Obesity: America’s Epidemic

The Role of Family of Origin in Current Lifestyle Choices: A Qualitative Secondary Data Analysis of Interracial and Same-Race Couples

Many Americans are in poor health. This is acute for racial/ethnic minorities compared with the Non-Hispanic white population. A grounded theory approach was used to analyze semistructured qualitative interviews to identify perceptions of family-of-origin lifestyle choices in same-race and interracial couples. Several central themes emerged from the data including influence of family-of-origin eating patterns, lack of family-of-origin importance for physical activity, and romantic partner influence in eating and exercise. Findings provide evidence for the socialization of family of origin on lifestyle choices into adulthood and also suggest promising changes due to romantic partner.

Alignment of diet prescription to genotype does not promote greater weight loss success in women with obesity participating in an exercise and weight loss program

OBJECTIVE

Genetics contribute to variability in individual response to weight-loss interventions. The objective of this study was to determine the efficacy of a commercially available exercise and weight-loss program and whether alignment of diet to genotype related to lipid metabolism promotes greater success.

DESIGN

Sedentary women with obesity (n = 63) had genotype (FABP2rs1799883, PPARG2rs1801282, ADRB3rs4994C3, ADRB2rs1042713, rs1042714) determined using a direct-to-consumer genetic screening kit purported to promote greater weight-loss success through dietary recommendations based on these genes. Participants were randomly assigned to follow a moderate carbohydrate (MC) or lower carbohydrate (LC) hypo-energetic diet that aligned (A) or did not align (NA) with genotype for 24 weeks while participating in a resistance training and walking program. Data were analysed by general linear model repeated measures adjusted for baseline variables and are presented as mean (95% confidence interval) changes from baseline.

RESULTS

Participants in the LC group experienced greater improvements (p = 0.051, ηp 2 = 0.025) in per cent changes in body composition (weight: MC -3.32 [-1.4, -5.2], LC -5.82 [-4.1, -7.6]; fat mass: MC -7.25 [-3.2, -11.2], LC -10.93 [-7.3, -14.5]; fat-free mass: MC -0.32 [1.4, -2.0], LC -1.48 [0.7, -3.0]; and body fat percentage: MC -4.19 [-1.6, -6.8], LC -5.60 [-3.3, -7.9] %). No significant differences were observed between genotype groups (weight: A -5.00 [-3.3, -6.7], NA -4.14 [-2.2, -6.1]; fat mass: A -10.15 [-7.0, -13.6], NA -8.02 [-4.0, -12.0]; fat-free mass: A -1.23 [0.3, -2.8], NA -0.56 [1.12, -2.3]; and body fat: A -5.28 [-3.0, -7.6], NA -4.51 [-1.9, -7.1] %).

CONCLUSIONS

Adherence to this exercise and weight-loss program promoted improvements in body composition and health outcomes. While individuals following the LC diet experienced greater benefits, alignment of these diets to this genetic profile did not promote greater health outcomes.

Model-Based Approach to Predict Adherence to Protocol During Antiobesity Trials

Development of antiobesity drugs is continuously challenged by high dropout rates during clinical trials. The objective was to develop a population pharmacodynamic model that describes the temporal changes in body weight, considering disease progression, lifestyle intervention, and drug effects. Markov modeling (MM) was applied for quantification and characterization of responder and nonresponder as key drivers of dropout rates, to ultimately support the clinical trial simulations and the outcome in terms of trial adherence. Subjects (n = 4591) from 6 Contrave^® trials were included in this analysis. An indirect‐response model developed by van Wart et al was used as a starting point. Inclusion of drug effect was dose driven using a population dose‐ and time‐dependent pharmacodynamic (DTPD) model. Additionally, a population‐pharmacokinetic parameter‐ and data (PPPD)‐driven model was developed using the final DTPD model structure and final parameter estimates from a previously developed population pharmacokinetic model based on available Contrave^® pharmacokinetic concentrations. Last, MM was developed to predict transition rate probabilities among responder, nonresponder, and dropout states driven by the pharmacodynamic effect resulting from the DTPD or PPPD model. Covariates included in the models and parameters were diabetes mellitus and race. The linked DTPD‐MM and PPPD‐MM was able to predict transition rates among responder, nonresponder, and dropout states well. The analysis concluded that body‐weight change is an important factor influencing dropout rates, and the MM depicted that overall a DTPD model‐driven approach provides a reasonable prediction of clinical trial outcome probabilities similar to a pharmacokinetic‐driven approach.

Calorie-induced ER stress suppresses uroguanylin satiety signaling in diet-induced obesity

Background/Objectives:

The uroguanylin-GUCY2C gut–brain axis has emerged as one component regulating feeding, energy homeostasis, body mass and metabolism. Here, we explore a role for this axis in mechanisms underlying diet-induced obesity (DIO).

