bluuebunny/crossref_metadata_2025 huggingface dataset:
Lifetime Overweight Status in Relation to Serial Changes in Body Composition and Risk Factors for Cardiovascular Disease: The Fels Longitudinal Study
Authors: Siervogel Roger M. , Wisemandle Wayne , Maynard L. Michele , Guo Shumei S. , Chumlea Wm. Cameron , Towne Bradford
Published: April 2008

Objective: The aims were to determine if 1) individuals who became and maintained overweight during their entire lifetime differ from those who were never‐overweight in terms of annual changes in adiposity and concurrent changes in cardiovascular disease (CVD) risk factors; 2) the changes and their relationships to each other varied between these groups or by sex within the groups; and 3) alcohol usage, smoking habits, and level of physical activity differed between groups.

Research Methods and Procedures: Data from 16,315 examinations of 414 individuals were utilized to assess lifetime overweight (body mass index [BMI] > 25 kg/m2) status. A regressive analytic approach was used to determine the average annual changes for each individual over an adult serial interval ranging from 4 to 20 years.

Results: Men and women who have become and maintained overweight have higher blood pressure and a poorer lipid/lipoprotein risk profile than those who have never been overweight. There is an accelerated deterioration in the atherogenic profile of overweight men and women as indicated by annual changes in CVD risk factors about double that of their never‐overweight counterparts. In women, increased risk is derived from increasing systolic and diastolic blood pressure, whereas in men the increased risk comes not only from increasing diastolic blood pressure but also cholesterol, triglycerides, and low‐density lipoprotein cholesterol levels and, to a lesser extent, decreasing high‐density lipoprotein cholesterol.

Discussion: The reduced physical activity observed in the overweight adults may be related to their accumulation of adipose tissue at a rate about double their never‐overweight counterparts, and this may be driving the higher rate of increase of CVD risk factors in the overweight groups.
Does Weight Loss Maintenance Become Easier Over Time?
Authors: Klem Mary L. , Wing Rena R. , Lang Wei , McGuire Maureen T. , Hill James O.
Published: April 2008

Objective: Studies of health‐related behaviors, including weight loss, have shown that risk of relapse decreases over time, although reasons for this relationship are unclear. The purpose of this cross‐sectional study was to determine if subjects who have maintained weight losses for varying periods of time report different strategies for weight loss maintenance or differences in the effort and pleasure associated with weight maintenance behaviors.

Research Methods and Procedures: Subjects were 758 women and 173 men who had maintained losses of at least 30 lb (mean = 60 lb) for 2 years or longer (mean = 6.8 ± 7.0 years). Self‐administered questionnaires assessed subjects’ use of weight maintenance strategies in the past year and their perceptions of the effort, attention, and pleasure associated with weight maintenance.

Results: Subjects who had maintained weight losses longer used fewer weight maintenance strategies and reported that less effort was required to diet and maintain weight and that less attention was required to maintain weight. The pleasure derived from exercise, low‐fat eating, and maintaining weight was unrelated to duration of weight loss maintenance.

Discussion: As duration increases, a shift in the balance between the effort and pleasure of weight maintenance may occur. This shift may increase the likelihood of continued maintenance.
Teasing History, Onset of Obesity, Current Eating Disorder Psychopathology, Body Dissatisfaction, and Psychological Functioning in Binge Eating Disorder
Authors: Jackson Tamara D. , Grilo Carlos M. , Masheb Robin M.
Published: April 2008

Objective: The primary goal of this study was to examine associations among teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in women with Binge Eating Disorder (BED).

Research Methods and Procedures: Subjects were 115 female adults who met DSM‐IV criteria for BED. Measurements assessing teasing history (general appearance [GAT] and weight and size [WST] teasing), current eating disorder psychopathology (binge frequency, eating restraint, and concerns regarding eating, shape, and weight), body dissatisfaction, and psychological functioning (depression and self‐esteem) were obtained.

Results: History of GAT, but not WST, was associated with current weight concerns and body dissatisfaction, whereas both GAT and WST were significantly associated with current psychological functioning. Patients with earlier onset of obesity reported more WST than patients with later onset of obesity, but the groups did not differ significantly in GAT, current eating disorder psychopathology, body dissatisfaction, or psychological functioning. Obese women reported more WST than non‐obese women, but no differences in GAT or the other outcome variables were observed. Higher frequency of GAT was associated with greater binge frequency in obese women, and with greater eating restraint in non‐obese women.

Discussion: Although physical appearance teasing history is not associated with variability in most eating disorder psychopathology, it is associated with related functioning, most notably body dissatisfaction, depression, and self‐esteem. Our findings also suggest that the age of onset of obesity and current body mass index status in isolation are not associated with eating psychopathology or associated psychological functioning in adult patients with BED.
Augmented Insulinotropic Action of Arachidonic Acid through the Lipoxygenase Pathway in the Obese Zucker Rat
Authors: Ahrén Bo , Magrum Linda J. , Havel Peter J. , Greene Stephanie F. , Phinney Stephen D. , Johnson Patricia R. , Stern Judith S.
Published: April 2008

Objective: The metabolism of arachidonic acid (AA) has been shown to be altered in severe insulin resistance that is present in obese (fa/fa) Zucker rats. We examined the effects and mechanism of action of AA on basal and glucose‐stimulated insulin secretion in pancreatic islets isolated from obese (fa/fa) Zucker rats and their homozygous lean (Fa/Fa) littermates.

