Socioeconomic consequences of obesity: the effect of obesity on the individual

Obesity Prevention and National Food Security: A Food Systems Approach

Interventions that cultivate sustainable food systems to promote health, prevent obesity, and improve food security have the potential for many large-scale and long-lasting benefits including improvements in social, environmental, health, and economic outcomes. We briefly summarize findings from previous research examining associations between obesity and food insecurity and discuss the need for greater synergy between food insecurity initiatives and national obesity prevention public health goals in the United States. The common ground between these two nutrition-related public health issues is explored, and the transformation needed in research and advocacy communities around the shared goal of improving population health through individual, environmental, and policy level changes to promote healthy sustainable food systems is discussed. We propose an ecological framework to simultaneously consider food insecurity and obesity that identifies levers for change to promote sustainable food systems to improve food security and prevent obesity.

Medical and behavioral evaluation of patients with obesity

Obesity may be the most significant medical problem that health care providers will face over the coming decades. Physicians must aggressively address this chronic disease, providing both preventive and therapeutic care. Since this topic has not been traditionally taught in medical school or residency training, physicians and other health providers will need to acquire the knowledge, skills, and attitudes necessary to be effective obesity care providers. Performing a detailed initial assessment, including an obesity focused history, physical examination, and selected laboratory and diagnostic tests is fundamental to the process of care.

Relationship between cumulative BMI and symptomatic, psychosocial, and medical outcomes in patients with borderline personality disorder

We examined the relationship between cumulative body mass index (BMI) and symptomatic, psychosocial, and medical outcomes in patients with borderline personality disorder (BPD). Two hundred female borderline patients were weighed and measured during their index admission. They were subsequently interviewed at six-, eight-, and 10-year intervals. Over 10 years of prospective follow-up, increases in cumulative BMI were significantly associated with self-mutilation and dissociation (but not suicide attempts). Increases in cumulative BMI were also significantly associated with having no life partner, a poor work or school history, being on disability, being rated with a GAF score in the fair or poor range, and having a low income. In addition, increases in BMI were related to having two or more other medical conditions and using costly forms of health care. Increases in cumulative BMI may be a marker for adverse symptomatic, functional, and medical outcomes in patients with BPD.

Gastrointestinal electrical stimulation for treatment of gastrointestinal disorders: gastroparesis, obesity, fecal incontinence, and constipation

Electrical stimulation of the gastrointestinal (GI) tract is an attractive concept. Since these organs have their own natural pacemakers, the electrical signals they generate can be altered by externally delivering electric currents by intramuscular, serosal, or intraluminal electrodes to specific sites in the GI tract. This article reviews the advances in electrical stimulation of the GI tract by describing various methods of GI electrical stimulation and their peripheral and central effects and mechanisms; updating the status of GI electrical stimulation in the clinical settings of gastroparesis, obesity, fecal incontinence, and constipation; and predicting future directions and developments of GI electrical stimulation technology and their areas of possible clinical applications.

Potential of intestinal electrical stimulation for obesity: a preliminary canine study

OBJECTIVE

The aims of this study were to investigate the therapeutic potential of intestinal electrical stimulation (IES) for obesity. Experiments were performed to investigate the effects of IES on food intake, gastric tone, gastric accommodation, and its possible pathway.

RESEARCH METHODS AND PROCEDURES

Ten normal dogs and six dogs with truncal vagotomy were used in this study. Each dog was equipped with a gastric cannula for the measurement of gastric tone and accommodation by barostat and one pair of duodenal serosal electrodes for IES. The experiment on food intake was composed of both control session without IES and IES session after a 28-hour fast. The experiment on gastric tone and accommodation was performed in the fasting and fed states and composed of three sessions: control, IES, and IES with N(G)-nitro-l-arginine.

RESULTS

IES significantly reduced food intake in the normal dogs (459.0 vs. 312.6 grams, p < 0.001). The food intake was negatively correlated with the fasting gastric volume during IES. IES significantly decreased fasting gastric tone in the normal dogs reflected as a decrease in gastric volume (89.1 vs. 261.3 mL, p < 0.01), which was abolished by vagotomy and N(G)-nitro-l-arginine.

DISCUSSION

IES reduces food intake and inhibits gastric tone in the fasting state. The inhibitory effect of IES on gastric tone is mediated by both vagal and nitrergic pathway.

Body mass index in urban Canada: neighborhood and metropolitan area effects

OBJECTIVES

We investigated the influence of neighborhood and metropolitan area characteristics on body mass index (BMI) in urban Canada in 2001.

METHODS

We conducted a multilevel analysis with data collected from a cross-sectional survey of men and women nested in neighborhoods and metropolitan areas in urban Canada during 2001.