Subjects/Methods:

Intestinal uroguanylin expression and secretion, and hypothalamic GUCY2C expression and anorexigenic signaling, were quantified in mice on high-calorie diets for 14 weeks. The role of endoplasmic reticulum (ER) stress in suppressing uroguanylin in DIO was explored using tunicamycin, an inducer of ER stress, and tauroursodeoxycholic acid (TUDCA), a chemical chaperone that inhibits ER stress. The impact of consumed calories on uroguanylin expression was explored by dietary manipulation. The role of uroguanylin in mechanisms underlying obesity was examined using Camk2a-Cre-ER^T2-Rosa-STOP^loxP/loxP-Guca2b mice in which tamoxifen induces transgenic hormone expression in brain.

Results:

DIO suppressed intestinal uroguanylin expression and eliminated its postprandial secretion into the circulation. DIO suppressed uroguanylin through ER stress, an effect mimicked by tunicamycin and blocked by TUDCA. Hormone suppression by DIO reflected consumed calories, rather than the pathophysiological milieu of obesity, as a diet high in calories from carbohydrates suppressed uroguanylin in lean mice, whereas calorie restriction restored uroguanylin in obese mice. However, hypothalamic GUCY2C, enriched in the arcuate nucleus, produced anorexigenic signals mediating satiety upon exogenous agonist administration, and DIO did not impair these responses. Uroguanylin replacement by transgenic expression in brain repaired the hormone insufficiency and reconstituted satiety responses opposing DIO and its associated comorbidities, including visceral adiposity, glucose intolerance and hepatic steatosis.

Conclusions:

These studies reveal a novel pathophysiological mechanism contributing to obesity in which calorie-induced suppression of intestinal uroguanylin impairs hypothalamic mechanisms regulating food consumption through loss of anorexigenic endocrine signaling. The correlative therapeutic paradigm suggests that, in the context of hormone insufficiency with preservation of receptor sensitivity, obesity may be prevented or treated by GUCY2C hormone replacement.

A Model of Clinical Intervention in the Maternity Ward: The Breastfeeding and Bonding EMDR Protocol

Breastfeeding is one of the main manifestations of the bond that a mother builds with her newborn baby. Literature on psychological support for mothers in the early stages of breastfeeding is limited and interventions often do not pinpoint the actual roots of the difficulties. Breastfeeding difficulties may cause emotional distress to women and this can impact significantly on bonding and the perinatal period may turn into a state of crisis. Therefore, it is essential for the clinical psychologist to intervene selectively and in a prompt, effective way, especially when working in a maternity ward. This article suggests a model of intervention: the Breastfeeding and Bonding EMDR Protocol. This protocol, created ad hoc for breastfeeding, combines the work with eye movement desensitization and reprocessing (EMDR) on recent events, the standard protocol and the installation of resources. The hospital case study presented here thoroughly illustrates the various stages of the protocol and the peculiarity and functionality of EMDR regarding breastfeeding and bonding issues in the immediate postpartum period. Prevention is the paramount subject of the model of clinical intervention on breastfeeding hereafter presented.

Effects of yam dioscorin interventions on improvements of the metabolic syndrome in high-fat diet-induced obese rats

BACKGROUND

The metabolic syndrome (MS) is termed a cluster of multiple metabolic risk criteria which is positively correlated with cardiovascular disease and type 2 diabetes mellitus (DM). Yam dioscorins have been reported to exhibit biological activities, however, little is known their preventive effects on the MS. Therefore, a high-fat (HF) diet was used to induce Wistar rat obesity and then yam dioscorin (50 mg/kg, dio50) was intervened daily concurrent HF diet (HF diet + dio50) for five weeks to check the changes of weights of body and tissues, blood pressures, and impaired glucose tolerances. The in vitro peptic hydrolysates of dioscorin with molecular mass between 3 kDa and 10 kDa and less than 3 kDa were used to determine dipeptidyl peptidase IV (DPP IV) inhibitory activities which DPP IV inhibitor has been reported to prevent and treat type 2 DM.

RESULTS

There were no significant difference in body weights, feed intakes, feed conversion, and weights of adipose tissues of obese rats in groups of HF and (HF diet + dio50). However, the systolic blood pressures in obese rats of 2-, 3- and 4-week dioscorin interventions were showed significantly lower (P < 0.05) compared to the HF group. The dioscorin intervention (HF+ dio50) was showed significantly different (P < 0.05) and improved the impaired glucose tolerances compared to HF group in obese rats by the oral glucose tolerance tests. It was also found that the fraction with different molecular mass of dioscorin peptic hydrolysates (5 mg/ml) showed inhibitory activities against DPP IV using sitagliptin phosphate as positive controls.