Research Methods and Procedures: Islets were isolated from 10‐ to 12‐week‐old rats and incubated for 45 minutes in glucose concentrations ranging from 3.3 to 16.7 mM with or without inhibitors of the cyclooxygenase or lipoxygenase pathways. Medium insulin concentrations were measured by radioimmunoassay, and islet production of the 12‐lipoxygenase metabolite, 12‐hydroxyeicosatetraenoic acid (12‐HETE), was measured by enzyme immunoassay.

Results: In islets from lean animals, AA stimulated insulin secretion at submaximally stimulatory glucose levels (< 11.1 mM) but not at 16.7 mM glucose. In contrast, in islets derived from obese rats, AA potentiated insulin secretion at all glucose concentrations. AA‐induced insulin secretion was augmented in islets from obese compared with lean rats at high concentrations of AA in the presence of 3.3 mM glucose. Furthermore, the inhibitor of 12‐lipoxygenase, esculetin (0.5 μM), inhibited AA‐stimulated insulin secretion in islets from obese but not lean rats. Finally, the islet production of the 12‐HETE was markedly enhanced in islets from obese rats, both in response to 16.7 mM glucose and to AA.

Discussion: The insulin secretory response to AA is augmented in islets from obese Zucker rats by a mechanism related to enhanced activity of the 12‐lipoxygenase pathway. Therefore, augmented action of AA may be a mechanism underlying the adaptation of insulin secretion to the increased demand caused by insulin resistance in these animals.
Post‐Exercise Substrate Utilization after a High Glucose vs. High Fructose Meal During Negative Energy Balance in the Obese
Authors: Tittelbach Thomas J. , Mattes Richard D. , Gretebeck Randall J.
Published: April 2008

Objective: To assess the effects of negative energy balance on the metabolic response of a meal containing either glucose or fructose as the primary source of carbohydrate after exercise in obese individuals in energy balance, or negative energy balance.

Research Methods and Procedures: Fourteen adults with mean body mass index (BMI) 30.3 ± 1 kg/m2, age 26 ± 2 years, and weight 93.5 ± 5.4 kg, adhered to an energy‐balanced (EB) or a negative energy‐balanced (NEB) diet for 6 days. On Day 7, subjects exercised at 70% VO2peak for 40 minutes then consumed either high glucose (50 g of glucose, HG) or high fructose (50 g of fructose, HF) liquid meal. Substrate utilization was measured by indirect calorimetry for 3 hours. Blood samples were collected before exercise and 0, 30, 60, 120, and 180 minutes after consuming the meal.

Results: The HG produced 15.9% greater glycemic (p < 0.05) and 30.9% larger insulinemic (p < 0.05) responses than the HF under both EB and NEB conditions. After the NEB diet, carbohydrate and fat oxidation did not differ for HG and HF. In contrast, carbohydrate oxidation increased 31%, and fat oxidation decreased 39% with HF compared with HG after the EB diet. Thus, HF and HG consumed after exercise produced marked differences in macronutrient oxidation when obese subjects followed an EB diet, but no difference when adhering to a NEB diet.

Discussion: The data suggest that the use of fructose in supplements/meals may provide no additional benefit in terms of substrate utilization during a weight loss program involving diet and exercise.
Diabetes Disease Stage Predicts Weight Loss Outcomes with Long‐Term Appetite Suppressants
Authors: Khan Mehmood A. , St. Peter John V. , Breen Gail A. , Hartley Guilford G. , Vessey John T.
Published: April 2008

Objectives: Characterize degree of weight loss with stage of diabetes and describe its effect on cardiovascular disease risk factors in obese patients with and without diabetes.

Research Methods and Procedures: Retrospective cohort analysis from patients participating in a long‐term weight management protocol using diet, exercise, behavioral modification, and appetite‐suppressant therapy. Patient groups, with (n = 19) and without diabetes (n = 19) were matched for age, gender, and weight before weight loss therapy. The effect of 12 months of therapy on weight, blood pressure, glycemic control, lipid profile, and medication requirements were tested. Additionally, patients were grouped or staged based upon therapy required for control of diabetes at the beginning of weight loss intervention. Analysis of covariance described relationships between diabetes disease stage and weight loss at 12 months.

Results: Nondiabetic patients had greater mean reduction in BMI than the diabetic group (7.98 kg/m2 vs. 4.77 kg/m2, p < 0.01). A significant linear trend (p < 0.001) for decreasing weight loss with stage of diabetes was observed. Blood pressure, lipid profile, and glycemia improved significantly. The average daily glyburide‐equivalent dose decreased from 9.4 to 3.0 mg (p < 0.01).