RESULTS

After we controlled for individual sociodemographic characteristics and behaviors, the average BMIs of residents of neighborhoods in which a large proportion of individuals had less than a high school education were higher than those BMIs of residents in neighborhoods with small proportions of such individuals (P< .01). Living in a neighborhood with a high proportion of recent immigrants was associated with lower BMI for men (P<.01), but not for women. Neighborhood dwelling density was not associated with BMI for either gender. Metropolitan sprawl was associated with higher BMI for men (P=.02), but the effect was not significant for women (P= .09).

CONCLUSIONS

BMI is strongly patterned by an individual's social position in urban Canada. A neighborhood's social condition has an incremental influence on the average BMI of its residents. However, BMI is not influenced by dwelling density. Metropolitan sprawl is associated with higher BMI for Canadian men, which supports recent evidence of this same association among American men. Individuals and their environments collectively influence BMI in urban Canada.

Chronic tachygastrial electrical stimulation reduces food intake in dogs

OBJECTIVE

Tachygastria is known to be associated with gastric hypomotility. This study investigated the effect of tachygastrial electrical stimulation (TES) on food intake and its effects on gastric motility.

RESEARCH METHODS AND PROCEDURES

Five experiments were performed to study the effects of TES on gastric slow waves, gastric tone, accommodation, and antral contractions, gastric emptying, acute food intake, and chronic food intake in dogs.

RESULTS

TES at tachygastrial frequencies induced tachygastria and reduced normal slow waves. TES significantly reduced gastric tone or induced gastric distention, impaired gastric accommodation, and inhibited antral contractions. TES significantly delayed gastric emptying. Acute TES reduced food intake but did not induce any noticeable symptoms. Chronic TES resulted in a 20% reduction in food intake, and the effect of TES was found to be related to specific parameters.

DISCUSSION

TES at the distal antrum results in a significant reduction in food intake in dogs, and this inhibitory effect is probably attributed to TES-induced reduction in proximal gastric tone, gastric accommodation, antral contractility, and gastric emptying. These data suggest a therapeutic potential of the specific method of TES for obesity.

Peripheral mechanisms of sibutramine involving proximal gastric motility in dogs

OBJECTIVE

Sibutramine, a serotonin-norepinephrine uptake inhibitor, has been used for treating obesity. However, its possible mechanisms involving gastric motility have not been reported. The aim of this study was to evaluate the effects of sibutramine on gastric accommodation and antral motility.

RESEARCH METHODS AND PROCEDURES

The study was performed in seven dogs with a stomach cannula and composed of two separate experiments: antral contractions and gastric tone. Each experiment included two sessions on 2 separate days in a randomized order: a control session and a treatment session with sibutramine (5 mg/kg per os) administrated 2 hours before the study.

RESULTS

Sibutramine significantly increased fasting gastric tone; the gastric volume in the fasting state at baseline was 103.8 +/- 12.3 mL and significantly decreased to 35.3 +/- 16.0 mL with sibutramine (p = 0.0075). Sibutramine also impaired gastric accommodation. The average postprandial gastric volume was 472.1 +/- 16.7 mL in the control session and reduced to 302.2 +/- 53.6 mL with sibutramine (p = 0.013). The average postprandial increase in gastric volume during the 60-minute postprandial period with sibutramine was significantly lower than the corresponding values in the control session: 266.8 +/- 46.1 vs. 393.9 +/- 15.3 mL (p = 0.03). Sibutramine had no effects on postprandial antral contractions.

DISCUSSION

Sibutramine increases gastric tone and impairs gastric accommodation to an orally ingested meal. The inhibitory effect of sibutramine on gastric accommodation may partially explain the reduced food intake with sibutramine in patients with obesity.

Pyloric electrical stimulation reduces food intake by inhibiting gastric motility in dogs

BACKGROUND & AIMS

The pylorus plays an important role in regulating gastric emptying. The aim of this study was to investigate the therapeutic potential of pyloric electrical stimulation (PES) for obesity in dogs.

METHODS

The study was composed of 3 separate experiments. The first experiment was designed to study the effects of PES with various parameters on gastric emptying and gastric slow waves in 5 sessions. The second experiment was used to test the effects of PES on antral contractions. The acute effect of PES on food intake was studied in the third experiment.