CONCLUSIONS

Yam dioscorins exhibit improved MS activities in obese rats which the related mechanisms may need further investigations.

Vitis thunbergii var. taiwaniana Extracts and Purified Compounds Ameliorate Obesity in High-Fat Diet-Induced Obese Mice

The increasing prevalence of obesity continues to gain more attention worldwide. In this study, diet-induced obese mice were used to evaluate the antiobesity effects of extracts, fractions, and purified compounds from Vitis thunbergii var. taiwaniana (VTT). The C57BL/6J mice were fed a 5-week high-fat diet (HF) concurrently with ethanol extracts (Et-ext, 80 mg/kg) from roots (R), stems (S), and leaves (L) by oral gavage daily. Only R-Et-ext interventions showed significant weight reduction in mice compared with those in the HF group; however, mouse plasma contents of total cholesterols (TC), total triglycerides (TG) and low-density lipoproteins (LDL) of all three Et-ext intervened groups showed significant reductions compared with those in the HF group. Furthermore, intervention with the ethyl acetate-partitioned fraction (EA-fra, 60 mg/kg) from R-Et-ext but not the n-butanol-partitioned fraction or water fraction from R-Et-ext showed significant weight reduction in mice compared with those in the HF group. The same molecular weights of three resveratrol tetramers, (+)-hopeaphenol, (+)-vitisin A, and (-)-vitisin B, were isolated from the EA-fra of VTT-R. The (+)-vitisin A and fenofibrate (25 mg/kg) but not the (+)-hopeaphenol and (-)-vitisin B interventions showed significant weight reduction in mice compared with those in the HF group. The total feed intake among the HF groups with or without interventions showed no significant differences. The mouse plasma contents of TC, TG, LDL, free fatty acid, and plasma lipase activity of the three resveratrol tetramer-intervened groups showed reductions in the mice compared with those in the HF group. It was proposed that the lipase inhibitory activities of VTT extracts and purified resveratrol tetramers might contribute in part to the antiobesity effect, and these results suggested that VTT may be developed as functional food for achieving antiobesity objectives and requires further investigation.

Characteristics of Postpartum Depression in Anand District, Gujarat, India

Characteristics of postpartum depression (PPD) in Anand District, Gujarat, India. PPD affects 1 in 10 women in the developed world. It has been implicated as an independent factor with adverse effect on child health, and health care-seeking behavior of mothers. We sought to find the prevalence of PPD in our hospital by including mothers who registered and delivered live babies at our hospital. Basic demographic information related to pregnancy was acquired from mothers and Edinburgh Postnatal Depression Scale (EPDS), pre-translated and validated in Gujarati language, was administered. Current study observed prevalence of PPD as 48.5% using cutoff score of 10.5 for classifying depression in Gujarati women. Factors associated with depression after multivariable logistic regression were: age of mother, modified Kuppuswami category (MKC) score, family type, violence from husband, gravida, para and sex of infant. PPD has higher prevalence in our study vis-a-vis Western countries. This may be because of early administration of EPDS.

Interleukin-15 modulates adipose tissue by altering mitochondrial mass and activity

Interleukin-15 (IL-15) is an immunomodulatory cytokine that affects body mass regulation independent of lymphocytes; however, the underlying mechanism(s) involved remains unknown. In an effort to investigate these mechanisms, we performed metabolic cage studies, assessed intestinal bacterial diversity and macronutrient absorption, and examined adipose mitochondrial activity in cultured adipocytes and in lean IL-15 transgenic (IL-15tg), overweight IL-15 deficient (IL-15-/-), and control C57Bl/6 (B6) mice. Here we show that differences in body weight are not the result of differential activity level, food intake, or respiratory exchange ratio. Although intestinal microbiota differences between obese and lean individuals are known to impact macronutrient absorption, differing gut bacteria profiles in these murine strains does not translate to differences in body weight in colonized germ free animals and macronutrient absorption. Due to its contribution to body weight variation, we examined mitochondrial factors and found that IL-15 treatment in cultured adipocytes resulted in increased mitochondrial membrane potential and decreased lipid deposition. Lastly, IL-15tg mice have significantly elevated mitochondrial activity and mass in adipose tissue compared to B6 and IL-15-/- mice. Altogether, these results suggest that IL-15 is involved in adipose tissue regulation and linked to altered mitochondrial function.