Discussion: Patients with diabetes lost less weight than similarly obese patients without diabetes. Regardless of differential weight loss between groups, cardiovascular disease risk factors improved. Hypoglycemic medication requirements decreased with weight loss therapy. A predictive relationship may exist between diabetes disease stage before weight loss therapy and future weight loss potential.
Percent Body Fat and Lean Mass Explain the Gender Difference in Leptin: Analysis and Interpretation of Leptin in Hispanic and Non‐Hispanic White Adults
Authors: Marshall Julie A. , Grunwald Gary K. , Donahoo William T. , Scarbro Sharon , Shetterly Susan M.
Published: April 2008

Objective: To reassess the relationship between body fat and fasting leptin concentrations comparing plasma vs. serum assessments of leptin; ratios vs. regression adjustment for body composition; fat and lean mass vs. percent body fat; and gender‐, ethnic‐, and age‐related variations.

Research Methods and Procedures: Subjects included 766 adults from the nondiabetic cohort of the San Luis Valley Diabetes Study examined at follow up (1997 to 1998). Body composition was determined by dual energy X‐ray absorptiometry. Leptin concentrations were determined after an overnight fast.

Results: Fasting serum and plasma assessments of leptin were correlated with percent body fat to the same degree. Women had significantly higher serum leptin concentrations than men when leptin concentrations were divided by body mass index, fat mass in kilograms or percent body fat. The methodological problem inherent in interpreting these ratio measures is pictorially demonstrated. In regression analysis, fat mass alone did not explain the gender difference. However, lean body mass was inversely related to leptin concentrations (p < 0.0001) and explained 71% of the gender difference at a given fat mass. Percent body fat explained all of the gender difference in leptin concentrations in both Hispanics and non‐Hispanic whites. Similar to findings about gender differences, ethnic‐ and age‐related variations in the leptin‐body fat association were minimized when percent body fat was employed as the body fat measure.

Discussion: Regression analysis and percent body fat measured with dual energy X‐ray absorptiometry are recommended when assessing the relationship between leptin and body fat. Gender differences in leptin concentrations were accounted for by percent body fat in free living (no diet control), Hispanic and non‐Hispanic white adults.
Evaluation of the Influence of Cardiorespiratory Fitness on Diverse Health Risk Factors, Independent of Waist Circumference, in 40‐Year‐Old Flemish Males
Authors: Delvaux Katrien , Philippaerts Renaat , Lysens Roeland , Vanhees Luc , Thomis Martine , Claessens Albrecht L. , Vanreusel Bart , Eynde Bart Vanden , Beunen Gaston , Lefevre Johan
Published: April 2008

Objective: To examine whether cardiorespiratory fitness is associated with health risk factors, independent of abdominal obesity (waist circumference).

Research Methods and Procedures: Data from 141 40‐year‐old Flemish male subjects were used in a cross‐sectional design. The main outcome measure in this study was the health risk profile, composed of lipid parameters, blood pressure, and body composition parameters. Data were analyzed by regression analysis and by means of analysis of covariance with waist circumference (WC) as covariate and cardiorespiratory fitness as source of variance.

Results: The data demonstrated that cardiorespiratory fitness was significantly associated with triglycerides, with the ratio of total cholesterol/serum high density lipoprotein cholesterol, and with percent body fat, independent of an association with WC.

Discussion: Major findings of the present cross‐sectional study indicate that a high WC is associated with adverse health‐related lipid profile and body composition characteristics and that relatively high levels of aerobic fitness attenuate the health risk associated with a large WC.
The Relationship Between Body Image Discrepancy and Body Mass Index Across Ethnic Groups
Authors: Fitzgibbon Marian L. , Blackman Lisa R. , Avellone Mary E.
Published: April 2008

Objective: This study sought to examine at what body mass index (BMI) body image discrepancy (BD) was reported in a community sample of 389 white, Hispanic, and black women. In addition, we assessed the trajectory of the BMI–BD relationship as BMI increases by ethnic group.

Research Methods and Procedures: All participants were assessed on height and weight and completed the Figure Rating Scale.

Results: We found no difference in the proportion of women in each ethnic group reporting BD. However, white women experienced BD at a lower BMI level (BMI = 24.6), and below the criterion for overweight (BMI = 25). In contrast, black and Hispanic women did not report BD until they were overweight (BMIs of 29.2 and 28.5, respectively). Compared with black and white women, Hispanic women registered increases in BD at smaller increases in BMI.

Discussion: These findings could have unhealthful implications for weight control behavior. The results encourage a closer look at ethnicity and BD, and their relationship to obesity and weight control.
On the Relation of Attempting to Lose Weight, Restraint, and Binge Eating in Outpatients with Binge Eating Disorder
Authors: Masheb Robin M. , Grilo Carlos M.
Published: April 2008

Objective: To examine the relationship among attempts to lose weight, restraint, and eating behavior in outpatients with binge eating disorder (BED).

