Obesity, lifestyle risk-factors, and health service outcomes among healthy middle-aged adults in Canada

Promoting a healthy lifestyle: exploring the role of social media and fitness applications in the context of social media addiction risk

The popularity of social networks turns them into a legal method for promoting a healthy lifestyle, which benefits not only people but also different countries' governments. This research paper aimed to examine the Keep fitness app integrated into WeChat, Weibo and QQ as regards long-term improvements in health-related behaviors (physical activity, nutrition, health responsibility, spiritual growth, interpersonal relationships and stress management) and assess the associated risk of increased social media addiction. Students from Lishui University in China (N = 300) participated in this study, and they were formed into control and experimental groups. The Healthy Lifestyle Behavior Scale and Social Media Disorder Scale were used as psychometric instruments. The Keep app was found to improve respondents' scores on the parameters of physical activity, nutrition and health responsibility (P = 0.00). However, the level of dependence on social media did not change in either the control or the experimental group during the year of research (P ≥ 0.05). It is concluded that fitness apps can be an effective tool to promote healthy lifestyles among young people in China and other countries. The feasibility of government investment in fitness apps to promote healthy lifestyles is substantiated.

Adherence to the Mediterranean lifestyle pattern is associated with favorable weight loss outcomes: the MedWeight study

Individual lifestyle targets have been associated with weight loss outcomes, yet few studies have examined associations of one's total lifestyle with weight loss maintenance. We aimed to examine the relationship between lifestyle patterns and weight loss outcomes in weight loss maintainers and regainers. We hypothesized that higher adherence to a broader healthy lifestyle favors maintenance (over regain). This is a cross-sectional analysis of 470 adults (62% women) with a history of overweight/obesity and significant weight loss 12 months before study entry. Participants were classified as maintainers (current weight ≤90% maximum weight) or regainers. They were asked to fill in a series of questionnaires on demographics and lifestyle habits (dietary intake and eating behaviors through two 24-hour recalls, physical activity, and sleep). A total Mediterranean Lifestyle Index (total-MLI, range 0-13) was generated by summing up ratings in the lifestyle domain quartiles (diet quality, physical activity, and sleep habits) and dietary behaviors (seasonal food and vegetable intake, intake of traditional foods, responsibility for food preparation, conviviality). Maintainers scored higher in the total-MLI than regainers (6.93 ± 2.31 vs 5.78 ± 2.49, P < .001). Adherence to the total-MLI was associated with 28% higher odds for weight loss maintenance (per unit increment) in linear analyses. Being in the highest total-MLI quartile was associated with 5.27 (95% CI, 2.77-10.02) odds for maintenance. Higher adherence to a comprehensive Mediterranean lifestyle pattern was associated with higher odds for weight loss maintenance. Our findings suggest that even modest shifts toward a healthier living may contribute to favorable weight loss outcomes.

A systematic literature review on obesity: Understanding the causes & consequences of obesity and reviewing various machine learning approaches used to predict obesity

Obesity is considered a principal public health concern and ranked as the fifth foremost reason for death globally. Overweight and obesity are one of the main lifestyle illnesses that leads to further health concerns and contributes to numerous chronic diseases, including cancers, diabetes, metabolic syndrome, and cardiovascular diseases. The World Health Organization also predicted that 30% of death in the world will be initiated with lifestyle diseases in 2030 and can be stopped through the suitable identification and addressing of associated risk factors and behavioral involvement policies. Thus, detecting and diagnosing obesity as early as possible is crucial. Therefore, the machine learning approach is a promising solution to early predictions of obesity and the risk of overweight because it can offer quick, immediate, and accurate identification of risk factors and condition likelihoods. The present study conducted a systematic literature review to examine obesity research and machine learning techniques for the prevention and treatment of obesity from 2010 to 2020. Accordingly, 93 papers are identified from the review articles as primary studies from an initial pool of over 700 papers addressing obesity. Consequently, this study initially recognized the significant potential factors that influence and cause adult obesity. Next, the main diseases and health consequences of obesity and overweight are investigated. Ultimately, this study recognized the machine learning methods that can be used for the prediction of obesity. Finally, this study seeks to support decision-makers looking to understand the impact of obesity on health in the general population and identify outcomes that can be used to guide health authorities and public health to further mitigate threats and effectively guide obese people globally.