Independent stem cell lineages regulate adipose organogenesis and adipose homeostasis

Adipose tissues have striking plasticity, highlighted by childhood and adult obesity. Using adipose lineage analyses, smooth muscle actin (SMA)-mural cell-fate mapping, and conditional PPARγ deletion to block adipocyte differentiation, we find two phases of adipocyte generation that emanate from two independent adipose progenitor compartments: developmental and adult. These two compartments are sequentially required for organ formation and maintenance. Although both developmental and adult progenitors are specified during the developmental period and express PPARγ, they have distinct microanatomical, functional, morphogenetic, and molecular profiles. Furthermore, the two compartments derive from different lineages; whereas adult adipose progenitors fate-map from an SMA+ mural lineage, developmental progenitors do not. Remarkably, the adult progenitor compartment appears to be specified earlier than the developmental cells and then enters the already developmentally formed adipose depots. Thus, two distinct cell compartments control adipose organ development and organ homeostasis, which may provide a discrete therapeutic target for childhood and adult obesity.

Young adults' strategies for managing social support during weight-loss attempts

Obesity and being overweight often result in serious health problems. Despite growing awareness of the dangers associated with being overweight, many individuals struggle to lose weight. Investigators have identified social support as a key element in weight-loss attempts. Unfortunately, little has been done to investigate how people solicit social support from members of their pre-existing social network without a structured intervention. To address this limitation, I conducted in-depth interviews with 25 participants. Through grounded theory analysis of these interviews, I developed a typology of support management strategies used by overweight young adults when attempting to lose weight. I outline these strategies, their perceived success, and implications for future research in this article.

Understanding the Factors That Determine Registered Nurses’ Turnover Intentions

Turnover among registered nurses (RNs) produces a negative impact on the health outcomes of any health care organization. It is also recognized universally as a problem in the nursing profession. Little is known about the turnover intentions and career orientations of RNs working in Calgary, Alberta, Canada. The aim of this study is to contribute to the knowledge of and to advance the discussion on the turnover of nursing professionals. The study population consisted of RNs employed in the five major hospitals in Calgary. There were 193 surveys returned, representing a response rate of 77.2%. The results show that age and education have a negative effect on turnover intention. Education was found to have a significant negative effect on career satisfaction but not on job satisfaction and organizational commitment. Length of service has a significant negative effect on turnover intention. Role ambiguity has significant highly negative effect on career satisfaction. Growth opportunity and supervisor support have a very significant positive effect on job satisfaction, career satisfaction, and organizational commitment. External career opportunities and organizational commitment do not seem to have a significant effect on turnover intention. Career satisfaction, on the other hand, had negative significant effects on turnover intention.

Perceptions of weight loss experience between African-Americans and Caucasians: a pilot study

BACKGROUND

Obesity is a growing epidemic in the USA, which leads to comorbidities associated with diseases such as hypertension, diabetes, sleep apnea, cardiovascular disease, osteoarthritis, cancer, gallbladder disease, and dyslipidemia. The purpose of this study is to identify perceptions of weight loss experience between African-American (AA) and Caucasian patients undergoing bariatric surgery.

METHODS

A convenience sample of 31 patients participated in this study from May to June 2013. The sample size consisted of 16 AA and 15 Caucasians from two fully accredited and licensed bariatric clinics in metropolitan Detroit.

RESULTS

The sample (N = 31) consists of eligible AA and Caucasian presurgical bariatric patients on their first preoperative appointment. Snacking and sexual satisfaction showed a significant difference (p < 0.05), lower amongst Caucasians than amongst the AA. The results revealed that salary within the AA population was significantly lower than that of the Caucasians, especially in the $26.000 to $36,000 category as well as in the over $40,000 category.

CONCLUSIONS

The discrepancy widened as the variables of snacks, sexual satisfaction, and salary revealed a significant difference for Caucasians than AA. It is prudent that health-care providers become part of the obesity management solution by examining these variables when planning weight loss interventions.

A journey toward wholeness, a journey to God: physical fitness as embodied spirituality

Physical fitness expressed through exercise can be, if done with the right intention, a form of spiritual discipline that reflects the relational love of humanity to God as well as an expression of a healthy love of the embodied self. Through an analysis of the physiological benefits of exercise science applied to the human body, this paper will demonstrate how such attention to the optimal physical fitness of the body, including weight and cardiovascular training and nutrition, is an affirmation of three foundational theological principles of human embodiment: as created in the "imago Dei", as unified body/spirit, and as part of God's creation calling for proper stewardship. In a contemporary climate where women's bodies in particular are viewed through the lens of commodification-as visual objects for sale based on prescribed notions of superficial esthetics and beauty-as well as the consistently high rates of eating disorders such as anorexia, bulimia, and obesity, authors Greenwood and Delgado offer a vision of how women and men can imagine a subjective relationship with their own bodies that reflects the abundant love of God for God's creation. Spoken from the lived experience of professional fitness competitor and trainer, as well as trained biokineticist, Dr. Greenwood presents the most current scientific data in the field of biokinetics that grounds the theological analysis offered by Dr. Delgado, whose personal journey through anorexia and scholarly emphasis on Christian theological anthropology inform this work. Taken together, Greenwood and Delgado suggest a response to God's love for humanity, including our physical bodily humanity, which entails a responsibility to attend to the physical fitness of our bodies in order to live into the fullness, flourishing and love of God's creation as God intended.

