Exercise in weight management of obesity

Promoting physical activity in a low-income neighborhood of the Paris suburb of Saint-Denis: effects of a community-based intervention to increase physical activity

Background

Physical activity (PA) is a key factor for facing the increasing prevalence of obesity and overweight, and should be part of every public health programs. In this context, a community-based public health program promoting PA was developed in a low-income neighborhood of the city of Saint-Denis (France).

Methods

This work aimed at assessing the effectiveness of a 2-year PA promotion program.

A quasi-experimental study was carried out using a pre/post design, with an assessment before (2013) and after (2015) the program. The interviewees were selected using a stratified random cluster sampling. The primary outcome was the proportion of participants practicing sufficient PA (WHO guidelines), and was measured using the RPAQ questionnaire. External interventions (on both neighborhood environment and inhabitants) were listed.

Results

We collected 199 questionnaires at baseline and 217 in 2015. There was a majority of women in both samples: 64.3 % in 2013 and 58.2 % in 2015. The average age of participants was 38.1 years (+/−1.1) and 40.6 (+/−1.1) respectively. The proportion of people practicing sufficient PA was modified from 48.1 % in 2013 to 63.5 % in 2015 (p = 0.001). This was mainly driven by women whose level of PA, increased from 40.3 % to 60.3 % (p = 0.002), reaching the average national French estimation of PA level among adults (63.5 %).

Conclusions

This work showed a significant increase of the proportion of people practicing PA in a disadvantaged neighborhood where a community-based program promoting PA was developed. Simultaneous external interventions contributed to the results, showing the necessity of synergic interventions to reach efficiency.

Trekking poles reduce downhill walking-induced muscle and cartilage damage in obese women

[Purpose] This study investigated the effect of the use of trekking poles on muscle and cartilage damage and fatigue during downhill walking in obese women. [Subjects and Methods] Subjects included eight obese women who had a body fat percentage greater than 30. Subjects performed downhill walking without a trekking pole (NP) and with a trekking pole (TP) at 50% heart rate reserve for 30 minutes on a treadmill. The treadmill was set at a 15% downhill declination. Blood samples were collected to examine muscle damage (serum creatine kinase [CK] and lactate dehydrogenase [LDH] levels), cartilage damage (serum cartilage oligomeric matrix protein [COMP] levels), and fatigue (plasma lactate levels) at the pre-walking baseline (PWB), immediately after walking (IAW), and 2 hours post-walking (2HPW). [Results] The CK, LDH, COMP, and lactate levels were significantly increased IAW when compared with those at the PWB in both trials. In addition, in the NP trial, the CK, LDH, and COMP levels were significantly increased at 2HPW when compared with those at the PWB. [Conclusion] Downhill walking can cause muscle and cartilage damage, and our results suggest that the use of a trekking pole can reduce temporary muscle and cartilage damage after downhill walking.

Exercise-Induced Skeletal Muscle Adaptations Alter the Activity of Adipose Progenitor Cells

Exercise decreases adiposity and improves metabolic health; however, the physiological and molecular underpinnings of these phenomena remain unknown. Here, we investigate the effect of endurance training on adipose progenitor lineage commitment. Using mice with genetically labeled adipose progenitors, we show that these cells react to exercise by decreasing their proliferation and differentiation potential. Analyses of mouse models that mimic the skeletal muscle adaptation to exercise indicate that muscle, in a non-autonomous manner, regulates adipose progenitor homeostasis, highlighting a role for muscle-derived secreted factors. These findings support a humoral link between skeletal muscle and adipose progenitors and indicate that manipulation of adipose stem cell function may help address obesity and diabetes.

Genotype vs. Phenotype and the Rise of Non-Communicable Diseases: The Importance of Lifestyle Behaviors During Childhood

Despite continued research and growing public awareness, the incidence of non-communicable diseases (NCD) continues to accelerate. While a person may have a genetic predisposition to certain NCDs, the rapidly changing epidemiology of NCDs points to the importance of environmental, social, and behavioural determinants of health. Specifically, three lifestyle behaviours expose children to important environmental cues and stressors: physical activity, nutritional intake, and sleep behaviour. Failure to expose children to proper gene-environment interactions, through the aforementioned lifestyle behaviours, can and will predispose children to the development of NCDs. Reengineering the environments of children can induce a paradigm shift, from a predominantly biomedical health model of treating symptomology, to a more holistic model based on encouraging appropriate behavioral decisions and optimal health.

Impacts of Physical Activity on the Obese

Approximately two-thirds of the US population is overweight or obese. Physical activity is recommended for preventing obesity, aiding in weight loss, and decreasing rates of chronic diseases. This article reviews current statistics for obesity, physical activity, and physician counseling patterns. Principles of exercise physiology relating to cardiopulmonary fitness and chronic disease are also reviewed and methods for increasing physical activity in adults and children are suggested.

European Guidelines for Obesity Management in Adults

Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management.

The gap between expectations and reality of exercise-induced weight loss is associated with discouragement

BACKGROUND

Exercise interventions result in modest weight loss, yet exercise is frequently prescribed for weight loss.

PURPOSE

To identify individuals who become discouraged when exercise fails to achieve weight loss.

METHODS

Representative samples of U.S. adults were recruited using Google Consumer Surveys in August-October 2014. Respondents were asked about beliefs and potential discouragement regarding the role of exercise and weight loss. An analysis of variance was performed to predict individuals that become discouraged if exercise does not lead to weight loss.

RESULTS

The belief that exercise is a very effective way to lose weight was common (71% of respondents). Stronger belief that exercise is an effective way to lose weight (p<0.001) in individuals with higher weight status (p=0.04) positively predicted discouragement with exercise. Higher weight status combined with the belief that exercise reduces weight was a significant positive predictor of discouragement (p=0.01).

CONCLUSIONS

Individuals with higher weight status that believe that exercise is an effective way to lose weight are more likely to become discouraged when exercise does not lead to weight loss. Prescribing exercise for weight loss might contribute to discouragement. Future studies should evaluate ways to encourage exercise without promoting the belief that exercise will yield weight loss.

Mediating Effect of Perceived Overweight on the Association between Actual Obesity and Intention for Weight Control; Role of Race, Ethnicity, and Gender

Background:

Although obesity is expected to be associated with intention to reduce weight, this effect may be through perceived overweight. This study tested if perceived overweight mediates the association between actual obesity and intention to control weight in groups based on the intersection of race and gender. For this purpose, we compared Non-Hispanic White men, Non-Hispanic White women, African American men, African American women, Caribbean Black men, and Caribbean Black women.

