Thinness and weight loss: beneficial or detrimental to longevity?

Effects of a Weight Loss Program on Metabolic Syndrome, Eating Disorders and Psychological Outcomes: Mediation by Endocannabinoids?

OBJECTIVE

To evaluate the effects of weight loss on endocannabinoids, cardiometabolic and psychological parameters, eating disorders (ED) as well as quality of life (QoL) and to elucidate the role of endocannabinoids in metabolic syndrome (MS).

METHODS

In total, 114 patients with obesity were prospectively included in a 12-month weight loss program. Plasma endocannabinoids were measured by mass spectrometry; ED, psychological and QoL-related parameters were evaluated by self-reported questionnaires; physical activity was measured by accelerometer. Nutritional assessment was done by a 3-day food diary.

RESULTS

Among completers (n = 87), body weight decreased in 35 patients (-9.1 ± 8.6 kg), remained stable in 39 patients, and increased in 13 patients (+5.8 ± 3.4 kg). 75% of patients with MS at baseline were free of MS at follow-up, and their baseline plasma N-palmitoylethanolamide (PEA) values were significantly lower when compared to patients with persisting MS. At baseline, there was a positive relationship between PEA and waist circumference (p = 0.005, R2 = 0.08), fasting glucose (p < 0.0001, R2 = 0.12), total cholesterol (p = 0.001, R2 = 0.11), triglycerides (p = 0.001, R2 = 0.11), LDL-cholesterol (p = 0.03, R2 = 0.05) as well as depression score (p = 0.002, R2 = 0.29).

CONCLUSION

Plasma PEA might play a role in metabolic improvement after weight loss. Even in subjects without weight loss, a multidisciplinary intervention improves psychological outcomes, ED, and QoL.

Body Mass Index: Obesity, BMI, and Health: A Critical Review

The body mass index (BMI) is the metric currently in use for defining anthropometric height/weight characteristics in adults and for classifying (categorizing) them into groups. The common interpretation is that it represents an index of an individual's fatness. It also is widely used as a risk factor for the development of or the prevalence of several health issues. In addition, it is widely used in determining public health policies.The BMI has been useful in population-based studies by virtue of its wide acceptance in defining specific categories of body mass as a health issue. However, it is increasingly clear that BMI is a rather poor indicator of percent of body fat. Importantly, the BMI also does not capture information on the mass of fat in different body sites. The latter is related not only to untoward health issues but to social issues as well. Lastly, current evidence indicates there is a wide range of BMIs over which mortality risk is modest, and this is age related. All of these issues are discussed in this brief review.

Low- and high-volume of intensive endurance training significantly improves maximal oxygen uptake after 10-weeks of training in healthy men

Regular exercise training improves maximal oxygen uptake (VO_2max), but the optimal intensity and volume necessary to obtain maximal benefit remains to be defined. A growing body of evidence suggests that exercise training with low-volume but high-intensity may be a time-efficient means to achieve health benefits. In the present study, we measured changes in VO_2max and traditional cardiovascular risk factors after a 10 wk. training protocol that involved three weekly high-intensity interval sessions. One group followed a protocol which consisted of 4×4 min at 90% of maximal heart rate (HR_max) interspersed with 3 min active recovery at 70% HR_max (4-AIT), the other group performed a single bout protocol that consisted of 1×4 min at 90% HR_max (1-AIT). Twenty-six inactive but otherwise healthy overweight men (BMI: 25–30, age: 35–45 y) were randomized to either 1-AIT (n = 11) or 4-AIT (n = 13). After training, VO_2max increased by 10% (∼5.0 mL⋅kg⁻¹⋅min⁻¹) and 13% (∼6.5 mL⋅kg⁻¹⋅min⁻¹) after 1-AIT and 4-AIT, respectively (group difference, p = 0.08). Oxygen cost during running at a sub-maximal workload was reduced by 14% and 13% after 1-AIT and 4-AIT, respectively. Systolic blood pressure decreased by 7.1 and 2.6 mmHg after 1-AIT and 4-AIT respectively, while diastolic pressure decreased by 7.7 and 6.1 mmHg (group difference, p = 0.84). Both groups had a similar ∼5% decrease in fasting glucose. Body fat, total cholesterol, LDL-cholesterol, and ox-LDL cholesterol only were significantly reduced after 4-AIT. Our data suggest that a single bout of AIT performed three times per week may be a time-efficient strategy to improve VO_2max and reduce blood pressure and fasting glucose in previously inactive but otherwise healthy middle-aged individuals. The 1-AIT type of exercise training may be readily implemented as part of activities of daily living and could easily be translated into programs designed to improve public health.

Trial Registration

ClinicalTrials.govNCT00839579

Competing motivational discourses for weight loss: means to ends and the nexus of beauty and health

Western cultural discourses generally deem fat unhealthy and unattractive, providing strong motivation for body nonconformists to lose weight. Semistructured interviews with 42 overweight and obese participants illuminate how individuals understand health and beauty weight-loss motivations and the relationship between the two. Interviews indicate that health and beauty motivate because they are seen as means to various ends. Specifically, participants aspire to health to fulfill various social roles and to live long, meaningful lives. Moreover, they aspire to conventional beauty ideals hoping that aesthetic conformity will elicit benefits, both psychological and social. Interviews also illustrate an intertwining of discourses in which participants conflate beauty and health in three ways: indicating that depictions of the beauty ideal are depictions of the health ideal; using beauty indicators as health indicators; and employing beauty as a motivator for health goals. This article concludes with a discussion of the health, social, and policy implications of these findings.