Translating research into practice in nursing homes: can we close the gap?

PURPOSE

A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger's innovation dissemination model.

DESIGN AND METHODS

The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices.

RESULTS

A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature.

IMPLICATIONS

NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs' adoption of these practices.

Regulation of appetite to treat obesity

Obesity has escalated into a pandemic over the past few decades. In turn, research efforts have sought to elucidate the molecular mechanisms underlying the regulation of energy balance. A host of endogenous mediators regulate appetite and metabolism, and thereby control both short- and long-term energy balance. These mediators, which include gut, pancreatic and adipose neuropeptides, have been targeted in the development of anti-obesity pharmacotherapy, with the goal of amplifying anorexigenic and lipolytic signaling or blocking orexigenic and lipogenic signaling. This article presents the efficacy and safety of these anti-obesity drugs.

Anti-obesity drugs: past, present and future

The ideal anti-obesity drug would produce sustained weight loss with minimal side effects. The mechanisms that regulate energy balance have substantial built-in redundancy, overlap considerably with other physiological functions, and are influenced by social, hedonic and psychological factors that limit the effectiveness of pharmacological interventions. It is therefore unsurprising that anti-obesity drug discovery programmes have been littered with false starts, failures in clinical development, and withdrawals due to adverse effects that were not fully appreciated at the time of launch. Drugs that target pathways in metabolic tissues, such as adipocytes, liver and skeletal muscle, have shown potential in preclinical studies but none has yet reached clinical development. Recent improvements in the understanding of peptidergic signalling of hunger and satiety from the gastrointestinal tract mediated by ghrelin, cholecystokinin (CCK), peptide YY (PYY) and glucagon-like peptide-1 (GLP-1), and of homeostatic mechanisms related to leptin and its upstream pathways in the hypothalamus, have opened up new possibilities. Although some have now reached clinical development, it is uncertain whether they will meet the strict regulatory hurdles required for licensing of an anti-obesity drug. However, GLP-1 receptor agonists have already succeeded in diabetes treatment and, owing to their attractive body-weight-lowering effects in humans, will perhaps also pave the way for other anti-obesity agents. To succeed in developing drugs that control body weight to the extent seen following surgical intervention, it seems obvious that a new paradigm is needed. In other therapeutic arenas, such as diabetes and hypertension, lower doses of multiple agents targeting different pathways often yield better results than strategies that modify one pathway alone. Some combination approaches using peptides and small molecules have now reached clinical trials, although recent regulatory experience suggests that large challenges lie ahead. In future, this polytherapeutic strategy could possibly rival surgery in terms of efficacy, safety and sustainability of weight loss.

Relationship between sleep quality and quantity and weight loss in women participating in a weight-loss intervention trial

Evidence suggests that individuals who report fewer total hours of sleep are more likely to be overweight or obese. Few studies have prospectively evaluated weight-loss success in relation to reported sleep quality and quantity. This analysis sought to determine the association between sleep characteristics and weight loss in overweight or obese women enrolled in a randomized clinical trial of a weight-loss program. We hypothesized that in overweight/obese women, significant weight loss would be demonstrated more frequently in women who report a better Pittsburgh Sleep Quality Index (PSQI) Global Score or sleep >7 h/night as compared to women who report a worse PSQI score or sleep ≤7 h/night. Women of ages 45.5 ± 10.4 (mean ± SD) years and BMI of 33.9 ± 3.3 (n = 245) were randomized and completed PSQI at baseline and 6 months; 198 had weight change assessed through 24 months. At baseline, 52.7% reported PSQI scores above the clinical cutoff of 5. Better subjective sleep quality increased the likelihood of weight-loss success by 33% (relative risk (RR), 0.67; 95% confidence interval (CI), 0.52-0.86), as did sleeping >7 h/night. A worse Global Score at 6 months was associated with a 28% lower likelihood of continued successful weight loss at 18 months, but unassociated by 24 months. These results suggest that sleep quality and quantity may contribute to weight loss in intervention-based studies designed to promote weight control in overweight/obese adult women.

Epidemiology and economic impact of obesity and type 2 diabetes

Obesity has become a major public health concern in the United States and the rest of the world. This disease carries significant health risks that encompass several organ systems. Type 2 diabetes mellitus is a major comorbidity of obesity that predisposes patients to significant end-organ damage. The prevalence of obesity and diabetes is increasing worldwide, and the economic impact of these diseases currently assumes a significant portion of health care expenditure. These factors mandate implementation of therapeutic medical and surgical strategies that target prevention and treatment of obesity and its related medical conditions.