Beyond weight: examining the association of obesity with cardiometabolic related inpatient costs among Canadian adults using linked population based survey and hospital administrative data

BACKGROUND

The global population has transitioned to one where more adults are living with obesity than are underweight. Obesity is associated with the development of cardiometabolic diseases and widely attributed to increased hospital resource use; however, empirical evidence is limited regarding obesity prevention to support hospital cost containment. This study aims to test for obesity in predicting hospitalization costs for cardiometabolic conditions among the Canadian population aged 45 and over.

METHODS

Data from the 2007-2011 Canadian Community Health Survey were linked to eight years of hospital discharge records. A cohort was identified of inpatients admitted for diabetes, hypertension, and other cardiometabolic diseases. Multiple linear regressions were used to investigate the association between obesity status and inpatient costs, controlling for sociodemographic and behavioural factors.

RESULTS

The target cohort included 23,295 admissions for cardiometabolic diseases. Although inflation-adjusted inpatient costs generally increased over time, compared with the non-obese group, living with obesity was not a significant predictor of differences in cardiometabolic-related resource use (0.972 [95% CI: 0.926-1.021]). Being female and rural residence were found to be protective factors.

CONCLUSIONS

Obesity was not found in this study to be independently linked to higher cardiometabolic hospitalization costs, suggesting that actions to mitigate disease progression in the population may be more beneficial than simply promoting weight loss. Results amplified the need to consider gender and urbanization when formulating which levers are most amenable to adoption of healthy lifestyles to reduce impacts of obesogenic environments to the healthcare system.

Earlier Provision of Gastric Bypass Surgery in Canada Enhances Surgical Benefit and Leads to Cost and Comorbidity Reduction

Background: Effective provision of bariatric surgery for patients with obesity may be impeded by concerns of payers regarding costs or perceptions of patients who drop out of surgical programs after referral. Estimates of the cost and comorbidity impact of these inefficiencies in gastric bypass surgery in Canada are lacking but would aid in informing healthcare investment and resource allocation.

Objectives: To estimate total and relative public payer costs for surgery and comorbidities (diabetes, hypertension, and dyslipidemia) in a bariatric surgery population.

Methods: A decision analytic model for a 100-patient cohort in Canada (91% female, mean body mass index 49.2 kg/m², 50% diabetes, 66% hypertension, 59% dyslipidemia). Costs include surgery, surgical complications, and comorbidities over the 10-year post-referral period. Results are calculated as medians and 95% credibility intervals (CrIs) for a pathway with surgery at 1 year (“improved”) compared with surgery at 3.5 years (“standard”). Sensitivity analyses were performed to test independent contributions to results of shorter wait time, better post-surgical weight loss, and randomly sampled cohort demographics.

Results: Compared to standard care, the improved path was associated with reduction in patient-years of treatment for each of the three comorbidities, corresponding to a reduction of $1.1 (0.68–1.6) million, or 34% (26-41%) of total costs. Comorbidity treatment costs were 9.0- and 4.7-fold greater than surgical costs for the standard and improved pathways, respectively. Relative to non-surgical bariatric care, earlier surgery was associated with earlier return on surgical investment and 2-fold reduction in risk of prevalence of each comorbidity compared to delayed surgery.

Conclusions: Comorbidity costs represent a greater burden to payers than the costs of gastric bypass surgery. Investments may be worthwhile to reduce wait times and dropout rates and improve post-surgical weight loss outcomes to save overall costs and reduce patient comorbidity prevalence.

Impact of weight trajectory after bariatric surgery on co-morbidity evolution and burden

Background

Bariatric surgery, such as Roux-en-Y gastric bypass [RYGB] has been shown to be an effective intervention for weight management in select patients. After surgery, different patients respond differently even to the same surgery and have differing weight-change trajectories. The present analysis explores how improving a patient’s post-surgical weight change could impact co-morbidity prevalence, treatment and associated costs in the Canadian setting.