The association between BMI value and long-term mortality

OBJECTIVES

To study total mortality in different categories of BMI values, with adjustments for important covariates in a population-based 26-year mortality follow-up. Special interest will be given to gender differences and low BMI values.

METHODS

From a stratified sample in 1969 of 32 185 individuals aged 18-64 years from Stockholm County, 2422 underwent a health examination, with complete data obtained for 1020 subjects. BMI was classified as underweight (<20), normal (20-24.9), overweight (25-29.9) or obesity (> or =30). Participants were followed up in the National Cause of Death Register until the end of 1996. Multivariate analysis was performed by Cox regression for men and women separately, with different models, with step-wise adjustment for age, care need category, heart rate, hypertension, blood glucose, alcohol intake and smoking, with hazard ratios (HR) and 95% confidence interval (CI) and with normal weight as reference.

RESULTS

Among men, the age-adjusted HR was 1.68 (95% CI 1.10-2.57) for underweight and 1.62 (95% CI 1.08-2.43) for obesity, and among women it was 0.93 (95% CI 0.58-1.51) for underweight and 1.88 (95% CI 1.26-2.82) for obesity. In men, the significantly increased mortality remained when also adjusting for care need category, but not when adjusting for other factors, whereas the opposite was found regarding obesity. For women, underweight was significantly associated with decreased mortality when adjusting for smoking and for all factors together, whereas obesity was associated with increased mortality when adjusting for the different factors except for all factors together.

CONCLUSIONS

Underweight was associated with higher mortality among men, but not when adjusting for covariates, whereas underweight was associated with lower mortality among women when adjusting for smoking.

Aerobic interval training reduces cardiovascular risk factors more than a multitreatment approach in overweight adolescents

The aim of the present study was to compare the effects of a multidisciplinary approach (MTG) and aerobic interval training (AIT) on cardiovascular risk factors in overweight adolescents. A total of 62 overweight and obese adolescents from Trøndelag County in Norway, referred to medical treatment at St Olav's Hospital, Trondheim, Norway, were invited to participate. Of these, 54 adolescents (age, 14.0 +/- 0.3 years) were randomized to either AIT (4 x 4 min intervals at 90% of maximal heart rate, each interval separated by 3 min at 70%, twice a week for 3 months) or to MTG (exercise, dietary and psychological advice, twice a month for 12 months). Follow-up testing occurred at 3 and 12 months. VO(2max) (maximal oxygen uptake) increased more after AIT compared with MTG, both at 3 months (11 compared with 0%; P<0.01) and 12 months (12 compared with -1%; P<0.01). AIT enhanced endothelial function compared with MTG at both 3 months (absolute change, 5.1 compared with 3.9%; P<0.01) and 12 months (absolute change, 6.3 compared with 1.0%; P<0.01). AIT was favourable compared with MTG in reducing BMI (body mass index), percentage of fat, MAP (mean arterial blood pressure) and increasing peak oxygen pulse. In addition, AIT induced a more favourable regulation of blood glucose and insulin compared with MTG. In conclusion, the novel findings of the present proof-of-concept study was that 3 months of twice weekly high-intensity exercise sessions reduced several known cardiovascular risk factors in obese adolescents more than that observed after a multitreatment strategy, which was initiated as hospital treatment. Follow-up at 12 months confirmed that AIT improved or maintained these risk factors to a better degree than MTG.

Both aerobic endurance and strength training programmes improve cardiovascular health in obese adults

Regular exercise training is recognized as a powerful tool to improve work capacity, endothelial function and the cardiovascular risk profile in obesity, but it is unknown which of high-intensity aerobic exercise, moderate-intensity aerobic exercise or strength training is the optimal mode of exercise. In the present study, a total of 40 subjects were randomized to high-intensity interval aerobic training, continuous moderate-intensity aerobic training or maximal strength training programmes for 12 weeks, three times/week. The high-intensity group performed aerobic interval walking/running at 85-95% of maximal heart rate, whereas the moderate-intensity group exercised continuously at 60-70% of maximal heart rate; protocols were isocaloric. The strength training group performed 'high-intensity' leg press, abdominal and back strength training. Maximal oxygen uptake and endothelial function improved in all groups; the greatest improvement was observed after high-intensity training, and an equal improvement was observed after moderate-intensity aerobic training and strength training. High-intensity aerobic training and strength training were associated with increased PGC-1alpha (peroxisome-proliferator-activated receptor gamma co-activator 1alpha) levels and improved Ca(2+) transport in the skeletal muscle, whereas only strength training improved antioxidant status. Both strength training and moderate-intensity aerobic training decreased oxidized LDL (low-density lipoprotein) levels. Only aerobic training decreased body weight and diastolic blood pressure. In conclusion, high-intensity aerobic interval training was better than moderate-intensity aerobic training in improving aerobic work capacity and endothelial function. An important contribution towards improved aerobic work capacity, endothelial function and cardiovascular health originates from strength training, which may serve as a substitute when whole-body aerobic exercise is contra-indicated or difficult to perform.