Short sleep duration and body mass index: a prospective longitudinal study in preadolescence

Short sleep duration is associated with incidence of overweight and obesity in preadolescent children. The authors performed regression analyses on data from the Quebec Longitudinal Study of Kindergarten Children (1986-1987), a prospective cohort study comprising 1,916 preadolescent children in Canada. The aim was to assess associations between time spent in bed and body mass index reported by mothers after adjusting for numerous confounding factors, such as pubertal status. Time-in-bed and body mass index trajectories were computed using a semiparametric model mixture. Time-in-bed trajectories were classified as short (15% of the preadolescents), 10.5-hour (68%), and 11-hour (17%) sleep-duration trajectories, decreasing over time. Body mass index trajectories were classified as normal weight (68% of the preadolescents), overweight (27%), and obese (5%). The short sleep trajectory was associated with an increased odds ratio of being in the overweight body mass index trajectory (odds ratio (OR)=1.55, 95% confidence interval (CI): 1.39, 1.71) or in the obese body mass index trajectory (OR=3.26, 95% CI: 3.20, 3.29) compared with the 11-hour trajectory. One hour less of sleep per night at 10 years of age was associated with an increased odds ratio of being overweight (OR=1.51, 95% CI: 1.28, 1.76) or obese (OR=2.07; 95% CI: 1.51, 2.84) at 13 years of age.

Body mass index, cognitive deficit and depressive symptoms in high cardiovascular risk patients

To evaluate the relationship of obesity, cognitive impairment and depressive symptoms in patients with high cardiovascular risk.

METHODS

A sample of 93 patients aged 50 years or older was selected from the Center of Dyslipidemia and High Cardiovascular Risk from Hospital de Clínicas de Porto Alegre (HCPA). Patients with stroke were excluded. For cognitive evaluation, the MMSE (Mini Mental State Examination) was used. A score of 24 or less was considered as cognitive impairment, and for those who had 4 years or less of education, the cutoff point was 17. The GDS-15 (Geriatric Depression Scale) was also used, with the cutoff of 6 for presence of depressive symptoms.

RESULTS

Obese patients showed lower mean MMSE scores compared to non-obese patients (p=0.0012). Additionally, for every one point increase in BMI above 30 there was a 27% increase in the chances of the patient having cognitive impairment. The obese patients presented 31% chance of having cognitive impairment compared with overweight subjects.

CONCLUSIONS

Our findings corroborated the association between obesity and cognitive impairment in high cardiovascular risk patients. This association however, was not observed for depressive symptoms.

Current trends in targeting the hormonal regulation of appetite and energy balance to treat obesity

With the eruption of the obesity pandemic over the past few decades, much research has been devoted to understanding the molecular mechanisms by which the human body regulates energy balance. These studies have revealed several mediators, including gut/pancreatic/adipose hormones and neuropeptides that control both short- and long-term energy balance by regulating appetite and/or metabolism. These endogenous mediators of energy balance have been the focus of many anti-obesity drug-development programs aimed at either amplifying endogenous anorexigenic/lipolytic signaling or blocking endogenous orexigenic/lipogenic signaling. Here, we discuss the efficacy and safety of targeting these pathways for the pharmacologic treatment of obesity.

High self-reported prevalence of diabetes mellitus, heart disease, and stroke in 11 counties of rural Appalachian Ohio

CONTEXT/PURPOSE: There is an epidemic of obesity and diabetes in the United States, especially in economically at-risk populations such as rural Appalachia. This survey determined the self-reported prevalence of obesity, diabetes mellitus, and associated macrovascular complications in 11 rural counties of Appalachian Ohio. The impacts of lifestyle, cardiovascular risk factors, income, and access to medical care were also determined.

METHODS

A telephone survey identical to the 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey was conducted. Surveys were collected from 3,927 randomly selected residents 18 years of age and older in 11 counties of Appalachian Ohio and compared to published aggregate Ohio and national 2004 BRFSS data.

FINDINGS

The self-reported prevalence of diabetes (11.3%) was markedly higher in Appalachian Ohio counties surveyed compared to aggregate Ohio (7.8%) or national (7.2%) 2004 BRFSS data (P < .044). The prevalence of heart disease (7.6%) and stroke (4.1%) in these counties was slightly higher than aggregate Ohio or national 2004 BRFSS data. In persons with diabetes, the prevalence of heart disease was 2-fold higher (20.0%) and stroke 3-fold higher (11.4%) than among nondiabetics (P < .042) in the region and higher than aggregate Ohio and National 2004 BRFSS data. Lower-income levels and decreased access to medications and glucose monitoring supplies correlated with the increased risk for cardiovascular complications in this rural population (P < .042).

