Measuring the accuracy of self-reported height and weight in a community-based sample of young people

Design and methods of the StepByStep randomized trial of a mobile health and social media physical activity intervention among adolescent and young adult survivors of childhood cancer: A report from the Children's Oncology Group

BACKGROUND

Interventions to increase physical activity are needed in adolescent and young adult survivors of childhood cancer who are largely inactive but at lifelong elevated risk of multiple chronic conditions improved by physical activity. The goals of the StepByStep study are to evaluate the effects of a 48-week distance-based, multi-component mobile health and social media behavioral intervention on physical activity, biomarkers of cardiometabolic health, and health-related quality of life.

METHODS

This ongoing study is a two-arm, prospective, multi-site randomized controlled trial. 384 childhood cancer survivors age ≥ 15 years and < 21 years who were 3-36 months off therapy and not meeting physical activity guidelines were enrolled. The trial will test the efficacy of a 24-week intensive multi-component physical activity intervention combining a wearable physical activity tracker, social media peer support group, and individualized goal setting followed by a 24-week maintenance phase of the intervention to improve outcomes. The control group receives the wearable physical activity tracker only.

CONCLUSION

There is a growing need for novel, developmentally appropriate interventions to increase physical activity and improve the health trajectory of adolescent and young adult survivors of childhood cancer. If efficacious, this portable and scalable intervention would be a much-needed tool to reduce the morbidity from cancer treatment and improve quality of life among survivors after treatment ends.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04089358; COG Identifier: ALTE2031.

Validity of self-reported weight and height among female young adults in the United Arab Emirates

Self-reported weight and height serve as important metrics in estimating overweight and obesity prevalence within epidemiological studies, primarily due to their cost and time efficiency. However, the accuracy and reliability of these self-reported measures remain controversial, with conflicting reports emerging from different regions. This study aims to compare self-reported weight and height with measured values among young female adults in the United Arab Emirates. A cross-sectional study of 131 female university students aged 17-27 reported their weight and height on a self-administered questionnaire and on the same day had their height and weight measured. Body Mass Index (BMI) values of both self-reported and measured weight and height were calculated and categorized according to the World Health Organization's cut-off points. Overall, 87% of students had a resultant self-reported BMI value within their actual BMI category. The mean differences between self-reported and measured weight and height in the present study were -0.92 kg and 0.38 cm, respectively. Results indicated strong agreement between self-reported and direct measurements, as demonstrated by weighted Kappa statistics (kappa = 0.87). Bland & Altman plots illustrated that the majority of values fell within the limits of agreement (2 SD), with no systemic bias detected. BMI calculated from self-reported data demonstrates high sensitivity and specificity. Linear regression analyses revealed that self-reported weight (r2 = 0.973; p<0.001), height (r2 = 0.902; p<0.001), and BMI (r2 = 0.964; p<0.001) accurately predicted measured weight, height, and BMI. The study's results highlight the ability of female university students in the UAE to accurately provide self-reports of their weight and height. This finding provides further support for the utilization of self-reported data on height and weight as a valid method for collecting anthropometric information.

Agreement between parent-report and EMR height, weight, and BMI among rural children

Introduction

Remote anthropometric surveillance has emerged as a strategy to accommodate lapses in growth monitoring for pediatricians during coronavirus disease 2019 (COVID-19). The purpose of this investigation was to validate parent-reported anthropometry and inform acceptable remote measurement practices among rural, preschool-aged children.

Methods

Parent-reported height, weight, body mass index (BMI), BMI z-score, and BMI percentile for their child were collected through surveys with the assessment of their source of home measure. Objective measures were collected by clinic staff at the child's well-child visit (WCV). Agreement was assessed using correlations, alongside an exploration of the time gap (TG) between parent-report and WCV to moderate agreement. Using parent- and objectively reported BMI z-scores, weight classification agreement was evaluated. Correction equations were applied to parent-reported anthropometrics.

Results

A total of 55 subjects were included in this study. Significant differences were observed between parent- and objectively reported weight in the overall group (-0.24 kg; p = 0.05), as well as height (-1.8 cm; p = 0.01) and BMI (0.4 kg/m2; p = 0.02) in the ≤7d TG + Direct group. Parental reporting of child anthropometry ≤7d from their WCV with direct measurements yielded the strongest correlations [r = 0.99 (weight), r = 0.95 (height), r = 0.82 (BMI), r = 0.71 (BMIz), and r = 0.68 (BMI percentile)] and greatest classification agreement among all metrics [91.67% (weight), 54.17% (height), 83.33% (BMI), 91.67% (BMIz), and 33.33% (BMI percentile)]. Corrections did not remarkably improve correlations.

Discussion

Remote pediatric anthropometry is a valid supplement for clinical assessment, conditional on direct measurement within 7 days. In rural populations where socioenvironmental barriers exist to care and surveillance, we highlight the utility of telemedicine for providers and researchers.

General somatic health and lifestyle habits in individuals with obsessive- compulsive disorder: an international survey

BACKGROUND

Obsessive-compulsive disorder (OCD) has been associated with a broad range of health-related issues. Unhealthy lifestyle habits such as physical inactivity, an unhealthy diet, smoking, and alcohol consumption are hypothesized to contribute to this association. However, the lifestyle habits of individuals with OCD have been scarcely investigated. In this international survey, we explored the physical health and lifestyle habits of adults with a self-reported diagnosis of OCD.

METHODS

An online global survey available in seven languages was disseminated through interest organizations and social media between July 2021 and March 2022. The survey included questions relating to socio-demographic variables and clinical characteristics (including OCD symptom severity - as measured with the 12-item self-report scale Obsessive-Compulsive Inventory [OCI-12] - and psychotropic medication), physical health, and lifestyle habits. Frequencies and percentages, or means and standard deviations, as appropriate, were calculated. Subgroup analyses by OCD symptom severity, gender, and age group were performed.

RESULTS

A total of 496 individuals with OCD completed the survey and were included in the analyses (mean age = 36.0 years, SD = 12.5, range 18-79; 78.8% women). Most participants were from Europe (n = 245, 49.4%) and North America (n = 187, 37.7%). OCD symptom severity scores were on the moderate range (OCI-12 mean score = 21.2, SD = 9.1). A majority (n = 354, 71.4%) reported having comorbid somatic health issues, mainly allergies, gastrointestinal conditions, and cardiometabolic conditions. Nearly half of the sample (n = 236, 47.6%) reported a body mass index ≥ 25, corresponding to at least overweight. A significant proportion of the participants reported low physical activity (n = 271, 55.0%), unhealthy dietary habits (n = 182, 36.7%), risk consumption of alcohol (n = 111, 22.3%), and non-restorative sleep (n = 268, 54.0%). Subgroup analyses showed overall similar results across groups, with some exceptions.

CONCLUSIONS

In this sample, individuals with OCD self-reported a range of health-related issues and a number of unhealthy lifestyle behaviors, most prominently a lack of physical activity. Interventions aimed at modifying unhealthy lifestyles to prevent or improve health conditions beyond the psychiatric symptoms should be considered.

Very tall female young adults tended to be smokers: A large-scale exploratory cross-sectional survey of 26,405 college students in China

OBJECTIVE

This study investigated the sex-specific prevalence of smoking (past 30 days) and the associations with height among university/college students.

PARTICIPANTS

25,405 (11,579/14,826 males/females) college students in Xi'an China.

METHODS

A cross-sectional, self-administered survey.

RESULTS

The male and female prevalence of smoking (past 30 days) was 32.9% and 7.4%, respectively. The prevalence of smoking of the male height groups ranged from 29.8% to 36.9%; only the ≥188 cm height group showed significantly higher prevalence than the reference group (i.e., 173-177cm; 33.0%). The female prevalence of smoking was 4.0-8.2% in the ≤170cm groups and increased to 12.3% in the 171-175 cm group and 36.1% in the ≥176 cm group, while it was 6.5% for the reference group (161-165 cm).

CONCLUSIONS

This exploratory study firstly revealed the significantly higher prevalence of smoking among the "tallest" height groups, especially among females. Future studies are warranted to confirm such findings and explore related mechanisms.

Prediction of Mortality and Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt Placement: Baseline and Longitudinal Body Composition Measurement

PURPOSE

To investigate effects of baseline and early longitudinal body composition changes on mortality and hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS).

MATERIALS AND METHODS

This is a case-control study with analysis of a TIPS registry (1995-2020) including data from patients with cirrhosis with computed tomography (CT) scans obtained within 1 month before and 3 months after TIPS. Core muscle area (CMA), macroscopic subcutaneous adipose tissue (mSAT), macroscopic visceral adipose tissue (mVAT) area, and muscle adiposity index (MAI) on CT were obtained. Multipredictor Cox proportional hazards models were used to assess the effect of body composition variables on mortality or HE.