Aerobic interval training vs. continuous moderate exercise in the metabolic syndrome of rats artificially selected for low aerobic capacity

AIMS

The recent development of a rat model that closely resembles the metabolic syndrome allows to study the mechanisms of amelioration of the syndrome by exercise training. Here, we compared the effectiveness for reducing cardiovascular risk factors by exercise training programmes of different exercise intensities.

METHODS AND RESULTS

Metabolic syndrome rats were subjected to either continuous moderate-intensity exercise (CME) or high-intensity aerobic interval training (AIT). AIT was more effective than CME at reducing cardiovascular disease risk factors linked to the metabolic syndrome. Thus, AIT produced a larger stimulus than CME for increasing maximal oxygen uptake (VO(2max); 45 vs. 10%, P < 0.01), reducing hypertension (20 vs. 6 mmHg, P < 0.01), HDL cholesterol (25 vs. 0%, P < 0.05), and beneficially altering metabolism in fat, liver, and skeletal muscle tissues. Moreover, AIT had a greater beneficial effect than CME on sensitivity of aorta ring segments to acetylcholine (2.7- vs. 2.0-fold, P < 0.01), partly because of intensity-dependent effects on expression levels of nitric oxide synthase and the density of caveolae, and a greater effect than CME on the skeletal muscle Ca2+ handling (50 vs. 0%, P < 0.05). The two exercise training programmes, however, were equally effective at reducing body weight and fat content.

CONCLUSION

High-intensity exercise training was more beneficial than moderate-intensity exercise training for reducing cardiovascular risk in rats with the metabolic syndrome. This was linked to more superior effects on VO(2max), endothelial function, blood pressure, and metabolic parameters in several tissues. These results demonstrate that exercise training reduces the impact of the metabolic syndrome and that the magnitude of the effect depends on exercise intensity.

Intentional weight loss and mortality among initially healthy men and women

Most prospective observational studies suggest that weight loss increases the risk of premature death among obese individuals. This is surprising because clinical studies show that weight loss generally leads to overall improvements in cardiovascular risk factors. It is sometimes argued that the increased mortality observed with weight loss must depend on confounding or poor study designs. This review was conducted to summarize results from studies on intentional weight loss and mortality among healthy individuals, while carefully considering the designs and problems in these studies. Evaluation criteria with a rating scale were developed. Of the studies evaluated, two found decreased mortality with intentional weight loss, three found increased mortality, and four found no significant associations between intentional weight loss and total mortality. Thus, it is still not possible for health authorities to make secure recommendations on intentional weight loss. More studies designed to specifically address this issue are warranted.

Beyond evidence-based nursing: tools for practice

AIM

This commentary shares my views of evidence-based nursing as a framework for practice, pointing out its limitations and identifying a wider base of appraisal tools required for making good clinical decisions.

BACKGROUND

As the principles of evidence-based nursing take an increasingly greater hold on nursing education, policy and management, it is important to consider the range of other decision-making tools which are subordinated by this approach.

EVALUATION

This article summarizes nursing's simultaneous reliance on and critique of evidence-based practice (EBP) in a context of inadequate critical reasoning. It then provides an exemplar of the limitations of evidence-based practice and offers an alternative view of important precepts of decision-making.

KEY ISSUE

I identify means by which nurses can develop skills to engage in informed and robust critique of practices and their underpinning rationale.

CONCLUSION

Nurses need to be able to locate and assess useful and reliable information for decision-making. This skill is based on a range of tools which include, but also go beyond EBP including: information literacy, humanities, social sciences, public health, statistics, marketing, ethics and much more.

IMPLICATIONS FOR NURSING MANAGEMENT

This essay prompts nursing managers to reflect upon whether a flurried enthusiasm to adopt EBP neglects other important decision-making skills which provide an even stronger foundation for robust nursing decisions.

The Impact of Body-Mass Index and Steps per Day on Blood Pressure and Fasting Glucose in Older Adults

The purpose of this study was to investigate the combined impact of obesity and physical activity (PA) on the health of older adults. Pedometer-determined steps/d, body-mass index (BMI), resting blood pressure, and fasting glucose (FG) were assessed in 137 older adults (69.0 ± 8.9 yr). The active group (>4,227 steps/d) had lower systolic blood pressure (SBP;p= .001), diastolic blood pressure (DBP;p= .028), and FG (p< .001) than the inactive group (≤4,227 steps/d). The normal-BMI group (18.5-24.9 kg/m2) had lower SBP (p< .001) and DBP (p= .01) than the obese group (≤30 kg/m2). There were no differences in SBP (p= .963) or DBP (p= 1.0) between active obese and inactive normal-BMI groups. The active obese group, however, had a more favorable FG than the inactive normal-BMI group (χ2= 18.9,df= 3,p= .001). Efforts to increase PA of older adults should receive the same priority as reducing obesity to improve BP and FG levels.