Methods

Published data were used to derive statistical models to predict weight loss and co-morbidity evolution after RYGB. Burden in the form of patient-years of co-morbidity treatment and associated costs was estimated for a 100-patient cohort on one of 6 weight trajectories, and for real-world simulations of mixed patient cohorts where patients experience multiple weight loss outcomes over a 10-year time horizon after RYGB surgery. Costs (2018 Canadian dollars) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language.

Results

Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Improvement of 100 patients from the worst to the best weight loss trajectory was associated with a 50% reduction in 10-year co-morbidity treatment costs, decreasing to a 27% reduction for an intermediate improvement. Results applied to mixed trajectory cohorts revealed that broad improvements by one trajectory group for all patients were associated with 602, 1710 and 966 patient-years of treatment of type 2 diabetes, hypertension and dyslipidaemia respectively in Ontario, the province of highest RYGB volume, corresponding to a cost difference of $3.9 million.

Conclusions

Post-surgical weight trajectory, even for patients receiving the same surgery, can have a considerable impact on subsequent co-morbidity burden. Given the potential for alleviated burden associated with improving patient trajectory after RYGB, health care systems may wish to consider investments based on local needs and available resources to ensure that more patients achieve a good long-term weight trajectory.

Behavioural risk factors of arterial hypertension in the Evenk population of the Russian Arctic

The urgency of the problem under study is determined by the high prevalence of arterial hypertension among the indigenous minorities of the North in modern socio-economic conditions. The following article is aimed to evaluate the prevalence of behavioural arterial hypertension risk factors according to the results of single-step epidemiological research of Evenk people in the Republic of Sakha (Yakutia), Russian Federation. The leading approach to the study of this problem was the questioning of the population using the international questionnaire for behavioural risk factors (CYNDI). As a result of research, widespread smoking was found among native population (52.0% of men and 23.7% of women). The frequency of alcohol consumption among the male Evenki is comparable to that in the Yakut population, and among the female, the number is much lower. Evenks including young men belong to the physically inactive population. The frequency of arterial hypertension (AH) cases along with the factors listed above are significantly influenced by: marital status, employment, education, and housing conditions. Article materials may be useful for a differentiated approach in the development of prevention and rehabilitation programs for the indigenous peoples of the North.

Hockey Fans in Training: A Pilot Pragmatic Randomized Controlled Trial

Introduction

Hockey Fans in Training (Hockey FIT) is a gender-sensitized weight loss and healthy lifestyle program. We investigated 1) feasibility of recruiting and retaining overweight and obese men into a pilot pragmatic randomized controlled trial and 2) potential for Hockey FIT to lead to weight loss and improvements in other outcomes at 12 wk and 12 months.

Methods

Male fans of two ice hockey teams (35–65 yr; body mass index ≥28 kg·m⁻²) located in Ontario (Canada) were randomized to intervention (Hockey FIT) or comparator (wait-list control). Hockey FIT includes a 12-wk active phase (weekly, coach-led group meetings including provision of dietary information, practice of behavior change techniques, and safe exercise sessions plus incremental pedometer walking) and a 40-wk minimally supported phase (smartphone app for sustaining physical activity, private online social network, standardized e-mails, booster session/reunion). Measurement at baseline and 12 wk (both groups) and 12 months (intervention group only) included clinical outcomes (e.g., weight) and self-reported physical activity, diet, and self-rated health.

Results

Eighty men were recruited in 4 wk; trial retention was >80% at 12 wk and >75% at 12 months. At 12 wk, the intervention group lost 3.6 kg (95% confidence interval, −5.26 to −1.90 kg) more than the comparator group (P < 0.001) and maintained this weight loss to 12 months. The intervention group also demonstrated greater improvements in other clinical measures, physical activity, diet, and self-rated health at 12 wk; most sustained to 12 months.

Conclusions

Results suggest feasible recruitment/retention of overweight and obese men in the Hockey FIT program. Results provide evidence for the potential effectiveness of Hockey FIT for weight loss and improved health in at-risk men and, thus, evidence to proceed with a definitive trial.