RESULTS

In total, 280 patients (158 men; median age, 57.0 years; median Model for End-stage Liver Disease-sodium [MELD-Na] score, 14.0) were included. Thirty-four patients had post-TIPS imaging. Median baseline CMA was 68.3 cm2 (interquartile range, 57.7-83.5 cm2). Patients with higher baseline CMA had decreased risks of mortality (hazard ratio [HR]: 0.82; P = .04) and HE (HR: 0.82; P = .009). It improved prediction of mortality over MELD-Na and post-TIPS right atrial pressure alone (confidence interval = 0.729). An increase in CMA (HR: 0.60; P = .043) and mSAT (HR: 0.86; P = .022) or decrease in MAI (HR: 1.50; P = .049) from before to after TIPS was associated with a decreased risk of mortality. An increase in mSAT was associated with an increased risk of HE (HR: 1.11; P = .04).

CONCLUSIONS

CMA on CT scan 1 month before TIPS placement predicts mortality and HE in patients with cirrhosis. Changes in body composition on CT measured 3 months after TIPS placement independently predict mortality and HE.

Validity of self-reported height, weight and BMI as applied to trends in malnutrition in Davao City, Philippines

BACKGROUND

Self-reported height, weight and body mass index (BMI) data are widely used to monitor trends in malnutrition. However, several studies expressed concerns about its reliability-citing trends of over-reporting and underreporting anthropometric data. This study aims to: (1) identify the validity of self-reported height and weight and BMI as compared with measured values and (2) examine the potential recurrence of malnutrition in an urban-based population.

METHODS

Paired t-tests and Pearson's correlation coefficients were conducted to identify potential discrepancies between self-reported and measured anthropometric data. These values were collected among 255 male and 400 female participants in the Davao City.

RESULTS

Height overestimation in females and underestimation in males were observed to be statistically significant (P < 0.05). Researchers also note an alarming rise in malnutrition cases when the Asia-Pacific Index was applied to the BMI study data. A 40.79 and 22% increase in obese cases among male and female respondents were recorded.

CONCLUSION

Modifying participant-gathered height and weight values is likely to result in discrepancies between self-reported and measured values. Identifying a person's height and weight status is crucial to understanding who among the population experience malnutrition. Thus, policymakers are called to strengthen educational support that trains respondents to report reliable and valid health data.

Knowledge, experiences, and perceptions relating to obesity management among primary care physicians in the Lazio Region, Italy

Background

Primary care providers (PCPs) play an essential role in obesity care as they represent the first contact for patients seeking weight loss interventions.

Objective

This study explored the knowledge, experiences, and perceptions of PCPs in the Lazio Region of Italy in the management of obesity.

Design and subjects

We conducted an anonymous survey delivered from March to July 2022 via the newsletter of Rome Provincial Order of Physicians and Dentists and at the annual meeting of the regional section of the Italian Obesity Society.

Approach

The survey consisted of 24 closed-ended questions grouped into 5 sections: sociodemographic and work information; assessment of obesity; management of obesity; connections with regional Centres for Obesity Management; attitudes towards obesity.

Key results

A total of 92 PCPs accessed the survey. Of those, 2.2% were excluded because they did not see any patients with obesity. A total of 68 PCPs (75.6%) had complete questionnaires and were included in this analysis. All participants reported asking their patients about their eating habits, lifestyle, and clinical complications at the first assessment. Body weight and blood pressure were measured by 98.5% of participants and 82% calculate body mass index (BMI), while a small proportion of PCPs analysed body composition and fat distribution. Over 80% prescribed laboratory tests and ECG. Approximately 40% of PCPs did not refer patients for nutritional counselling, and most prescribed a low-calorie diet. Sixty-three percent referred patients to an endocrinologist, 48.5% to a psychotherapist, and a minority to specialists for obesity complications. Twenty-three percent prescribed anti-obesity medications and 46.5% referred patients for bariatric surgery only in severe cases. Ninety-one percent stated that obesity is "a complex and multifactorial disease" and 7.4% considered obesity to be secondary to other conditions.

Conclusions

Despite most PCPs adopt a correct approach to manage patients with obesity, many aspects could be improved to ensure optimal and multidisciplinary management.

Changes in Nutrition, Physical Activity, and Body Weight among Lithuanian Students during and after the COVID-19 Pandemic

The long-term effect of the COVID-19 pandemic on lifestyle changes remains understudied. This cross-sectional study aimed to assess changes in nutrition, physical activity, and body weight among Lithuanian students during the pandemic and their post-pandemic persistence. Data were collected from 1430 first-year students (325 males, 1105 females) through an online self-administered questionnaire. The students indicated an increase in the consumption of snacks, fast food, home-made confectionery, and sweets. A decrease in physical activity during the pandemic was reported by 34.9% of males and 33.2% of females. Lifestyle changes during the pandemic were associated with post-pandemic habits. A higher proportion of females (38.7%) than males (31.1%) indicated an increase in BMI, which was more pronounced among students with overweight. A multivariate logistic regression analysis revealed that reduced physical activity; the increased consumption of red meat, snacks, fast food, and home-made confectionery during the pandemic; and post-pandemic BMI were linked with weight gain. After the pandemic, weight gain persisted in 40.9% of students who continued to follow unhealthy nutrition habits and had reduced physical activity. The study emphasizes that the promotion of a healthy diet and regular physical activity among university students is essential for developing lifelong habits that contribute to a healthy body weight and overall well-being.

How tall am I again? A longitudinal analysis of the reliability of self-reported height

Self-reported height measures are increasingly being included in large-scale surveys in order to measure BMI. There have been concerns about the validity of self-reported measures but there remains little understanding of why respondents may not give accurate height reports. We examine whether a lack of knowledge could be a contributing factor, by investigating the reliability of self-reported height over time and across countries. We use longitudinal data from four large-scale longitudinal surveys conducted in Australia, United States, United Kingdom, and Europe (14 countries) where survey respondents were asked to report their height over multiple time periods to measure the extent of consistency of height reports across time. The overall level of inconsistent reporting of height is largest in Australia and Europe. Individuals with lower levels of education were significantly more likely to give two height reports that differed by 5 cm or more. Across all countries, inconsistent reporting with large height differences between waves was also more common among those in older populations. The findings point to subgroups of the population exhibiting a lack of knowledge regarding their own height.

Do the short die young? Evidence from a large sample of deceased Polish adults

Body height is associated with various socioeconomic and health-related outcomes. Despite numerous studies, the relationship between stature and longevity remains uncertain. This study explores the association between self-reported height and lifespan. Data from 848,860 adults who died between 2004 and 2008 in Poland were collected. After excluding a small proportion of records due to missing data or errors, we examined records for 848,387 individuals (483,281 men, age range: 20–110 years; 365,106 women, age range: 20–112 years). Height was expressed as standardized residual variance derived from linear regression in order to eliminate the variance of year of birth on height. After the elimination of the cohort effect, five height classes were designated using centiles: very short, short, medium, tall and very tall. The differences between sexes and among classes were evaluated with two-way ANOVA and post hoc Tukey’s test. The effect size was assessed using partial eta squared (η2). Pearson’s r coefficients of correlation were calculated. The effect of sex on lifespan was nearly 17 times stronger than the effect of height. No correlation between height and lifespan was found. In conclusion, these findings do not support the hypothesis that taller people have a longevity advantage. We offer tentative explanations for the obtained results.

Public Awareness of Obesity and Risk of Pelvic Floor Disorders: A Cohort Study

IMPORTANCE

Obesity is a risk factor for pelvic floor disorders (PFDs), but limited information exists about the public awareness of this association.

OBJECTIVE

Our primary objective was to assess awareness of the association between obesity and PFDs, comparing 2 cohorts of women with body mass index (BMI) <30 versus BMI ≥30.

STUDY DESIGN

We conducted a cross-sectional, survey-based cohort study. The survey included questions about demographics, height and weight self-assessment, and the risk of PFDs with obesity. Our primary outcome was the rate of women correctly identifying that obesity increases the risk of PFDs.

RESULTS

Of 377 eligible participants 272 (72.1%) completed the survey, with 266 analyzed. Of these, 159 (59.8%) had a BMI <30 and 107 (40.2%) had a BMI ≥30. Comparing the cohorts, the lower BMI cohort was older (mean age of 54.4 ± 18.3 vs 48.4 ± 17.5 years, P = 0.008) and had higher rates of graduate/professional school (35.2% vs 19.6%, P = 0.04). Both groups had similarly high rates of PFDs. There was no difference in identifying obesity as a risk factor for PFDs, although the lower BMI group was less likely to identify the implications of weight loss on urinary incontinence (UI) (27.7% vs 45.8%, P = 0.002). Controlling for potential confounders, obesity remained positively associated with knowledge about the implications of weight loss on UI (odds ratio, 2.5; 95% confidence interval, 1.5-4.4).

CONCLUSIONS

Few women identified the increased risk of PFDs with obesity. Obese women may have increased awareness of the implications of weight loss on UI.