Methods:

National Survey of American Life, 2001–2003 included 5,810 American adults (3516 African Americans, 1415 Caribbean Blacks, and 879 Non-Hispanic Whites). Weight control intention was entered as the main outcome. In the first step, we fitted race/gender specific logistic regression models with the intention for weight control as outcome, body mass index as predictor and sociodemographics as covariates. In the next step, to test mediation, we added perceived weight to the model.

Results:

Obesity was positively associated with intention for weight control among all race × gender groups. Perceived overweight fully mediated the association between actual obesity and intention for weight control among Non-Hispanic White women, African American men, and Caribbean Black men. The mediation was only partial for Non-Hispanic White men, African American women, and Caribbean Black women.

Conclusions:

The complex relation between actual weight, perceived weight, and weight control intentions depends on the intersection of race and gender. Perceived overweight plays a more salient role for Non-Hispanic White women and Black men than White men and Black women. Weight loss programs may benefit from being tailored based on race and gender. This finding also sheds more light to the disproportionately high rate of obesity among Black women in US.

The Association Between Obesity and Weight Loss Intention Weaker Among Blacks and Men than Whites and Women

INTRODUCTION

Although obesity is associated with weight loss intention, the magnitude of this association may differ across various populations. Using a nationally representative data of the United States, this study tested the variation of the association between obesity and weight loss intention based on race and gender.

METHODS

Data came from the National Survey of American Life (NSAL), 2001-2003, which enrolled 5,810 nationally representative sample of adults (3,516 African Americans, 1,415 Caribbean Blacks, and 879 Non-Hispanic Whites). Socio-demographics, body mass index (BMI), and weight loss intention were measured. We fitted logistic regression models in the pooled sample with weight loss intention as outcome, obesity (BMI > 30) as predictor, while the effect of covariates were controlled. To test our moderation hypotheses, we entered race * obesity and gender * obesity interactions to the model.

RESULTS

Although the association between obesity and weight loss intention was significant among both race and gender groups, the magnitude of the association between obesity and weight loss intention was larger for women than men and Whites than Blacks. That means individuals with obesity have less intention for weight loss if they are Black or men.

CONCLUSION

The link between obesity and weight loss intention depends on race and gender. Weight loss intention may not increase in response to obesity among Blacks and men, compared to Whites and women. Healthy weight programs in the United States may benefit from tailoring based on race and gender.

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers

Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.

Sudden cardiac death and obesity

For individuals and the society as a whole, the increased risk of sudden cardiac death in obese patients is becoming a major challenge, especially since obesity prevalence has been increasing steadily around the globe. Traditional risk factors and obesity often coexist. Hypertension, diabetes, obstructive sleep apnea and metabolic syndrome are well-known risk factors for CV disease and are often present in the obese patient. Although the bulk of evidence is circumstantial, sudden cardiac death and obesity share common traditional CV risk factors. Structural, functional and metabolic factors modulate and influence the risk of sudden cardiac death in the obese population. Other risk factors such as left ventricular hypertrophy, increased number of premature ventricular complexes, altered QT interval and reduced heart rate variability are all documented in both obese and sudden cardiac death populations. The present review focuses on out-of-hospital sudden cardiac death and potential mechanisms leading to sudden cardiac death in this population.

Change in weight and body composition in obese subjects following a hypocaloric diet plus different training programs or physical activity recommendations

The aim of the present study was to compare the effects of different physical activity programs, in combination with a hypocaloric diet, on anthropometric variables and body composition in obese subjects. Ninety-six obese (men: n = 48; women: n = 48; age range: 18-50 yr) participated in a supervised 22-wk program. They were randomized into four groups: strength training (S; n = 24), endurance training (E; n = 26), combined strength + endurance training (SE; n = 24), and physical activity recommendations (C; n = 22). In addition, all groups followed the same hypocaloric diet. At baseline and at the end of the intervention, dietetic and physical activity variables were assessed using validated questionnaires. Anthropometric variables were recorded along with body composition variables measured using dual-energy X-ray absorptiometry techniques. At the end of the intervention, significant improvements were seen within groups in terms of body weight (S: -9.21 ± 0.83 kg; E: -10.55 ± 0.80 kg; SE: -9.88 ± 0.85 kg; C: -8.69 ± 0.89 kg), and total fat mass (S: -5.24 ± 0.55%; E: -5.35 ± 0.55%; SE: -4.85 ± 0.56%; C: -4.89 ± 0.59%). No differences were seen between groups at this time in terms of any other anthropometric or body composition variables examined. All groups increased their total physical activity in metabolic equivalents (MET) per week during the intervention, but with no difference between groups (S: 976 ± 367 MET-min/wk; E: 954 ± 355 MET-min/wk; SE: 1 329 ± 345 MET-min/wk; C: 763 ± 410 MET-min/wk). This study shows that, when combined with a hypocaloric diet, exercise training and adherence to physical activity recommendations are equally effective at reducing body weight and modifying body composition in the treatment of obesity (Clinical Trials Gov. number: NCT01116856).

Suryanamaskar: An equivalent approach towards management of physical fitness in obese females

BACKGROUND

In India, obesity is highly prevalent in women as compared to men. As the obesity epidemic spreads, there are growing concerns about efficient obesity management.

AIMS

To compare between circuit training (CT), treadmill (TM) walking and suryanamaskar (SN) training in weight management and physical fitness enhancement in obese females.

SETTINGS AND DESIGNS

Comparative controlled study conducted in a community setting.

MATERIALS AND METHODS

119 females of age between 20 and 40 years of body mass index (BMI) between 25.1 and 34.9 kg/m(2). 87 participants completed the study. Group 1: CT; group 2: TM walking; group 3: Modified SN; group 4: Control.

OUTCOME MEASURES

Body composition, cardio-respiratory and muscle endurance, flexibility.

STATISTICAL ANALYSIS

Within-group data was analyzed with the paired t-test. P =0.05. Analysis between the groups was done using one way ANOVA test. Analysis between the groups was done using ANCOVA test controlling for baseline differences only for those variables that have significant differences at baseline. For those which do not have significant difference at baseline, RMANOVA was done at end of 8 weeks.

