associated with adult obesity have early antecedents , yet few studies have focused on obesity prevention interventions targeting very young children . Efforts to prevent obesity beginning at birth seem particularly important in population s at risk for early-onset obesity . National estimates indicate that American Indian ( AI ) children have higher rates of overweight and obesity than children of other races/ethnicities . The Prevention of Toddler Obesity and Teeth Health Study ( PTOTS ) is a community-partnered r and omized controlled trial design ed to prevent obesity beginning at birth in AI children . PTOTS was developed to test the effectiveness of a multi-component intervention design ed to : promote breastfeeding , reduce sugar-sweetened beverage consumption , appropriately time the introduction of healthy solid foods , and counsel parents to reduce sedentary lifestyles in their children . A birth cohort of 577 children from five AI tribes is r and omized by tribe to either the intervention ( three tribes ) or the comparison condition ( two tribes ) . The strengths and weaknesses of PTOTS include a focus on a critical growth phase , placement in the community , and intervention at many levels , using a variety of approaches BACKGROUND Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being . With the growing population of older adults in the United States , effective and scalable public health approaches are needed to address this problem . Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health . METHODS The study design was a translational , r and omized controlled trial of physical activity ( PA ) and weight loss ( WL ) on mobility in overweight or obese older adults with cardiovascular disease ( CVD ) or at risk for CVD . The study was conducted within the community infrastructure of Cooperative Extension Centers . Participants were r and omized to 1 of 3 interventions : PA , WL + PA , or a successful aging ( SA ) education control arm . The primary outcome was time to complete a 400-m walk in seconds ( 400MWT ) . RESULTS A significant treatment effect ( P = .002 ) and follow-up testing revealed that the WL + PA group improved their 400MWT ( adjusted mean [ SE ] , 323.3 [ 3.7 ] seconds ) compared with both PA ( 336.3 [ 3.9 ] seconds ; P = .02 ) and SA ( 341.3 [ 3.9 ] seconds ; P < .001 ) . Participants with poorer mobility at baseline benefited the most ( P < .001 ) . CONCLUSION Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility ; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00119795 BACKGROUND Prevention of childhood obesity is a public health priority . Parents influence a child 's weight by modeling healthy behaviors , controlling food availability and activity opportunities , and appropriate feeding practice s. Thus interventions should target education and behavioral change in the parent , and positive , mutually reinforcing behaviors within the family . METHODS This paper presents the design , rationale and baseline characteristics of Kids and Adults Now ! - Defeat Obesity ( KAN-DO ) , a r and omized controlled behavioral intervention trial targeting weight maintenance in children of healthy weight , and weight reduction in overweight children . 400 children aged 2 - 5 and their overweight or obese mothers in the Triangle and Triad regions of North Carolina are r and omized equally to control or the KAN-DO intervention , consisting of mailed family kits encouraging healthy lifestyle change . Eight ( monthly ) kits are supported by motivational counseling calls and a single group session . Mothers are targeted during a hypothesized " teachable moment " for health behavior change ( the birth of a new baby ) , and intervention content addresses : parenting skills ( ( e.g. , emotional regulation , authoritative parenting ) , healthy eating , and physical activity . RESULTS The 400 mother-child dyads r and omized to trial are 75 % white and 22 % black ; 19 % have a household income of $ 30,000 or below . At baseline , 15 % of children are overweight ( 85th-95th percentile for body mass index ) and 9 % are obese ( ≥ 95th percentile ) . CONCLUSION This intervention addresses childhood obesity prevention by using a family-based , synergistic approach , targeting at-risk children and their mothers during key transitional periods , and enhancing maternal self-regulation and responsive parenting as a foundation for health behavior change Background Given the increase in overweight and obesity prevalence in adolescents in the last decade , effective prevention strategies for these conditions in adolescents are urgently needed . The PRALIMAP ( Promotion de l'ALImentation et de l'Activité Physique ) trial aims to evaluate the effectiveness for these conditions of 3 health promotion strategies -- educational , screening and environmental -- applied singly or in combination in high schools over a 2-year intervention period . Methods PRALIMAP is a stratified 2 × 2 × 2 factorial cluster r and omised controlled trial including 24 state high schools in Lorraine , northeastern France , in 2 waves : 8 schools in 2006 ( wave 1 ) and 16 in 2007 ( wave 2 ) . Students entering the selected high schools in the 4 academic years from 2006 to 2009 are eligible for data collection . Interventional strategies are organized over 2 academic years . The follow-up consists of 3 visits : at the entry of grade 10 ( T0 ) , grade 11 ( T1 ) and grade 12 ( T2 ) . At T0 , 5,458 ( 85.7 % ) adolescents participated . The educational strategy consists of nutritional lessons , working groups and a final party . The screening strategy consists in detecting overweight/obesity and eating disorders in adolescents and proposing , if necessary , an adapted care management program of 7 group educational sessions . The environmental strategy consists in improving dietary and physical activity offerings in high schools and facilities , especially catering . The main outcomes are body size evolution over time , nutritional behaviour and knowledge , health and quality of life . An evaluation process documents how each intervention strategy is