Research Methods and Procedures: Participants were 93 consecutive outpatients evaluated for a clinical trial who met Diagnostic and Statistical Manual, Fourth edition criteria for BED. The Eating Disorder Examination Interview was administered to assess attempts at weight loss, restraint, different forms of overeating, and the attitudinal psychopathology of eating disorders (i.e., concerns regarding eating, shape, and weight). In addition, the Three‐Factor Eating Questionnaire was used to assess cognitive restraint, hunger, and disinhibition. Psychometrically established measures were given to assess body dissatisfaction, depression, and self‐esteem.

Results: The majority of participants (75.3%; N = 70) reported attempting to lose weight, but only 37.6% (N = 35) reported dietary restraint on at least half the days of the month. Dietary restraint and cognitive restraint were not associated with any form of binge eating or overeating. Dietary restraint and cognitive restraint were positively correlated with weight concern, shape concern, and body dissatisfaction, and negatively correlated with body mass index. To further examine the interplay between attempting to lose weight and restraint, three study groups were created: unrestrained nonattempters (21.5%, N = 20), unrestrained attempters (40.9%; N = 38), and restrained attempters (34.4%; N = 32). The three groups did not differ significantly on binge eating or other eating behaviors; however, significant differences were observed for weight concern, shape concern, and body dissatisfaction.

Discussion: Attempts to lose weight and restraint are not synonymous for patients with BED. Although 75.3% of BED patients reported that they were attempting to lose weight, only 37.6% reported dietary restraint on at least half the days of the previous month. While restraint was negatively associated with body mass index, it was not related to binge eating or overeating. Our findings raise questions about prevailing models that posit restraint as a predominant factor in the maintenance of binge eating in BED.
Bias, Discrimination, and Obesity
Authors: Puhl Rebecca , Brownell Kelly D.
Published: April 2008

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.
The Effect of Low‐Intensity Exercise Training on Fat Metabolism of Obese Women
Authors: van Aggel‐Leijssen Dorien P. , Saris Wim H. , Wagenmakers Anton J. , Hul Gabby B. , van Baak Marleen A.
Published: April 2008

Objective: Previous studies have shown that fat metabolism is different in upper body (UB) and lower body (LB) obese women. The present study investigated whether the effect of low‐intensity exercise training on fat metabolism is different in UB and LB obese premenopausal women.

Research Methods and Procedures: Twenty‐one healthy, premenopausal women with either LB obesity (waist‐to‐hip ratio of ≤0.79; n = 8) or UB obesity (waist‐to‐hip ratio of ≥0.85; n = 13) participated in the present study. The UB obese women were matched and randomly divided in an exercise training group (UB) and a nonexercising control group (UB‐C). Subjects in the UB and LB groups participated in a low‐intensity exercise training program (40% Vo2max) three times per week for 12 weeks. Before and after the intervention, measurements of fat metabolism at rest and during exercise, body composition, and maximal aerobic capacity were performed.

Results: Exercise training did not change the respiratory exchange ratio at rest in the UB and LB groups. During exercise, relative fat oxidation increased in the UB group by 19% (p < 0.05), whereas no change in the LB and UB‐C groups was found. Plasma free fatty acid oxidation did not change by exercise training, and nonplasma fatty acid oxidation tended to increase in the UB group compared with the UB‐C group (p = 0.08).

Discussion: Low‐intensity exercise training increased the contribution of fat oxidation to total energy expenditure during exercise but not at rest in UB obese women. Exercise training had no significant effect on fat metabolism in the LB obese women.
The Worldwide Obesity Epidemic
Authors: James Philip T. , Leach Rachel , Kalamara Eleni , Shayeghi Maryam
Published: April 2008

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/m2 rather than 18.5 to 24.9 kg/m2) 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.
Obesity in the Elderly
Authors: Elia Marinos
Published: April 2008

In developed countries, there is a general increase in body weight and body mass index (BMI) with age, until ∼60 years of age, when body weight and BMI begin to decline. The proportion of intra‐abdominal fat, which is related to increased morbidity and mortality, progressively increases with age. There is also a progressive decline in energy intake and daily total energy expenditure (165 kcal/decade in men and 103 kcal/decade in women in developed countries), which is primarily due to a decrease in physical activity, and to a lesser extent, a decrease in basal metabolic rate. The decrease in physical activity is more pronounced in those with chronic disabilities and diseases. The BMI–mortality curves have been reported to move upward (greater overall mortality), become flatter (less effect of BMI on mortality), and in some cases shift to the right (minimum mortality occurs at a higher BMI), for a variety of possible reasons. Weight loss in the elderly has been reported to increase, decrease, or not alter mortality, but the studies are confounded by numerous methodological problems. It has been argued that there may be little benefit in encouraging weight loss in extreme old age (short life expectancy), especially when there are no obesity‐related complications or biochemical risk factors and when strong resistance and distress arise from changes in lifelong habits of eating and exercise. In contrast, weight loss in the elderly can reduce morbidity from arthritis, diabetes and other conditions, reduce cardiovascular risk factors, and improve well‐being. BMI also predicts morbidity in those without disease. Furthermore, increased physical activity in the elderly, which is an important component of weight management, can produce beneficial effects on muscle strength, endurance, and well‐being.
Determinants of Food Choice: Relationships with Obesity and Weight Control
Authors: Mela David J.
Published: April 2008