RESULTS

Reducation in mean body weight in CT group (2.2%), TM (1.7%) and SN (1.6%), (P < 0.05), BMI in all the three groups (P < 0.01), total body fat % in the CT (5%) and SN (3.7%), (P < 0.01), metabolic age with CT (2%) and TM (2%), (P = 0.001). Improvement in muscle mass in CT (4%, P = 0.009), VO2max in CT group by 17.2%, SN (14%), TM group (8%) (P < 0.05). Upper limb Muscle endurance in CT (51.3%), SN group (51.24%) and in TM group (40%), (P = 0.05), in lower limb TM (21.2%) and SN (24.5%) (P = 0.05), flexibility in SN (12.4%, P = 0.0001).

CONCLUSIONS

All three methods were effective in weight and physical fitness management. CT and SN were more effective in improving cardio-respiratory fitness and upper limb muscle endurance while only SN was effective in improving body flexibility.

Can't wait to lose weight? Characterizing temporal discounting parameters for weight-loss

Obesity is often related to steeper temporal discounting, that is, higher decision impulsivity for immediate rewards over delayed rewards. However, previous studies have measured temporal discounting parameters through monetary rewards. The aim of this study was to develop a temporal discounting measure based on weight-loss rewards, which may help to understand decision-making mechanisms more closely related to body weight regulation. After having their heights and weights measured, healthy young adults completed the Monetary Choice Questionnaire (MCQ), and an adapted version of the MCQ, with weight-loss as a reward. Participants also completed self-reports that measure obesity-related cognitive variables. For 42 participants who expressed a desire to lose weight, weight-loss rewards were discounted over time and had a positive correlation with temporal discounting for monetary rewards. Higher temporal discounting for weight loss rewards (i.e., preference for immediate weight loss) showed correlations with beliefs that obesity is under obese persons' control and largely due to lack of willpower, while temporal discounting parameters for monetary rewards did not. Taken together, our weight loss temporal discounting measure demonstrated both convergent and divergent validity, which can be utilized for future obesity research and interventions.

Mechanisms governing the health and performance benefits of exercise

Humans are considered among the greatest if not the greatest endurance land animals. Over the last 50 years, as the population has become more sedentary, rates of cardiovascular disease and its associated risk factors such as obesity, type 2 diabetes and hypertension have all increased. Aerobic fitness is considered protective for all-cause mortality, cardiovascular disease, a variety of cancers, joint disease and depression. Here, I will review the emerging mechanisms that underlie the response to exercise, focusing on the major target organ the skeletal muscle system. Understanding the mechanisms of action of exercise will allow us to develop new therapies that mimic the protective actions of exercise.

Impact of bariatric surgery on cardiac structure, function and clinical manifestations in morbid obesity

Obesity results from the excessive accumulation of fat. Risk of premature death is doubled compared to nonobese individuals, and risk of death from cardiovascular disease is increased fivefold. In patients with morbid obesity, a variety of adaptations and alterations in cardiac structure and function occur in the individual, as an excess amount of adipose tissue accumulates. The high long-term failure rate of diet intervention is well acknowledged by the clinician. Surgery for severe obesity has evolved during the last 40 years. Many surgical techniques have been described and abandoned. Nevertheless, numerous different techniques are still in use today. Weight loss has beneficial impacts on functional and structural cardiac status and will be reviewed in this report.

Does the effect of supervised cardiac rehabilitation programs on body fat distribution remained long time?

INTRODUCTION

An increased accumulation of fat in the intra-abdominal cavity is highly correlated with adverse coronary risk profiles. Cardiac rehabilitation (CR) produces a host of health benefits related to modifiable cardiovascular risk factors. Further research is needed to define better program for weight loss and risk improvement in coronary patients. The aim of this study was to determine the effect of supervised and unsupervised cardiac rehabilitation program on body composition and body fat distribution in a population with coronary artery disease.

METHODS

The study investigated 167 patients with coronary artery disease (73% males; mean age = 52.67±9.11 years) before and after a supervised protocol cardiac rehabilitation program, and 12-months later. Target variables included body fat distribution indices (waist and hip circumference and waist to hip ratio), weight and body mass index.

RESULTS

Weight, waist circumference, waist to hip ratio and body mass index significantly decreased with 2 month supervised program (P<0.001), but hip circumference was not significantly changed. Males improved to a greater extent than the female patients. All of measurements relatively returned to baseline at the end of program (after 12 months).

CONCLUSION

Supervised cardiac rehabilitation program results in improvements in body composition and body fat distribution. The effects of non-supervised program were minimal and the program needed to be reviewed.

Management of Cardiovascular Risk Factors in High Risk Patients: Correlates of Quality of Care

Izhodišča: Bolezni srca in ožilja (BSO) predstavljajo vodilni vzrok smrti v večini evropskih držav, njihovo preprečevanje pa predstavlja pomembno nalogo osnovnega zdravstvenega varstva. Ocena dejavnikov tveganja in usmerjene preventivne aktivnosti so posebej pomembne pri visokoogroženih bolnikih. Pomembno je poznati tudi dejavnike, ki vplivajo na uspešnost preventive teh bolezni.

Metode: V presečno raziskavo je bilo z naključnim stratificiranim vzorčenjem vključenih 36 slovenskih ambulant. Vsaka ambulanta je iz registra visokoogroženih vključila 30 bolnikov, ki so izpolnili vprašalnik o življenjskem slogu, kakovosti življenja, samooceni zdravja in o uporabi zdravstvenih storitev. Vir podatkov o dejavnikih tveganja BSO so bile kartoteke bolnikov, z vprašalnikom o ambulanti pa so bila pridobljena vprašanja o obremenjenosti, projektih kakovosti, izobraževanju, informacijski tehnologiji, o preventivnih aktivnostih.

Rezultati: Sodelovalo je 871 bolnikov iz 36 ambulant (80,6 % predvidenega vzorca), starih 62,4 leta (SD±8,6). 22,4 % je bilo kadilcev; priporočeno raven aerobne telesne aktivnosti je vzdrževalo 330 (48,8 %) sodelujočih, najmanj urejen dejavnik tveganja pa je bil indeks telesne mase (29,3kg/m2). V multivariatnem modelu so vsi dejavniki (ambulante, bolniki in zdravniki) statistično značilno napovedali urejenost dejavnikov tveganja (p<0,005, F=2,7, R2 =0,087). Neodvisne spremenljivke bolje urejenih dejavnikov tveganja so bile: ženski spol, višja starost in višja izobrazba bolnika, uporaba informacijskega sistema v ambulanti, organizacija srčno-žilne preventive in zdravnikova profesionalna aktivnost v projektih preventive.