CONCLUSION

The self-reported prevalence of diabetes mellitus and its associated macrovascular complications are much higher in rural Appalachian Ohio compared to aggregate Ohio and National 2004 BRFSS data.

Examining the effect of maternal obesity on outcome of labor induction in patients with preeclampsia

OBJECTIVE

The objective of this investigation was to evaluate the effect of maternal obesity, as measured by prepregnancy body mass index (BMI), on the mode of delivery in women undergoing indicated induction of labor for preeclampsia.

STUDY DESIGN

Following Institutional Review Board (IRB) approval, patients with preeclampsia who underwent an induction of labor from 1997 to 2007 were identified from a perinatal information database, which included historical and clinical information. Data analysis included bivariable and multivariable analyses of predictor variables by mode of delivery. An artificial neural network was trained and externally validated to independently examine predictors of mode of delivery among women with preeclampsia.

RESULTS

Six hundred and eight women met eligibility criteria and were included in this investigation. Based on multivariable logistic regression (MLR) modeling, a 5-unit increase in BMI yields a 16% increase in the odds of cesarean delivery. An artificial neural network trained and externally validated confirmed the importance of obesity in the prediction of mode of delivery among women undergoing labor induction for preeclampsia.

CONCLUSION

Among patients who are affected by preeclampsia, obesity complicates labor induction. The risk of cesarean delivery is enhanced by obesity, even with small increases in BMI. Prediction of mode of delivery by an artificial neural network performs similar to MLR among patients undergoing labor induction for preeclampsia.

Pediatric nurse practitioners' assessment and management of childhood overweight/obesity: results from 1999 and 2005 cohort surveys

INTRODUCTION

Recently, public and professional emphasis has been placed on addressing the increasing prevalence of childhood overweight.

METHOD

This survey study was conducted with two cohorts of pediatric nurse practitioners (N = 413) to explore differences in self-reported practice skills over time.

RESULTS

Significant improvements in assessment, screening, and laboratory evaluations were reported, although reduced adherence to recommended psychosocial assessments was noted.

DISCUSSION

This study outlines self-reported barriers to effective childhood weight management. One support that participants requested was evidence-based guidelines. Motivational interviewing may be an additional strategy to enhance provider skills to assess and manage challenging patient behavior change (e.g., dietary and activity changes).

UCP1 -3826 AG+GG genotypes, adiponectin, and leptin/adiponectin ratio in severe obesity

BACKGROUND AND AIMS

Non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) are well-recognized complications of obesity. This study was designed to evaluate the role of the UCP1 -3826 A>G polymorphism, adiponectin levels, leptin/adiponectin ratio (L/A), and main biochemical parameters in 102 unrelated severely obese adults [61 females and 41 males, median body mass index (BMI) = 47.8 kg/m2] with NAFLD, with (MS+) or without MS (MS-) from Southern Italy.

SUBJECT AND METHODS

The UCP1 polymorphism was tested by the TaqMan method, main biochemical parameters by routinary methods, adiponectin, and leptin serum levels by enzyme-linked immunosorbent assay. MS was diagnosed according to the American Heart Association criteria, liver steatosis was detected by ultrasound.

RESULTS

MS was present in 53% male and 66% female obese patients. Only total cholesterol (p=0.04 males and p=0.002 females) and L/A ratio (p=0.03 males) differed between MS+ and MS- obese patients. At multivariate analysis, severe liver steatosis was significantly associated with: UCP1 (AG+GG) genotypes [odds ratio-confidence interval (OR-CI): 4.25; 1.12-16.13], MS (OR-CI: 8.47; 1.78-40.25), low adiponectin levels (OR-CI: 0.92; 0.87-0.98), high alanine aminotransferase levels (OR-CI: 1.03; 1.00-1.06), age (ORCI: 1.08; 1.00-1.15), and male gender (OR-CI: 10.78; 1.61- 71.96).

CONCLUSION

In addition to traditional factors, total cholesterol and L/A ratio appear to contribute to MS characterization in severe obesity. Furthermore, the UCP1 (AG+GG) genotypes and low adiponectin levels could predispose to a more severe liver steatosis independently of MS presence. Based on our data, polymorphic UCP1 (AG+GG) obese patients with low adiponectin levels appear to be high-risk subjects for worsening of liver steatosis, a NAFLD, possibly requiring a second-step evaluation by liver biopsy.

