The economic and psychosocial consequences of obesity

Impaired Early-Response Inhibition in Overweight Females with and without Binge Eating Disorder

Objective

Several studies report increased reward sensitivity towards food in overweight individuals. By contrast, data is inconclusive with respect to response inhibition in overweight individuals without binge eating disorder (BED). Hence, the latter was addressed in the present study in a group of overweight/obese females with and without BED and a normal-weight control group without eating disorders.

Method

A group of women with BED (n = 29), a group of overweight women without BED (n = 33) and normal-weight females (n = 30) participated in a pictorial priming paradigm, with food items (relevant primes) and office utensils (neutral primes) and color blobs (neutral primes) as stimuli. Increased response priming effects (i.e. priming with switches between stimulus categories) were taken as indicators of deficient behavioral inhibition.

Results

Priming effects for neutral primes were moderate and comparable across all groups. However, primes associated with the food task set lead to increased priming effects in both overweight groups. But, effects were comparable for overweight/obese participants with and without BED.

Discussion

Results suggest that early response inhibition in the context of food is impaired in overweight individuals compared to normal-weight individuals.

Socioeconomic status and obesity among semi-urban Nigerians

OBJECTIVE

The relation between socioeconomic status (SES) and obesity in Sub-Saharan Africa (SSA) has been inconsistent.

METHODS

This study examined the prevalence of obesity and SES/obesity relations in 1,067 adults aged 30-60 years from a semi-urban Nigerian population. A structured questionnaire validated by a pictorial selfrating ladder was used to determine the participants' SES.

RESULTS

SES was found to be inversely related (p < 0.010) to weight and BMI, respectively. The odds ratio (OR) and 95% confidence interval (CI) for obesity among lower SES individuals were OR 2.4 and CI 1.91-2.88 compared with OR 2.9 and CI 2.42-3.39 in those of the middle and higher socioeconomic strata. Among males, the OR and 95% CI for obesity among lower SES individuals were OR 1.9 and CI 1.21-2.59 compared with OR 1.7 and CI 1.00-2.39 in those of the middle and higher socioeconomic strata. Among females, the OR and 95% CI for obesity among lower SES individuals were OR 3.0 and CI 2.32-3.68 compared with OR 4.7 and CI 4.02-5.38 in those of the middle and higher socioeconomic strata.

CONCLUSION

SES was inversely associated with the risk of obesity, with a higher prevalence of obesity in the lower socioeconomic stratum of the semi-urban Nigerian population.

Overweight and obesity in young and middle age and early retirement: the ARIC study

The objective of this study was to examine associations between weight status in young and middle age and early retirement in African-American and white men and women. Data were from the Atherosclerosis Risk in Communities (ARIC) study. Analyses were restricted to participants aged 45-55 years at baseline (n = 6,483). Associations between weight status at age 25 and ages 45-55 and age at early retirement (prior to age 65) over 9 years of follow-up were examined using proportional hazard regression analyses in models stratified by race and gender. Models were adjusted for education, household income, health insurance status, occupation, occupational physical activity, marital status, smoking, and field center. Between 18.7 and 21.6% of African-American and white men and women reported retiring prior to age 65. Although not always statistically significant, overweight and obesity were associated with early retirement in all but white women. Overweight (BMI >or= 25 kg/m(2)) at age 25 was significantly associated with early retirement in African-American women (hazard ratio (95% confidence interval): 1.62 (1.17-2.23)) and white men (1.32 (1.12-1.57)). There was also a trend between overweight at age 25 and early retirement in African-American men (1.43 (0.99-2.07)). Obesity (BMI >or= 30 kg/m(2)) in middle age was significantly associated with early retirement in white men only (1.32 (1.03-1.69)). Furthermore, overweight at age 25 and obesity at ages 45-55 were associated with early retirement for health reasons among African-American and white men and women. In conclusion, analyses of the economic impact of obesity may need to consider its effects on early retirement.

Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES)

BACKGROUND

The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery.

METHODS

A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued.

RECOMMENDATIONS

After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.