Body mass index and healthcare costs: a systematic literature review of individual participant data studies

Excess weight is associated with increased total healthcare costs, but it is less well known how the associations between excess weight and costs vary across different types of healthcare service. We reviewed studies using individual participant data to estimate associations between body mass index and healthcare costs, and summarized how annual healthcare costs for overweight (body mass index 25 to <30 kg/m2 ) and obese (≥30 kg/m2 ) individuals compared with those for healthy weight individuals (18.5 to <25 kg/m2 ). EMBASE and MEDLINE were searched from January 1990 to September 2016, and 75 studies were included in the review. Of these, 34 studies presented adequate information to contribute to a quantitative summary of results. Compared with individuals at healthy weight, the median increases in mean total annual healthcare costs were 12% for overweight and 36% for obese individuals. The percentage increases in costs were highest for medications (18% for overweight and 68% for obese), followed by inpatient care (12% and 34%) and ambulatory care (4% and 26%). Percentage increases in costs associated with obesity were higher for women than men. The substantial costs associated with excess weight in different healthcare settings emphasize the need for investment to tackle this major public health problem.

Economic Burden of Obesity: A Systematic Literature Review

Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.

EXERCISE, BLOOD PRESSURE AND MORTALITY: FINDINGS OF EIGHT YEARS OF FOLLOW-UP

ABSTRACT Introduction: In the last decades, unhealthy habits, such as low levels of physical activity and poor diet, have increased. Consequently, the prevalence of cardiovascular diseases and mortality has increased significantly among adults. However, it is known that regular physical exercises help to improve health outcomes. Thus, the aim of this study was to analyze the effects of eight years of regular participation in an exercise program on blood pressure and mortality in the Brazilian public health system. Methods: The sample consisted of 34 participants with hypertension and/or type II diabetes who were followed up for eight years. They were paired by age, body mass index and chronic disease in two groups: exercise and control. During the follow-up period, medical records were used to assess systolic and diastolic blood pressure, as well as number of medical appointments and the occurrence of deaths. Results: In the follow-up period, five participants died in the control group and none in the exercise group. The Kaplan-Meier analysis identified 29.4% lower mortality among active participants (Fisher's exact test with p = 0.044). The number of medical appointments and the values of diastolic blood pressure were significantly lower for active participants. Conclusion: After a follow-up of eight years, participants in the exercise group attended fewer medical appointments, had better blood pressure control and a lower occurrence of deaths.

Relationship Between Cardiac Rehabilitation Participation and Health Service Expenditures Within a Universal Health Care System

OBJECTIVES

To examine the relationship between cardiac rehabilitation participation and health service expenditures in Ontario, Canada.

PATIENTS AND METHODS

A total of 6284 patients referred to cardiac rehabilitation between April 1, 2003, and December 31, 2010, were linked to 6284 matched cardiac rehabilitation eligible nonreferred controls and followed over a 3-year period across multiple linked administrative databases to identify health service utilization expenditures and mortality. All patients had previous cardiac hospitalizations within the preceding year. Four cardiac rehabilitation eligible groups of patients were balanced using propensity score weights: (1) no referral; (2) no participation; (3) low participation levels (ie, attending <67% of prescheduled classes); and (4) high participation levels (ie, attending ≥67% prescheduled classes). Each group of patients was balanced in age, sex, geography, socioeconomic status, previous hospitalizations, ambulatory care conditions, cardiovascular risk factors, comorbidities, and previous health care expenditures. Generalized linear models were used to examine differences in health service expenditures (from all sources including hospitalizations, physician visits, diagnostic tests, and drugs for those older than 65 years) per "eligible day alive" over the 3-year period.

RESULTS

Compared with the nonreferred population, health service expenditures followed a dose-response relationship and were lowest in patients who had the highest cardiac rehabilitation programmatic participation levels (P<.001). Cost differences across groups separated early, remained divergent, and applied to all components of health care expenditures (P<.001). Sensitivity analyses confirmed that the findings were not secondary to reverse causality.