Zaključki: Urejenost dejavnikov tveganja je v največji meri odvisna od značilnosti ambulante, predvsem organizacije na področju preventive, ter od strokovne aktivnosti zdravnika. Vplivajo tudi nekatere splošne značilnosti bolnika. Pomembni so še drugi dejavniki, ki niso bili vključeni v model.

Are obese women more likely to participate in a mobile mammography program?

Mobile mammography services are typically offered as a means to increase access and adherence to mammography screenings. As mobile mammography becomes a viable strategy to increase screening, a 3 year study of such a state-wide program in WV found surprisingly high rates of obesity within the study population. Thus, the objectives were to: (1) describe the demographic characteristics and comorbidities of women who utilized the WV program, and (2) determine the association between body mass index (BMI) and personal health and screening history, preventive care and wellness behaviors, nutrition and exercise behaviors, and demographics. Data collected from 1,099 women, age 40 and above, were analyzed using descriptive statistics, bivariate analyses, and a multivariate regression model. The majority (60.4 %) were married, had an income <$25,000 (59.2 %), and had health insurance (53.5 %). Major comorbidities were hypertension (49 %) and high cholesterol (43.9 %). Based on BMI scores, 884 participants were either overweight (26.6 %), mildly obese (27.7 %), moderately obese (15.1 %), or severely obese (11.1 %). Bivariate analyses indicated that increasing BMI was significantly associated with factors such as having hypertension or diabetes, limited daily activities, perceived health, and not smoking or drinking. The regression model was significant (p < 0.001; R2 = 0.425) indicating that women who engaged in preventive care behaviors were less likely to be obese than those who did not. The WV mobile mammography program appeared to attract women who were disproportionately obese and had multiple comorbidities, thus providing a great opportunity for targeted interventions related to improving preventive care and screening behaviors.

Origins of balance disorders during a daily living movement in obese: can biomechanical factors explain everything?

Obese people suffer from postural deficits and are more subject to falls than their lean counterpart. To improve prevention and post-fall rehabilitation programs, it seems important to better understand the posturo-kinetic disorders in daily life situations by determining the contribution of some key factors, mainly morphological characteristics and physical activity level, in the apparition of these disorders. Twelve severe android obese and eight healthy non obese adults performed a reaching task mobilizing the whole body. To further determine the origin of the postural and motor behavior differences, non obese individuals also performed an experimental session with additional constraints which simulated some of the obese morphological characteristics. Impact of the sedentary lifestyle was also studied by dissociation of the obese in two subgroups: physically « active » and physically « inactive ». Movement kinetics and kinematics were characterized with an optoelectronic system synchronized to a force platform. The mechanical equilibrium pattern was evaluated through the displacements of the Centre of Mass (CoM) and the centre of foot pressure within the Base of Support (BoS). Results showed that obesity decreased movement speed (≈-23%, p<0.01), strongly increased CoM displacement (≈+30%, p<0.05) and induced an important spatio-temporal desynchronization (≈+40%, p<0.05) of the focal and postural components of the movement during the transition between the descending and ascending movements. The role of some morphological characteristics and of physical activity on obese patients' postural control disorder is discussed and set back in the more general context of overall factors contributing to postural deficits with obesity.

The effects of an 8-week multicomponent inpatient treatment program on body composition and anaerobic fitness in overweight and obese children and adolescents

Background

High intensity exercise is considered as an effective means for reducing body fat. The aims of the present study were to investigate (1) whether body mass would be lost and body composition would change and (2) whether variables of anaerobic fitness prior to the intervention period would be related to loss of body mass and changes in body composition in overweight and obese children and adolescents.

Methods

A total of 28 children and adolescents (19 boys, 9 girls) attended an 8-week multicomponent inpatient program. Caloric intake was based on the subject’s weight and a daily energy deficit of ~500 kcal was targeted. At the beginning and at the end of the program, variables of anaerobic fitness were assessed using Wingate tests. Body composition was measured before and after the program using dual-energy X-ray absorptiometry.

Results

Body mass decreased by 11.4% ± 1.6% in boys and by 11.0% ± 2.8% in girls (P < 0.001). Fat mass decreased by 23.8% ± 6.1% in boys and by 21.5% ± 5.2% in girls (P < 0.001). The decrease in fat mass was associated with the decrease in body mass in boys (r = 0.54, P = 0.017) but not in girls (P > 0.05). The decrease in body mass and the decrease in fat mass were neither associated with overall energy expenditure nor with the energy deficit in both genders (P > 0.05). Mean power in W/kg increased in the Wingate tests by 95.4% ± 109.1% in boys and by 100.0% ± 119.9% in girls (P < 0.001).

Conclusions

Adjustments of the chronically positive imbalance of energy intake and energy expenditure of obese children and adolescents living in obesogenic environments should be addressed in a multisectoral approach. Future research in multicomponent childhood and adolescent weight loss programs should be directed towards a better understanding of the underlying complex dynamics in energy homeostasis which promote weight loss and changes in body composition due to high intensity exercise interventions.

Cardiovascular benefits of exercise

Regular physical activity during leisure time has been shown to be associated with better health outcomes. The American Heart Association, the Centers for Disease Control and Prevention and the American College of Sports Medicine all recommend regular physical activity of moderate intensity for the prevention and complementary treatment of several diseases. The therapeutic role of exercise in maintaining good health and treating diseases is not new. The benefits of physical activity date back to Susruta, a 600 BC physician in India, who prescribed exercise to patients. Hippocrates (460–377 BC) wrote “in order to remain healthy, the entire day should be devoted exclusively to ways and means of increasing one’s strength and staying healthy, and the best way to do so is through physical exercise.” Plato (427–347 BC) referred to medicine as a sister art to physical exercise while the noted ancient Greek physician Galen (129–217 AD) penned several essays on aerobic fitness and strengthening muscles. This article briefly reviews the beneficial effects of physical activity on cardiovascular diseases.

