Obesity Treatment: Examining the Premises

The effects of acute exercise on appetite and energy intake in men and women

PURPOSE

To compare energy intake (EI) and appetite regulation responses between men and women following acute bouts of aerobic (AEx), resistance exercise (REx), and a sedentary control (CON).

METHODS

Men and women (n = 24; 50% male) with overweight/obesity, matched on age (32.3 ± 2 vs. 36.8 ± 2 yrs, p = 0.14) and BMI (28.1 ± 1.2 vs 29.0 ± 1.5 kg/m2, p = 0.64) completed 3 conditions: 1) AEx (65-70% of age-predicted maximum heart rate for 45 min); 2) REx (1-set to failure on 12 exercises); and 3) CON. Each condition was initiated in the post-prandial state (35 min following consumption of a standardized breakfast). Appetite (visual analog scale for hunger, satiety, and prospective food consumption [PFC]) and hormones (ghrelin, PYY, and GLP-1) were measured in the fasted state and every 30 min post-prandially for 3 h. Post-exercise ad libitum EI at the lunch meal was also measured.

RESULTS

Men reported higher levels of hunger compared to women across all study conditions (AEx: Men: 7815.00 ± 368.3; Women: 5428.50 ± 440.0 mm x 180 min; p = 0.025; REx: Men: 7110.00 ± 548.4; Women: 6086.25 ± 482.9 mm x 180 min; p = 0.427; CON: Men: 8315.00 ± 429.8; Women: 5311.25 ± 543.1 mm x 180 min; p = 0.021) and consumed a greater absolute caloric load than women at the ad libitum lunch meal (AEx: Men: 1021.6 ± 105.4; Women: 851.7 ± 70.5 kcals; p = 0.20; REx: Men: 1114.7 ± 104.0; Women: 867.7 ± 76.4 kcals; p = 0.07; CON: Men: 1087.0 ± 98.8; Women: 800.5 ± 102.3 kcals; p = 0.06). However, when adjusted for relative energy needs, there was no difference in relative ad libitum EI observed between men and women. No differences in Area Under the Curve for Satiety, PFC, ghrelin, PYY, and GLP-1 were noted between men and women following acute exercise (all p > 0.05).

CONCLUSIONS

These data suggest that women report lower ratings of appetite following an acute bout of exercise or sedentary time when compared to men, yet have similar relative EI. Future work is needed to examine whether sex-based differences in appetite regulation and EI are present with chronic exercise of differing modalities.

Shifting to a control diet after a high-fat, high-sucrose diet intake induces epigenetic changes in retroperitoneal adipocytes of Wistar rats

The aim of the study was to analyze the phenotypic and epigenetic changes induced by the shift to a chow diet after an obesogenic environment. Animals were randomized to fed chow (control group) or high-fat-sucrose diet (HFS). After 10 weeks, half of the rats fed with HFS diet were reassigned to a chow diet (rest group) while the other half continued with the obesogenic diet (HFS group) until week 20. Changes in fat content, biochemical profile, and DNA methylation levels of several gene promoters from retroperitoneal adipocytes were analyzed. HFS diet intake for 10 weeks induced obese phenotype in the animals, increasing body weight and fat content. These effects were maintained until the end of the trial in HFS group, where an increase in liver fat content, a modification of lipid profile, and retroperitoneal adipose tissue hypertrophy were also observed. Changing the dietary pattern reversed these parameters. Epigenetic analysis showed that HFS diet intake for 20 weeks hypermethylated several CpG sites (6.7 and 29.30) and hypomethylated CpG site 15 from leptin gene promoter. Moreover, the obesogenic diet also hypomethylated CpG site 1 from Fasn (fatty acid synthase) gene promoter, without changes on Ppargc1a (peroxisome proliferator-activated receptor gamma coactivator 1-alpha), Srebf1 (sterol regulatory element-binding transcription factor 1), and aquaporin 7. Shifting to a chow diet reverted HFS-induced DNA methylation levels of some CpG sites of leptin promoter. Changing the dietary pattern hypomethylated a CpG site of Srebf1 and hypermethylated other CpGs on Ppargc1a and Fasn promoter. This study shed light on the reversibility of phenotypical and epigenetic changes induced by a HFS diet intake.