Recruiting participants for ergonomic research using self-reported stature and body mass

BACKGROUND

A valid distribution of key anthropometric parameters among participants is often a perquisite of ergonomics research.

OBJECTIVE

In this paper, we investigated the accuracy of self-reported stature and body mass of the population in the Netherlands.

METHODS

Data from 4 experiments was synthesized where in each experiment, participants self-reported their stature and body mass prior to being measured, of which they were not notified before.

RESULTS

Statistical analysis of 249 records indicated that on average, participants overreported their stature by 1.31 cm and underreported their mass by 1.45 kg. This is especially true for people with a BMI≥25.

CONCLUSION

Two models were proposed to adjust the self-reported stature and body mass for ergonomic researchers in a survey or recruitment. Limitations in using the models are highlighted as well.

Shared Genetic Factors Contributing to the Overlap between Attention-Deficit/Hyperactivity Disorder Symptoms and Overweight/Obesity in Swedish Adolescent Girls and Boys

Attention-deficit/hyperactivity disorder (ADHD) and obesity are positively associated, with increasing evidence that they share genetic risk factors. Our aim was to examine whether these findings apply to both types of ADHD symptoms for female and male adolescents. We used data from 791 girl and 735 boy twins ages 16-17 years to examine sex-specific phenotypic correlations between the presence of ADHD symptoms and overweight/obese status. For correlations exceeding .20, we then fit bivariate twin models to estimate the genetic and environmental correlations between the presence of ADHD symptoms and overweight/obese status. ADHD symptoms and height/weight were parent- and self-reported, respectively. Phenotypic correlations were .30 (girls) and .08 (boys) for inattention and overweight/obese status and .23 (girls) and .14 (boys) for hyperactivity/impulsivity and overweight/obese status. In girls, both types of ADHD symptoms and overweight/obese status were highly heritable, with unique environmental effects comprising the remaining variance. Furthermore, shared genetic effects explained most of the phenotypic correlations in girls. Results suggest that the positive association of both types of ADHD symptoms with obesity may be stronger in girls than boys. Further, in girls, these associations may stem primarily from shared genetic factors.

Psychological inflexibility in terms of eating behaviors among individuals seeking treatment for comorbid affective vulnerabilities and weight-related behaviors

Maladaptive eating patterns and behaviors are frequently documented in relation to obesity onset and management. To better understand these occurrences, it is important to examine psychological processes that may be guiding these patterns and behaviors. The current study examined the role of psychological inflexibility on emotional eating, food cravings, and disordered eating symptoms among 161 participants (60.9% female, Mage = 31.58, SD = 10.71) who attended a baseline appointment for a larger randomized-controlled trial for individuals with elevated anxiety sensitivity and obesity. Three separate two-step hierarchal regressions were conducted. Results indicated that greater levels of psychological inflexibility were associated with greater levels of emotional eating, food cravings, and disordered eating symptoms. These findings suggest that promoting psychological flexibility may be a key factor in promoting positive changes in eating behaviors among individuals seeking treatment for comorbid affective vulnerabilities and weight-related behaviors.

The accuracy of patient-reported weight prior to total joint arthroplasty and arthroscopy of the lower extremity

PURPOSE

The accuracy of preoperative patient-reported weight was never evaluated in patients undergoing lower extremity procedures. The purpose of this study was to: (1) compare the disparity between patient-reported and measured weights in patients undergoing lower extremity total joint arthroplasty (LE-TJA) and arthroscopy; and (2) investigate the association between patient-specific factors (patient age, BMI, zip code, and psychiatric comorbidities) and the accuracy of patient-reported weight.

METHODS

Preoperative self-reported weights were retrospectively compared to measured weights in 400 LE-TJA and 85 control arthroscopy patients. The difference between reported and measured weights was calculated. Additionally, the percent of accurate reporting within 0.5, 1, and 5 kg ranges of the measured weight was calculated. Outcomes were compared between surgical modalities as well as between patient-specific factors.

RESULTS

There was low disparity (p = 0.838) between patient-reported and measured weights among LE-TJA (mean difference 0.18 ± 3.63 kg; p = 0.446) and that of arthroscopy (0.27 ± 4.08 kg; p = 0.129) patients. Additionally, LE-TJA patients were equally likely to report weights accurately within 0.5 kg of the measured weight (74% vs. 71.76%; p = 0.908). LE-TJA and arthroscopy patients had similar reporting accuracy within 1 and 5 kg of the measured weights (p > 0.05).

CONCLUSION

Preoperative patient-reported weights demonstrated acceptable accuracy in both LE-TJA and lower extremity arthroscopic orthopaedic patient populations making it a potentially reliable parameter of preoperative assessment.

Obesity, Fruit and Vegetable Intake, and Physical Activity Patterns in Austrian Farmers Compared to the General Population

Low fruit and vegetable (F&V) intake, sedentary behavior, excessive alcohol consumption, and smoking are risk factors for the development of non-communicable diseases. This study describes the patterns and factors of nutrition (F&V and alcohol intake), physical activity (PA), obesity, and other chronic diseases of 10,053 adult farmers (52.7% female) in Austria, based on the cross-sectional survey from the Austrian Social Insurance Institution for the Self-Employed and compared with the results of the general Austrian population from 2019 (n = 14,606; 53.7% female). Compared to the general Austrian population, farmers showed a higher prevalence of overweight and obesity (42.8% vs. 36.5%; 18.8% vs. 17.1%), as well as hypertension, hypercholesterolemia, and diabetes mellitus. Additionally, farmers ate less F&V (0 servings/day 39.7% vs. 14.0%; 1−4 servings/day 55.5% vs. 80.8%) and only 4.8% vs. 5.1% (p < 0.001) fulfilled the F&V recommendations. Lower participation in endurance training (38.3% vs. 52.1%) was found, whereas farmers did more strength training (64.1% vs. 27.6%). Those who failed to fulfill the PA recommendations reported worse health status (OR: 3.14; 95%-CI: 2.08−4.76) and a higher chance for obesity (OR: 1.68; 95%-CI: 1.38−2.05). Since obesity rates among farmers are high and recommendations have rarely been met, every opportunity should be taken to promote healthy eating and adequate PA.

Validation of remote height and weight assessment in a rural randomized clinical trial

BACKGROUND

The purpose of this study is to describe and assess a remote height and weight protocol that was developed for an ongoing trial conducted during the SARS COV-2 pandemic.

METHODS

Thirty-eight rural families (children 8.3 ± 0.7 years; 68% female; and caregivers 38.2 ± 6.1 years) were provided detailed instructions on how to measure height and weight. Families obtained measures via remote data collection (caregiver weight, child height and weight) and also by trained staff. Differences between data collection methods were examined.

RESULTS

Per absolute mean difference analyses, slightly larger differences were found for child weight (0.21 ± 0.21 kg), child height (1.53 ± 1.29 cm), and caregiver weight (0.48 ± 0.42 kg) between school and home measurements. Both analyses indicate differences had only minor impact on child BMI percentile (- 0.12, 0.68) and parent BMI (0.05, 0.13). Intraclass coefficients ranged from 0.98 to 1.00 indicating that almost all of the variance was due to between person differences and not measurement differences within a person.

CONCLUSION

Results suggest that remote height and weight collection is feasible for caregivers and children and that there are minimal differences in the various measurement methods studied here when assessing group differences. These differences did not have clinically meaningful impacts on BMI. This is promising for the use of remote height and weight measurement in clinical trials, especially for hard-to reach-populations.

TRIAL REGISTRATION

Clinical. Registered in clinicaltrials.gov ( NCT03304249 ) on 06/10/2017.

Adolescent's self-reported weight and its association with media impact on decision to lose weight and body thinness perception

This study investigated the accuracy of self-reported weight among Kuwaiti adolescents and the associations of self-reported weight and calculated BMI with the impact of media use on adolescent’s decision to lose weight and body thinness perception. A total of 706 Kuwaiti adolescents (363 females) 15–18 year-olds were randomly selected from schools. Weight and height were self-reported by the adolescents and measured by the researchers. A specifically designed questionnaire reported the impact of media use on adolescent’s decision to lose weight and body thinness perception. There were significant (p < 0.001) relationships between measured and reported weight (r = 0.947), height (r = 0.777), and calculated BMI (r = 0.623). Intraclass correlation coefficients (95% CI) between self-reported and measured weight and height were 0.973 (0.968–0.977) and 0.867 (0.839–0.891), respectively. The mean differences between self-reported and measured weight (1.26 kg) and BMI (0.478 kg/m²) were relatively small. Females under-reported their weight and the calculated BMI from estimated weight and height was underestimated by adolescents with overweight/obesity. The impact of media use on the adolescent’s perception of being thin relative to the accuracy of the calculated BMI was significant (p = 0.043–0.001). The age-adjusted odds ratio of the calculated (underestimated) BMI in adolescents without overweight/obesity was 0.437 (95% CI = 0.257–0.741; p = 0.002). It was concluded that the validity of self-reported weight was high. Adolescents with overweight/obesity were more likely to underestimate their weight and calculated BMI. Educating adolescents about proper lifestyles and weight loss through media appears warranted.