Change of energy expenditure from physical activity is the most powerful determinant of improved insulin sensitivity in overweight patients with coronary artery disease participating in an intensive lifestyle modification program

The objective was to evaluate the determinants of change (Δ) in insulin sensitivity in overweight coronary artery disease male patients without diabetes after an intensive lifestyle intervention. All patients received nutritional counseling and performed 4 months of exercise training (ET) according to 1 of 2 protocols: aerobic ET (65%-70% of peak aerobic capacity [VO(2)]) 25 to 40 minutes 3 times a week (n = 30) or walking (50%-60% of peak VO(2)) 45 to 60 minutes at least 5 times a week (n = 30). Data from participants of both ET groups were pooled, and post-intensive lifestyle intervention results were compared with baseline data. The primary outcome was Δ insulin sensitivity (m-value) assessed by the criterion standard technique, the euglycemic-hyperinsulinemic clamp. Changes in weight, body mass index, total and percentage fat mass (by dual-energy x-ray absorptiometry scan), waist circumference, total abdominal and visceral fat (by computed tomographic scan), high-sensitivity C-reactive protein, peak VO(2), daily energy intake, and physical activity energy expenditure (PAEE) (by doubly labeled water technique) were also assessed. Daily energy intake decreased by 335 kcal, and PAEE increased by 482 kcal/d (all P < .0001). The mean weight loss was 6.4 kg, and the mean improvement in m-value was 1.6 mg/kg fat-free mass per minute. Univariate determinants of Δ m-value were low baseline PAEE, walking protocol, Δ weight, Δ body mass index, Δ total and percentage fat mass, Δ waist circumference, Δ total abdominal and visceral fat, and Δ PAEE (all P < .05). In multivariate analysis, the only significant determinant of Δ m-value was Δ PAEE (P < .02). In this analysis, the most powerful determinant of improved insulin sensitivity in overweight coronary artery disease patients is the change in PAEE.

Differences in amounts and types of physical activity by obesity status in US adults

OBJECTIVES

To describe the physical activity patterns across levels of obesity among US adults.

METHODS

The frequency, intensity, and duration of physical activities were compared across obesity status in 7695 adults from NHANES, 1999-2006.

RESULTS

Significantly more normal-weight adults engaged in moderate- and vigorous- intensity activities and for a longer duration than did their overweight or obese counterparts. Lower intensity, longer duration walking contributed to nearly half of all moderate activity among obese subjects.

CONCLUSIONS

Significant differences exist in intensity, frequency, and duration of physical activity by weight status. This information suggests a targeted approach to current physical activity interventions be explored.

Obesity management and continuing medical education in primary care: results of a Swiss survey

Background

The worldwide increase in obesity is becoming a major health concern. General practitioners (GPs) play a central role in managing obesity. We aimed to examine Swiss GPs self-reported practice in diagnosis and treatment of obesity with a special focus on the performance of waist measurement.

Methods

A structured self-reported questionnaire was mailed to 323 GPs recruited from four urban physician networks in Switzerland. Measures included professional experience, type of practice, obesity-related continuing medical education (CME) and practice in dealing with obesity such as waist measurement. We assessed the association between the performance of waist measurement and obesity-related CME by multivariate ordered logistic regression controlling for GP characteristics as potential confounders.

Results

A total of 187 GPs responded to the questionnaire. More than half of the GPs felt confident in managing obesity. The majority of the GPs (73%) spent less than 4 days in the last 5 years on obesity-related CME. More than half of GPs gave advice to reduce energy intakes (64%), intakes of high caloric and alcoholic drinks (56%) and to increase the physical activity (78%). Half of the GPs seldom performed waist measurement and documentation. The frequency of obesity-related CME was independently associated with the performance of waist measurement when controlled for GPs' characteristics by multivariate ordered logistic regression.

Conclusions

The majority of GPs followed guideline recommendations promoting physical activity and dietary counselling. We observed a gap between the increasing evidence for waist circumference assessment as an important measure in obesity management and actual clinical practice. Our data indicated that specific obesity-related CME might help to reduce this gap.

Reproducibility, validity and predictors of six-minute walk test in overweight and obese adolescents with intellectual disability

OBJECTIVES

To assess the reproducibility and validity of the six-minute walk test (6MWT) and predictors of the six-minute walk distance (6MWD) in adolescents with overweight or obesity and intellectual disability (ID).

STUDY DESIGN

Sixty-one adolescents with overweight or obesity and mild-to-moderate ID (intelligent quotient [IQ] 40-70; age 14-22 years) participated in this study. To test reproducibility, 39 of the participants performed the 6MWT twice with an interval of 1 week. To test validity (n = 39), peak oxygen uptake (peak VO(2)) was measured on a bicycle ergometer. For the predictor study (n = 61), weight, height, peak VO(2) and quadriceps strength were measured, and IQ and orthopedic conditions were collected from the participants' medical records.

RESULTS

There was no significant difference between the means of the two 6MWTs (571.3 vs. 576.5 m; p = 0.452). The intraclass correlation coefficient was 0.82, indicating good reliability. The smallest real difference was 82.6 m. 6MWD correlated significantly with relative peak VO(2) (β = 0.69) indicating validity. Relative peak VO(2), height, IQ, body mass index (BMI) and quadriceps strength are predictors of the 6MWD in this population.

CONCLUSION

6MWT is a reliable and valid test in adolescents with overweight or obesity and ID. Low IQ, overweight/obesity and low physical fitness contribute to the outcome of the 6MWT.

Biochemical and anthropometric effects of a weight loss dietary supplement in healthy men and women

Background:

We have recently noted an acute increase in circulating free fatty acids and glycerol, as well as resting metabolic rate, when men and women ingested the dietary supplement OxyELITE Pro™ in a single dose. We have also noted a reduction in appetite when subjects were treated with this supplement for 14 consecutive days. It is possible that such findings may favor body weight and fat loss over time. Therefore, the purpose of the present study was to determine the effects of this dietary supplement on weight loss and associated markers using an eight week intervention.

Methods:

Exercise-trained subjects were randomly assigned in double blind manner to ingest either the dietary supplement (n = 16; aged 22.8 ± 0.7) or a placebo (n = 16; 22.5 ± 0.5) every day for eight weeks. Body weight, body composition, skinfold thickness, serum lipids, and appetite were measured as the primary outcome variables. As measures of supplement safety, a complete blood count and comprehensive metabolic panel were performed, and resting heart rate and blood pressure were measured (pre and post intervention).