The decision to eat, and to eat particular foods, varies for different individuals and situations. Individual differences in food likes and desires develop throughout life because of differing food experiences and attitudes. There are many internal and external cues, not just stimulation from foods or hunger, which can trigger the immediate desire to eat or orient eating toward certain foods. Food desires and intake are an outcome of interactions between these cues and more stable individual physiological and psychological characteristics. Overweight and obese individuals show a tendency toward greater liking and selection of energy‐dense foods, which may contribute to development and maintenance of these conditions. However, although liking (pleasure from eating) is an important part of food choice, it may make only a modest contribution to overall variation in food choice and eating behaviors. Indeed, difficulties of weight control may reflect problems with cues and motivations to eat, rather than with heightened pleasure derived from eating. Paradoxically, individuals highly concerned with food intake and weight control may be particularly susceptible to thoughts, emotions, and situational cues that can prompt overeating and undermine their attempts to restrain eating. Repeat dieting, high day‐to‐day fluctuations in intakes, and attempts to enforce highly rigid control over eating all seem to be counterproductive to weight control efforts and may disrupt more appropriate food choice behaviors. Longer‐term weight maintenance solutions and programs that offer a degree of structuring of the personal food environment, while retaining flexibility in choices, therefore, may be particularly beneficial in weight management.
Macronutrient Composition and Food Selection
Authors: Flatt Jean‐Pierre
Published: April 2008

Humans can maintain health on diets differing widely in their macronutrient content, and numerous diet recommendations have been made to maintain health and to help weight control. Net adenosine triphosphate yields during the oxidation of carbohydrate, fat, and protein come to 75%, 90%, and 55%, respectively. However, macronutrient proportions can only be varied within limits, and differences in energy dissipation achievable by macronutrient exchanges are minor. In the National Health and Nutrition Examination Survey III data, stature explains 10% to 16% of the variance in fat‐free mass in adults (the most significant predictor of resting energy expenditure), but <1% of the variance in the percentage of body fat. Thus, differences in resting energy expenditure cannot be expected to have much effect on adiposity. Recommendations designed to facilitate weight control, therefore, should be based on their potential impact on food consumption and energy intake. They should also reflect the fact that the logic for nutrient selection is not the same during weight maintenance and weight reduction. Glycogen levels, along with inherited traits and exercise habits, influence fat oxidation, and, hence, the size that the adipose tissue mass has to reach for fat oxidation to become commensurate with fat intake. Recent increases in the prevalence of obesity could have been brought about by the effect of changes in the food supply and by further declines in physical activity on habitual glycogen levels. Given that biological evolution led to food intake regulating mechanisms that are more powerful in promoting search for food than in seeking to restrain energy intake, it is not surprising that constant availability of desirable foods would lead to a high prevalence of obesity.
Control of Food Intake in the Obese
Authors: Blundell John E. , Gillett Angela
Published: April 2008

Food intake (eating) is a form of behavior that is subject to conscious control. In practice, many obese and weight‐gaining individuals claim that their eating is out of (their) control. Mechanistic models describe the interplay of biological and environmental forces that control food intake. However, because human food intake is characterized by individuals intervening to adjust their own patterns of behavior, food intake should reflect interactions among biology, environment, and attempted self‐imposed control of behavior. In general, humans display a system of weight regulation that is asymmetrical—a reduction in body weight is strongly defended but weight gain is not. The body seems to tolerate a positive energy balance. There is no mechanism that can detect a positive energy balance per se or that can implement a sufficiently strong correction to behavior to maintain body weight in an environment that promotes consumption. The evolutionary process has favored biological traits associated with preferences for high energy density (sweet and/or fatty) energy‐yielding foods. The control of food intake in obese or weight‐gaining individuals may display various risk factors that favor an increase in energy. These include the preference for high energy‐dense over low energy‐dense foods, weak postprandial inhibitory signaling, strong hunger traits associated with low leptin levels after weight loss, and the consumption of fatty foods. In addition, many individuals (up to 47% of some samples) display binge eating patterns, whereas ∼16% show either night eating or nocturnal eating. Because energy expenditure is only loosely coupled to energy intake, sedentariness does not down‐regulate food intake.
Implementation of a Primary Care Physician Network Obesity Management Program
Authors: Bowerman Susan , Bellman Mindy , Saltsman Pamela , Garvey Denise , Pimstone Kevin , Skootsky Samuel , Wang He‐Jing , Elashoff Robert , Heber David
Published: April 2008