Evaluation of a “Nondieting” Stress Reduction Program for Overweight Women: A Randomized Trial

Purpose.

Determine if a “nondieting” intervention focused on intensive training in eliciting the relaxation response enhances health outcomes compared with nondieting interventions without such training.

Design.

Randomized trial with follow-up at 10 weeks, 4 months, and 12 months.

Setting.

General community.

Subjects.

Total of 225 overweight and obese women with at least one other cardiovascular risk factor.

Interventions.

Three 10-week nondieting interventions: a group program (P1) focused on intensive training in techniques for eliciting the relaxation response (n = 60), a group program (P2) focused on healthy eating and physical activity (n = 61), and a self-guided, mail-delivered version of P2 (P3; n = 101).

Measures.

The Revised Symptom Checklist measured psychological distress, the Medical Symptoms Checklist measured the experience of medical symptoms, and the Health-Promoting Lifestyle Profile measured a range of lifestyle behaviors. Self-efficacy for low-fat eating, intuitive eating, and body mass index were also assessed.

Analysis.

An intention-to-treat analysis was used.

Results.

At 12 months, P1 produced statistically greater improvements in stress management behaviors and medical symptom discomfort and was the only program to significantly improve self-efficacy for low-fat eating. In P1, the effect sizes for reductions in depression (0.75) and interpersonal sensitivity (0.85) were large. At 12 months, mean weight was unchanged.

Conclusion.

Inclusion of intensive relaxation response training in a nondieting program for overweight women enhanced stress management and medical symptoms outcomes but not weight outcomes.

Weight cycling and 6-year weight change in healthy adults: The Aerobics Center Longitudinal Study

OBJECTIVE

To determine the longitudinal relationship between a reported history of weight cycling and the trajectory of weight in a group of normal-weight to obese women and men.

RESEARCH METHODS AND PROCEDURES

This was a clinic-based cohort study conducted over 6 years. Subjects were healthy women (n = 141) and men (n = 797) age 20 to 78 years who completed at least four comprehensive medical exams at the Cooper Clinic (Dallas, TX) between 1987 and 2003. Weight loss history was reported, and body weight was measured at all examinations. Weight cycling status was derived from weight loss history and defined as > or = five episodes of weight loss of > or = 2.3 kg/episode. Using linear mixed effects models, weight at each examination was regressed on weight cycling status separately for women and men while controlling for selected covariables.

RESULTS

Baseline BMI was 23 and 21 kg/m2 among cycling and non-cycling women and was 27 and 25 kg/m2 among cycling and non-cycling men, respectively. We observed a non-significant difference (p = 0.09) in women by cycling status (average weight gain = 0.5 and 0.2 kg/yr among cyclers and non-cyclers, respectively) and no difference in weight gain over time among men by cycling status (average weight gain = 0.2 kg/yr among both groups, p = 0.99). Higher baseline cardiorespiratory fitness level and increased fitness over the follow-up were associated with attenuated weight gain in both women and men.

DISCUSSION

In healthy, middle-aged individuals, a history of weight cycling does not seem to increase the risk of long-term weight gain in men; however, this relation needs to be studied further in women.

Effects of Intended Weight Loss on Morbidity and Mortality: Possible Explanations of Controversial Results

Long-term, population-based, observational studies have shown that intended weight loss does not always reduce the mortality associated with obesity. The effects of weight loss on mortality may be a balance between the effects of the loss of harmful abdominal and ectopic fat mass and the loss of beneficial peripheral subcutaneous fat mass and lean body mass.

The emergence of overweight as a disease entity: Measuring up normality

As Charles Rosenberg [(2002). The tyranny of diagnosis. The Milbank Quarterly, 80, 237-260] has recently written, clinical diagnosis contributes to imposing structure on cultural reality in a manner which is not unproblematic. A social power resides in the process of naming diseases-one, which legitimises concerns, explains reality, naturalises deviance and imposes status. But clinical entities are not static, as both the concerns of society, and the technological ability of practitioners change (what Rosenberg refers to as the "iatrogenesis of nosology"), so too do the range of labels available for identifying disease. In this paper, I argue that being "overweight," once predominantly an adjectival descriptor of corpulence, a physical sign or a symptom, and even, in some cultures, a sign of wealth and status, is undergoing the transformation to disease entity. I suggest that evidence of this is present in both the frequency and the way in which the term is being used by the media, the medical establishment and the laity. I argue that this change stems from the convergence of two particular phenomena. The first is the belief in the neutrality of quantification, and the objectivity that measurement brings to qualitative description. The second is the importance attributed to normative appearance in health. I discuss some of the implications of this evolution and its impact on health practices, including the exploitation of this purported disease state for commercial benefit.

Reference body composition in adult rhesus monkeys: glucoregulatory and anthropometric indices

Rhesus monkeys have been used as models to study obesity and disease. The aim of this study was to define body mass indices for underweight and obesity in rhesus monkeys. Longitudinal data collected over 8-14 years from 40 male and 26 female rhesus monkeys were analyzed. Body weight, insulin sensitivity index, and disposition index were regressed against percent body fat (%BF). A minimal %BF beyond which further loss of body weight resulted in loss of lean mass was determined to be 11.5% in older males, 8% in adult females, and 9% in younger adult males. Insulin sensitivity index and disposition index reached minimum values at 23% fat in older males, 18% in adult females, and 21% in younger adult males, indicating obesity. The estimated reference range for %BF was 9%-23% in male and 8%-18% in female monkeys, corresponding to body mass indices of 32-44 kg/m(2) for male and 27-35 kg/m(2) for female monkeys.

