The obesity epidemic: scope of the problem and management strategies

The Impact of Violent Crime on Obesity

Dwelling in a violence-plagued neighborhood may amplify obesity by engendering psychological distress or by cultivating a sedentary, homebound lifestyle. This relationship is speculated to be especially relevant for black and Hispanic citizens because they are much more likely than whites to live in violence-beleaguered neighborhoods. Results from two multilevel analyses of 12,645 residents living in 34 New York City neighborhoods show that, while the violent crime rate does not have a direct effect on obesity, it does condition the relationships between race, ethnicity, and obesity. As the violent crime rate rises in a neighborhood, the probability of both a black and Hispanic resident being obese increases, controlling for both individual and neighborhood factors. The BMI of black and Hispanic residents is also higher in neighborhoods beset by violence. These findings suggest that violent crime may be a salient but unappreciated factor in explaining both racial and ethnic differences in obesity.

Cardiovascular risk assessment according to the Framingham score and abdominal obesity in individuals seen by a clinical school of nutrition

OBJECTIVE

To analyze the relation of abdominal obesity on cardiovascular risk in individuals seen by a clinic school of nutrition, classifying them based on Framingham score.

METHODS

Cross-sectional study, conducted at the nutrition clinic of a private college in the city of Maceió, Alagoas. We included randomly selected adults and elderly individuals with abdominal obesity, of both sexes, treated from August to December of 2009, with no history of cardiomyopathy or cardiovascular events. To determine the cardiovascular risk, the Framingham score was calculated. All analyzes were performed with SPSS software version 20.0, with p <0.05 as significative.

RESULTS

We studied 54 subjects, 83% female, the mean age was 48 years old, ranging from 31 to 73 years. No correlation was observed between measurements of waist circumference and cardiovascular risk in the subjects studied (r=0.065, p=0.048), and there was no relationship between these parameters.

CONCLUSION

Abdominal fat distribution was weakly related to cardiovascular risk in patients seen by a clinical school of nutrition.

Is osteoarthritis a metabolic disorder?

BACKGROUND

Obesity is associated with an increased risk of developing osteoarthritis (OA), even in non-weight bearing joints. High levels of adipose tissue-associated inflammation may explain this association.

SOURCES OF DATA AND AREAS OF DEBATE

Published evidence looking at the associations between components of Metabolic Syndrome (MetS) and knee, hip or hand OA and the higher mortality described with knee OA.

EMERGING POINTS

Development of MetS and OA shares a relationship with adipose tissue-associated inflammation. This review supports this inflammatory pathway being part of the shared mechanism behind obesity as a risk factor for OA and the recently described OA-associated increased mortality.

TIMELY AREAS FOR DEVELOPMENT

In an era of an obesity epidemic, this review identifies a need for well-designed cohort studies assessing early metabolic changes in populations at high risk of OA and MetS, and to identify risk factors for increased mortality in patients with OA.

Changes in body weight after total hip arthroplasty: short-term and long-term effects

BACKGROUND

Elevated body weight is associated with hip osteoarthritis (OA) and subsequently with total hip arthroplasty (THA). Patients with hip OA who are overweight often mention their restricted mobility as a factor that thwarts their attempts to be physically active and lose weight. There is some evidence that THA increases physical activity, but none for losing body weight after THA.

OBJECTIVE

The purpose of this study was to analyze the short-term (1-year) and long-term (4.5-year) effects of a THA on body weight.

DESIGN

This was an observational, multicenter cohort study.

METHODS

For the short-term effect, all patients (N=618) were analyzed; for the long-term effect, a random subgroup (n=100) was analyzed. Preoperative and postoperative body weight and height were self-reported. Patients were categorized according to their preoperative body mass index (BMI <25 kg/m(2)=normal weight, 25-30 kg/m(2)=overweight, >30 kg/m(2)=obese). Clinical relevancy was set at a minimum of 5% weight loss compared with baseline.

RESULTS

The mean age of the study group was 70 years (SD=8), 74% were women, and mean preoperative body mass was 79 kg (SD=14). One year after THA, a significant decrease in body weight of 1% and 3.4% occurred for the overweight and obese BMI categories, respectively. After 4.5 years, a significant decrease in body weight of 6.4% occurred for the obese BMI category.

LIMITATIONS

Height and weight-and thus BMI-were self-reported.

CONCLUSION

Patients in the overweight and obese groups showed a decrease, albeit not clinically relevant, in body weight after 1 year. After 4.5 years, a decrease that was relevant clinically was observed in the patients who were obese. It can be concluded that no clinically relevant reduction of weight occurred after THA, except in the long term for patients who were obese.

Maternal nutrition and perinatal outcomes

Diet and patterns of eating during pregnancy can affect perinatal outcomes through direct physiologic effects or by stressing the fetus in ways that permanently affect phenotype. Supplements are not a magic nutritional remedy, and evidence of profound benefit for most supplements remains inconclusive. However, research supports calcium supplements to decrease preeclampsia. Following a low glycemic, Mediterranean-type diet appears to improve ovulatory infertility, decrease preterm birth, and decrease the risk of gestational diabetes. Although women in the United States have adequate levels of most nutrients, subpopulations are low in vitamin D, folate, and iodine. Vitamin D has increasingly been shown to be important not only for bone health, but also for glucose regulation, immune function, and good uterine contractility in labor. To ensure adequate vitamin and micronutrient intake, especially of folate before conception, all reproductive age women should take a multivitamin daily. In pregnancy, health care providers need to assess women's diets, give them weight gain recommendations based on their body mass index measurement, and advise them to eat a Mediterranean diet rich in omega-3 fatty acids (ingested as low-mercury risk fatty fish or supplements), ingest adequate calcium, and achieve adequate vitamin D levels through sun exposure or supplements. Health care providers should continue to spend time on nutrition assessment and counseling.