The association between distress tolerance and eating expectancies among trauma-exposed college students with obesity

Objective Obesity is a significant health concern among college populations, and trauma-exposed students are particularly at risk for behaviors associated with weight gain. There is need for further understanding of factors that may contribute to increased obesity among this population. Participants: Participants included 139 trauma-exposed college students with obesity (76.3% females; M_age = 25.4 years, SD = 8.07). Method: The current cross-sectional study examined distress tolerance in terms of expectancies of eating to help manage negative affect and to lead to feeling out of control among trauma-exposed college students with obesity. Results: Results indicated that lower perceived distress tolerance was associated with greater expectancies of eating to help manage negative affect and to lead to feeling out of control. Conclusions: These findings suggest that distress tolerance may be a clinically significant target for treatment in order to better understand and treat expectancies of eating among trauma-exposed college students with obesity.

Perceptions of body weight that vary by body mass index: Clear associations with perceptions based on personal control and responsibility

This project aimed to identify the perceptions of body weight that vary by body mass index. First, a qualitative study explored body weight perceptions in 17 individuals with overweight. Second, a questionnaire was developed and completed by a UK sample with body mass index from 16.6 to 59.7 kg/m2 (N = 328). A higher body mass index was associated with perceptions of less personal control and responsibility. Body mass index in females was also associated with three other questionnaire factors and body mass index in males with illness/medication. Thus, body mass index was associated with different perceptions of body weight. Focussing on personal control and responsibility may be useful for treatment and prevention.

Impact of elevated BMI and types of comorbid conditions on health-related quality of life in a nationally representative US sample

OBJECTIVE

Elevated BMI is associated with multiple chronic conditions including diabetes and CVD. Patients with overweight or obesity may also suffer from comorbidities not directly related to the pathophysiology of elevated BMI. The current study sought to determine the impact of BMI and different types of chronic conditions on health-related quality of life (HRQoL) outcomes.

DESIGN

Six weight categories by BMI were identified: underweight, normal weight, overweight, Class-I obesity, Class-II obesity and Class-III obesity. Twenty chronic conditions were considered and categorised as elevated BMI-related (concordant) or -unrelated (discordant) conditions. HRQoL outcomes were measured using Short Form-6 Dimensions (SF-6D). Multivariable regression models were performed to examine the impact of type, number of comorbid conditions and BMI categories on SF-6D scores.

SETTING

Medical Expenditure Panel Survey (2013-2015).

PARTICIPANTS

Nationally representative sample of US population; 18 years or older (n 58 960).

RESULTS

Of the sample, 1·7 %, 32·9 %, 34·0 % and 31·4 % were classified as underweight, normal weight, overweight and obese, respectively. The SF-6D scores were significantly decreased across all obesity classes, with the largest reduction in Class-III obesity (0·033; P < 0·001). Additionally, individuals with obesity having one or more concordant or discordant comorbidities further reduced SF-6D scores between 0·031 and 0·148 (P-values < 0·001) or between 0·080 and 0·212 (P-values < 0·001), respectively.

CONCLUSIONS

Individuals with obesity had a significant reduction in HRQoL outcomes compared to those with normal BMI. Importantly, discordant comorbidity resulted in greater reduction in HRQoL outcomes compared to concordant comorbidity in subjects with elevated BMI.

Overweight and obesity by school socioeconomic composition and adolescent socioeconomic status: a school-based study

BACKGROUND

The main objective of this study was to investigate the interaction effect of school socioeconomic composition (SEC) and adolescent socioeconomic status (SES) in the prevalence of overweight and obesity among a representative sample of French adolescents of the third most populous département of France.

METHODS

1038 adolescents agreed to participate (response rate: 91.4%). They self-reported anthropomorphic variables, SES, school lunch and physical activity. The body mass index was divided into six categories according to the Center for Disease Control. Multivariable binary logistic regressions analysis without and with interaction term were performed on overweight or obesity. Models fit was compared using the Aikaike Information Criterion. Odds-ratios (OR) and their 95% accelerated-bootstrap confidence interval (95%BCa CI) were computed to estimate overweight or obesity risk.

RESULTS

8.9% of the adolescents were overweight. 3.4% were obese. No school-SEC effect was observed among low-SES adolescents. Medium-SES adolescents were at greater risk in low-SEC (OR = 10.75, 95%BCa CI = 2.67-64.57) and medium-SEC (OR = 5.08, 95%BCa CI = 1.55-24.84) compared with high-SEC schools. High-SES adolescents in low-SEC schools were at greater risk compared with those in medium-SEC (OR = 5.94, 95%BCa CI = 1.94-17.29) and high-SEC schools (OR = 4.99, 95%BCa CI = 1.71-13.14). A social gradient was observed in medium-SEC (OR_low/high = 2.79, 95%BCa CI = 1.22-7.41) and high-SEC (OR_low/medium = 6.86, 95%BCa CI = 1.06-5.22*10⁶) schools.

CONCLUSIONS

Physical activity and lunch at and outside school help to understand these differences. Implications for obesity prevention initiatives are discussed.

A case-control study of factors associated with SARS-CoV-2 infection among healthcare workers in Colombia

Background

Healthcare Workers (HCW) are repeatedly exposed to SARS-CoV-2 infection. The aim of this study was to identify factors associated with SARS-CoV-2 infection among HCW in one of the largest cities in Colombia.

Methods

We conducted a case–control study, where cases had a positive reverse transcription-polymerase chain reaction and controls had a negative result. Participants were randomly selected and interviewed by phone. Analyses were performed using logistic regression models.

Results

A total of 110 cases and 113 controls were included. Men (AdjOR 4.13 95% CI 1.70–10.05), Nurses (AdjOR 11.24 95% CI 1.05–119.63), not using a high-performance filtering mask (AdjOR 2.27 95% CI 1.02–5.05) and inadequate use of personal protective equipment (AdjOR 4.82 95% CI 1.18–19.65) were identified as risk factors. Conversely, graduate (AdjOR 0.06 95% CI 0.01–0.53) and postgraduate (AdjOR 0.05 95% CI 0.005–0.7) education, feeling scared or nervous (AdjOR 0.45 95% CI 0.22–0.91), not always wearing any gloves, caps and goggles/face shields (AdjOR 0.10 95% CI 0.02–0.41), and the use of high-performance filtering or a combination of fabric plus surgical mask (AdjOR 0.27 95% CI 0.09–0.80) outside the workplace were protective factors.

Conclusion

This study highlights the protection provided by high-performance filtering masks or double masking among HCW. Modifiable and non-modifiable factors and the difficulty of wearing other protective equipment needs to be considered in designing, implementing and monitoring COVID-19 biosafety protocols for HCW.

Does Self-Perception Equal the Truth When Judging Own Body Weight and Height?

Background: Data from the research project “Fitness clubs—a venue for public health?” provided an opportunity to evaluate the accuracy of self-reported body weight and height, and subsequent Body Mass Index (BMI), as well as the “trueness” of novice exercisers perception of weight status category, which has not been examined in this population. The aims were to examine self-reported body weight, height, and calculated BMI data from an online survey compared with measured data at fitness club start-up, investigate how accurately novice exercisers place themselves within self-classified weight group (underweight, normal weight, overweight, and obese), and compare this with fitness club attendance at three months follow-up. Methods: Prior to anthropometric measurements, 62 men and 63 women responded to an online questionnaire, including body weight (kilogram, kg) and height (centimeters, cm), and self-classified weight group (“I think I am … underweight, normal weight, overweight, obese”). We used the following statistical analysis: Paired sample t-tests, a Bland–Altman plot kappa statistics, chi-squared tests, and a logistic regression. Results: Mean difference of BMI calculated from self-reported and measured data was 0.06 (95% CI −0.29 to 0.17, p = 0.593) in men, and 0.16 (95% CI −0.40 to 0.09, p = 0.224) in women, with four participants being outliers of the 95% limits of agreement (Bland-Altman plot). Allowing a difference of 0.5 kg between self-reported and measured weight, we found that 16% reported their weight correctly, 31.2% underreported (−1.89 ± 1.59 kg), and 52.8% overreported (1.85 ± 1.23 kg), with no sex differences (p = 0.870). Further, our results suggest that both sexes may have difficulty recognizing overweight/obesity in themselves, and particularly men are likely to underreport their perceived weight group compared with women. More than half (53.3%) of the overweight men perceived themselves to be normal weight (women: 14%), and only 33.3% of obese men and women correctly classified themselves as being obese. We did not find any difference between participants correctly or incorrectly classifying weight group and fitness club attendance (≥2 times a week) at three months follow-up. Conclusion: Both sexes reported body weight and height reasonably accurately, and BMI based on self-report appears to be valid measure. Still, a large proportion of novice exercisers do not recognise their own overweight or obesity status, which may in part explain why public health campaigns do not reach risk populations.

Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market

Background

Our study estimated insurance payments and patient out-of-pocket (OOP) expenses associated with discarded weight-based intravenous antineoplastic drugs for privately insured US adult patients with cancer.

Methods

We identified patients who received weight-based antineoplastic drugs from a 2017 MarketScan health risk assessment (IBM Corp, Armonk, NY) linked to claims data. Using weight information in the health risk assessment, we derived the recommended dose and calculated the percentage of drugs discarded. We applied β-regression to determine factors associated with the discarded percentages. To compare patients with and without high-deductible plans, we employed a generalized linear model and a 2-part model to examine insurance payment and OOP expense, respectively. All statistical tests were 2-sided.

Results

Of 27 350 claims for 58 weight-based antineoplastic drugs from 1970 patients, the median discarded percentage was 9.8% (mean [SD] = 12.8% [10.5%]). Aside from drug and tumor type, statistically significantly higher discarded percentages were found for patients in the lowest weight group (5.5% [95% confidence interval = 4.7% to 6.4%]; P < .001; weight <150 lb [68.0 kg] vs ≥200 lb [90.7 kg]). Private payers spent $5090 per patient in 2017 on discarded weight-based antineoplastic drugs, and patients' mean OOP expense on discarded drugs was $63. In total, 39.7% of patients had high-deductible plans. The adjusted mean OOP expense for discarded drugs was statistically significantly higher for those in high-deductible plans ($95 vs $47; P < .001).

Conclusions

Private insurers incurred substantial financial burden from discarded weight-based antineoplastic drugs. Although the OOP expenses of discarded drugs were modest for most privately insured patients with cancer, approximately 5% spent more than $400 on the discarded drugs. Policies designed to reduce drug waste from single-dose, weight-based antineoplastic drugs should evaluate their financial consequences for payers and patients.

Internalized weight bias and cortisol reactivity to social stress

Weight-associated stigmatization and discrimination may induce chronic stress in individuals with obesity. As a consequence, this stressor may cause an imbalance of HPA stress axis leading to increased eating behavior, and ultimately, weight gain. However, the direct link between internalized weight bias and stress response to acute stressors via cortisol secretion has not been investigated so far. Therefore, the purpose of this study was to investigate the interaction between internalized weight stigma as a stressor and cortisol reactivity in an acute psychosocial stress situation induced by the Trier Socials Stress Test for groups (TSST-G). Participants with BMI >30 kg/m² (n = 79) were included in the study. Results reveal that while individuals with low internalized stigma reacted as predicted with an increase in cortisol secretion to acute psychosocial stress, individuals with medium or high internalized stigma did not show a typical cortisol response. However, these findings depend on the several factors, for instance on gender. In sum, acute stress in individuals with internalized weight bias seems to blunt HPA axis reactions to acute psychosocial stress. The study contributes to the understanding of the psychological and endocrinological consequences of internalized weight bias and underlines the importance of interventions to reduce stigmatization.

Perspectives of e-health interventions for treating and preventing eating disorders: descriptive study of perceived advantages and barriers, help-seeking intentions, and preferred functionality

PURPOSE

Digital interventions that consider end-user needs, preferences, and concerns may address suboptimal rates of e-health uptake, usage, and engagement. We explored target-user perspectives of e-health treatment and prevention programs for eating disorders (EDs), with a focus on investigating (1) perceived advantages and barriers of e-health; (2) help-seeking intentions; and (3) preferences for different digital functionality, device types, and content-delivery formats.

METHODS

Survey data were analysed from 722 community-based participants. Participants were categorized into one of four groups based on symptom presentation and severity, ranging from low risk to probable bulimia nervosa or binge-eating disorder.

RESULTS

e-health advantages that received the highest endorsement (~ 84%) were "always there in times of need" and "travel not required". e-health barriers that received the highest endorsement (~ 50%) were concerns about data privacy and the accuracy of content presented. Nearly three-quarters reported an intention to use an e-health platform for preventing or treating EDs. Preference ratings were highest for programs to be available on all digital devices (relative to restricting the program to one type of device) and for content to be presented via graphics and video tutorials (rather than audio-based). e-health functionality that received highest preference ratings (~ 80%) were added clinician support, tailored feedback, strategies to change unhelpful ED thoughts, screening scales to assess symptoms, ED psychoeducation, and just-in-time intervention prompts. Preference and intention ratings were strikingly similar across all subgroups.

CONCLUSION

Findings may inform the development and design of e-health platforms that meet the needs of people at different stages of an ED.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Respondent Characteristics and Dietary Intake Data Collected Using Web-Based and Traditional Nutrition Surveillance Approaches: Comparison and Usability Study

Background

There are many constraints to conducting national food consumption surveys for national nutrition surveillance, including cost, time, and participant burden. Validated web-based dietary assessment technologies offer a potential solution to many of these constraints.

Objective

This study aims to investigate the feasibility of using a previously validated, web-based, 24-hour recall dietary assessment tool (Foodbook24) for nutrition surveillance by comparing the demographic characteristics and the quality of dietary intake data collected from a web-based cohort of participants in Ireland to those collected from the most recent Irish National Adult Nutrition Survey (NANS).

Methods

Irish adult participants (aged ≥18 years) were recruited to use Foodbook24 (a web-based tool) between March and October 2016. Demographic and dietary intake (assessed by means of 2 nonconsecutive, self-administered, 24-hour recalls) data were collected using Foodbook24. Following the completion of the study, the dietary intake data collected from the web-based study were statistically weighted to represent the age-gender distribution of intakes reported in the NANS (2008-2010) to facilitate the controlled comparison of intake data. The demographic characteristics of the survey respondents were investigated using descriptive statistics. The controlled comparison of weighted mean daily nutrient intake data collected from the Foodbook24 web-based study (329 plausible reporters of a total of 545 reporters) and the mean daily nutrient intake data collected from the NANS (1051 plausible reporters from 1500 reporters) was completed using the Wilcoxon–Mann-Whitney U test in Creme Nutrition software.

Results

Differences between the demographic characteristics of the survey participants across the 2 surveys were observed. Notable differences included a lower proportion of adults aged ≥65 years and a higher proportion of females who participated in the web-based Foodbook24 study relative to the NANS study (P<.001). Similar ranges of mean daily intake for the majority of nutrients and food groups were observed (eg, energy [kilocalorie per day] and carbohydrate [gram per day]), although significant differences for some nutrients (eg, riboflavin [mg/10 MJ], P<.001 and vitamin B12 [µg/10 MJ], P<.001) and food groups were identified. A high proportion of participants (200/425, 47.1%) reported a willingness to continue using Foodbook24 for an additional 6 months.

Conclusions

These findings suggest that by using targeted recruitment strategies in the future to ensure the recruitment of a more representative sample, there is potential for web-based methodologies such as Foodbook24 to be used for nutrition surveillance efforts in Ireland.

Barriers to physical activity during the COVID-19 pandemic in adults: a cross-sectional study

Social isolation due to the coronavirus disease 2019 (COVID-19) pandemic has reduced physical activity levels in both men and women. The identification of barriers to physical activity may assist in developing strategies to increase levels of physical activity during this pandemic. The study aim was identify the barriers to regular participation in physical during the COVID-19 pandemic in Brazilian adults. This cross-sectional study included 1570 [56.6% women; aged: 39.1 (37.7–40.7) years old] in social isolation due COVID-19. Barriers to physical activity were obtained using the validated questionnaires. “Laziness and fatigue” (50.2%), “lack of motivation” (31.2%), “lack of appropriate facilities/equipment/space” (17.4%), and “lack of time” (13.0%) were the barriers most prevalent in the study. Lack of motivation (OR = 1.49; 95% CI = 1.19–1.86) and lack of appropriate facilities/equipment/space (OR = 2.11; 95% CI = 1.57–2.83) were most associated with impacting physical activity levels due to the COVID-19, independent of sex, age, education level, days of social isolation and status weight. In conclusion, personal barriers to physical activity are common between both sexes, with lack of motivation and lack of appropriate facilities/equipment/space most associated with a decreased level of physical activity due to the COVID-19 pandemic.

Trajectories and determinants of weight gain in two cohorts of young adult women born 16 years apart

BACKGROUND

The aims were to compare: (1) baseline weights and weight gain trajectories; (2) sociodemographic, behavioural and health characteristics driving weight gain; and (3) estimated average weight in 20 years' time, in two cohorts of young women.

METHODS

Data were from 16066 participants in two population-based cohorts of young adult women, born in 1973-78 ("GenX") and 1989-95 ("millennials"). Weight was reported at baseline (age 18-23 in both cohorts) and 4 years later. High weight gain was defined as >2.5% per year. Data were analysed in 2020.