Most primary care physicians do not treat obesity, citing lack of time, resources, insurance reimbursement, and knowledge of effective interventions as significant barriers. To address this need, a 10‐minute intervention delivered by the primary care physician was coupled with individual dietary counseling sessions delivered by a registered dietitian via telephone with an automated calling system (House‐Calls, Mobile, AL). Patients were seen for follow‐up by their physician at weeks 4, 12, 24, 36 and 52. A total of 252 patients (202 women and 50 men) were referred by 18 primary care physicians to the program. The comorbid conditions reported for all patients at baseline included low back pain, 29% (n = 72); hypertension, 45% (n = 113); hypercholesterolemia, 41% (n = 104); type 2 diabetes, 10% (n = 26); and sleep apnea, 5% (n = 12). When offered a choice of meal plans based on foods or meal replacements, two‐thirds of patients (n = 166) chose to use meal replacements (Ultra Slim‐Fast; Slim‐Fast Foods Co., West Palm Beach, FL) at least once daily. Baseline weights of subjects averaged 200 ± 46 lb for women (n = 202) and 237 ± 45 lb for men (n = 50). Patients completing 6 months in the program lost an average of 19.0 ± 4.0 lb for women (n = 94) and 15.5 ± 8.2 lb for men (n = 26). Physicians reported a high degree of satisfaction with the program, suggesting that a brief, effective physician‐directed program with nutritionist support by telephone can be implemented in a busy primary care office.
Dietary Treatment and Long‐Term Weight Loss and Maintenance in Type 2 Diabetes
Authors: Hensrud Donald D.
Published: April 2008

Increasing body weight, particularly abdominal weight, is associated with increasing risk for type 2 diabetes, and 80% of people with type 2 diabetes are overweight or obese. Weight loss and maintenance are challenging in the obese population without diabetes, and data suggest that this may be more difficult in obese people with diabetes. Various weight‐loss strategies with follow‐up for at least 1 year have been evaluated in people with diabetes with mixed results. Diet is most effective in promoting initial weight loss. Energy restriction will improve glycemic control within days of initiation, independent of weight loss. There is deterioration of the effects of dietary therapy on glycemic control over time, even with partial weight maintenance, because of the relaxation of energy restriction. Diet composition has little effect on glycemic control independent of total calories. Very‐low‐calorie diets lead to better initial weight loss and glycemic control but yield no better long‐term results than more moderate treatment. The initial results from studies using prepared meals and liquid meal replacements show that weight loss and glycemic control are comparable with conventional dietary treatment. Comprehensive lifestyle therapies, involving diet, exercise, and behavioral modification, can lead to weight losses of ∼2 to 10 kg over 10 to 20 weeks, with regain over 1 year of one‐third to one‐half of weight initially lost. The net improvement on glycemic control is usually small 1 year after weight loss. Creative strategies using these and other modalities are needed to improve long‐term weight loss, weight maintenance, and glycemic control in patients with type 2 diabetes. Greater efforts in primary prevention are also needed because of the increasing prevalence of obesity and type 2 diabetes.
Outcome Success in Obesity
Authors: Klein Samuel
Published: April 2008

Intentional weight loss improves many of the medical complications associated with obesity. Moreover, many of these beneficial effects have a dose‐dependent relationship with the amount of weight lost and begin after only modest weight losses of 5% to 10% of initial body weight. There is no conclusive evidence that weight loss decreases mortality in obese people. The therapeutic effect of weight loss on risk factors for cardiovascular disease (insulin resistance and diabetes, dyslipidemia, and hypertension) has received the most attention in clinical trials. The hazard of developing coronary heart disease is directly related to the concomitant burden of risk factors. Modest weight loss can affect the entire cluster of risk factors simultaneously. Both negative energy balance and weight loss improve insulin sensitivity and glycemic control in obese patients with type 2 diabetes. Most studies have found that weight loss decreases serum triglyceride, total cholesterol, and low‐density lipoprotein cholesterol concentrations and increases serum high‐density lipoprotein cholesterol concentration. Regain of weight leads to relapse in triglyceride and cholesterol concentrations. Weight loss, independent of sodium restriction, decreases systolic and diastolic blood pressure. Dietary intervention is the cornerstone of weight‐loss therapy. Most diets proposed for losing weight vary in two principal dimensions: energy content and macronutrient composition. Manipulation of food acronutrient content, energy density, and portion size can help decrease energy intake and facilitate weight loss.
Increasing Fruit and Vegetable Intake and Decreasing Fat and Sugar Intake in Families at Risk for Childhood Obesity
Authors: Epstein Leonard H. , Gordy Constance C. , Raynor Hollie A. , Beddome Marlene , Kilanowski Colleen K. , Paluch Rocco
Published: April 2008

Objective: The goal of this study was to evaluate the effect of a parent‐focused behavioral intervention on parent and child eating changes and on percentage of overweight changes in families that contain at least one obese parent and a non‐obese child.

Research Methods and Procedures: Families with obese parents and non‐obese children were randomized to groups in which parents were provided a comprehensive behavioral weight‐control program and were encouraged to increase fruit and vegetable intake or decrease intake of high‐fat/high‐sugar foods. Child materials targeted the same dietary changes as their parents without caloric restriction.

Results: Changes over 1 year showed that treatment influenced targeted parent and child fruit and vegetable intake and high‐fat/high‐sugar intake, with the Increase Fruit and Vegetable group also decreasing their consumption of high‐fat/high‐sugar foods. Parents in the increased fruit and vegetable group showed significantly greater decreases in percentage of overweight than parents in the decreased high‐fat/high‐sugar group.