Results:

No interactions or main effects were noted for our primary outcome measures (P > 0.05). However, when comparing pre and post intervention values for the supplement, significant decreases were noted in appetite, body weight, body fat percentage, and skinfold thickness (P < 0.05), while increases were noted for total and HDL-C, as well as for resting heart rate (P < 0.05). No changes were noted for placebo from pre to post intervention (P > 0.05), with the exception of an increase in HDL-C (P < 0.05). Blood pressure and bloodborne safety variables were not differently impacted by supplement or placebo (P > 0.05), with the exception of monocytes, for which an interaction effect was noted (P = 0.04).

Conclusion:

These data indicate that the dietary supplement OxyELITE Pro™ may assist in weight and body fat loss in a sample of exercise-trained men and women. The supplement does not result in any adverse effects pertaining to resting blood pressure or bloodborne markers of safety; however a small increase in resting heart rate is observed.

The effect of combined exercise training in adolescents who are overweight or obese with intellectual disability: the role of training frequency

Data about effects of exercise training in adolescents with intellectual disability (ID) are very limited. This study investigated the effect of 2 different frequencies of the same intensity and total training volume of combined exercise training on indices of body composition, physical fitness, and lipid profile in overweight and obese adolescents with ID. A total of 45 overweight and obese adolescents with ID aged 14-22 years with a total IQ 45-70 received combined exercise training 3 times a week (CET3) for 30 sessions (10 weeks; n = 15), twice a week (CET2) for 30 sessions (15 weeks; n = 15), or no training (10 weeks; n = 15). Groups were matched for age, sex, and education form. Before and after the intervention period, indices of body composition, physical fitness and lipid profile have been evaluated. Compared to the control group, CET3 resulted in a significant improvement of physical fitness, obesity indices, and lipid profile of the participants. Comparing CET2 with CET3, no significantly different evolutions were noticed, except for lower limb strength in favor of exercising 3 times a week. In conclusion, exercising 2 times a week, which is more feasible and practical for participants and guidance, has the same health beneficial effects as 3 times per week in overweight and obese adolescents with ID in short-term training.

Expression of microRNAs: potential molecular link between obesity, diabetes and cancer

Clinicians are routinely challenged in their management of cancer patients because of the complexities of obesity and diabetes that are often found as comorbid conditions. Although attention has been given to optimizing treatment planning for these patients, less attention has been given to manage their obesity and diabetes. This suggests that newer, comprehensive approaches must be developed for the treatment of cancer patients as a 'whole' rather than as a single disease. While the specific pathologies of each are unique, years of research have indicated intimate molecular links between these chronic diseases. The contribution of sedentary lifestyles and poor dietary habits is recognized; however, the precise molecular links are still not well-explored. In addition, emerging evidence suggests the important role of microRNAs (miRNAs) in the development and progression of several diseases, yet their roles in linking obesity, diabetes and cancer are only now beginning to be recognized. It is hoped that miRNAs will serve as novel biomarkers and molecular targets for cancer therapy in patients with comorbid conditions. In this review, we discuss the current understanding of the pathobiology of obesity, diabetes and cancer, and document molecular roles of miRNAs linking cancer with obesity and diabetes.

Similar qualitative and quantitative changes of mitochondrial respiration following strength and endurance training in normoxia and hypoxia in sedentary humans

Endurance and strength training are established as distinct exercise modalities, increasing either mitochondrial density or myofibrillar units. Recent research, however, suggests that mitochondrial biogenesis is stimulated by both training modalities. To test the training “specificity” hypothesis, mitochondrial respiration was studied in permeabilized muscle fibers from 25 sedentary adults after endurance (ET) or strength training (ST) in normoxia or hypoxia [fraction of inspired oxygen (FiO2) = 21% or 13.5%]. Biopsies were taken from the musculus vastus lateralis, and cycle-ergometric incremental maximum oxygen uptake (V̇o2max) exercise tests were performed under normoxia, before and after the 10-wk training program. The main finding was a significant increase ( P < 0.05) of fatty acid oxidation capacity per muscle mass, after endurance and strength training under normoxia [2.6- and 2.4-fold for endurance training normoxia group (ETN) and strength training normoxia group (STN); n = 8 and 3] and hypoxia [2.0-fold for the endurance training hypoxia group (ETH) and strength training hypoxia group (STH); n = 7 and 7], and higher coupling control of oxidative phosphorylation. The enhanced lipid oxidative phosphorylation (OXPHOS) capacity was mainly (87%) due to qualitative mitochondrial changes increasing the relative capacity for fatty acid oxidation ( P < 0.01). Mitochondrial tissue-density contributed to a smaller extent (13%), reflected by the gain in muscle mass-specific respiratory capacity with a physiological substrate cocktail (glutamate, malate, succinate, and octanoylcarnitine). No significant increase was observed in mitochondrial DNA (mtDNA) content. Physiological OXPHOS capacity increased significantly in ETN ( P < 0.01), with the same trend in ETH and STH ( P < 0.1). The limitation of flux by the phosphorylation system was diminished after training. Importantly, key mitochondrial adaptations were similar after endurance and strength training, regardless of normoxic or hypoxic exercise. The transition from a sedentary to an active lifestyle induced muscular changes of mitochondrial quality representative of mitochondrial health.

Implications of nonshivering thermogenesis for energy balance regulation in humans

The incidence of the metabolic syndrome has reached epidemic levels in the Western world. With respect to the energy balance, most attention has been given to reducing energy (food) intake. Increasing energy expenditure is an important alternative strategy. Facultative thermogenesis, which is the increase in energy expenditure in response to cold or diet, may be an effective way to affect the energy balance. The recent identification of functional brown adipose tissue (BAT) in adult humans promoted a renewed interest in nonshivering thermogenesis (NST). The purpose of this review is to highlight the recent insight in NST, general aspects of its regulation, the major tissues involved, and its metabolic consequences. Sustainable NST in adult humans amounts to 15% of the average daily energy expenditure. Calculations based on the limited available literature show that BAT thermogenesis can amount to 5% of the basal metabolic rate. It is likely that at least a substantial part of NST can be attributed to BAT, but it is possible that other tissues contribute to NST. Several studies on mitochondrial uncoupling indicate that skeletal muscle is another potential contributor to facultative thermogenesis in humans. The general and synergistic role of the sympathetic nervous system and the thyroid axis in relation to NST is discussed. Finally, perspectives on BAT and skeletal muscle NST are given.

Effects of interactive video game cycling on overweight and obese adolescent health

The purpose of this study was to examine the efficacy of interactive video game stationary cycling (GameBike) in comparison with stationary cycling to music on adherence, energy expenditure measures, submaximal aerobic fitness, body composition, and cardiovascular disease risk markers in overweight and obese adolescents, using a randomized controlled trial design. Thirty overweight (with at least 1 metabolic complication) or obese adolescents aged 12-17 years were stratified by gender and randomized to video game or music condition, with 4 participants (2 per group) failing to complete the twice weekly 60 min sessions of the 10-week trial. The music group had a higher rate of attendance compared with the video game group (92% vs. 86%, p < 0.05). Time spent in minutes per session at vigorous intensity (80%-100% of predicted peak heart rate) (24.9 ± 20 min vs. 13.7 ± 12.8 min, p < 0.05) and average distance (km) pedaled per session (12.5 ± 2.8 km vs. 10.2 ± 2.2 km, p < 0.05) also favoured the music group. However, both interventions produced significant improvements in submaximal indicators of aerobic fitness as measured by a graded cycle ergometer protocol. Also, when collapsed, the exercise modalities reduced body fat percentage and total cholesterol. The present study indicates that cycling to music was just as effective as stationary cycling while playing video games at improving fitness, body composition, and cholesterol profiles in overweight and obese teens, and resulted in increased attendance, vigorous intensity of physical activity, and distance pedaled. Therefore, our data support the superiority of cycling to music and indicate investing in the more expensive GameBike may not be worth the cost.

MC4R variant is associated with BMI but not response to resistance training in young females

Recently, a genome-wide association study (GWAS) that identified eight single-nucleotide polymorphisms (SNPs) associated with BMI highlighted a possible neuronal influence on the development of obesity. We hypothesized these SNPs would govern the response of BMI and subcutaneous fat to resistance training in young individuals (age = 24 years). We genotyped the eight GWAS-identified SNPs in the article by Willer et al. in a cohort (n = 796) that undertook a 12-week resistance-training program. Females with a copy of the rare allele (C) for rs17782313 (MC4R) had significantly higher BMIs (

CC/CT

n = 174; 24.70 ± 0.33 kg/m², TT: n = 278; 23.41 ± 0.26 kg/m², P = 0.002), and the SNP explained 1.9% of overall variation in BMI. Males with a copy of the rare allele (T) for rs6548238 (TMEM18) had lower amounts of subcutaneous fat pretraining (CT/TT: n = 65; 156,534 ± 7,415 mm³, CC: n = 136; 177,825 ± 5,139 mm³, P = 0.019) and males with a copy of the rare allele (A) for rs9939609 (FTO) lost a significant amount of subcutaneous fat with exercise (

AT/AA

n = 83; -798.35 ± 2,624.30 mm³, TT: n = 47; 9,435.23 ± 3,494.44 mm³, P = 0.021). Females with a copy of the G allele for a missense variant in the SH2B1 (rs7498665) was associated with less change of subcutaneous fat volume with exercise (

AG/GG

n = 191; 9,813 ± 2,250 mm³ vs. AA: n = 126; 770 ± 2,772 mm³; P = 0.011). These data support the original finding that there is an association between measures of obesity and a variant near the MC4R gene and extends these results to a younger population and implicates FTO, TMEM18, and SH2B1 polymorphisms in subcutaneous fat regulation.

Effects of a lifestyle modification trial among phenotypically obese metabolically normal and phenotypically obese metabolically abnormal adolescents in comparison with phenotypically normal metabolically obese adolescents

This study aimed to assess the effects of a 2-month lifestyle modification trial on cardio-metabolic abnormalities and C-reactive protein (CRP) among obese adolescents with metabolic syndrome [phenotypically obese metabolically abnormal (POMA)] and obese adolescents without a cardio-metabolic disorder [phenotypically obese metabolically normal (POMN)], as well as in normal-weight adolescents with at least one cardio-metabolic disorder [phenotypically normal metabolically obese (PNMO)]. The study comprised 360 adolescents assigned in three groups of equal number of POMN, POMA and PNMO. They were enrolled in a trial consisting of aerobic activity classes, diet and behaviour modification, and were recalled after 6 months. Overall, 94.7% of participants completed the 2-month trial, and 87.3% of them returned after 6 months. The mean CRP was not significantly different between the POMA and PNMO groups, but was higher than in the POMN group. After the trial, body mass index (BMI) and waist circumference (WC) decreased in obese participants, and the mean body fat mass decreased in all groups. At 2 months, the mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and CRP decreased in the POMA and PNMO groups. After 2 and 6 months, the decrease in mean TC, LDL-C, TG, CRP and systolic blood pressure was greater in the POMA than in the POMN group. The magnitude of decrease in CRP correlated with that of BMI, WC, fat mass, TG, TC and LDL-C. Lifestyle modification programmes for primordial/primary prevention of chronic diseases would be beneficial at the population level and should not be limited to obese children.

Lifestyle factors and other health measures in a Canadian university community

With the increasing prevalence of obesity, there is a continuous search for effective obesity-prevention and health-promotion interventions. These interventions should be based on factors that have the potential to influence body weight and health. This study describes various health-related factors in a Canadian university community with the aim of developing more specific obesity interventions. A total of 3143 individuals completed an online questionnaire made up of 3 sections--on physical activity (PA), food habits, and other relevant lifestyle factors. The sampling error was +/-3.3% with a 95% confidence interval. Results showed that 22.9% of students and 37.3% of staff members were either overweight or obese. Students had less desirable eating patterns than staff members in terms of fish, energy drink, and regular milk product intake, and both groups reported undesirable breakfast consumption and quality. Nevertheless, results also showed that a high percentage of individuals in both groups did not meet the recommendations for vegetable, fruit, and fish intake, or PA. Only a few gender differences were observed in eating habits. Soft drink and energy drink consumption was higher and breakfast consumption was lower in men, whereas a higher percentage of women did not meet the recommendations for vegetable, fruit, or fish consumption. Dieting behaviours, disinhibition susceptibility, and moderate-intensity (MIPA) were the 3 lifestyle factors most highly associated with overweight and obesity in both groups. Results also suggest that female students were highly preoccupied with their body weight. This study shows that overweight and obesity are problems in a university community, and that they are associated with many health-related lifestyle behaviours. Although most of the lifestyle factors and health measures examined are similar across groups and genders, some differences call for the development of health-promotion programs with specific targeting strategies.