Size Acceptance and Intuitive Eating Improve Health for Obese, Female Chronic Dieters

OBJECTIVE

Examine a model that encourages health at every size as opposed to weight loss. The health at every size concept supports homeostatic regulation and eating intuitively (ie, in response to internal cues of hunger, satiety, and appetite).

DESIGN

Six-month, randomized clinical trial; 2-year follow-up.

SUBJECTS

White, obese, female chronic dieters, aged 30 to 45 years (N=78).

SETTING

Free-living, general community.

INTERVENTIONS

Six months of weekly group intervention (health at every size program or diet program), followed by 6 months of monthly aftercare group support.

MAIN OUTCOME MEASURES

Anthropometry (weight, body mass index), metabolic fitness (blood pressure, blood lipids), energy expenditure, eating behavior (restraint, eating disorder pathology), and psychology (self-esteem, depression, body image). Attrition, attendance, and participant evaluations of treatment helpfulness were also monitored.

STATISTICAL ANALYSIS PERFORMED

Analysis of variance.

RESULTS

Cognitive restraint decreased in the health at every size group and increased in the diet group, indicating that both groups implemented their programs. Attrition (6 months) was high in the diet group (41%), compared with 8% in the health at every size group. Fifty percent of both groups returned for 2-year evaluation. Health at every size group members maintained weight, improved in all outcome variables, and sustained improvements. Diet group participants lost weight and showed initial improvement in many variables at 1 year; weight was regained and little improvement was sustained.

CONCLUSIONS

The health at every size approach enabled participants to maintain long-term behavior change; the diet approach did not. Encouraging size acceptance, reduction in dieting behavior, and heightened awareness and response to body signals resulted in improved health risk indicators for obese women.

Causes and demographic, medical, lifestyle and psychosocial predictors of premature mortality: the CARDIA study

We examined the 16-year mortality experience among participants in the baseline examination (1985-86) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a U.S. cohort of 5115 urban adults initially 18-30 years old and balanced by sex and race (black and whites) in the USA. We observed 127 deaths (annual mortality of 0.15%). Compared to white women, the rate ratio (95% confidence interval) of all-cause mortality was 9.3 (4.4, 19.4) among black men, 5.3 (2.5, 11.4) among white men and 2.7 (1.2, 6.1) among black women. The predominant causes of death, which also differed greatly by sex-race, were AIDS (28% of deaths), homicide (16%), unintentional injury (10%), suicide (7%), cancer (7%) and coronary disease (7%). The significant baseline predictors of all-cause mortality in multivariate analysis were male sex, black race, diabetes, self-reported liver and kidney disease, current cigarette smoking and low social support. Two other factors, self-reported thyroid disease and high hostility, were significant predictors in analyses adjusted for age, sex and race. In conclusion, we found striking differences in the rates and underlying cause of death across sex-race groups and several independent predictors of young adult mortality that have major implications for preventive medicine and social policies.

The effects of intentional weight loss as a latent variable problem

Although obesity is associated with increased mortality rate and short-term weight loss improves risk factors for mortality, it has not been convincingly shown that weight loss among obese people results in reduced mortality rate. When considering the human literature, it has been pointed out that weight loss is often a sign of illness and that investigators therefore need to separate intentional from unintentional weight loss. It has generally been assumed that among people who state that they do not intend to lose weight, weight change subsequently observed is unintentional. Among such people, weight loss has been consistently associated with increased mortality rate. Complementarily, it has generally been assumed that among people who state that they do intend to lose weight, weight change subsequently observed is intentional. In these people who are intending to lose weight, some studies show apparent benefits of weight loss, some are neutral, and some show deleterious effects. The overall conclusion that some reviewers have drawn from this literature is that intentional weight loss (IWL) is at best not beneficial and may even be harmful with respect to mortality rate. We believe that this conclusion is drawn by inappropriately conflating weight loss (or more generally weight change) among people intending to lose weight with IWL (or change). Herein, under certain assumptions, we: (1) show that the association between mortality rate and weight loss among people intending to lose weight and between mortality rate and IWL are two different things; (2) show that the association between IWL and mortality rate is an inherently unobservable entity; (3) derive a method for estimating the plausible range of true effect of IWL on mortality rate if one is willing to make a number of restrictive, but perhaps reasonable assumptions; and (4) illustrate the method by application to a data set involving middle-age onset calorie restriction in mice.

Weight-loss intention in the well-functioning, community-dwelling elderly: associations with diet quality, physical activity, and weight change

BACKGROUND

Many older adults desire to lose weight, yet the proportion with a health-related weight-loss indication, weight-loss strategies, and success is unknown.

OBJECTIVE

We examined the associations of reported intention to lose weight with health-related indications for weight loss, diet quality, physical activity, and weight-loss success in well-functioning older adults.