Discussion: These results suggest that focusing on increasing intake of healthy foods may be a useful approach for nutritional change in obese parents and their children.
Comparison of Two Software Versions for Assessment of Body‐Composition Analysis by DXA
Authors: Vozarova Barbora , Wang Jack , Weyer Christian , Tataranni P. Antonio
Published: April 2008

Objective: To compare two software versions provided by Lunar Co. for assessment of body composition analysis by DXA.

Research Methods and Procedures: Soft‐tissue phantoms for lean tissue (water) and fat tissue (methanol) were repeatedly scanned using DXA machines (DPX‐L; Lunar Co., Madison, WI) and analyzed using software version 1.33 and the updated year 2000‐compatible version 1.35. For the intersoftware comparison, the phantoms were scanned 10 times (each scan was analyzed once) with both software versions using all three scanning modes (slow, medium, and fast) for a total of 60 scans and analyses. For the intermachine comparison, the same phantoms were scanned three times (each scan was analyzed once) with a second machine from the same manufacturer using all three scanning modes and version 1.35 only. Percentage of fat was the variable of interest.

Results: For version 1.33, fat was 9.9 ± 0.4%, 10.0 ± 0.5%, and 11.0 ± 0.5% (mean ± SD) for the lean‐tissue phantom and 50.8 ± 0.3%, 50.9 ± 0.5%, and 51.1 ± 0.6% for the fat‐tissue phantom using the slow, medium, and fast scanning modes, respectively. For version 1.35, the respective fat values were 9.8 ± 0.7%, 9.9 ± 0.4%, and 10.3 ± 0.7%, and 50.6 ± 0.5%, 50.9 ± 0.6%, and 50.8 ± 0.8%, respectively. For the lean‐tissue phantom, the estimation of percentage of fat was significantly (p < 0.05) affected by scanning mode but not by software version. For the fat‐tissue phantom, the estimation of percentage of fat was not affected by either scanning mode or software version. The use of version 1.35 did not effect intermachine variability.

Discussion: Versions 1.33 and 1.35 of the Lunar body composition software appear to be comparable. Soft‐tissue phantoms, such as the ones described in this paper, may be useful in monitoring the reproducibility of body composition analyses within and between DXA machines, particularly in longitudinal studies.
Evolution of the Prevalence of Obesity in the Workers of a General Hospital in Mexico
Authors: Fanghänel Guillermo , Sánchez‐Reyes Leticia , Berber Arturo , Gómez‐Santos Rosario
Published: April 2008

Objective: The objective of this study was to compare the prevalence of overweight and obesity in the first Prevalencia de factores de nesso cardiovascular en Trabajadores survey (1994) with the prevalence of overweight and obesity observed in the second survey (1996).

Research Methods and Procedures: For both surveys the following individual data were collected: age, sex, weight, height, and body mass index (BMI). The 1994 survey included 2383 people and the 1996 survey included 2759 people. The degree of BMI was classified according to the current World Health Organization definitions. The population was divided by gender and age group, and the prevalence of each level of overweight was calculated. Additionally, the prevalence of different cutoff levels of BMI was calculated by gender and age groups.

Results: The global prevalence of age‐adjusted overweight increased from 26.91% to 37.45%. This increase was observed in both genders but the men had a higher increase from 24.51% to 40.21%. Overweight was more frequent in men than in women in all age groups. Male overweight prevalence was higher in the 40‐ to 59‐year‐old group and ≥60‐year‐old group. Female overweight prevalence was predominant in the 30‐ to 39‐year‐old, 40‐ to 49‐year‐old, and 50‐ to 59‐year‐old groups. Global prevalence of obesity (≥30 kg/m2) changed from 13.8% to 17.2%. Particularly, global prevalence of obesity class I increased from 9.66% to 12.6%; in men this figure increased from 9.04% to 13.05% and in women from 9.9% to 12.71%.

Discussion: Prevalence of overweight and obesity has increased significantly in the studied population. It is necessary to implement lifestyle modifications to prevent the increase of prevalence of overweight and obesity.
Racial Differences in the Sums of Skinfolds and Percentage of Body Fat Estimated from Impedance in Black and White Girls, 9 to 19 Years of Age: The National Heart, Lung, and Blood Institute Growth and Health Study
Authors: Morrison John A. , Barton Bruce A. , Obarzanek Eva , Crawford Patricia B. , Guo Shumei S. , Schreiber George B.
Published: April 2008

Objectives: This National Heart, Lung, and Blood Institute Growth and Health Study report assesses racial differences in fat patterning in black and white girls ages 9 to 19 years, comparing the sum of triceps and subscapular skinfolds (SSFs) and percentage of body fat (%BF) from impedance as two indices of adiposity. It is hypothesized that racial differences in fat patterning manifest during puberty.