Review paper: Current strategies in the development of anti-obesity drugs and their safety concerns

Obesity is a well-established risk factor for hypertension, hyperlipidemia, type II diabetes, coronary heart disease, stroke, obstructive sleep apnea, asthma, orthopedic disorders, and certain cancers. Despite this risk, the prevalence of obesity continues to increase worldwide, and there is a growing demand for safe and effective antiobesity drugs. Previous antiobesity drugs or anorexigens, particularly centrally acting agents, have poor safety records. Life-threatening safety issues led to the withdrawal of aminorex in 1968, fenfluramine and dexfenfluramine in 1997, and phenylpropanolamine in 2000. Many of the safety issues, such as valvulopathy with fenfluramine and pulmonary arterial hypertension with aminorex, were initially not predicted by routine preclinical toxicology studies. To date, there are no validated animal models or preclinical and/or toxicologic screens to accurately predict anorexigen-induced valvulopathy and pulmonary arterial hypertension in humans. This review covers the current state of antiobesity drugs and their safety concerns, and highlights new therapeutic targets and scientific advances toward the development of appropriate animal models by using novel techniques that will aid in understanding pathogenesis and pathophysiology of anorexigen-related safety issues.

The nursing home culture-change movement: recent past, present, and future directions for research

This article uses a retrospective approach to critique the research base underlying the nursing home culture-change movement-an effort to radically transform the nation's nursing homes by delivering resident-directed care and empowering staff. The article traces the development of the movement from its inception 10 years ago to 2005, when the Centers for Medicare and Medicaid Services implemented its own initiative to support the movement, thus giving it new momentum, to the present day. This historical overview provides context for a proposed research agenda aimed at strengthening the movement's empirical base, thereby facilitating culture-change interventions as well as helping the movement navigate the next step in its evolution.

Stress and sex influences on food-seeking behaviors

OBJECTIVE

Stress increases the drive to consume calorically dense preferred foods suggesting an exogenous factor that may induce caloric overconsumption and weight gain. As females show heightened stress sensitivity and present with increased rates of obesity, we hypothesized that stress-induced increases in the motivation for preferred foods may be a sex-specific predisposing factor for weight gain.

METHODS AND PROCEDURES

To investigate this hypothesis, we have developed a buried food paradigm that permits the measurement of sex differences and effects of chronic variable stress (CVS) on the latency to uncover and the consumption of a preferred food pellet without the requisite caloric restriction required in traditional operant conditioning tasks.

RESULTS

In our studies, females consistently showed latencies that were twice as fast as males to locate the buried pellet in limited access tests. Interestingly, during stress exposure, male latencies decreased to that of control female levels. Male and female mice showed a significant effect of stress, three- and fourfold, respectively, on increased consumption of the preferred food during testing.

DISCUSSION

These results support a basal sex difference in behaviors toward a preferred food, and a possible role of stress sensitivity in the drive and intake of such foods. Sex differences in the role stress plays in these behaviors may provide insight into underlying mechanisms related to an increased obesity risk.

Voluntary exercise together with oral caffeine markedly stimulates UVB light-induced apoptosis and decreases tissue fat in SKH-1 mice

Treatment of SKH-1 mice orally with caffeine (0.1 mg/ml in the drinking water), voluntary running wheel exercise, or a combination of caffeine and exercise for 2 weeks (i) decreased the weight of the parametrial fat pads by 35, 62, and 77%, respectively; (ii) decreased the thickness of the dermal fat layer by 38, 42, and 68%, respectively; (iii) stimulated the formation of UVB-induced apoptotic sunburn cells in the epidermis by 96, 120, and 376%, respectively; and (iv) stimulated the formation of UVB-induced caspase 3 (active form)-positive cells in the epidermis by 92, 120, and 389%, respectively (average of two experiments). Oral administration of caffeine (0.4 mg/ml in the drinking water) in combination with voluntary exercise was less effective than administration of the low dose of caffeine in combination with exercise in stimulating UVB-induced apoptosis. Although orally administrated caffeine (0.1 mg/ml in the drinking water) or voluntary exercise for 2 weeks caused only a small nonsignificant stimulation of UVB-induced increase in the percentage of phospho-p53 (Ser-15)-positive cells in the epidermis (27 or 18%, respectively), the combination of the two treatments enhanced the UVB-induced increase in phospho-p53 (Ser-15)-positive cells by 99%. The plasma concentration of caffeine in mice ingesting caffeine (0.1-0.4 mg/ml drinking water) is similar to that in the plasma of most coffee drinkers (one to four cups per day). Our studies indicate a greater than additive stimulatory effect of combined voluntary exercise and oral administration of a low dose of caffeine on UVB-induced apoptosis.

The skinny on weight-loss surgery: what occupational health nurses need to know

Occupational health nurses are in a position to follow individuals undergoing bariatric surgery before and after the procedure. By fully understanding the health problems caused by obesity, occupational health nurses can effectively communicate the importance of diet and exercise.