CONCLUSION

Participation in cardiac rehabilitation is associated with lower long-term health service utilization expenditures within a publicly funded health care system.

Retirement and Healthy Lifestyle: A National Health and Nutrition Examination Survey (NHANES) Data Report

BACKGROUND

The objective of this study was to compare the rates of healthy lifestyle adherence among retired late-middle-aged adults with rates among those who are still working.

METHODS

A national cross-sectional study using data from the National Health and Nutrition Examination survey (NHANES). The main outcome was the proportion of retires versus nonretirees who were adherent to ideal or intermediate goals of the American Heart Association's Life's Simple 7, cardiovascular factors including physical activity, healthy diet, healthy weight, smoking status, total cholesterol, glucose, and blood pressure.

RESULTS

Retirees were more likely than nonretirees to have poorly controlled blood pressure (23.9% vs 15.1%; P = .05). However, there were no differences in healthy weight, smoking rates, healthy diet, or glucose or cholesterol control (P > .05). In controlled logistic regression analyses, retirees were more likely to be physically active than nonretirees (odds ratio, 1.85; 95% confidence interval, 1.11-3.09), but were not more likely to be following any other Life's Simple 7 factors.

CONCLUSIONS

Retired adults were more likely to be physically active but were not more likely to be adhering to most of the Life's Simple 7 lifestyle and cardiovascular risk factors. More public health attention to encouraging healthy lifestyles during the transition into retirement may be warranted.

Incremental impact of body mass status with modifiable unhealthy lifestyle behaviors on pharmaceutical expenditure

BACKGROUND

Overweight/obesity is a growing health risk in Korea. The impact of overweight/obesity on pharmaceutical expenditure can be larger if individuals have multiple risk factors and multiple comorbidities. The current study estimated the combined effects of overweight/obesity and other unhealthy behaviors on pharmaceutical expenditure.

METHODS

An instrumental variable quantile regression model was estimated using Korea Health Panel Study data. The current study extracted data from 3 waves (2009, 2010, and 2011).

RESULTS

The final sample included 7148 person-year observations for adults aged 20 years or older. Overweight/obese individuals had higher pharmaceutical expenditure than their non-obese counterparts only at the upper quantiles of the conditional distribution of pharmaceutical expenditure (by 119% at the 90th quantile and 115% at the 95th). The current study found a stronger association at the upper quantiles among men (152%, 144%, and 150% at the 75th, 90th, and 95th quantiles, respectively) than among women (152%, 150%, and 148% at the 75th, 90th, and 95th quantiles, respectively). The association at the upper quantiles was stronger when combined with moderate to heavy drinking and no regular physical check-up, particularly among males.

CONCLUSION

The current study confirms that the association of overweight/obesity with modifiable unhealthy behaviors on pharmaceutical expenditure is larger than with overweight/obesity alone. Assessing the effect of overweight/obesity with lifestyle risk factors can help target groups for public health intervention programs.

Health care costs associated with prolonged sitting and inactivity

BACKGROUND

Physical inactivity and prolonged sitting are associated with negative health outcomes.

PURPOSE

To examine the health-related costs of prolonged sitting and inactivity in middle-aged women.

METHODS

Australian Longitudinal Study on Women's Health participants (born 1946-1951) answered questions about time spent sitting, walking, and in moderate and vigorous leisure activities in 2001 (n=6108); 2004 (n=5902); 2007 (n=5754); and 2010 (n=5535) surveys. Sitting time was categorized as low (0-4); moderate (5-7); and high (≥8 hours/day). Physical activity was categorized as inactive (<40); low (40-600); moderate (600-1200); and high (≥1200 MET-minutes/week). National health insurance claims data averaged over the survey year ±1 year were used to calculate annual costs (Australian dollars [AU$]). Differences between categories in median costs were estimated using quantile regression over four surveys with bootstrapped 95% CIs. Analyses were performed in 2013.