Research Methods and Procedures: SSF and %BF were measured annually. Racial differences in SSF and %BF were evaluated by age. Associations between %BF and SSF were evaluated using the Pearson's correlations coefficient. Classification agreement was evaluated using the kappa‐statistic. Effects of pubertal stage and race on classification agreement were examined using multivariate models.

Results: White girls had a greater mean %BF at 9 to 12 years of age; black girls had a greater %BF thereafter. Black girls had a greater mean SSF at every age. The correlation coefficient between SSF and %BF was 0.79, and there was good agreement between %BF and SSF in separating high (>85th percentile) from not high (kappa = 0.60 for whites and 0.66 for blacks). SSF associated more with %BF in prepuberty and early puberty than in late puberty.

Discussion: Despite good correlations between %BF and SSF, the two methods indicate different fat patterns in black and white girls.
Self‐Reported Body Mass Index and Health‐Related Quality of Life: Findings from the Behavioral Risk Factor Surveillance System
Authors: Ford Earl S. , Moriarty David G. , Zack Matthew M. , Mokdad Ali H. , Chapman Daniel P.
Published: April 2008

Objective: To examine the relationship between self‐reported body mass index (BMI) and health‐related quality of life in the general adult population in the United States.

Research Methods and Procedures: Using data from 109,076 respondents in the 1996 Behavioral Risk Factor Surveillance System, we examined how self‐reported BMI is associated with five health‐related quality of life measures developed by the Centers for Disease Control and Prevention for population health surveillance.

Results: After adjusting for age, gender, race or ethnicity, educational attainment, employment status, smoking status, and physical activity status, participants with a self‐reported BMI of <18.5 kg/m2 and participants with a self‐reported BMI of ≥30 kg/m2 reported impaired quality of life. Compared with persons with a self‐reported BMI of 18.5 to <25 kg/m2, odds ratios (ORs) of poor or fair self‐rated health increased among persons with self‐reported BMIs of <18.5 (1.57, 95% confidence interval [CI]: 1.31 to 1.89), 25 to <30 kg/m2 (1.12, 95% CI: 1.04 to 1.20), 30 to <35 kg/m2 (1.65, 95% CI: 1.50 to 1.81), 35 to <40 kg/m2 (2.58, 95% CI: 2.21 to 3.00), and ≥40 kg/m2 (3.23, 95% CI: 2.63 to 3.95); ORs for reporting ≥14 days of poor physical health during the previous 30 days were 1.44 (95% CI: 1.21 to 1.72), 1.04 (95% CI: 0.96 to 1.14), 1.32 (95% CI: 1.19 to 1.47), 1.80 (95% CI: 1.52 to 2.13), and 2.37 (95% CI: 1.90 to 2.94), respectively; ORs for having ≥14 days of poor mental health during the previous 30 days were 1.18 (95% CI: 0.97 to 1.42), 1.02 (95% CI: 0.95 to 1.11), 1.22 (95% CI: 1.10 to 1.36), 1.68 (95% CI: 1.42 to 1.98), and 1.66 (95% CI: 1.32 to 2.09), respectively.

Discussion: In the largest study to date, low and increased self‐reported BMI significantly impaired health‐related quality of life. Particularly, deviations from normal BMI affected physical functioning more strongly than mental functioning.
Childhood Psychological, Physical, and Sexual Maltreatment in Outpatients with Binge Eating Disorder: Frequency and Associations with Gender, Obesity, and Eating‐Related Psychopathology
Authors: Grilo Carlos M. , Masheb Robin M.
Published: April 2008

Objective: To examine rates of reported childhood maltreatment in binge eating disorder (BED), and to explore associations with obesity, gender, eating disorder features, and associated functioning.

Research Methods and Procedures: Subjects were 145 consecutive outpatients with BED as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Subjects were interviewed and they completed questionnaires to assess eating disorder features and functioning. The Childhood Trauma Questionnaire was given to assess childhood maltreatment in five domains (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect).

Results: A total of 83% of BED patients reported some form of childhood maltreatment. A total of 59% of BED patients reported emotional abuse, 36% reported physical abuse, 30% reported sexual abuse, 69% reported emotional neglect, and 49% reported physical neglect. There were no differences in the distribution of any form of childhood maltreatment by gender or by obesity status. The different forms of maltreatment were not associated with variability in current body mass index, binge eating, or in the attitudinal features of eating disorders. Only one of the five forms of maltreatment (physical neglect) was associated with dietary restraint in women. Emotional abuse was significantly associated with greater body dissatisfaction, higher depression, and lower self‐esteem in men and women and sexual abuse was associated with greater body dissatisfaction in men. The different forms of maltreatment were unrelated to the age at onset of overweight, dieting, or binge eating.

Discussion: BED outpatients reported a wide range of childhood experiences of maltreatment that do not differ by gender or obesity status. Different forms of maltreatment were not associated with the onset of overweight, dieting, or binge eating, or with variability in current body mass index or eating disorder features (except for one association between physical neglect and dietary restraint). Reports of emotional abuse were associated with greater body dissatisfaction and depression and lower self‐esteem in men and women and sexual abuse with greater body dissatisfaction in men.