RESULTS

Women born in 1989-95 were almost 4 kg heavier at age 18-23 and gained weight over 4 years 1.7 times faster than those born in 1973-78. Prevalence of high weight gain was 34.2% in the 1989-95 cohort and 24% in the 1973-78 cohort. In both cohorts, older age, higher education and high physical activity were associated with lower odds of high weight gain, and more hours in paid work, poorer self-rated health and higher baseline BMI were associated with higher odds of high weight gain. Five factors (outer regional areas, one child, ex or current smoker, high stress and depression) were determinants of high weight gain in the 1989-95 cohort, but not in the 1973-78 cohort. Based on average weight at age 21 and annual percentage weight gain, we estimate that women born in 1989-95 will, on average, be 16.7 kg heavier at age 41 (93.2 kg), than women in the 1973-78 cohort (76.5 kg).

CONCLUSION

High weight gain was evident in every sociodemographic group in both cohorts but most evident in millennial women with high levels of stress and depression. Without effective weight gain prevention strategies we estimate that more than 50% of the millennial women will be in the obese BMI category in 20 years. This will have serious economic, health and societal consequences.

The Role of Anxiety Sensitivity in terms of Weight-related Impairment and Fatigue Severity among Adults with Obesity and Chronic Low Back Pain

BACKGROUND

Obesity and chronic low back pain often co-occur and are associated with psychosocial and physical impairments such as weight-related impairment and fatigue. Yet, there is little understanding of psychological factors that may be associated with weight-related impairment and fatigue (a psychosocial factor) among this vulnerable population.

METHODS

Thus, the current study examined the role of anxiety sensitivity as it relates to self-reported weight-related impairment and fatigue severity among persons with obesity and chronic low back pain. Participants included a nationally representative sample of adults (N = 616) with co-occurring obesity and chronic low back pain (77.3% female, M age = 45.9 years, SD = 11.53).

RESULTS

Results revealed that anxiety sensitivity was associated with greater levels of weight-related impairment and fatigue severity after controlling for age, sex, body mass index (BMI), pain interference, and perceived general health.

CONCLUSIONS

The findings suggest that anxiety sensitivity may be a mechanistic target for better understanding and addressing weight-related impairment and fatigue severity among individuals with obesity and chronic low back pain.

The Relationship between Obesity and Physical Activity of Children in the Spotlight of Their Parents' Excessive Body Weight

Background: The study reveals the relationships between daily physical activity (PA) and the prevalence of obesity in family members separated according to the participation of their offspring in organized leisure-time physical activity (OLTPA), and answers the question of whether the participation of children in OLTPA is associated with a lower prevalence of obesity in offspring with respect to parental PA and body weight level. Methods: The cross-sectional study included 1493 parent-child dyads (915/578 mother/father-child aged 4–16 years) from Czechia selected by two-stage stratified random sampling with complete data on body weight status and weekly PA gathered over a regular school week between 2013 and 2019. Results: The children who participated in OLTPA ≥ three times a week had a significantly lower (p < 0.005) prevalence of obesity than the children without participation in OLTPA (5.0% vs. 11.1%). Even in the case of overweight/obese mothers/fathers, the children with OLTPA ≥ three times a week had a significantly lower (p < 0.002) prevalence of obesity than the children without OLTPA (6.7%/4.2% vs. 14.9%/10.7%). Conclusions: The cumulative effect of regular participation in OLTPA and a child’s own PA is a stronger alleviator of children’s obesity than their parents’ risk of overweight/obesity.

Esport: Fortnite Acutely Increases Heart Rate of Young Men

Esports has rapidly increased in online play and viewing. A myriad of literature focuses on heart rate (HR) during traditional athletic competition, little research has addressed the HR responses of individuals playing esports and none in the esport: Fortnite. The purpose of this study was to compare the HR response during a 3-hour seated session of the esport: Fortnite to resting HR. Male college students (n = 23; age = 21 ± 1.8 years; BMI = 25.7 ± 3.9; Esport mean hours per week = 13 ± 8.7) were recruited to participate in the study. Mean and peak resting HR were collected during two HR measurements in a controlled laboratory setting. Additionally, participants wore the HR monitor to record mean and peak HR during their regular 3-hour esport: Fortnite session at home. Participants were also instructed to record their match statistics from each solo round. Separate paired sample t-tests were conducted to compare mean resting heart rate (rHR) vs. mean seated esport heart rate (eHR) and peak rHR vs. peak eHR. Pearson's r correlations were used to investigate relationships between variables. There was a statistically significant increase in mean eHR compared to mean rHR (76 ± 10 bpm vs. 70 ± 11 bpm; p < 0.05) and peak eHR compared to peak rHR (120 ± 16 bpm vs. 81 ± 11 bpm; p < 0.05). The average number of kills was 29 ± 18.6. This initial study suggests esport: Fortnite increases individuals seated HR, suggesting a physiological stressful event.

Physiological and Perceptual Response to a Live Collegiate Esports Tournament

Competitive esports has grown rapidly across the globe justifying a need to quantify the physiological stress response to this environment. The purpose of this study was to describe the physiological and perceptual responses in a live collegiate esports tournament. Male members of the University of Mississippi Esports team (n = 14; age = 19.8 ± 1.0 years; BMI = 24.1 ± 5.5) completed the study during the esports Egg Bowl. Heart rate (HR) and heart rate variability (HrV) were collected pre-, during, and post-competition. Rating of perceived exertion for the session (S-RPE) and mental fatigue were collected post competition. Mean HR during competition were significantly elevated compared to mean pre- and post- (131.4 ± 19.0 bpm vs. 97.1 ± 19.9 bpm and 101.9 ± 17.4 bpm; p = 0.000) and peak HR during competition were significantly elevated compared to peak pre- and post-(188.1 ± 32.9 bpm vs. 119.6 ± 20.1 bpm and 119.9 ± 16.3 bpm; p = 0.000). R-R intervals were significantly lower in-competition (465.71 ± 68.99) compared to pre- (643.64 ± 138.54) or post- competition (616.07 ± 109.98; p = .000). No significant differences were found in rMSSD, (ln) rMSSD, SDNN, or NN50 across the three measurements. LF was lower post- competition than pre-competition (d = 0.278). Participants indicated moderate mental fatigue (3.7 ± 1.2; on a scale of 1-7). These findings demonstrate competing in esports causes a physiological stress response. Given the elevated HR, further understanding of the chronic physiological stress to competitive esports is warranted.

Body areas satisfaction and body mass in adolescents: mediating effects of actual-ideal body weight discrepancies

PURPOSE

This study aims at investigating prospective associations between body areas satisfaction (BAS), actual (objectively measured)-ideal body weight discrepancy, actual (self-reported)-ideal body weight discrepancy and BMI among adolescents from the general population.

METHODS

Data were collected at three measurement points: baseline (T1), 2-month follow-up (T2), 13-month follow-up (T3) among 1011 adolescents (59.3% girls) aged 13-19 years (M = 16.30, SD = 0.82) with BMIs ranging from 15.20 to 38.78 (M = 20.01, SD = 3.33). Adolescents completed questionnaires regarding BAS (T1), actual and ideal body weight (T2). Body weight and height were measured objectively (T1 and T3).

RESULTS

Adolescents satisfied with most areas of their bodies had lower levels of actual (objectively measured)-ideal body weight discrepancy, which in turn predicted higher BMI, while lower levels of actual (self-reported)-ideal body weight discrepancy predicted lower BMI. No moderating effect of gender was found.

CONCLUSIONS

Actual-ideal weight discrepancies may operate in complex manner prompting opposite effects on BMI.

LEVEL OF EVIDENCE

Level III, longitudinal study without control group.

Use and reporting of Bland-Altman analyses in studies of self-reported versus measured weight and height

BACKGROUND/OBJECTIVES

Bland-Altman methods for assessing the agreement between two measures are highly cited. However, these methods may often not be used to assess agreement, and when used, they are not always presented or interpreted correctly. Our objective was to evaluate the use and the quality of reporting of Bland-Altman analyses in studies that compare self-reported with measured weight and height.

METHODS

We evaluated the use of Bland-Altman methods in 394 published articles that compared self-reported and measured weight and height data for adolescents or adults. Six reporting criteria were developed: assessment of the normality of the distribution of differences, a complete and correctly labeled Bland-Altman plot displaying the mean difference and limits of agreement (LOA), numerical values and confidence intervals, standard errors, or standard deviations for mean difference, numerical values of LOA, confidence intervals for LOA, and prespecified criteria for acceptable LOA.

RESULTS

Only 72/394 (18%) studies comparing self-reported with measured weight and height or BMI used some form of Bland-Altman analyses. No study using Bland-Altman analyses satisfied more than four of the six criteria. Of the 72 studies, 64 gave mean differences along with confidence intervals or standard deviations, 55 provided complete Bland-Altman plots that were appropriately labeled and described, 37 provided numerical values for LOA, 4 reported that they examined the normality of the distribution of differences, 3 provided confidence intervals for LOA, and 3 had prespecified criteria for agreement.