RESULTS

In 2010, annual median costs were AU$689 (interquartile range [IQR]=274, 1541) in highly active participants; AU$741 (IQR=279, 1690) in inactive participants; AU$671 (IQR=273, 1551) in participants with low sitting time; and AU$709 (IQR=283, 1575) in participants with high sitting time. The difference in median costs for inactive and highly active participants was AU$94 (CI=57, 131) after adjustment for confounders. No statistically significant associations were found between sitting time and costs. When sitting and physical activity were combined, high sitting time did not add to the inactivity-associated increased costs. Associations were consistent across normal-weight, overweight, and obese subgroups.

CONCLUSIONS

Physical inactivity, but not prolonged sitting, was associated with higher health-related costs in middle-aged women.

Influence of smoking and diet on glycated haemoglobin and 'pre-diabetes' categorisation: a cross-sectional analysis

BACKGROUND

The new HbA1c criteria for diagnosis of pre-diabetes have been criticised for misdiagnosis. It is possible that some elevation of HbA1c is not driven by hyperglycaemia. This study assesses associations of HbA1c, commonly assumed to relate solely to glucose concentration, with (i) smoking, a major source of reactive oxygen species (ROS) and (ii) fruit & vegetables consumption associated with improved redox status.

METHODS

One-way ANOVA, Chi-squared and multivariate linear regressions, adjusted for all known confounders were used to explore associations of HbA1c with self-reported smoking status and fruit & vegetables consumptions in the Scottish Health Surveys 2003-2010, among individuals without known diabetes and HbA1c < 6.5%.

RESULTS

Compared to non-smokers (n = 2831), smokers (n = 1457) were younger, consumed less fruit & vegetables, had lower physical activity levels, lower BMI, higher HbA1c and CRP (p < 0.05). HbA1c was higher in smokers by 0.25 SDs (0.08%), and 0.38 SDs higher (0.14%) in heavy smokers (>20 cigarettes/day) than non-smokers (p < 0.001 both). Smokers were twice as likely to have HbA1c in the 'pre-diabetic' range (5.7-6.4%) (p < 0.001, adj.model). Pre-diabetes and low grade inflammation did not affect the associations. For every extra 80 g vegetable portion consumed, HbA1c was 0.03 SDs (0.01%) lower (p = 0.02), but fruit consumption did not impact on HbA1c, within the low range of consumptions in this population.

CONCLUSION

This study adds evidence to relate smoking (an oxidative stress proxy) with protein glycation in normoglycaemic subjects, with implications for individuals exposed to ROS and for epidemiological interpretation of HbA1c.

Body mass index patterns following dysvascular lower extremity amputation

PURPOSE

Using preliminary data, we examined: (i) patterns of body mass index (BMI) over the year following amputation by amputation level and (ii) the association between BMI and mobility and prosthetic device use.

METHOD

Patients from three medical centers undergoing dysvascular amputation (N = 87; M age = 62) participated in interviews pre-surgically and at 6 weeks, 4 months, and 12 months following amputation. The main outcome was self-reported BMI, adjusting for limb weight lost due to amputation. Additional outcomes were mobility and time spent using and walking in a prosthetic device.

RESULTS

Adjusted BMI slightly decreased at 6 weeks (pre-surgery M = 31.2; 6 weeks M = 30.3) and 4 months (M = 30.7) but exceeded baseline levels by 12 months (M = 31.7). There were no significant BMI differences by amputation level. In multivariable analyses, higher pre-surgical BMI was associated with fewer hours of prosthetic device walking at month 4 (β = -0.49) and poorer overall mobility at month 12 (β = -0.22).

CONCLUSIONS

BMI increased at one year following amputation surgery. Higher pre-surgical BMI was associated with poorer mobility and prosthetic device use. Interventions are needed to prevent excess weight gain in the year following amputation.

IMPLICATIONS FOR REHABILITATION

• People undergoing lower-extremity amputation have high rates of overweight and obesity and continue to gain weight in the year following amputation. • Objective assessment of body mass index (both with and without a prosthetic device) and waist circumference would help future research efforts. • Targeting weight loss post-amputation could improve the health of people with lower-extremity amputations.