DESIGN

This prospective, community-based cohort included 2708 elderly persons aged 70-79 y at baseline. We determined indication for weight loss by using the modified National Institutes of Health guidelines, diet quality by using the Healthy Eating Index, and weight-loss intention and physical activity by using questionnaires. Measured weight change over 1 y was assessed.

RESULTS

Twenty-seven percent of participants reported an intention to lose weight, and 67% of those participants had an indication for weight loss. Participants who reported a weight-loss intention were heavier than those who did not, had more depressive symptoms, and were more likely to be dissatisfied with their weight, regardless of weight-loss indication. Participants with an intention to lose weight reported better eating behaviors and a more active lifestyle than did participants without a weight-loss intention, independent of other health conditions. No significant difference in actual weight loss was found between participants intending and not intending to lose weight, regardless of indication for weight loss.

CONCLUSIONS

Despite being associated with healthier behaviors, the intention to lose weight did not predict greater weight loss in this well-functioning elderly cohort. More attention needs to be focused on the necessity and efficacy of specific strategies for weight loss in older adults.

Body fat distribution of overweight females with a history of weight cycling

Weight cycling may cause a redistribution of body fat to the upper body fat compartments. We investigated the distribution of subcutaneous adipose tissue (SAT) in 30 overweight women with a history of weight-cycling and age-matched controls (167 normal weight and 97 overweight subjects). Measurements of SAT were performed using an optical device, the Lipometer. The SAT topography describes the thicknesses of SAT layers at 15 anatomically well-defined body sites from neck to calf. The overweight women with a history of weight cycling had significantly thicker SAT layers on the upper body compared to the overweight controls, but even thinner SAT layers on their legs than the normal weight women. An android fat pattern was attributed to overweight females and, even more pronounced, to the weight cyclers. The majority of normal weight women showed a gynoid fat pattern. Using stepwise discriminant analysis, 89.0% of all weight cyclers and overweight controls could be classified correctly into the two groups. These findings show the importance of normal weight maintenance as a health-promoting factor.

Body mass index and short-term weight change in relation to mortality in Dutch women after age 50 y

BACKGROUND

The question of whether weight loss increases a person's longevity is important given the high prevalence of obesity and the large number of people trying to lose weight in industrialized countries.

OBJECTIVE

This study assessed the effect of body mass index (BMI) and weight change (within 1 y of baseline) on subsequent mortality.

DESIGN

This prospective cohort study had a median follow-up of 17 y. Subjects were 8100 women aged 50-66 y who participated in a population-based breast cancer-screening project in the Netherlands between 1974 and 1977. Weight and height were measured during the first and second screening visits. All women were followed until 1996 for causes of death. Cox proportional hazard analyses were conducted for mortality from all causes (n = 1269), cardiovascular disease (CVD; n = 402), and cancer (n = 492).

RESULTS

During follow-up we observed a statistically significant increased risk of mortality from all causes (hazard ratio: 1.4; 95% CI: 1.2, 1.6), cardiovascular disease, and cancer for women in the highest quartile of BMI (in kg/m(2)), > or =27.77. Mortality from all causes, CVD, and cancer did not increase significantly in women with a weight gain of > or =15%. Weight loss was also not significantly related to mortality from all causes, CVD, and cancer.

CONCLUSIONS

Mortality was highest for women in the highest BMI quartile (> or =27.77). Extreme weight gain or weight loss within 1 y was not statistically significantly associated with subsequent higher mortality.

Leadership and achieving a vision--how does a profession lead a nation?

The author examines the role of leadership in achieving a new vision for health promotion. Leadership challenges and threats, and contemporary views on leadership are reviewed to frame the opportunity available to the health promotion profession to change national health policy. He concludes by describing the actions every professional can take to play a leadership role in helping to achieve the new vision articulated in this special issue.

Associação do índice de massa corporal e da relação cintura/quadril com hospitalizações em adultos do Município do Rio de Janeiro, RJ

O índice de massa corporal tem sido associado à morbidade e à mortalidade. Câncer, doenças infecciosas e pulmonares têm sido associadas ao baixo peso; entretanto, qualquer grau de excesso de peso e também a deposição de gordura abdominal associam-se a diabetes e doenças cardiovasculares. A associação do índice de massa corporal e da razão cintura quadril com a ocorrência de hospitalizações foram avaliadas em uma amostra de base populacional no Município do Rio de Janeiro (1996). Moradores de ambos os sexos, de 20 a 60 anos, totalizando 1.446 homens e 1.749 mulheres foram medidos e entrevistados em seus próprios domicílios. A hospitalização referiu-se à presença ou não de internações no último ano, excluindo-se partos. Cerca de 5% dos homens e 5,8% das mulheres relataram ter sido internados. Para as mulheres, a prevalência de hospitalizações aumentou gradativamente com o aumento do índice de massa corporal. O método de regressão logística foi escolhido para a análise, tendo a hospitalização como variável dependente e incluindo no modelo a idade, tabagismo, renda per capita, índice de massa corporal e razão cintura quadril. Estes dois últimos associaram-se positivamente com as hospitalizações somente para mulheres (Odds ratio=1,06 para cada unidade de índice de massa corporal, p=0,01), e em relação à gordura abdominal, um aumento de 12 cm na cintura de uma mulher com 80 cm de quadril resultou num Odds ratio de 3,5 (p=0,01). O excesso de peso e, particularmente, a deposição abdominal de gordura são importantes preditores de morbidade em mulheres, avaliadas através das hospitalizações.