Perioperative optimization of patients undergoing bariatric surgery

Bariatric surgery is fast becoming an efficient and safe method of weight reduction, especially for patients in whom conservative measures have failed. As the obese population of the world increases, so will the number of patients requesting or requiring surgical weight loss methods. Bariatric patients however have numerous co-morbidities that make their operative course more difficult, and therefore is important to have a good understanding of the important issues surrounding their pre, peri and post operative management. This article aims to educate the reader about optimal management of the bariatric surgical patient.

Psychiatric comorbidity and quality of life in obese patients. Results from a case-control study

OBJECTIVE

The authors sought to evaluate psychiatric comorbidity, subjective quality of life, and impact of psychopathology on quality of life measures in a clinical sample of patients attending a center for the diagnosis and treatment of obesity compared to a matched sample of non-obese subjects.

METHODS

Two hundred ninety-three consecutive obese patients (48 males, 245 females, mean age 45.41 +/- 13.55 yrs; mean BMI 35.60 +/- 6.20) were compared with a control group made of 293 non obese subjects (48 males, 245 females, mean age 45.66 +/- 13.86 yrs; mean BMI 21.8 +/- 2.06); all subjects were interviewed by means of SCID I and SCID II and completed the WHO-QoL-Bref, a self-administered instrument for evaluation of subjective quality of life.

RESULTS

Obesity was associated with a significant lifetime major risk both for axis I (OR = 3.47, p = 0.000) and axis II disorders (OR = 2.27, p = 0.000); obesity was also associated with significantly lower measures of subjective quality of life on physical, social, and psychological domains; comorbidity with axis I/II disorders was associated with lower QoL measures on WHO-QoL-Bref, in particular among obese patients.

CONCLUSIONS

Obesity is significantly associated with a significant major risk of psychiatric comorbidity and poor quality of life; comorbid mental disorders play a significant role in worsening quality of life of obese patients; a multimodal approach to the treatment of obesity, including psychiatric evaluation and intervention, is needed to improve quality of life of patients.

Intentional weight loss reduces mortality rate in a rodent model of dietary obesity

OBJECTIVE

We used a rodent model of dietary obesity to evaluate effects of caloric restriction-induced weight loss on mortality rate. Research Measures and Procedures: In a randomized parallel-groups design, 312 outbred Sprague-Dawley rats (one-half males) were assigned at age 10 weeks to one of three diets: low fat (LF; 18.7% calories as fat) with caloric intake adjusted to maintain body weight 10% below that for ad libitum (AL)-fed rat food, high fat (HF; 45% calories as fat) fed at the same level, or HF fed AL. At age 46 weeks, the lightest one-third of the AL group was discarded to ensure a more obese group; the remaining animals were randomly assigned to one of three diets: HF-AL, HF with energy restricted to produce body weights of animals restricted on the HF diet throughout life, or LF with energy restricted to produce the body weights of animals restricted on the LF diet throughout life. Life span, body weight, and leptin levels were measured.

RESULTS

Animals restricted throughout life lived the longest (p < 0.001). Life span was not different among animals that had been obese and then lost weight and animals that had been nonobese throughout life (p = 0.18). Animals that were obese and lost weight lived substantially longer than animals that remained obese throughout life (p = 0.002). Diet composition had no effect on life span (p = 0.52).

DISCUSSION

Weight loss after the onset of obesity during adulthood leads to a substantial increase in longevity in rats.

A randomized double-blind placebo-controlled clinical trial of a product containing ephedrine, caffeine, and other ingredients from herbal sources for treatment of overweight and obesity in the absence of lifestyle treatment

OBJECTIVE

To evaluate the efficacy and side effects of an herbal formulation to promote weight loss, as compared to placebo.

DESIGN

12-week multicenter double-blind, placebo-controlled, randomized parallel groups design. Study conducted at three clinical sites in New York State. Subjects were randomized to receive either the 'active' product or a 'placebo' supplement for 12 weeks. Minimal steps were taken to influence lifestyle changes with regard to diet or exercise.