RESULTS

(1) Pyloric myoelectrical recording showed dual frequencies. The lower frequency was identical to the frequency of the gastric slow waves, and the higher frequency was similar to that of the intestinal slow waves. (2) Gastric emptying was significantly delayed with PES, and the delay in gastric emptying was significantly and negatively correlated with stimulation energy ( r = -.673; P < .001). (3) PES significantly impaired the regularity and coupling of the intrinsic gastric myoelectrical activity in an energy-dependent manner. The delayed gastric emptying was significantly correlated with the impairment of the coupling of gastric myoelectrical activity ( r = .441; P < .02). (4) Antral contractions on the fed state were significantly and substantially inhibited with PES. (5) Acute PES significantly reduced food intake.

CONCLUSIONS

PES reduces food intake that may be attributed to its inhibitory effects on intrinsic gastric myoelectrical activity, antral contractions, and gastric emptying.

The Prevalence of Obesity and its Relationship with Lifestyle Factors in Jamaica

We surveyed the prevalence of obesity in the general population in Jamaica, and examined the relationship between it and lifestyle. The survey population consisted of 1,935 inhabitants in Jamaica, whose body weight, height, marital status, educational history, employment status and other obesity-associated lifestyle factors were surveyed. Six major findings emerged. The first finding is that the proportion of obesity in women was very high, and there was a big gender difference. Secondly, a lower prevalence towards obesity was associated with cohabitation of the subjects in both genders, and higher educational levels in female subjects. Thirdly, the proportion of the subjects who considered their weight to be quite acceptable was higher in the obese/overweight groups in both genders. Fourthly, exercise frequency showed a negative correlation with the body mass index (BMI) in men, and the frequency of exercising was apparently lower in women than in men. Fifthly, as for dietary factors, in both genders vegetables showed a negative correlation with the BMI. Sixthly, non-smokers were also associated with a lower obesity prevalence in men. In conclusions, these findings suggest that social and lifestyle factors such as the educational level, marital status and dietary habits of the general population influence Jamaican obesity.

Health-related quality of life in physically active and sedentary obese women

The aim was to assess dimensions of health-related quality of life (HRQL) in women attending an obesity clinic, and to rate differences in HRQL in those with the highest and lowest levels of physical activity (PA). The sample included 113 sedentary and 101 physically active subjects from a total sample of 375 overweight women 16-65 years, with a body mass index (BMI) > or =27.5 kg/m(2) consulting at an outpatient Endocrinology Clinic, and 82 lean female volunteers who served as a reference. Weight, height, body composition, PA, physical medical conditions, depression, body image, cognitive-behavioral conceptualization of obesity, eating behavior, functional status, walking ability, exercise capacity, social functioning, and general health and perceived quality of life were assessed cross-sectionally. The prevalence of medical conditions and depression was not statistically different (P < 0.05) in sedentary and active women. In sedentary obese women, body attitude, walking ability, and aerobic fitness were poorer; the number of people to turn to for social support was smaller; physical attributions about the basis of the subjects obesity were less pronounced; and eating was more the consequence of external triggers or diffuse emotions than in physically active obese women (P < 0.05). The findings indicate that a higher level of PA in an obese female clinical population was positively associated with diverse dimensions of HRQL. However, it was not possible to determine if these favorable aspects of HRQL are the cause or the consequence of a higher PA level.

Sibutramine. A review of its contribution to the management of obesity

Sibutramine is an orally administered centrally acting weight management agent apparently devoid of amphetamine-like abuse potential. Its primary (M2; BTS 54,505) and secondary (M1; BTS 54,354) amine metabolites are pharmacologically active and are thought to induce the natural processes leading to enhancement of satiety and thermogenesis by inhibiting serotonin (5-hydroxytryptamine, 5-HT) and noradrenaline (norepinephrine) reuptake. In clinical trials, once-daily sibutramine was administered at dosages of < or = 30 mg for < or = 24 weeks and 10 or 15 mg for 1 year in conjunction with reduced calorie intake, increased daily exercise and advice on eating behaviour. Dose-related bodyweight loss was greater with sibutramine than with placebo. Clinical effects were most commonly apparent at dosages > or = 10 mg/day. Weight loss of > 1% within the first month of treatment appears indicative of good long term response with sibutramine. Weight loss was maintained during therapy for 1 year; longer term data are lacking. Weight regain occurred after treatment cessation in studies of < or = 24 weeks' duration; data from longer trials are unavailable. Up to 15% of patients in < or = 6-month studies did not respond to treatment irrespective of dose. Obese patients with type 2 (non-insulin-dependent) diabetes or hypertension lost significantly more mean bodyweight with sibutramine than with placebo, although weight loss was less than that in obese patients without comorbidities. The effect of sibutramine on mean fasting blood glucose levels and plasma lipid levels was unclear. Sibutramine, compared with placebo, statistically significantly increased blood pressure and heart rate in obese patients with or without hypertension when given for up to 12 months. However, after 12 weeks' treatment in hypertensive obese patients, diastolic blood pressure was reduced by similar amounts with sibutramine or placebo. Concerns over potential pressor effects with sibutramine are reflected in the manufacturer's dosage and administration recommendations.

Burden of illness review of obesity: are the true costs realised?

Obesity can no longer be viewed as merely a cosmetic or social problem, but must be acknowledged as a serious disease, responsible for the premature death and morbidity of millions and for significant expenditure of limited healthcare resources. In addition, there are significant costs to the individual with regard to social status and quality of life. It has been argued that obesity is one of the most important preventable causes of ill health in the UK today. This is especially important when one considers that the incidence of obesity is actually rising, with 13% of men and 16% of women in the UK in 1997 being obese. To begin treating such a disease it is essential to raise awareness of this problem, not only from the associated morbidity and mortality risks that have been well documented, but the socio-economic and psychological costs. This paper reviews the literature available globally, giving some measure of the magnitude of the associated burden of illness.

Dexfenfluramine. An updated review of its therapeutic use in the management of obesity

Dexfenfluramine increases serotonergic activity by stimulating serotonin (5-hydroxytryptamine; 5-HT) release into brain synapses, inhibiting its reuptake into presynaptic neurons and by directly stimulating postsynaptic serotonin receptors. On the basis of the serotonin hypothesis of appetite control, these actions would be expected to reduce appetite and, consequently, bodyweight. Studies conducted in animals and in overweight patients with and without associated disorders have confirmed the weight-reducing efficacy and good tolerability of dexfenfluramine. In 3-month clinical studies in obese patients, weight reductions with dexfenfluramine 15mg twice daily combined with dietary support were significantly higher than those achieved with placebo and similar to those with ephedrine/caffeine 20/20mg 3 times daily, sibutramine 10mg once daily and fluoxetine 60 mg/day. Furthermore, dexfenfluramine recipients with non-insulin-dependent diabetes mellitus, hyperlipidaemia or hypertension consistently show improvements in glycaemic control, blood lipid profiles and blood pressure. 12-month trial results indicate that most weight loss occurs in the initial 6 months and appears to be maintained for a further 6 months. Weight regain after withdrawal of treatment in 12-month studies demonstrates that dexfenfluramine is effective in maintaining a stable bodyweight at a lower level than placebo and in limiting food intake over this time period. Commonly reported adverse events with dexfenfluramine include diarrhoea, tiredness, dry mouth and somnolence; these symptoms are generally mild and transient. Approximately 7 and 10% of dexfenfluramine recipients in short and long term studies withdrew because of adverse events. Dexfenfluramine was better tolerated than ephedrine/caffeine and fluoxetine in short term studies. Obesity is a chronic condition that is accompanied by a number of metabolic complications. It is a significant health problem in developed countries, and as a major risk factor for many chronic diseases, including diabetes and cardiovascular disease, the economic burden of this condition is considerable. As with other chronic conditions, there is a role for pharmacological intervention in patients with severe obesity. However, drugs should be considered as only one component of a weight-control programme, since additional lifestyle modification is required to maintain weight loss. The promising data on the long term efficacy and tolerability of dexfenfluramine as well as its favourable effects on risk factors associated with obesity requires confirmation in long term studies. In the meantime, dexfenfluramine should be considered a valuable adjunct to a reduced-calorie diet in the management of severe obesity, particularly in patients with associated disorders and those unsuccessful with conventional weight loss measures. Available data support the use of the drug for up to 1 year to maintain weight loss and thus dexfenfluramine should be considered for long term administration.

Future directions in obesity and eating disorders

The purpose of this article is to explore future directions in the treatment of obesity and eating disorders. After briefly reviewing the costs of eating disorders, in terms of morbidity, mortality, and economics, we provide suggestions for future research and treatment. We first focus on changes that should be considered to improve etiological and outcome research, with the idea that a better understanding of etiological factors will lead to better interventions. We then examine promising treatment approaches, public health initiatives, and the importance of focusing on health and self-acceptance as valid treatment outcomes.

The economic and psychosocial consequences of obesity

Obesity is a multifaceted problem with wide-reaching medical, social and economic consequences. These are partly determined by the wealth and disease pattern of the population. In less-developed societies overweight may be advantageous and socially acceptable. In affluent societies obesity is a well-recognized health hazard and a socially stigmatized condition. For the obese person, excess weight denotes an increased risk of disabling chronic diseases, lowered quality of life and loss of earnings. For the society, obesity is a major economic burden. Treatment costs of diseases directly attributable to obesity are estimated to correspond to about 4-5% of the total health care expenditure. The indirect costs arising from loss of productivity due to obesity may be even higher.