implemented in the schools and estimates the dose of the intervention , allowing for a per protocol analysis after the main intention-to-treat analysis . Discussion PRALIMAP aims at improving the prevention and management of overweight and obesity in adolescents by translating current evidence into public health practice . Particular attention is paid to clustering , multiple factorials and long-term duration to address common pitfalls in health promotion trials . The results should inform how best to implement , in a school environment , effective nutrition prevention programs targeting adolescents who are at a point their lives when they develop responsibilities and empowerment for health attitude behaviours . Trial registration This trial is registered at Clinical Trials.gov under NCT00814554 Review question / objective What are the effects of weight management interventions that include a diet component on weight‐related outcomes in pregnant and postpartum women ? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aim ed at limiting gestational weight gain and postpartum weight retention in women . The second objective of this systematic review is to investigate included intervention components with respect to effect on weight‐related outcomes . This may include , but is not limited to : length of intervention , use of face‐to‐face counselling , group or individual consultations , use of other interventions components including exercise , use of goals and use of support tools like food diaries , coaching , including email or text message support . Background Around half of all women of reproductive age are either overweight or obese,1,2,3 with women aged 25‐34 years having a greater risk of substantial weight gain compared with men of all ages.1,4 Excessive gestational weight gain ( GWG ) and postpartum weight retention ( PPWR ) may play a significant role in long term obesity . Having one child doubles the five‐ and 10‐year obesity incidence for women , with many women who gain excessive weight during pregnancy remaining obese permanently.5 Excessive GWG and /or PPWR can also significantly contribute to short‐ and long‐term adverse health outcomes for mother , baby and future pregnancies.6,7 Maternal obesity increases the risk of pregnancy related complications such as pre‐eclampsia , gestational diabetes mellitus , stillbirth and the rate of caesarean section.8 Childhood obesity is a further long term complication of maternal obesity for offspring , which may persist in to adulthood.9 Excess GWG is also a risk factor for PPWR both in the short and long‐term.10,11 Nehring et al. conducted a meta‐ analysis with over 65,000 women showing that , compared to women who gained weight within recommendations during pregnancy , women with GWG above Institute of Medicine weight gain recommendations , 12 retained an additional 3.1 kg and 4.7 kg after three and greater than or equal to 15 years postpartum , respectively.13 The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index ( kg/m2 ) between consecutive pregnancies ( an average of two years ) was much higher compared with women whose BMI changed from ‐1.0 and 0.9 units.14 Long‐term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post‐partum has been found to be a predictor of maternal overweight 15 years later.15With around 14‐20 % of women retaining 5 kg or more 12 months postpartum,16,5 the risk of developing conditions like diabetes , metabolic syndrome and cardiovascular disease may be increased.17 It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage . Lifestyle factors of overweight , having poor diet quality , and not undertaking enough moderate‐to‐vigorous physical activity are amongst the top five predictors of mortality in women.18 Additionally it is noted that , for many women , pregnancy and the postpartum period are associated with a reduction in physical activity.19 It is known that a combination of poor dietary choices , an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity . With this in mind , current research has focused on lifestyle interventions to limit GWG and PPWR . Thangaratinam et al. review ed 44 r and omized controlled trials ( 7278 women ) where interventions including diet , physical activity or both were evaluated for their influence on maternal weight during  pregnancy.20 Results indicate that all were significantly effective in reducing GWG compared with the control group . More specifically , dietary interventions were the most effective in reducing weight gain , with a mean weight loss of ‐3.84 kg compared with ‐0.72 kg and ‐1.06 kg for physical activity and the mixed ( diet plus physical activity ) approach , respectively.20 This finding is supported by Hill and colleagues ' recent systematic review of theory based interventions to limit GWG.21 Included studies in this review reported an underpinning theory base and were classified as adopting a dietary , physical activity or mixed approach . Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.21 In 2011 Tanentsapf et al. review ed the effect of dietary interventions alone for reducing GWG in normal weight , overweight and obese pregnant women.22 This review analysed 13 r and omized controlled trials and quasi‐r and omized controlled trials with a dietary intervention to prevent excessive GWG in women . The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of ‐1.92 kg ( n=1434 ) compared with the control group.22 Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non‐diet related components utilised . Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake . Some trials further provided feedback based on maternal weight gain guidelines .12 Interventions also varied in delivery method with a variety of modes used , including face‐to‐face , individual or group consultations and /or written correspondence . The frequency of communication , despite the type or mix , also changed from trial to trial with additional methods via telephone , posted material s , feedback or food diaries utilised . The inclusion of physical activity in addition to diet intervention was also common . Whilst the recent review by Tanentsapf et al.22 identified that dietary interventions are effective in reducing GWG , the review did not investigate the impact that different intervention components , delivery methods or dietary counselling approaches had on gestational weight management . It remains unclear as to which intervention components optimize GWG in women . The impact of lifestyle interventions has also been investigated in the postpartum period . The recent systematic review from van der Pligt et al. reported seven of 11 studies review ed were successful in limiting PPWR.23 As with studies aim ed at limiting GWG , interventions included in van der Pligt et al. 's review differed greatly in their conduct . Six of these seven studies included both dietary and physical activity components for the intervention , with the final successful study including a diet only intervention . Five of the successful studies recruited overweight or obese women only . Intervention time varied considerably in successful studies with some running for as little at ten days , and others up to six months . Bertz et al. demonstrated that their 12‐week behavior modification intervention which targeted diet alone or diet and exercise , including two individual sessions with a dietitian and physical therapist , provision of scales for weight self‐monitoring and bi‐weekly text messages was successful in achieving significant weight loss following the intervention , and sustained at one year.24 The diet intervention and the diet and exercise intervention  yielded significant weight loss compared to the control . Following 12 weeks a reduction of ‐8.3 + /‐ 4.2 kg for diet intervention and ‐6.9 + /‐ 3.0 kg for diet and exercise was observed . Additionally after one year , the diet intervention showed ‐10.2 + /‐ 5.7 kg reduction and ‐7.3 + /‐ 6.3 kg for the diet and exercise intervention (p<0.001).24 Colleran et al. also found significant weight change results by implementing a 16‐week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction , two additional home visits regarding exercise , weekly food diary completion and email support.25 The intervention group had greater weight loss compared to the control group ( ‐5.8 kg + /‐ 3.5 kg vs ‐1.6 kg + /‐ 5.4 kg ) . It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR . The review by van der Pligt et al.23 highlights the impact successful lifestyle interventions can have on postpartum weight change . However , this review did not investigate the different intervention strategies utilized . It remains unclear as to the optimal setting , delivery method , diet strategy , contact frequency or intervention length to limit PPWR . Previous systematic review s for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women.20,23 And despite Tanentsapf et al. 's focus on dietary interventions for GWG,22 much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period . Specifically , the impact of differing diet intervention strategies on maternal weight gain is not known . Firstly , this systematic review will focus on whether  weight management interventions which include a dietary component  are effective in pregnant and postpartum women . In addition to this , this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management . A search of systematic review protocol data bases has shown that there is no current review underway for this topic BACKGROUND Although ooverweight and obesity are considered as a health problem that affects millions of people worldwide , the implication of socio-economic status ( SES ) in these healthy conditions have rarely been investigated . We evaluated the associations of overweight and obesity with SES , in a population based sample of Greek adults . METHODS During 2001 - 2002 we r and omly enrolled 1514 men ( 18 - 87 years old ) and 1528 women ( 18 - 89 years old ) , stratified by the age-sex distribution ( census 2001 ) of the Attica area , Greece . We studied several demographic , anthropometric , lifestyle , dietary and bio- clinical factors of the participants . SES ( low , middle and high ) was defined through the education and economical level of the participants . RESULTS The prevalence of overweight and obesity was 53 and 20 % in men , and 31 and 15 % in women , respectively , while an increase in the prevalence of obesity was observed with progressing age . Both men and women in the higher SES group had significantly lower prevalence of obesity as compared to the middle and lower SES group ( p<0.001 ) . However , multivariate analysis showed that the observed associations between SES and obesity were mainly explained by differences in physical activity status and energy intake of the participants . CONCLUSION Overweight and obesity seems to be a serious health problem , affecting more prominently people in the lower SES . However , eating and other lifestyle habits mainly explained the association between SES and obesity Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences . This paper presents a process evaluation of the implementation of the University of California , Los Angeles , Working Out Regularly Keeps Individuals Nurtured and Going ( WORKING ) pilot study . WORKING focuses on integrating physical activity and nutrition practice s into workplace routine during non-discretionary paid work time . The purpose of the evaluation was to assess the quality of implementation and to underst and factors that facilitated or hindered organizations ' full uptake of the intervention . Fifteen worksites were r and omly assigned to an intervention condition . Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite 's intervention period . Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies . Six key factors emerged that were related to implementation success : site layout and social climate , wellness infrastructure , number and influence of Program Champions , leadership involvement , site innovation and creativity . This pilot study has informed the conduct of WORKING II ; a cluster r and omized controlled trial aim ed at enrolling 60 - 70 worksites in Los Angeles County The prevalence of type 2 diabetes continues to increase in minority and underserved patients , who are also more likely to have poorer control of diabetes and related risk factors for complications . Although the Look AHEAD trial has demonstrated improved risk factor control among overweight or obese diabetes patients who received an intensive lifestyle intervention  , translating such findings into accessible programs is a major public health challenge . The purpose of this paper is to report the design and baseline characteristics of the Lifestyle Interventions for the Treatment of Diabetes study ( LIFT Diabetes ) . The overall goal is to test the impact of a community-based lifestyle weight loss ( LWL ) intervention adapted from Look AHEAD on cardiovascular disease risk at 12-months and 24-months among minority and lower income diabetes patients . Secondary outcomes include body weight , physical activity , medication use , cost , re source utilization , and safety . The primary hypothesis being tested is that the  LWL  will result in 10 % relative reduction in CVD risk compared to the DSM . We have r and omized 260 overweight or obese adults with diabetes one of two 12-month interventions : a LWL condition delivered by community health workers or a diabetes self-management ( DSM ) education condition . The baseline demographic characteristics indicate that our sample is predominantly female , obese , low income , and ethnic minority . Translating evidence -based , lifestyle strategies , and targeting minority and underserved patients , will yield , if successful , a model for addressing the burden of diabetes and may favorably impact health disparities Objective . The objective was to evaluate the feasibility of delivering a pediatric weight management intervention adapted for low-income families . Academic research ers , a Medicaid health plan , a State Medicaid agency , and community pediatric providers partnered in the project . Methods . Participants were 48 families with 52 overweight/obese children aged 4 to 12 recruited from Medicaid health plan and providers ’ offices . Elements of efficacious pediatric obesity interventions were modified for low literacy and implemented in person and telephonically with parents . Results . Families report ents in food shopping and preparation , and child eating and activity habits . The retention rate was 88 % . Children grew significantly taller ( F = 7.1 ; P = .012 ) but did not gain significant weight ( F = 0.91 ; P = .35 ) , with a trend toward decreased BMI ( F = 3.2 ; P = .08 ) . Conclusions . The authors demonstrate the feasibility of delivering an adapted pediatric obesity intervention with low-income families . They also discuss implication s for public — private partnerships among key stakeholders to address pediatric obesity in this high-risk population Background . Vitamin D deficiency ( VDD ) is a public health concern in adults worldwide . This study aims to explore the extent of VDD and its associated factors among adults in the United Arab Emirates ( UAE ) . Subjects and Methods . Quantitative , cross-sectional research was used to assess VDD and its associated factors in 216 adults recruited from r and omly selected community-based healthcare setting s over a six-month period . Recent values of vitamin D and glycated hemoglobin ( HbA1c ) were abstract ed from medical records , followed by interviews with participants to obtain information on factors related to VDD and other covariates and to measure their heights and weights . Results . A total of 74 % of participants demonstrated VDD ( vitamin D serum level ≤ 30 nmol/L ) . Emirati participants had higher odds of having VDD compared to non-Emiratis ( OR : 2.95 ; 95 % CI : 1.58–5.52 ) , with also significantly increased odds of the condition appearing in older , less educated , and employed adults . Diabetes type 2 ( HbA1c ≥ 6.5 % ) , depression , and obesity were significantly associated with an increased likelihood of VDD  after accounting for other covariates . Conclusion . VDD is a significant problem for UAE adults and requires attention by public health policy makers . Diabetes , obesity , and depression need to be considered when screening for vitamin This paper describes the effectiveness of the Minnesota Heart Health Program ( MHHP ) in modifying mean body mass index ( BMI ) in whole communities . The MHHP is a 13-year research and demonstration project design ed to reduce cardiovascular risk . One member of each of three pairs of matched communities received 7 years of community intervention activities that included risk factor screening , mass media education , adult education classes , worksite interventions , home correspondence programs , school-based programs , restaurant programs , and point-of-purchase education in supermarkets .  Weight gain prevention was emphasized for all adults and weight loss was encouraged among those who were obese or who had elevated risk factors known to be responsive to weight loss ( e.g. , high blood pressure ) . A strong upward secular trend in weight was noted in all MHHP communities over time . Intervention effects were evaluated conservatively with community as the unit of analysis . This analysis showed no overall effect of the MHHP intervention program on mean BMI . However , a positive intervention effect was noted early in the intervention among those with elevated cholesterol or a history of obesity-related disease . Possible reasons for this relatively weak community effect are discussed , including secular forces overwhelming intervention effects , an intervention effort not sufficiently focused on obesity , ceiling effects for weight concern in a population that was highly aware of the issue at baseline , and inherent limitations in educational approaches for this recalcitrant public health problem
We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk .
Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .
INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success .
About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .