Lifetime health and economic consequences of obesity

Temporal and spatial distribution of Nrf2 in rat brain following stroke: quantification of nuclear to cytoplasmic Nrf2 content using a novel immunohistochemical technique

Activation of the redox-sensitive transcription factor NF-E2 related factor 2 (Nrf2) affords protection against cerebral ischaemia-reperfusion injury via the upregulation of antioxidant defence genes. We have quantified for the first time Nrf2 content in brains from rats subjected to stroke and from cultured bEnd.3 brain endothelial cells using a novel immunohistochemical technique. Male Sprague-Dawley rats were subjected to middle cerebral artery occlusion for 70 min followed by reperfusion for 4, 24 or 72 h. Coronal brain sections were incubated with anti-Nrf2 primary and biotinylated-horseradish peroxidase-conjugated secondary antibody, after which sections were reacted with 3,3-diaminobenzidine (DAB) in the presence of hydrogen peroxide. The initial rates of DAB polymer formation were directly proportional to the Nrf2 protein concentration. Image processing was used to determine the temporal and spatial distribution of Nrf2 in nuclear and cytoplasmic compartments in stroke-affected and contralateral hemispheres. Nuclear to cytoplasmic Nrf2 ratios were increased in the stroke region after 24 h reperfusion and declined after 72 h reperfusion. Pretreatment with the Nrf2 inducer sulforaphane reduced total cellular Nrf2 levels in peri-infarct and core regions of the stroke hemisphere after 24 h reperfusion. Treatment of cultured murine brain endothelial cells with sulforaphane (2.5 μm) increased nuclear accumulation of Nrf2 over 1-4 h. We report the first quantitative measurements of spatial and temporal nuclear Nrf2 expression in rat brains following stroke, and show that sulforaphane pretreatment affects Nrf2 distribution in the brain of naïve rats and animals subjected to cerebral ischaemia. Our findings provide novel insights for targeting endogenous redox-sensitive antioxidant pathways to ameliorate the damaging consequences of stroke.

Health-e-call, a smartphone-assisted behavioral obesity treatment: pilot study

Background

Individual and group-based behavioral weight loss treatment (BWL) produces average weight loss of 5-10% of initial body weight, which improves health and wellbeing. However, BWL is an intensive treatment that is costly and not widely available. Smartphones may be a useful tool for promoting adherence to key aspects of BWL, such as self-monitoring, thereby facilitating weight loss while reducing the need for intensive in-person contact.

Objective

The objective of this study was to evaluate smartphones as a method of delivering key components of established and empirically validated behavioral weight loss treatment, with an emphasis on adherence to self-monitoring.

Methods

Twenty overweight/obese participants (95% women; 85% non-Hispanic White; mean age 53.0, SE 1.9) received 12-24 weeks of behavioral weight loss treatment consisting of smartphone-based self-monitoring, feedback, and behavioral skills training. Participants also received brief weekly weigh-ins and paper weight loss lessons.

Results

Average weight loss was 8.4kg (SE 0.8kg; 9%, SE 1% of initial body weight) at 12 weeks and 10.9kg (SE 1.1kg; 11%, SE 1% of initial body weight) at 24 weeks. Adherence to the self-monitoring protocol was 91% (SE 3%) during the first 12 weeks and 85% (SE 4%) during the second 12 weeks.

Conclusions

Smartphones show promise as a tool for delivering key components of BWL and may be particularly advantageous for optimizing adherence to self-monitoring, a cornerstone of BWL.

Translating an evidence-based lifestyle intervention program into primary care: lessons learned

The E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care) trial evaluated the feasibility and potential effectiveness of translating an evidence-based lifestyle intervention for the management of obesity and related risk factors in a primary care setting. Delivered by allied health care providers, the intervention promoted at least 7% weight loss and at least 150 minutes per week of moderate-intensity physical activity through gradual, sustainable lifestyle changes. Activities included interactive group lessons, food tasting, guided physical activity, and technology-mediated self-monitoring and behavioral counseling. This article discusses insights and potential areas for improvement to strengthen program implementation for dissemination of the E-LITE program to other primary care settings. We focus on (a) the role of allied health professionals in program delivery, (b) strengthening program integration within a primary care clinic, and (c) the use of information technology to extend the reach and impact of the program. Our experience shows the feasibility of implementing an evidence-based lifestyle intervention program combining group-delivered nutrition and behavioral counseling, physical activity training, and technology-mediated follow-up in a primary care setting. Challenges remain, and we offer possible solutions to overcome them.

Relationships between health behaviors and weight status in American Indian and white rural children

PURPOSE

Preventing obesity in childhood is an increasingly important public health goal. Prevention efforts can be improved by better understanding relationships between health behaviors and overweight and obesity. This study examined such relationships in young American Indian and white children living in the rural United States.

METHODS

Self-report measures of diet, screen time (passive and active), and physical activity were combined with cardiovascular fitness in cross-sectional analyses to predict weight categories based on body mass index percentiles in 306 American Indian and white children (aged 8-9 years) from a rural area in the upper Midwestern United States.

FINDINGS

Multinomial logistic regression models were statistically significant for girls (χ2 [20] = 42.73, P < .01), boys (χ2 [20] = 50.44, P < .001), American Indian (χ2 [20] = 36.67, P < .05), and white children (χ2 [20] = 55.99, P < .001). Obesity was associated with poorer cardiovascular fitness in girls (OR = 0.82), boys (OR = 0.83), American Indian (OR = 0.79), and white children (OR = 0.85), and with passive screen time in girls (OR = 1.69), boys (OR = 2.1), and white children (OR = 1.81). Overweight was associated with passive screen time (OR = 2.24) and inversely with active screen time (OR = 0.54), but only in boys.

CONCLUSIONS

Logistic regression models were more successful at predicting obesity than overweight in all groups of participants. Poorer cardiovascular fitness showed the strongest and most consistent association with obesity, but passive screen time was also a significant and important contributor to the prediction of obesity in most prediction models. Prediction models were similar in girls, boys, American Indian, and white children.

Cost analyses of obesity in Canada: scope, quality, and implications

BACKGROUND

Rapid changes in lifestyle have led to a global obesity epidemic. Understanding the economic burden associated with the obesity epidemic is essential to decision making of cost-effective interventions. This study reviewed costs of obesity and intervention programs in Canada, assessed the scope and quality of existing cost analyses, and identified implications for economic evaluations and public health decision makers.

METHODS

A systematic search of costs associated with obesity or intervention program in Canada between 1990 and 2011 yielded 10 English language articles eligible for review.

RESULTS

The majority of studies was prevalence-based or top-down costing; 40% had excellent quality assessed using the Quality of Health Economic Study scale. The aggregated annual costs of obesity in Canada ranged from 1.27 to 11.08 billion dollars. Direct costs accounted for 37.2% to 54.5% of total annual costs. Between 2.2% and 12.0% of Canada's total health expenditures were attributable to obesity. The average annual physician cost of overweight male ($ 427) and female ($ 578) adults was lower than that of obese male ($ 475) and female ($ 682) adults; this cost differential across weight status groups was comparable to that found in adolescents. The cost for implementation and maintenance of a school-based obesity prevention program was $ 23 per student.

CONCLUSIONS

We observed high costs associated with overweight and obesity and modest costs for obesity prevention programs; however, no cost-effectiveness study of obesity interventions has been performed in Canada. Cost-effectiveness analyses of preventive programs that constitute incidence-based life-time modeling of costs and health outcomes from societal perspective are urgently needed.

Myocardial performance index (MPI) is not influenced by increased left ventricular mass in healthy obese men

BACKGROUND

Notwithstanding its clinical use as a reliable measure of left ventricular performance, little is known about whether myocardial performing index (MPI) is influenced by increased left ventricular mass (LVM) in healthy obese individuals.

AIM

The present study was targeted at investigating the impact of increased LVM on the LV MPI in healthy obese men.

SUBJECTS AND METHOD

Sixty-six normal male subjects were involved in this study. The subjects were divided according to their body mass index (BMI), into group I (BMI=20-24.9, n=37, mean age 33.405±10.277 years) which served as the control group, and group II (BMI=≥ 30, n=29, mean age 39.208±10.214 years). The MPI was determined in all subjects using the following formula proposed by Tei: MPI=IVCT+IVRT/ET. LVM was calculated according to the following Devereux formula as: LVM=0.8[1.04(IVSd+PWTd+LVIDd)-(LVIDd)] +0.6.

RESULTS

There were no significant differences in MPI between control subjects and obese subjects with increased LVM (p>0.05). Additionally, there was no linear correlation between MPI and LVM (R(2)=0.0003, p=0.89).

CONCLUSION

MPI is a simple and accurate tool for the quantitative assessment of left ventricular function. Because of its ease of application, cost effectiveness, and reproducibility, this tool could be regarded as a principal measurement for comprehensive hemodynamic studies. MPI values (according to the Tei index) did not vary significantly between healthy obese and morbidly obese individuals, and therefore may have limited utility for predicting cardiac diseases in at-risk obese individuals.

What moves them? Active transport among inhabitants of Dutch deprived districts

BACKGROUND

Active modes of transport like walking and cycling have been shown to be valuable contributions to daily physical activity. The current study investigates associations between personal and neighbourhood environmental characteristics and active transport among inhabitants of Dutch deprived districts.

METHOD

Questionnaires about health, neighbourhoods, and physical activity behaviour were completed by 742 adults. Data was analysed by means of multivariate linear regression analyses.

RESULTS

Being younger, female, and migrant and having a normal weight were associated with more walking for active transport. Being younger, male, and native Dutch and having a normal weight were associated with more cycling for active transport. Neighbourhood characteristics were generally not correlated with active transport. Stratified analyses, based on significant person-environment interactions, showed that migrants and women walked more when cars did not exceed maximum speed in nearby streets and that younger people walked more when speed of traffic in nearby streets was perceived as low. Among migrants, more cycling was associated with the perceived attractiveness of the neighbourhood surroundings.

DISCUSSION AND CONCLUSION

Results indicated that among inhabitants of Dutch deprived districts, personal characteristics were associated with active transport, whereas neighbourhood environmental characteristics were generally not associated with active transport. Nevertheless, interaction effects showed differences among subgroups that should be considered in intervention development.

Systems science and childhood obesity: a systematic review and new directions

As a public health problem, childhood obesity operates at multiple levels, ranging from individual health behaviors to school and community characteristics to public policies. Examining obesity, particularly childhood obesity, from any single perspective is likely to fail, and systems science methods offer a possible solution. We systematically reviewed studies that examined the causes and/or consequences of obesity from a systems science perspective. The 21 included studies addressed four general areas of systems science in obesity: (1) translating interventions to a large scale, (2) the effect of obesity on other health or economic outcomes, (3) the effect of geography on obesity, and (4) the effect of social networks on obesity. In general, little research addresses obesity from a true, integrated systems science perspective, and the available research infrequently focuses on children. This shortcoming limits the ability of that research to inform public policy. However, we believe that the largely incremental approaches used in current systems science lay a foundation for future work and present a model demonstrating the system of childhood obesity. Systems science perspective and related methods are particularly promising in understanding the link between childhood obesity and adult outcomes. Systems models emphasize the evolution of agents and their interactions; such evolution is particularly salient in the context of a developing child.

Veteran Status and Body Weight: A Longitudinal Fixed-Effects Approach

About 10-12 % of young men (and increasingly, women) have served a term in the military. Yet, we know relatively little about the consequences of military service for the lives of those who serve. In this article, we provide estimates of the relationship between men's peacetime military service during the all-volunteer era (AVE) and body weight using longitudinal data on 6,304 men taken from the National Longitudinal Survey of 1979 (NLSY-79). Using fixed-effects estimators on up to 13 years of data and numerous controls for time-varying life-course characteristics linked to body weight, we find that veterans of active-duty military service have higher levels of BMI and obesity. We argue that eating habits learned during service, coupled with patterns of physical activity, lead to a situation whereby veterans making the transition to less active civilian lifestyles gain weight that is not lost over time.

Physical, Behavioral, and Body Image Characteristics in a Tri-Racial Group of Adolescent Girls

OBJECTIVES

The purpose of this study was to evaluate physical characteristics, nutrient intake, physical activity level, and body image in white (CC), African-American (AA), and Hispanic-American (HA) female adolescents.

RESEARCH METHODS AND PROCEDURES

High school volunteers were solicited for this study. Self-reported information was used to determine subject characteristics, family income, physical activity, body image, and nutrient intake. Physical evaluations were used to determine body mass index, percent body fat, fat distribution, resting heart rate, and blood pressure (BP).

RESULTS

Results showed that AA girls displayed significantly higher diastolic BP than HA girls (p = 0.029). CC adolescents showed greater physical activity (p = 0.010) and lower adiposity than HA adolescents (p = 0.048), as well as lower subscapular skinfold than AA adolescents (p = 0.018). AA adolescents selected a higher ideal body size than CC girls (p = 0.038). There was also a significant difference in percentage carbohydrates (p < 0.034) and cholesterol consumed (p < 0.016) among groups, with CC girls showing the highest values for carbohydrates and lowest values for cholesterol intake among groups.

DISCUSSION

Given our findings of higher adiposity and lower physical activity levels in HA adolescents and greater diastolic BP levels and subscapular skinfold in AA adolescents, more interventions should be targeted toward improving health-related variables among minority populations.

Economic Analysis of a School-Based Obesity Prevention Program

OBJECTIVE

To assess the cost-effectiveness and cost-benefit of Planet Health, a school-based intervention designed to reduce obesity in youth of middle-school age children.

RESEARCH METHODS AND PROCEDURES

Standard cost-effectiveness analysis methods and a societal perspective were used in this study. Three categories of costs were measured: intervention costs, medical care costs associated with adulthood overweight, and costs of productivity loss associated with adulthood overweight. Health outcome was measured as cases of adulthood overweight prevented and quality-adjusted life years (QALYs) saved. Cost-effectiveness ratio was measured as the ratio of net intervention costs to the total number of QALYs saved, and net-benefit was measured as costs averted by the intervention minus program costs.

RESULTS

Under base-case assumptions, at an intervention cost of $33,677 or $14 US dollars per student per year, the program would prevent an estimated 1.9% of the female students (5.8 of 310) from becoming overweight adults. As a result, an estimated 4.1 QALYs would be saved by the program, and society could expect to save an estimated $15,887 USD in medical care costs and $25,104 USD in loss of productivity costs. These findings translated to a cost of $4305 USD per QALY saved and a net saving of $7313 USD to society. Results remained cost-effective under all scenarios considered and remained cost-saving under most scenarios.

DISCUSSION

The Planet Health program is cost-effective and cost-saving as implemented. School-based prevention programs of this type are likely to be cost-effective uses of public funds and warrant careful consideration by policy makers and program planners.

Moderate and Severe Obesity Have Large Differences in Health Care Costs

OBJECTIVE

To analyze health care use and expenditures associated with varying degrees of obesity for a nationally representative sample of individuals 54 to 69 years old.

RESEARCH METHODS AND PROCEDURES

Data from the Health and Retirement Study, a nationwide biennial longitudinal survey of Americans in their 50s, were used to estimate multivariate regression models of the effect of weight class on health care use and costs. The main outcomes were total health care expenditures, the number of outpatient visits, the probability of any inpatient stay, and the number of inpatient days.

RESULTS

The results indicated that there were large differences in obesity-related health care costs by degree of obesity. Overall, a BMI of 35 to 40 was associated with twice the increase in health care expenditures above normal weight (about a 50% increase) than a BMI of 30 to 35 (about a 25% increase); a BMI of over 40 doubled health care costs (approximately 100% higher costs above those of normal weight). There was a difference by gender in how health care use and costs changed with obesity class. The primary effect of increasing weight class on health care use appeared to be through elevated use of outpatient health care services.

DISCUSSION

Obesity imposes an increasing burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population. Because the prevalence of severe obesity is increasing much faster than that of moderate obesity, average estimates of obesity effects obscure real consequences for individuals, physician practices, hospitals, and health plans.

Economics and Obesity: Costing the Problem or Evaluating Solutions?

There is no doubt that obesity is a major public health problem. However, what is the contribution of economics to solving it? In this report, we make the case that the role of economics is not in measuring the economic burden of obesity, through so-called cost-of-illness studies. Such studies merely confirm that obesity is a serious societal issue; adding a monetary figure to this does not add much. The economic foundations of such estimates can also be questioned, thus lessening their policy relevance. The real value of economics in the arena of obesity care is in evaluating, through formal economic evaluation, the use of our scarce health care resources in different strategies to prevent and treat obesity.

The value of medical and pharmaceutical interventions for reducing obesity

This paper attempts to quantify the social, private, and public-finance values of reducing obesity through pharmaceutical and medical interventions. We find that the total social value of bariatric surgery is large for treated patients, with incremental social cost-effectiveness ratios typically under $10,000 per life-year saved. On the other hand, pharmaceutical interventions against obesity yield much less social value with incremental social cost-effectiveness ratios around $50,000. Our approach accounts for: competing risks to life expectancy; health care costs; and a variety of non-medical economic consequences (pensions, disability insurance, taxes, and earnings), which account for 20% of the total social cost of these treatments. On balance, bariatric surgery generates substantial private value for those treated, in the form of health and other economic consequences. The net public fiscal effects are modest, primarily because the size of the population eligible for treatment is small. The net social effect is large once improvements in life expectancy are taken into account.

Adiposity measures predict olfactory processing speed in older adult carriers of the apolipoprotein E ε4 allele

OBJECTIVE

The current study investigated the relationship between adiposity and P3 latency.

METHODS

Fifty-one adults in two age groups (18-25 and 65+) participated. Odor stimuli were delivered via olfactometer as participants focused on a computer screen. Each stimulus was followed by presentation on the screen of four odor identification choices. Participants attempted identification by button press. Olfactory event-related potentials (OERPs) were recorded. BMI and waist circumference were measured as indicators of adiposity.

RESULTS

In bivariate analyses with all participants included, positive correlations for P3 latency with both BMI and waist circumference were observed, indicating that as adiposity increased latencies also increased. When each age group was separately examined, correlations between adiposity measures and latency remained statistically significant for older adults. Furthermore, ApoE ε4 allele status was examined. Latencies remained positively correlated with adiposity in older adult ε4 carriers; but not in non-carriers.

CONCLUSIONS

This study indicates that adiposity predicts olfactory processing speed in older adults, specifically in ε4 carriers.

SIGNIFICANCE

The results suggest that olfactory processing speed may be a useful measure for detecting and following the effects of adiposity on brain integrity and cognitive function in those at genetic risk for AD.

Economic evaluations of adult weight management interventions: a systematic literature review focusing on methods used for determining health impacts

BACKGROUND

One of the challenges when undertaking economic evaluations of weight management interventions is to adequately assess future health impacts. Clinical trials commonly measure impacts using surrogate outcomes, such as reductions in body mass index, and investigators need to decide how these can best be used to predict future health effects. Since obesity is associated with an increased risk of numerous chronic diseases occurring at different future time points, modelling is needed for predictions.

OBJECTIVE

To assess the methods used in economic evaluations to determine health impacts of weight management interventions and to investigate whether differences in methods affect the cost-effectiveness estimates.

METHODS

Eight databases were systematically searched. Included studies were categorized according to a decision analytic approach and effect measures incorporated.

RESULTS

A total of 44 articles were included; 21 evaluated behavioural interventions, 12 evaluated surgical procedures and 11 evaluated pharmacological compounds. Of the 27 papers that estimated future impacts, eleven used Markov modelling, seven used a decision tree, five used a mathematical application, two used patient-level simulation and the modelling method was unclear in two papers. The most common types of effects included were co-morbidity treatment costs, heath-related quality of life due to weight loss and gain in survival. Only 12 of the studies included heath-related quality of life gains due to reduced co-morbidities and only one study included productivity gains. Despite consensus that trial-based analysis on its own is inadequate in guiding resource allocation decisions, it was used in 39% of the studies. Several of the modelling papers used model structures not suitable for chronic diseases with changing health risks. Three studies concluded that the intervention dominated standard care; meaning that it generated more quality-adjusted life-years (QALYs) for less cost. The incremental costs per QALY gained varied from $US235 to $US56,836 in the remaining studies using this outcome measure. An implicit hypothesis of the review was that studies including long-term health effects would illustrate greater cost effectiveness compared with trial-based studies. This hypothesis is partly confirmed with three studies arriving at dominating results, as these reach their conclusion from modelling future co-morbidity treatment cost savings. However, for the remaining studies there is little indication that decision-analytic modelling disparities explain the differences.

CONCLUSIONS

This is the first literature review comparing methods used in economic evaluations of weight management interventions, and it is the first time that observed differences in study results are addressed with a view to methodological explanations. We conclude that many studies have methodological deficiencies and we urge analysts to follow recommended practices and use models capable of depicting long-term health consequences.

From model to action: using a system dynamics model of chronic disease risks to align community action

Health planners in Austin, Texas, are using a System Dynamics Model of Cardiovascular Disease Risks (SD model) to align prevention efforts and maximize the effect of limited resources. The SD model was developed using available evidence of disease prevalence, risk factors, local contextual factors, resulting health conditions, and their impact on population health. Given an interest in understanding opportunities for upstream health protection, the SD model focused on the portion of the population that has never had a cardiovascular event. Leaders in Austin used this interactive simulation model as a catalyst for convening diverse stakeholders in thinking about their strategic directions and policy priorities. Health officials shared insights from the model with a range of organizations in an effort to align actions and leverage assets in the community to promote healthier conditions for all. This article summarizes the results from several simulated intervention scenarios focusing specifically on conditions in East Travis County, an area marked by higher prevalence of adverse living conditions and related chronic diseases. The article also describes the formation of a new Chronic Disease Prevention Coalition in Austin, along with shifts in its members' perceived priorities for intervention both before and after interactions with the SD model.

Healthcare use and costs associated with obesity in Badalona, Spain: a study protocol

Introduction The objectives of the study are twofold. First, to calculate healthcare resource utilisation and costs for a cohort of adult overweight and obese patients observed in primary and hospital care centres during eight consecutive years (2003-2010) in an urban setting in Spain. An analysis of whether these costs vary by groups of individuals and types of disease, and of how they compare with the previous literature, is carried out in order to predict actions or policies for resource optimisation. The second objective is to estimate the impact of overweight and obesity on the consumption of resources and costs, accounting for a wide array of controls. Methods and analysis Observational and retrospective cohort data are used, consisting of medical records of patients followed up in outpatient and hospital care facilities during the years 2003-2010. Three cohorts of patients are analysed: normal weight (18.5≥ body mass index (BMI) <25), overweight (25≥ BMI <30) and obese (BMI ≥30); BMI is computed using clinical information. Individual-level data on comorbidity, resource utilisation and costs are available, and external information provided by the population census regarding socioeconomic status is used. Utilisation and associated costs across BMI groups are compared by computing ratios for overweight and obese individuals relative to those of normal weight. Count data regression models (hurdle and finite mixture models) are used, together with two-part model regression models and taking into account the panel structure of the data set to explore the impact of overweight and obesity on the increased utilisation of health services and costs, accounting for a wide set of controls.

Impact of obesity, overweight and underweight on life expectancy and lifetime medical expenditures: the Ohsaki Cohort Study

OBJECTIVES

People who are obese have higher demands for medical care than those of the normal weight people. However, in view of their shorter life expectancy, it is unclear whether obese people have higher lifetime medical expenditure. We examined the association between body mass index, life expectancy and lifetime medical expenditure.

DESIGN

Prospective cohort study using individual data from the Ohsaki Cohort Study.

SETTING

Miyagi Prefecture, northeastern Japan.

PARTICIPANTS

The 41 965 participants aged 40-79 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

The life expectancy and lifetime medical expenditure aged from 40 years.

RESULTS

In spite of their shorter life expectancy, obese participants might require higher medical expenditure than normal weight participants. In men aged 40 years, multiadjusted life expectancy for those who were obese participants was 41.4 years (95% CI 38.28 to 44.70), which was 1.7 years non-significantly shorter than that for normal weight participants (p=0.3184). Multiadjusted lifetime medical expenditure for obese participants was £112 858.9 (94 954.1-131 840.9), being 14.7% non-significantly higher than that for normal weight participants (p=0.1141). In women aged 40 years, multiadjusted life expectancy for those who were obese participants was 49.2 years (46.14-52.59), which was 3.1 years non-significantly shorter than for normal weight participants (p=0.0724), and multiadjusted lifetime medical expenditure was £137 765.9 (123 672.9-152 970.2), being 21.6% significantly higher (p=0.0005).

CONCLUSIONS

According to the point estimate, lifetime medical expenditure might appear to be higher for obese participants, despite their short life expectancy. With weight control, more people would enjoy their longevity with lower demands for medical care.

Measuring the meanings of eating in minority youth

The aim of this study is to present the development of the Meanings of Eating Index (MEI) in a diverse sample of children. Exploratory factor analysis was performed on MEI items. Factors with eigenvalues above 1.0 were retained. Items that loaded on multiple factors or with item-total correlations below 0.50 were discarded. A 24-item, 5-factor scale comprised the final MEI. Personal Negative Emotions and Disturbed Eating were positively associated with frequency of high calorie snack food intake (r=0.21, p<0.05; r=0.33, p<0.01), and Personal Well Being was positively associated with eating vegetables more frequently (r=0.20; p<0.05). Eating on Behalf of Others was negatively associated with frequency of vegetable intake (r=-.20; p<0.05). Pleasure Eating was not associated with dietary intake. The MEI shows promise as a tool for understanding the affective determinants of dietary intake in minority youth.

Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity

This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011. Two reviewers independently assessed the risk of bias of included studies. Three metrics were (re-)calculated per study: the net benefits, benefit cost ratio (BCR) and return on investment (ROI). Metrics were averaged, and a post hoc subgroup analysis was performed to compare financial return estimates between study designs. Four randomized controlled trials (RCTs), 13 non-randomized studies (NRSs) and one modelling study were included. Average financial return estimates in terms of absenteeism benefits (NRS: ROI 325%, BCR 4.25; RCT: ROI -49%, BCR 0.51), medical benefits (NRS: ROI 95%, BCR 1.95; RCT: ROI -112%, BCR -0.12) or both (NRS: ROI 387%, BCR 4.87; RCT: ROI -92%, BCR 0.08) were positive in NRSs, but negative in RCTs. Worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity generate financial savings in terms of reduced absenteeism costs, medical costs or both according to NRSs, whereas they do not according to RCTs. Since these programmes are associated with additional types of benefits, conclusions about their overall profitability cannot be made.

A pathway to endoscopic bariatric therapies

The American Society for Gastrointestinal Endoscopy (ASGE) is dedicated to advancing patient care and digestive health by promoting excellence in gastrointestinal endoscopy. The American Society for Metabolic and Bariatric Surgery (ASMBS) is dedicated to improving public health and well-being by lessening the burden of the disease of obesity and related diseases. They are the largest professional societies for their respective specialties of gastrointestinal endoscopy and bariatric surgery in the world. The ASGE/ASMBS task force was developed to collaboratively address opportunities for endoscopic approaches to obesity, reflecting the strengths of our disciplines, to improve patient and societal outcomes. This white paper is intended to provide a framework for, and a pathway towards, the development, investigation, and adoption of safe and effective endoscopic bariatric therapies (EBT).

A cost-benefit analysis of bariatric surgery on the South Plains region of Texas

The regional economic burdens of obesity have not been fully quantified. This study incorporated bariatric surgery demographics collected from a large university hospital with regional economic and employment data to evaluate the cost of obesity for the South Plains region of Texas. Data were collected from patients who underwent laparoscopic gastric bypass and laparoscopic banding between September 2003 and September 2005 at Texas Tech University Health Sciences Center. A regional economic model estimated the economic impact of lost productivity due to obesity. Comparisons of lost work days in the year before and after surgery were used to estimate the potential benefit of bariatric surgery to the South Plains economy. Total output impacts of obesity, over $364 million, were 3.3% of total personal income; total labor income impacts neared $60 million: the losses corresponded to $2,389 lost output and $390 lost labor income per household. Obesity cost the South Plains over 1,977 jobs and decreased indirect business tax revenues by over $13 million. The net benefit of bariatric surgery was estimated at $9.9 billion for a discount rate of 3%, $5.0 billion for a discount rate of 5%, and $1.3 billion for a discount rate of 10%. Potential benefits to the South Plains economy of performing bariatric surgery more than outweigh its costs.

Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association

The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030-make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society.

The cost of obesity and overweight in 2005: a case study of Alberta, Canada

OBJECTIVE

The aim of this paper is to highlight the potential impact of costs associated with overweight and obesity for provincial policy and prevention initiatives.

METHOD

Prevalence-based cost-of-illness methodology was used to estimate the direct costs (hospital care, drugs, physician care, institutional care, additional costs) and indirect costs (short- and long-term disability, premature mortality) associated with excess weight for 22 health conditions. Total costs for each health condition were estimated using the Public Health Agency of Canada's Economic Burden of Illness database. Population attributable fractions (PAF) were also estimated using 2004 and 2005 CCHS data and current literature reviews.

RESULTS

In 2005, the cost of excess weight in Alberta totaled $1.27 billion. The direct cost of excess weight was $630.1M (49.5%), the indirect cost $643.8M (50.5%). Excluding costs associated with premature mortality and caregiving, obesity accounted for 69.5% ($500.8M) of costs and overweight the remaining 30.5% ($220.2M). Among the 22 health conditions, coronary heart disease had the highest costs attributable to excess weight ($307.1 M), followed by osteoarthritis ($167.7M) and type 2 diabetes ($161.5M). The total cost of excess weight equated to 5.6% of the province's annual health care expenditures for 2005.

CONCLUSION

While obesity costing research often focuses on the direct health care costs, this study reveals that the indirect costs of excess weight are also significant and can account for over half of the total costs. Interventions to reduce excess weight among Canadians have the potential to improve the health of the population while reducing provincial and national health care costs.

Short-term medication cost savings for treating hypertension and diabetes after gastric bypass

BACKGROUND

The cost of medication for the treatment of hypertension and diabetes in the morbidly obese is a significant economic healthcare burden. In the present study, we assessed the effect of gastric bypass surgery on the average annual costs for hypertension and diabetes medication.

METHODS

A prospective database of gastric bypass patients at the Palo Alto Veterans Affairs Health Care System was reviewed. The preoperative and postoperative medication requirements to treat hypertension and diabetes were identified before surgery and at 1 year postoperatively. Comparisons were made between the annual costs of the antihypertensive and diabetic medications before and after bariatric surgery using the Student paired t test.

RESULTS

Of 106 patients who had undergone gastric bypass, 90 (85%) had either hypertension or diabetes. Of these 90 patients, 88 (98%) had hypertension and 60 (67%) had diabetes before surgery. Complete remission of hypertension occurred in 44% and remission of diabetes in 80% at 1 year after surgery. The annual cost of medications to treat hypertension was reduced by 65% at 1 year after surgery ($63.52 compared with $20.50, P < .0001). To treat diabetes, the annual medication cost was reduced by 88% at 1 year after gastric bypass surgery ($532.06 compared with $64.58, P < .0001). In the subset of patients with persistent hypertension or diabetes after surgery, the annual cost reduction for antihypertensive medications was 58% ($87.14 versus $36.82, P < .002). The annual cost reduction for diabetic medications was 69% ($1036.60 versus $322.90, P < .02).

CONCLUSION

Gastric bypass surgery resulted in a significant reduction in the cost of medications to treat hypertension and diabetes in the morbidly obese at 1 year after surgery. These cost savings were also significant in the subset of patients who had persistent hypertension and diabetes after surgery.

Cost-effectiveness of bariatric surgery: should it be universally available?

This paper is the first to conduct cost-effectiveness analyses of bariatric surgery comparing obese patients with obesity-related diseases to obese people without comorbidities across different BMI categories, using the meta-analysis results of surgery outcomes for our effectiveness inputs. We find that surgery treatment is in general cost-effective for people whose BMI is greater than 35 kg/m(2) with or without obesity-related comorbidities, and it is even cost-saving for super obese (BMI ≥ 50 kg/m(2)) with obesity-related comorbidities. Our results also suggest that surgery can be cost-effective for the mildly obese (BMI ≥ 30 kg/m(2)). The bottom line is that bariatric surgery should be universally available to all classes of obese people.

Teaching medical students about obesity: a pilot program to address an unmet need through longitudinal relationships with bariatric surgery patients

BACKGROUND

Despite obesity's relevance and impact, curricula addressing obesity are underrepresented in clinical medical education. A novel pilot program to begin teaching medical students about care of the obese patient was developed and student attitudes toward obesity and bariatric surgery were assessed.

METHODS

The authors paired third-year students with obese patients undergoing bariatric surgery. Students established a longitudinal patient relationship, received faculty mentorship, and kept a reflections journal. An attitude assessment survey was administered before and after third year. Reflections were analyzed for common themes.

RESULTS

Baseline student responses differed from those previously reported for practicing physicians on many survey statements, including more strongly agreeing with the relationship between obesity and serious medical conditions (P < .001), the need to educate patients about obesity risks (P < .001), and willingness to recommend bariatric surgery evaluation (P = .004). These differences were maintained after clinical clerkships. Reflection themes included recognition of obesity stereotypes, improved estimation of body mass index, and awareness of physicians' attitudes about obesity.

CONCLUSION

Development and assessment of a novel pilot program to teach third-year medical students about obesity and bariatric surgery suggests a potential impact on student attitudes and understanding of obesity and obesity surgery. Students today may have different attitudes toward obesity than those reflected in prior data for physicians in practice, and programs such as this may help maintain positive attitudes.

The economic burden of obesity worldwide: a systematic review of the direct costs of obesity

In the last decade, the prevalence of obesity has increased significantly in populations worldwide. A less dramatic, but equally important increase has been seen in our knowledge of its effects on health and the burden it places on healthcare systems. This systematic review aims to assess the current published literature on the direct costs associated with obesity. A computerized search of English language articles published between 1990 and June 2009 yielded 32 articles suitable for review. Based on these articles, obesity was estimated to account for between 0.7% and 2.8% of a country's total healthcare expenditures. Furthermore, obese individuals were found to have medical costs that were approximately 30% greater than their normal weight peers. Although variations in inclusion/exclusion criteria, reporting methods and included costs varied widely between the studies, a lack of examination of how and why the excess costs were being accrued appeared to be a commonality between most studies. Accordingly, future studies must better explore how costs accrue among obese populations, in order to best facilitate health and social policy interventions.

Direct medical cost of overweight and obesity in the USA: a quantitative systematic review

To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. PubMed (1968-2009), EconLit (1969-2009) and Business Source Premier (1995-2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. A total of 33 US studies met review criteria. Among the four highest-quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimates included use of national samples vs. more selected populations, age groups examined, inclusion of all medical costs vs. obesity-related costs only, and body mass index cut-offs for defining overweight and obesity. Depending on the source of total national healthcare expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of US healthcare spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs and use standard body mass index cut-offs.

Economics of type 1 diabetes

This article reviews economic methodologies developed for estimating cost of illness, examines the current literature on diabetes costs, and presents the latest estimates of the economic impact of type 1 diabetes in terms of direct medical costs (ie, treatment costs) and indirect costs (eg, lost wages).

The association between obesity and urban food environments

Several studies have examined associations between the food retail environment and obesity, though virtually no work has been done in the urban South, where obesity rates are among the highest in the country. This study assessed associations between access to food retail outlets and obesity in New Orleans. Data on individual characteristics and body weight were collected by telephone interviews from a random sample of adults (N = 3,925) living in New Orleans in 2004-2005. The neighborhood of each individual was geo-mapped by creating a 2-km buffer around the center point of the census tract in which they lived. Food retailer counts were created by summing the total number of each food store type and fast food establishment within this 2-km neighborhood. Hierarchical linear models assessed associations between access to food retailers and obesity status. After adjusting for individual characteristics, each additional supermarket in a respondent's neighborhood was associated with a reduced odds for obesity (OR 0.93, 95% CI 0.88-0.99). Fast food restaurant (OR 1.01, 95% CI 1.00-1.02) and convenience store (OR 1.01, 95% CI 1.00-1.02) access were each predictive of greater obesity odds. An individual's access to food stores and fast food restaurants may play a part in determining weight status. Future studies with longitudinal and experimental designs are needed to test whether modifications in the food environment may assist in the prevention of obesity.

The economic impact of obesity in the United States

Over the past several decades, obesity has grown into a major global epidemic. In the United States (US), more than two-thirds of adults are now overweight and one-third is obese. In this article, we provide an overview of the state of research on the likely economic impact of the US obesity epidemic at the national level. Research to date has identified at least four major categories of economic impact linked with the obesity epidemic: direct medical costs, productivity costs, transportation costs, and human capital costs. We review current evidence on each set of costs in turn, and identify important gaps for future research and potential trends in future economic impacts of obesity. Although more comprehensive analysis of costs is needed, substantial economic impacts of obesity are identified in all four categories by existing research. The magnitude of potential economic impact underscores the importance of the obesity epidemic as a focus for policy and a topic for future research.

Lifestyle Interventions and the Prevention and Treatment of Type 2 Diabetes

The diabetes epidemic is fueled by a societal increase in insulin resistance, caused by lifestyle factors, particularly excessive caloric intake and physical inactivity. Aging also plays a role in the increase in insulin resistance; however, even in older populations, the increase in insulin resistance appears to be attributable mainly to age-related obesity and inactivity. Insulin resistance reflects deposition of visceral, hepatic, and intramyocellular fat, while toxic messages from the adipose organ (free fatty acids, cytokines, and oxidative stress) impair insulin action to restrain glucose production in the liver and promote glucose disposal in muscle. Unexercised muscle is also insulin resistant because of intracellular sequestration of glucose transporters. These processes lead to hyperglycemia if compensatory secretion of insulin is inadequate due to decreases in pancreatic β -cell function and mass, ultimately resulting in the development of prediabetes and, later, type 2 diabetes mellitus (T2DM). Lifestyle interventions, programs that promote diabetes risk reduction and weight loss through behavior change, increased physical activity, and dietary modification, can decrease insulin resistance and prevent or delay the development of prediabetes and progression to T2DM. Lifestyle interventions are also important to improve diabetes management, particularly early in the natural history before loss of β -cell function and mass is so extensive that multidrug pharmacologic therapy is required. Effective interventions often include both an increase in physical activity (ideally, at least 150 minutes per week of moderate-to-vigorous aerobic exercise and strength training) and dietary modification to promote weight loss. major contributor to morbidity and mortality. T2DM can lead to renal dysfunction, peripheral and autonomic neuropathy, vision problems, and cardiovascular disease.2 In the United States alone, from 2005 to 2050, the prevalence of diagnosed diabetes is expected to more than double from 5.6% to 12.0%.3 In 2005 to 2006, the prevalence of prediabetes and diabetes combined was estimated to be 42.3% for Americans aged 20 years or older. The total prevalence of

Estimating the cost of type 1 diabetes in the U.S.: a propensity score matching method

BACKGROUND

Diabetes costs represent a large burden to both patients and the health care system. However, few studies that examine the economic consequences of diabetes have distinguished between the two major forms, type 1 and type 2 diabetes, despite differences in underlying pathologies. Combining the two diseases implies that there is no difference between the costs of type 1 and type 2 diabetes to a patient. In this study, we examine the costs of type 1 diabetes, which is often overlooked due to the larger population of type 2 patients, and compare them to the estimated costs of diabetes reported in the literature.

METHODOLOGY/PRINCIPAL FINDINGS

Using a nationally representative dataset, we estimate yearly and lifetime medical and indirect costs of type 1 diabetes by implementing a matching method to compare a patient with type 1 diabetes to a similar individual without the disease. We find that each year type 1 diabetes costs this country $14.4 billion (11.5-17.3) in medical costs and lost income. In terms of lost income, type 1 patients incur a disproportionate share of type 1 and type 2 costs. Further, if the disease were eliminated by therapeutic intervention, an estimated $10.6 billion (7.2-14.0) incurred by a new cohort and $422.9 billion (327.2-519.4) incurred by the existing number of type 1 diabetic patients over their lifetime would be avoided.

CONCLUSIONS/SIGNIFICANCE

We find that the costs attributed to type 1 diabetes are disproportionately higher than the number of type 1 patients compared with type 2 patients, suggesting that combining the two diseases when estimating costs is not appropriate. This study and another recent contribution provides a necessary first step in estimating the substantial costs of type 1 diabetes on the U.S.

Gender Differences in Perceptions of Weight and Body Image and Comparison to Recommended Weight among Adult Bermudians

The objective of this study was to determine adult Bermudians' perceptions of ideal weight, overweight, and body image and to decide if a discrepancy exists between their perceptions and World Health Organization standards. A cross-sectional survey of body weight perceptions was administered to 462 men ( n = 207) and women ( n = 255), 18–65 years of age and various body weights, living on the Island of Bermuda. Additionally, measurement of height, and weight was collected. There was a significant difference in mean current body mass index (BMI) between men ( M = 28.6, SD = 5.82), and women ( M = 30.1, SD = 6.80) ( p < .05). Significant gender differences were evident in mean self-perceived BMI, ideal BMI, and perceived body image. The data presented have important implications for understanding perceptions, knowledge, and beliefs concerning body weight and body image. Public health programs must stress to adults the correct definition of overweight and obesity acceptable by medical standards.

Obesity in women

Obesity carries a unique disease burden on women and is influenced by a variety of biological, hormonal, environmental, and cultural factors. Reproductive transitions, such as pregnancy and menopause, increase the risk for obesity. Psychologically, obese women experience greater weight-related stigma and discrimination and are at increased risk for depression than obese men. Women are also particularly susceptible to psychological stress, sleep debt, and lack of physical activity, all of which are risk factors for the development of excess weight. Obesity risk is increased among women with psychiatric disorders and those who use certain psychotropic medications. Obesity treatment should take into consideration degree of obesity, health risks, past weight loss attempts, and individual differences in motivation and readiness for treatment.

A pilot study of chromium picolinate for weight loss

BACKGROUND

Chromium is an essential trace element and nutritional supplement that has garnered interest for use as a weight loss aid.

OBJECTIVE

This trial assesses the effects of chromium picolinate supplementation, alone and combined with nutritional education, on weight loss in apparently healthy overweight adults.

DESIGN

This was a randomized, double-blind, placebo-controlled trial of 80 otherwise healthy, overweight adults assessed at baseline for central adiposity measured by computerized tomography. Subjects were randomly assigned to daily ingestion of 1000 microg of chromium picolinate or placebo for 24 weeks. All subjects received passive nutritional education at the 12-week point in both the intervention and control groups. Outcomes include weight, height, blood pressure, percent body fat, serum, and urinary biomarkers.

RESULTS

At baseline, both the chromium and placebo groups had similar mean body mass index (BMI) (chromium = 36 +/- 6.7 kg/m(2) versus placebo = 36.1 +/- 7.6 kg/m(2); p = 0.98). After 12 weeks, no change was seen in BMI in the intervention as compared to placebo (chromium = 0.3 +/- 0.8 kg/m(2) versus placebo = 0.0 +/- 0.4 kg/m(2); p = 0.07). No change was seen in BMI after 24 weeks in the intervention as compared to placebo (chromium = 0.1 +/- 0.2 kg/m(2) versus placebo = 0.0 +/- 0.5 kg/m(2); p = 0.81). Variation in central adiposity did not affect any outcome measures.

CONCLUSIONS

Supplementation of 1000 microg of chromium picolinate alone, and in combination with nutritional education, did not affect weight loss in this population of overweight adults. Response to chromium did not vary with central adiposity.

Why are we fat? Discussions on the socioeconomic dimensions and responses to obesity

This paper draws together contributions to a scientific table discussion on obesity at the European Science Open Forum 2008 which took place in Barcelona, Spain. Socioeconomic dimensions of global obesity, including those factors promoting it, those surrounding the social perceptions of obesity and those related to integral public health solutions, are discussed. It argues that although scientific accounts of obesity point to large-scale changes in dietary and physical environments, media representations of obesity, which context public policy, pre-eminently follow individualistic models of explanation. While the debate at the forum brought together a diversity of views, all the contributors agreed that this was a global issue requiring an equally global response. Furthermore, an integrated ecological model of obesity proposes that to be effective, policy will need to address not only human health but also planetary health, and that therefore, public health and environmental policies coincide.

A case study of ex ante, value-based price and reimbursement decision-making: TLV and rimonabant in Sweden

Value-based pricing (VBP) is a method of setting prices for products based on perceived benefits to the consumer. When information is symmetric and freely available and agency is perfect, VBP is efficient and desirable. Because of substantial information asymmetries, medical insurance distortions, and the prescribing monopoly of physicians, VBP is rare for prescription drugs, though a number of countries have recently moved in this direction. Because the potential benefits can be sizable, it is high time for a review of actual VBP-based decision-making in practice. Sweden, with its pharmaceutical benefits board (TLV), was an early adopter of VBP decision-making. We illustrate actual decision-making, thus, using the case of Acomplia for the treatment of obesity in Sweden, with and without the presence of co-morbid conditions. This example has a number of features that will be useful in illustrating the strengths and weaknesses of VBP in actual practice, including multiple indications, a need for not just one but two economic simulation models, considerable sub-group analysis, and requirements for additional evidence development. TLV concluded, in 2006, that Acomplia was cost-effective for patients with a body mass index (BMI) exceeding 35 kg/m2 and patients with a BMI exceeding 28 kg/m2 and either dyslipidemia or type 2 diabetes. Because of uncertainty in some of the underlying assumptions, reimbursement was granted only until 31 December 2008, at which time the manufacturer would be required to submit additional documentation of the long-term effects and cost-effectiveness in order to obtain continued reimbursement. Deciding on reimbursement coverage for pharmaceutical products is difficult. Ex ante VBP assessment is a form of risk sharing, which has been used by TLV to speed up reimbursement and dispersion of effective new drugs despite uncertainty in their true cost-effectiveness. Manufacturers are often asked in return to generate additional health economic evidence that will establish cost-effectiveness as part of ex post review. The alternative is to delay the reimbursement approval until satisfactory evidence is available.

The medical risks of obesity

Obesity is at epidemic proportions in the United States and in other developed and developing countries. The prevalence of obesity is increasing not only in adults, but especially among children and adolescents. In the United States in 2003 to 2004, 17.1% of children and adolescents were overweight, and 32.2% of adults were obese. Obesity is a significant risk factor for and contributor to increased morbidity and mortality, most importantly from cardiovascular disease (CVD) and diabetes, but also from cancer and chronic diseases, including osteoarthritis, liver and kidney disease, sleep apnea, and depression. The prevalence of obesity has increased steadily over the past 5 decades, and obesity may have a significant impact on quality-adjusted life years. Obesity is also strongly associated with an increased risk of all-cause mortality as well as cardiovascular and cancer mortality. Despite the substantial effects of obesity, weight loss can result in a significant reduction in risk for the majority of these comorbid conditions. Those comorbidities most closely linked to obesity must be identified to increase awareness of potential adverse outcomes. This will allow health care professionals to identify and implement appropriate interventions to reduce patient risk and mortality. A systematic search strategy was used to identify published literature between 1995 and 2008 that reported data from prospective longitudinal studies of obesity and comorbid medical conditions. This article will review evidence for significant associations of obesity with comorbidities to provide information useful for optimal patient management.

Difference of body compositional changes according to the presence of weight cycling in a community-based weight control program

Many obese people who try to control body weight experience weight cycling (WC). The present study evaluated the importance of WC in a community-based obesity intervention program. We analyzed the data of 109 Korean participants (86% women) among 177 subjects who had completed a 12-week intervention program at two public health centers in Korea from April to December, 2007. Completion of a self-administrated questionnaire at baseline was used to obtain anthropometric measurements, and laboratory testing was done before and after the program. Differences in body composition change and obesity-related life style between the two groups were compared with respect to WC and non-weight cycling (NWC). After 12 weeks, both groups showed reductions in weight, waist circumference, and body mass index. The group differences were not significant. However, significant differences were evident for the WC group compared to the NWC group in fat percent mass (WC vs. NWC, -3.49+/-2.31% vs. -4.65+/-2.59%, P=0.01), fat free mass (WC vs. NWC, -0.95+/-1.37 kg vs. -0.38+/-1.05 kg, P=0.01), and total cholesterol (WC vs. NWC, -3.32+/-14.63 vs. -16.54+/-32.39, P=0.005). In conducting a community-based weight control program that predominantly targets women, changes of body composition and total cholesterol may be less effective in weight cyclers than in non-weight cyclers.

Cognitive Performance of Morbidly Obese Patients Seeking Bariatric Surgery

Bariatric surgery is efficacious for the treatment of severe obesity; however, little empirical research exists describing the demographic, psychosocial, and cognitive characteristics of patients presenting for the surgery. One hundred and sixty-nine morbidly obese patients seeking bariatric surgery underwent a presurgical psychological assessment, including cognitive testing. Morbidly obese individuals seeking bariatric surgery were similar in education, income status, and IQ compared with normative data. IQ was average, did not correlate with body mass index, and reflected a normal distribution. As a group, bariatric surgery patients endorsed minimal levels of depression and low levels of psychopathology. Obese individuals did demonstrate specific cognitive deficits on tests of executive function (e.g., problem solving and planning) when compared with normative data. This data suggests that bariatric surgery patients differ very little from other surgical populations on most demographic and psychosocial variables. The data does provide evidence for specific cognitive deficits in the area of executive functions at baseline in morbidly obese adults seeking bariatric surgery.

Epidemiological studies of smell: discussion and perspectives

The critical epidemiological data for estimating the prevalence of chemosensory disorders in the United States are lacking. Several reasons for this will be discussed, including the time-consuming nature of many existing tests, stimulus delivery in a large-scale study, and the rationale for inclusion in a large-scale epidemiological study. The opportunity to include measures of chemosensory function in ongoing population-based studies has greatly facilitated the collection of recent data that establish the high prevalence of olfactory impairment in older adults in the U.S. population and the inability of self-report measures to capture this impairment. Epidemiological studies of the complete range of the population that involve chemosensory testing pose considerable challenges, but are critical to establishing prevalence rates. These studies have the potential to suggest prevention or intervention strategies for chemosensory impairment. Key issues, including cross-cultural issues in stimulus design, testing of special populations, cohort effects, and optimal analyses of population-based chemosensory data, are considered.