Body mass index and mortality: the influence of physical activity and smoking

PURPOSE

To study the association between body mass index (BMI) and mortality, and to evaluate the effect of physical activity during leisure time and smoking on this association in a general male population.

METHODS

During 1974-1978, all men aged 35-49 yr living in three Norwegian counties were invited to a cardiovascular screening, and 87.1% attended and had their weight and height measured. Men with recognized cardiovascular diseases, diabetes mellitus, or cancer at screening were excluded. The cohort (N = 22,304) was followed for an average of 16.3 yr with respect to total and cause-specific mortality.

RESULTS

During follow-up, 1909 men died. We found a J-shaped association between BMI and total mortality, and the form of association was similar for death from cardiovascular diseases. Although not statistically significant, a J-shaped association was also suggested in never-smokers. Irrespective of BMI level, ex- and never-smokers had lower mortality than current smokers. Obese smoking men had a relative risk of dying of 2.01 (95% CI: 1.29-3.11) compared with obese never-smokers, and a relative risk of 4.55 (95% CI: 3.34-6.20) compared with normal weight never-smokers (BMI 22-24.9 kg x m(-2)). Within each category of physical activity during leisure time, obese men had a similar increased relative risk of death compared with normal-weight individuals. However, the U- to J-shaped association between BMI and mortality seemed to disappear by increasing level of physical activity, but this finding was not significant.

CONCLUSION

This study suggests a J-shaped association between BMI and total mortality, also when stratified on smoking habits and physical activity. The suggested linear trend in the most physical active men needs to be reassessed.

The enigma of increased non-cancer mortality after weight loss in healthy men who are overweight or obese

OBJECTIVE

To study effects on non-cancer mortality of observational weight loss in middle-aged men stratified for body mass index (BMI), taking a wide range of possible confounders into account.

DESIGN

Prospective, population based study.

SETTING

Male population of Malmö, Sweden.

PARTICIPANTS

In all 5722 men were screened twice with a mean time interval of 6 years in Malmö, southern Sweden. They were classified according to BMI category at baseline (<21, 22-25, overweight: 26-30, and obesity: 30+ kg m(-2)) and weight change category until second screening (weight stable men defined as having a baseline BMI +/- 0.1 kg m(-2) year-1 at follow-up re-screening).

MAIN OUTCOME MEASURES

Non-cancer mortality calculated from national registers during 16 years of follow-up after the second screening. Data from the first year of follow-up were excluded to avoid bias by mortality caused by subclinical disease at re-screening.

RESULTS

The relative risk (RR; 95% CI) for non-cancer mortality during follow-up was higher in men with decreasing BMI in all subgroups: RR 2.64 (1.46-4.71, baseline BMI <21 kg m(-2)), 1.39 (0.98-1.95, baseline BMI 22-25 kg m(-2)), and 1.71 (1.18-2.47, baseline BMI 26+ kg m(-2)), using BMI-stable men as reference group. Correspondingly, the non-cancer mortality was also higher in men with increasing BMI, but only in the obese group (baseline BMI 26+ kg m(-2)) with RR 1.86 (1.31-2.65). In a subanalysis, nonsmoking obese (30+ kg m(-2)) men with decreased BMI had an increased non-cancer mortality compared with BMI-stable obese men (Fischer's test: P=0.001). The mortality risk for nonsmoking overweight men who increased their BMI compared with BMI-stable men was also significant (P=0.006), but not in corresponding obese men (P=0.094). CONCLUSIONS. Weight loss in self-reported healthy but overweight middle-aged men, without serious disease, is associated with an increased non-cancer mortality, which seems even more pronounced in obese, nonsmoking men, as compared with corresponding but weight-stable men. The explanation for these observational findings is still enigmatic but could hypothetically be because of premature ageing effects causing so-called weight loss of involution.

Evaluating a 'non-diet' wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors

CONTEXT

Current public health policy recommends weight loss for obese individuals, and encourages energy-restricted diets. Others advocate an alternative, 'non-diet' approach which emphasizes eating in response to physiological cues (eg hunger and satiety) and enhancing body acceptance.

OBJECTIVE

To evaluate the effects of a 'health-centered' non-diet wellness program, and to compare this program to a traditional 'weight loss-centered' diet program.

DESIGN

Six-month, randomized clinical trial.

SETTING

Free-living, general community.

PARTICIPANTS

Obese, Caucasian, female, chronic dieters, ages 30-45 y (n=78).

INTERVENTIONS

Six months of weekly group intervention in a non-diet wellness program or a traditional diet program, followed by 6 months of monthly after-care group support.

OUTCOME MEASURES

Anthropometry (weight, body mass index); metabolic fitness (blood pressure, blood lipids); energy expenditure; eating behavior (restraint, eating disorder pathology); psychology (self-esteem, depression, body image); attrition and attendance; and participant evaluations of treatment helpfulness. Measures obtained at baseline, 3 months, 6 months and 1 y.