CONCLUSIONS

Bland-Altman methods appear to be infrequently used in studies comparing measured with self-reported weight, height, or BMI, and key information is missing in many of those that do use Bland-Altman methods. Future directions would be defining acceptable LOA values and improving the reporting and application of Bland-Altman methods in studies of self-reported anthropometry.

Impact of Disadvantaged Neighborhoods and Lifestyle Factors on Adult Obesity: Evidence From a 5-Year Cohort Study in Australia

PURPOSE

This study aims to investigate the impact of disadvantaged neighborhoods and lifestyle factors on obesity among Australian adults.

DESIGN

Quantitative, longitudinal research design.

SETTING

Cohort.

SAMPLE

Data for this study came from a cohort of 10 734 adults (21 468 observations) who participated in the Household, Income and Labour Dynamics in Australia survey. The participants were interviewed at baseline in 2013 and were followed up in 2017.

MEASURES

Generalized Estimating Equation model with logistic link function was employed to examine within-person changes in obesity due to disadvantaged neighborhoods and lifestyle factors at 2-time points over a 4-year follow-up period.

RESULTS

Adults living in the most disadvantaged area were 1.22 (odds ratio [OR]: 1.22, 95% CI: 1.08-1.38) and 1.30 (OR: 1.30, 95% CI: 1.20-1.42) times, respectively, more prone to be overweight and obese compared with peers living at least disadvantaged area. Study results also revealed that adults who consume fruits regularly and perform high levels of physical activity were 6% (OR: 0.94, 95% CI: 0.91-0.98) and 12% (OR: 0.88, 95% CI: 0.85-0.92) less likely to be obese, respectively, compared to their counterparts. Current alcohol drinkers were 1.07 (OR: 1.07, 95% CI: 1.01-1.13) times more likely to be obese compared to peers not consuming alcohol. Highly psychologically distressed adults were 1.08 times (OR: 1.08, 95% CI: 1.02-1.13) more likely to be obese than their peers.

CONCLUSION

This study contributes to the literature regarding disadvantaged neighborhoods and lifestyle factors, which have an influence on adult obesity rates and thus help health decision-makers to formulate effective obesity prevention strategies.

Text messaging as an intervention for weight loss in emerging adults

BACKGROUND AND PURPOSE

Rates of overweight and obesity in emerging adults are rapidly increasing and associated with many chronic illnesses, quality of life concerns, and increased health care spending. Effective weight management interventions are needed for this population. The purpose of this study was to examine effects of a text-messaging weight loss intervention on motivation, stage of change for weight loss, and BMI.

METHODS

Overweight and obese emerging adults were enrolled (n = 188) and randomized to control or intervention groups. Weight loss information was delivered via a website to both groups. The intervention group also received daily weight loss-related text messages. Motivation, stage of change, and BMI were assessed online, via self-report at baseline, 4, and 8 weeks.

CONCLUSIONS

Ninety-five participants were included in the final data analysis. There was a significant increase in motivation and stage of change and decrease in BMI over the study duration, with no significant differences between groups.

IMPLICATIONS FOR PRACTICE

Nurse practitioners are well positioned to provide innovative weight loss interventions in a variety of settings. These results provide important insights for the design of effective weight loss treatment for emerging adults and support the use of web-based and text message-based interventions.

Consumption of Sugar-Sweetened Beverages, Juice, Artificially-Sweetened Soda and Bottled Water: An Australian Population Study

Reducing consumption of free sugars, such as those found in high concentrations in manufactured products such as sugar-sweetened beverages (SSBs) and 100% fruit juices, is a global public health priority. This study aimed to measure prevalence of widely available pre-packaged non-alcoholic water-based beverages (carbonated sodas, sports drinks, energy drinks, artificially-sweetened sodas, fruit juices (any type), and bottled water) and to comprehensively examine behavioral, environmental, current health, and demographic correlates of consumption. A cross-sectional, nationally-representative population survey of 3430 Australian adults (18+ years) was conducted using computer-assisted telephone (mobile and landline) interviewing. Past week prevalence of pre-packaged drinks containing free sugar was 47.3%; daily prevalence was 13.6%. Of all the pre-packaged drinks assessed, consumption of fruit juices (any type) was the most prevalent (38.8%), followed by bottled water (37.4%), soda (28.9%), artificially-sweetened soda (18.1%), sports drinks (8.1%), and energy drinks (4.2%). Higher soda consumption was associated with males, younger age, socio-economic disadvantage, frequent takeaway food consumption, availability of soda in the home, obesity, and a diagnosis of heart disease or depression. A diagnosis of Type 2 Diabetes was associated with increased likelihood of consuming artificially-sweetened sodas and decreased likelihood of consuming sugar-sweetened soda. SSB consumption is prevalent in Australia, especially among young adults and males, foreshadowing continued population weight gain and high burdens of chronic disease. To reduce consumption, Australia must take a comprehensive approach, incorporating policy reform, effective community education, and active promotion of water.

The relationship between measures of obesity and atherogenic lipids among Nigerians with hypertension

Aim

This study aimed to determine the relationship between measures of obesity and serum lipid levels among hypertensive patients.

Methods

This was a cross-sectional study in which participants newly diagnosed with hypertension formed the study population. A range of demographic and anthropometric data was obtained, including weight, height, and waist and hip circumference. Fasting serum lipids were also measured, including total cholesterol, high density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Low density lipoprotein cholesterol (LDL-C) was calculated using Friedewald formula. Statistical analysis was then carried out to determine the relationship between anthropometric indices and lipid profile levels.

Results

The study population consisted of 124 male and 290 female subjects with a mean age of 66±16.95 years (range, 30-100 years). The female subjects were older than the male subjects (p=0.020). Our analysis showed that 85%, 58.5% and 30.7% of the study population had abnormal waist circumference (WC), abnormal waist-hip ratio (WHR) and a body mass index (BMI) >25 kg/m2, respectively. Decreased HDL-C (70.1%) was the commonest lipid abnormality detected, followed by elevated LDL (6.0%). None of the anthropometric indices were independent predictors of abnormal lipid levels. However, advanced age and female sex were independent predictors for at least one serum lipid abnormality.

Conclusion

None of the measures of obesity could independently predict abnormal lipid levels in individuals newly diagnosed with hypertension. However, female sex, advanced age and systolic blood pressure were independently associated with abnormal serum lipids. Encouraging regular exercise, and the possible addition of statins, may be beneficial in addressing both obesity and dyslipidaemia.

Flexible age-period-cohort modelling illustrated using obesity prevalence data

Background

Use of generalized linear models with continuous, non-linear functions for age, period and cohort makes it possible to estimate these effects so they are interpretable, reliable and easily displayed graphically. To demonstrate the methods we use data on the prevalence of obesity among Australian women from two independent data sources obtained using different study designs.

Methods

We used data from two long-running nationally representative studies: seven cross-sectional Australian National Health Surveys conducted between 1995 and 2017–18, each involving 6000–8000 women; and the Australian Longitudinal Study on Women’s Health which started in 1996 and involves more than 57,000 women in four age cohorts who are re-surveyed at three-yearly intervals or annually. Age-period-cohort analysis was conducted using generalized linear models with splines to describe non-linear continuous effects.

Results

When analysed in the same way both data sets showed similar patterns. Prevalence of obesity increased with age until late middle age and then declined; increased only slightly across surveys; but increased steadily with birth year until the 1960s and then accelerated.

Conclusions

The methods illustrated here make the estimation and visualisation of age, period and cohort effects accessible and interpretable. Regardless of how the data are collected (from repeated cross-sectional surveys or longitudinal cohort studies), it is clear that younger generations of Australian women are becoming heavier at younger ages. Analyses of trends in obesity should include cohort, in addition to age and period, effects in order to focus preventive strategies appropriately.

A Digital Health Weight Loss Program in 250,000 Individuals

IMPORTANCE

Obesity is a worsening epidemic worldwide. Effective and accessible weight loss programs to combat obesity on a large scale are warranted, but a need for frequent face-to-face care might impose a limitation.

OBJECTIVE

To evaluate whether individuals following a weight loss program based on a mobile application, wireless scale, and nutritional program but no face-to-face care can achieve clinically significant weight loss in a large cohort.

DESIGN

Retrospective observational analysis. Setting. China from October 2016 to December 2017. Participants. Mobile application users with a minimum of 2 weights (baseline and ≥35 days). Intervention. A commercial (Weijian Technologies) weight loss program consisting of a dietary replacement, self-monitoring using a wireless home scale, and frequent guidance via mobile application. Main Outcome. Mean weight change around 42, 60, 90, and 120 days after program initiation with subgroup analysis by gender, age, and frequency of use.