Addressing obesity in the hospitalized patient: a needs assessment

OBJECTIVE

To perform a needs assessment to determine the extent to which hospitalist providers recognize and intervene upon obese patients in the hospital setting.

METHODS

A chart review was performed for patients admitted to the hospitalist service at Johns Hopkins Bayview Medical Center between September 1 and October 1, 2008. Patient charts were reviewed for documentation of obesity and treatment plans were ordered and implemented. Demographic data for patients and hospitalist providers was also collected. Providers were also surveyed about their documentation practices related to obesity and any perceived barriers.

RESULTS

Forty-nine percent (136/276) of admitted patients were obese. Obesity was documented in 19% (26/136) of admission notes and a discrete plan was made to address obesity 7% (10/136) of the time. Hospitalist providers were more likely to document obesity in patients <60 years old (85% versus 55% respectively, P <0.007), and in patients with body mass indices (BMI) >or= 35 (77% versus 44% respectively, P < 0.004). Provider survey results suggest that providers do not document obesity because it is not considered to be an acute issue (67%), and they elect not to address obesity because they lack the time (63%), skill (37%), and they believe that their efforts will be unsuccessful (33%).

CONCLUSION

Documentation of obesity by hospitalist providers is poor. Because an inpatient admission has been characterized as a teachable moment when patients are willing to reflect on behavior change, this may be an ideal time to counsel and educate obese patients.

The role of physical activity in type 2 diabetes prevention: physiological and practical perspectives

Lifestyle changes that include a nutritionally balanced diet and increased physical activity (PA) are effective intervention options for persons with prediabetes who want to prevent progression to type 2 diabetes mellitus. Although nutritional counseling is standard practice for patients in a clinical setting, an individualized PA prescription, including recommendations on the type, frequency, duration, and intensity, is much less likely to occur. This is surprising because lifestyle modifications including a PA program are at least as effective in diabetes prevention as any single pharmacological agent. The success of regular PA in improving glycemic control in persons with either prediabetes or type 2 diabetes likely results from adaptations that occur in several organs and tissues, including adipose, skeletal muscle, liver, and pancreas. Increased insulin sensitivity is an important link between increased PA, body composition, and metabolic health, and it is at this link where increases in PA and energy expenditure exert much of their effect on preventing metabolic disorders and improving symptoms of existing disease. In addition to improving insulin sensitivity, regular PA has several cardioprotective effects, especially for persons with metabolic dysfunction, and has been shown to elicit minimal adverse events in these populations. Effective PA prescription is contingent on an understanding of the underlying physiological adaptations and the differing responses to diverse modes and intensities of PA. This article highlights recent findings on the beneficial role of regular PA for improving and/or maintaining insulin sensitivity in persons with prediabetes. We also provide an evidence-informed prescription for the type, intensity, and duration of both resistance and aerobic PA in persons with prediabetes.

Ovarian function and obesity--interrelationship, impact on women's reproductive lifespan and treatment options

Insulin resistance (IR) is a consequence of obesity, and in women it is often inextricably linked with ovarian function leading to clinical reproductive manifestations such as early menarche onset, subfertility and polycystic ovary syndrome (PCOS). Likewise, the dramatic fall in oestrogen production after menopause may contribute to weight gain and changes in adipose tissue distribution. Overall, women who are obese, especially those with reproductive complications including PCOS, have been identified as specific high risk subgroups for further progression through to prediabetes, type 2 diabetes mellitus (T2DM) and potentially cardiovascular disease (CVD). This review focuses on the interrelationship between the ovarian function and obesity as well as its treatment strategies.

Obesity treatment-more than food and exercise: a qualitative study exploring obese adolescents' and their parents' views on the former's obesity

The aim of this study was to explore obese adolescents’ and their parents’ views on the former's obesity; especially to gain knowledge about barriers and motivational factors that influence obese adolescents’ ability to lose weight. This is a qualitative study involving field observation and semi-structured interviews with obese adolescents and their parents. The analysis takes a phenomenological–hermeneutic approach. Fifteen obese adolescents aged 13–16 years and their parents/grandparents participated in this study (one father, seven mothers, five sets of parents and two sets of grandparents). The results showed that obese adolescents’ are aware that they have unhealthy eating habits and they wish they were able to attain to a healthier diet. Although in poor physical shape, obese adolescents perceive their daily level of exercise as moderate. Obese adolescents blame themselves for being obese and blame their parents for an unhealthy diet, and for being unsupportive regarding exercise. Parents blame their obese child of lacking will power to change eating and exercise habits. As a consequence, the homely atmosphere is often characterised by quarrels and negative feelings. The conclusion is that despite obese adolescents’ intention of reducing weight, underlying issues interfere with this goal. This is particularly related to quarrels with parents, self-blame and misguided understanding of eating and exercising habits. These matters need to be addressed when treating obesity among adolescents.

Exercise following bariatric surgery: systematic review

The contribution of physical activity on the degree of weight loss following bariatric surgery is unclear. To determine impact of exercise on postoperative weight loss. Medline search (1988–2009) was completed using MeSH terms including bariatric procedures and a spectrum of patient factors with potential relationship to weight loss outcomes. Of the 934 screened articles, 14 reported on exercise and weight loss outcomes. The most commonly used instruments to measure activity level were the Baecke Physical Activity Questionnaire, the International Physical Activity Questionnaire, and a variety of self-made questionnaires. The definition of an active patient varied but generally required a minimum of 30 min of exercise at least 3 days per week. Thirteen articles reported on exercise and degree of postoperative weight loss (n = 4,108 patients). Eleven articles found a positive association of exercise on postoperative weight loss, and two did not. Meta-analysis of three studies revealed a significant increase in 1-year postoperative weight loss (mean difference = 4.2% total body mass index (BMI) loss, 95% confidence interval (CI; 0.26–8.11)) for patients who exercise postoperatively. Exercise following bariatric surgery appears to be associated with a greater weight loss of over 4% of BMI. While a causal relationship cannot be established with observational data, this finding supports the continued efforts to encourage and support patients’ involvement in post-surgery exercise. Further research is necessary to determine the recommended activity guidelines for this patient population.