RESULTS

(1 y after program initiation): Cognitive restraint increased in the diet group and decreased in the non-diet group. Both groups demonstrated significant improvement in many metabolic fitness, psychological and eating behavior variables. There was high attrition in the diet group (41%), compared to 8% in the non-diet group. Weight significantly decreased in the diet group (5.9+/-6.3 kg) while there was no significant change in the non-diet group (-0.1+/-4.8 kg).

CONCLUSIONS

Over a 1 y period, a diet approach results in weight loss for those who complete the intervention, while a non-diet approach does not. However, a non-diet approach can produce similar improvements in metabolic fitness, psychology and eating behavior, while at the same time effectively minimizing the attrition common in diet programs.

Long-live euthymic BALB/c-nu mice. I. Survival study suggests body weight as a life span predictor

This paper is the first of a series aimed to show the main physiological and pathological characteristics of male euthymic BALB/c-nu mice, a long-live strain of BALB/c mice bred in our own Institute. In particular, the first two paired papers are respectively devoted to general survival information and disease characteristics, also taking into account very old animals that are of high interest for studies on successful aging. In this paper we report the analysis of survival kinetics, the time course of body weight and the correlation between body weight and time-at-death. The longitudinal study has been performed on 88 male mice, checking individually their body weight and date of death and analyzing survival data by a model built by our own. Survival analysis shows quite higher longevity (median age: about 29 months) in this population when compared with other BALB/c strains. The most relevant finding on body weight is its correlation with longevity until the age of 22 months: thinner subjects live longer and lose weight at a lower rate than their heavier mates. Results have formed the basis on which to plan the cross-sectional experiment to study pathologies and biological parameters at different ages, including a group of mice at very advanced ages (34 months).

Perfil dos indivíduos que iniciam programas de exercícios em academias, quanto à composição corporal e aos objetivos em relação a faixa etária e sexo

A busca de melhor qualidade de vida nos últimos anos faz aumentar o número de pessoas preocupadas com a redução do peso corporal. Muitos indivíduos procuram atividades físicas regulares como forma alternativa de tratamento. O objetivo deste estudo foi investigar o perfil dos indivíduos que iniciam programas de exercícios em academias, quanto à composição corporal e aos objetivos em relação à faixa etária e ao sexo. Pesquisa transversal, com amostragem de 90 homens e 89 mulheres, composta por alunos iniciantes de uma academia em Curitiba, avaliados entre agosto de 1998 e setembro de 1999. Para a coleta de dados os alunos preencheram uma ficha que continha objetivos predeterminados. As medidas antropométricas, massa corporal, estatura e dobras cutâneas seguiram as indicações de Wartenweiler et al. (1974). No cálculo da densidade corporal em adultos utilizou-se a fórmula de Petroski (1995) - 4 dobras cutâneas. Para a estimativa do percentual de gordura (%G) em adultos a fórmula de Siri (1961). O tratamento estatístico foi com o teste "t" de Student para grupo independentes. Foram observadas diferenças significativas (p < 0,05), para o índice de massa corporal (IMC) e %G nos homens, e, para %G nas mulheres entre as faixas etárias. Para os indivíduos de 20 a 30 anos, 45,7% dos homens desejam aumentar massa muscular; 54,9% das mulheres esperam reduzir peso. Entre 30 e 40 anos, 35% dos homens desejam redução de peso corporal. Embora 55% das mulheres entre 20 e 30 anos desejem redução de peso corporal, somente 16,9% delas realmente necessitam. Pode-se concluir que o incremento da gordura corporal ocorre em ambos os sexos com o avanço da idade e que a análise dos valores médios de %G e IMC indicam que homens e mulheres têm sua condição de saúde agravada e seus objetivos modificados com a idade.

The health at any size paradigm for obesity treatment: the scientific evidence

Traditional weight loss (TWL) treatments have been unsuccessful at reducing the prevalence of obesity in the population. Health-care professionals and consumers have criticized TWL treatments as being detrimental to the obese person's health. Consequently, an alternative approach to obesity treatment, the health at any size (H@AS) paradigm, has been proposed. The H@AS paradigm is based on the philosophy that once diet restrictions and barriers to activity have been removed, the individual will develop healthier eating and activity patterns that lead to a naturally healthy body weight. This paper reviews the philosophical foundation and the scientific data that support and oppose the H@AS paradigm and compares it with that of TWL treatments.

Effective health promotion and clinical care for large people

Health and fitness professionals most often approach health care for large people in the context that health improvement can only be attained through weight loss. Unequivocal acceptance of the notion that thinness equals health and fitness presents an obstacle for large people who want to improve their health through lifestyle changes in eating and activity patterns and also weakens the working relationship between the health care professional and the large client. Since the health benefits of exercise and sound nutrition are significant for people of all sizes, the strategy for health care professionals should be to assist people of all sizes in eating healthier and becoming more active. Because large people face even more barriers to exercise than smaller people, we address the special needs of large people trying to become more physically active, outline an approach sensitive to their needs, and suggest how health and fitness professionals can improve their effectiveness with this population.