RESULTS

251,718 individuals, with a mean age of 37.3 years (SD: 9.86) (79% female), were included with a mean weight loss of 4.3 kg (CI: ±0.02) and a mean follow-up of 120 days (SD: 76.8 days). Mean weight loss at 42, 60, 90, and 120 d was 4.1 kg (CI: ±0.02), 4.9 kg (CI: ±0.02), 5.6 kg (CI: ±0.03), and 5.4 kg (CI: ±0.04), respectively. At 120 d, 62.7% of participants had lost at least 5% of their initial weight. Both genders and all usage frequency tertiles showed statistically significant weight loss from baseline at each interval (P < 0.001), and this loss was greater in men than in women (120 d: 6.5 vs. 5.2 kg; P < 0.001). The frequency of recording (categorized as high-, medium-, or low-frequency users) was associated with greater weight loss when comparing high, medium, and low tertile use groups at all time intervals investigated (e.g., 120 d: -8.6, -5.6, and -2.2 kg, respectively; P < 0.001).

CONCLUSIONS

People following a commercially available hybrid weight loss program using a mobile application, wireless scale, and nutritional program without face-to-face interaction on average achieved clinically significant short- and midterm weight loss. These results support the implementation of comparable technologies for weight control in a large population.

Errors in body mass index from self-reported data by sex and across waves of Add Health

PURPOSE

Body mass index (BMI) derived from self-reported height and weight is often used to study adiposity and its health implications. However, misestimates of BMI from self-reported data have been observed. This study adds to the literature by demonstrating how anthropometric misreporting patterns differed by sex and changed across time in a nationally representative cohort, as well as examining behavioral/psychological correlates of biases in BMI.

METHODS

Misreporting of height and weight (and thus BMI) from adolescence to adulthood in the United States was studied using the National Longitudinal Study of Adolescent to Adult Health (1996-2008). Behavioral/psychological characteristics possibly associated with errors in BMI were analyzed with fixed-effects models.

RESULTS

Different patterns of anthropometric misreporting resulted in larger underestimation of BMI among females than males at the beginning waves, but females saw a reduction by the last wave. Males did not see such a decrease, and their error, at 0.75 BMI units by 2008, was comparable to that of females. For both sexes, body image perception was a significant predictor of biases in BMI.

CONCLUSIONS

From adolescence to adulthood, anthropometric reporting patterns changed, and its variation differed by sex. Nevertheless, errors in BMI were similarly associated with behavioral/psychological characteristics.

Prevalence of Overweight and Obesity among Libyan Men and Women

Libya is following the trend observed in developing countries of steadily becoming more obese, such that obesity in Libya has reached epidemic proportions in the twenty-first century. The prevalence of obesity in Libya has more than doubled in the last three decades, with the numbers of overweight and obese adults being continuing to grow. Therefore, this study aimed to estimate and describe the prevalence of overweight and obesity among Libyan men and women. A cross-sectional survey was conducted to examine the prevalence of overweight and obesity among the Libyan population. A multistage sampling technique was employed to select 401 Libyan adults randomly from the Benghazi electoral register. Qualified nurses were allocated to take anthropometric measurements (including visceral fat and Body Mass Index (BMI)) from participants using the Segmental Body Composition Analyser and a portable Stadiometer. The response rate achieved in this cross-sectional study was 78%. Four hundred and one Libyan adult, aged 20-65 years, participated; 253 were female (63%). The prevalence of obesity, overweight, and normal weight among Libyan adults was 42.4%, 32.9%, and 24.7%, respectively. The results also revealed that approximately 75.3% of Libyan adults were overweight and obese, and the prevalence of overweight and obesity in women was significantly higher than that in men (the prevalence of overweight was 33.2% in women compared to 32.4% in men, while the prevalence of obesity was 47.4% in women compared to 33.8% in men, respectively). The findings of this study confirmed that obesity and overweight are the fastest growing issues and have become one of the most serious public health challenges confronting the Libyan authorities. As the obesity epidemic in Libya continues to escalate, with a complete absence of prevention interventions to reduce obesity, more research is desperately needed to follow the trend of gender difference in the prevalence of overweight and obesity among Libyans adults across the Libyan state to improve the effective interventions for preventing obesity.

An Investigation of Chiropractor-Directed Weight-Loss Interventions: Secondary Analysis of O-COAST

OBJECTIVE

The purpose of this study was to investigate weight-loss interventions offered by Canadian doctors of chiropractic to their adult patients.

METHODS

This paper reports a secondary analysis of data from the Ontario Chiropractic Observation and Analysis STudy (N_c = 42 chiropractors, N_p = 2162 patient encounters). Multilevel logistic regression was performed to assess the odds of chiropractors initiating or continuing weight management interventions with patients. Two chiropractor variables and 8 patient-level variables were investigated for influence on chiropractor-directed weight management. In addition, the interaction between the effects of patient weight and comorbidity on weight management interventions by chiropractors was assessed.

RESULTS

Around two-thirds (61.3%) of patients who sought chiropractic care were either overweight or had obesity. Very few patients had weight loss managed by their chiropractor. Among patients with body mass index equal to or greater than 18.5 kg/m², guideline recommended weight management was initiated or continued by Ontario chiropractors in only 5.4% of encounters. Chiropractors did not offer weight management interventions at different rates among patients who were of normal weight, overweight, or obese (P value = 0.23). Chiropractors who graduated after 2005 who may have been exposed to reforms in chiropractic education to include public health were significantly more likely to offer weight management than chiropractors who graduated between 1995 and 2005 (odds ratio 0.02; 95% CI [0.00-0.13]) or before 1995 (odds ratio 0.08; 95% CI [0.01-0.42]).

CONCLUSION

The prevalence of weight management interventions offered to patients by Canadian chiropractors in Ontario was low. Health care policy and continued chiropractic educational reforms may provide further direction to improve weight-loss interventions offered by doctors of chiropractic to their patients.

Are Australians ready for warning labels, marketing bans and sugary drink taxes? Two cross-sectional surveys measuring support for policy responses to sugar-sweetened beverages

OBJECTIVE

To assess public support for 10 potential policy initiatives to reduce sugar-sweetened beverage (SSB) consumption.

DESIGN

A 2014 historical data set, which employed a face-to-face survey in one Australian state (study 1), provided the basis for comparison with our 2017 nationally representative, cross-sectional, computer-assisted telephone interviewing population survey (study 2).

PARTICIPANTS

Study 1: South Australians, 15+ years (n=2732); study 2: Australians, 18+ years (n=3430).

PRIMARY OUTCOME MEASURES

levels of support for SSB-specific policy initiatives. For the 2017 national study (study 2), demographic characteristics, body mass index, knowledge of potential harms caused by consuming SSBs and SSB consumption were included in multivariable regression analyses.

RESULTS

In 2017, all 10 potential policy initiatives received majority support (60%-88% either 'somewhat' or 'strongly' in favour). Initiatives with educative elements or focused on children received high support (>70%), with highest support observed for text warning labels on drink containers (88%) and government campaigns warning of adverse health effects (87%). Higher support was observed for SSB tax paired with using funds for obesity prevention (77%) than a stand-alone tax (60%). Support for policy initiatives was generally greater among those who believed SSB daily consumption could cause health problems in adults (4%-18% absolute difference) and/or in children (8%-26% absolute difference) and lower among SSB high consumers (7+ drinks per week; 9%-29% absolute difference). State-specific data comparison indicated increased support from 2014 to 2017 for taxation (42%vs55%; χ²=15.7, p<0.001) and graphic health warnings (52%vs68%; χ²=23.4. p<0.001).

CONCLUSIONS

There is strong public support for government action, particularly regulatory and educational interventions, to reduce SSB consumption, which appears to have increased since 2014. The findings suggest that framing policies as protecting children, presenting taxation of SSBs in conjunction with other obesity prevention initiatives and education focused on the harms associated with SSB consumption will increase support.

5-2-1-0 Lifestyle risk factors predict obesity in Millennials

The Making Effective Nutritional Choices Generation Y (MENU GenY) study is a web-based intervention trial aimed at improving food choices in those aged 21-30 years. We report baseline levels of the 5-2-1-0 healthy lifestyle patterns to predict a body mass index (BMI) ≥30 vs <30 kg m^-2 . Overall, 1674 young adults (69% female) from two large health systems enroled and completed an online survey asking questions about lifestyle habits. A multivariable binary logistic regression model was utilized to predict a BMI ≥30 while controlling for known predictors of obesity. Consuming >3 daily servings of fruits/vegetables (odds ratio, OR = 0.90, 95% confidence interval, CI = 0.81, 0.99), and reporting >2.5 hours/week of vigorous physical activity (OR = 0.93, 95% CI = 0.89-0.96, P < 0.001) was associated with a BMI <30. Conversely, time sitting (OR = 1.07, 95% CI = 1.04, 1.11) and consuming sugar-sweetened beverages (OR = 1.08, 95% CI = 1.00, 1.15) were related to a BMI ≥30. In this cohort of 20-30-year-olds, we observed a consistent relationship between obesity and the 5-2-1-0 healthy lifestyle patterns previously reported among children and adolescents.