SUBJECTS

102 overweight/obese (30<BMI</=39.9 kg/m(2)) volunteers between the ages of 18 and 65 y.

MAIN OUTCOME MEASURES

Weight, percent body fat, fat mass, waist circumference, BMI, blood pressure, and pulse measured at 2 days, 1 week, 2 weeks, 4 weeks, 8 weeks, and 12 weeks postrandomization.

RESULTS

Subjects receiving the 'active' treatment experienced, on average, an additional 1.5 kg of weight loss compared with subjects receiving the placebo. In addition, subjects receiving the 'active' treatment experienced greater reductions in BMI and waist circumference over the 12-week period. No differences were observed with respect to percent body fat, fat mass, diastolic or systolic blood pressure, pulse, the occurrence of any adverse event, or the occurrence of any presumed treatment-related adverse event. Testing of the study product by two independent laboratories indicated that it had only approximately half of the intended amount of ephedrine alkaloids and caffeine.

CONCLUSIONS

Over the 12-week trial, subjects on the active treatment experienced significantly greater weight loss than subjects on placebo, without an increase in blood pressure, pulse, or the rate of adverse events. These benefits were achieved in the absence of any lifestyle treatment to change dietary or exercise behavior and with lower doses of ephedrine alkaloids and caffeine than those commonly utilized.

Does intentional weight loss affect mortality rate?

Short-term studies indicate that intentional weight loss among obese persons significantly improves physiologic variables. Hence, it is logical to conjecture that intentional weight loss would lead to long-term benefits and increased longevity. Herein, we review recent epidemiologic studies that investigate the weight loss-mortality association using a conservative analytic approach that included distinguishing between intentional and unintentional weight loss, adjusting for potential confounders, and excluding unhealthy subjects. On balance, results indicate that intentional weight loss appears to neither increase nor decrease mortality rate. Discussion focuses on the problems of addressing this important public health question with observational data.

Clozapine's effects on body weight and resting metabolic rate: a case series

The purpose of this pilot study is to determine if an association exists between clozapine-associated weight gain and resting metabolic rate (RMR). In doing so, we used a "pretest-posttest" single group design in which we measured resting metabolic rate and total body weight prior to implementing clozapine therapy and then again approximately 1 month after initiating clozapine therapy. The results of three patients treated with clozapine revealed an inverse relationship between resting metabolic rate and total body weight. Resting metabolic rates were notably reduced by 10.3-16.0% whereas total body weights had increased between 2.9 and 9 kg. To our knowledge, this is the first documentation of an antipsychotic medication being associated with the reduction in resting metabolic rate.

Results of soy-based meal replacement formula on weight, anthropometry, serum lipids & blood pressure during a 40-week clinical weight loss trial

BACKGROUND

To evaluate the intermediate-term health outcomes associated with a soy-based meal replacement, and to compare the weight loss efficacy of two distinct patterns of caloric restriction.

METHODS

Ninety overweight/obese (28 < BMI < or = 41 kg/m2) adults received a single session of dietary counseling and were randomized to either 12 weeks at 1200 kcal/day, 16 weeks at 1500 kcal/d and 12 weeks at 1800 kcal/d (i.e., the 12/15/18 diet group), or 28 weeks at 1500 kcal/d and 12 weeks at 1800 kcal/d (i.e., the 15/18 diet group). Weight, body fat, waist circumference, blood pressure and serum lipid concentrations were measured at 4-week intervals throughout the 40-week trial.

RESULTS

Subjects in both treatments showed statistically significant improvements in outcomes. A regression model for weight change suggests that subjects with larger baseline weights tended to lose more weight and subjects in the 12/15/18 group tended to experience, on average, an additional 0.9 kg of weight loss compared with subjects in the 15/18 group.

CONCLUSION

Both treatments using the soy-based meal replacement program were associated with significant and comparable weight loss and improvements on selected health variables.

Modern statistical methods for handling missing repeated measurements in obesity trial data: beyond LOCF

This paper brings together some modern statistical methods to address the problem of missing data in obesity trials with repeated measurements. Such missing data occur when subjects miss one or more follow-up visits, or drop out early from an obesity trial. A common approach to dealing with missing data because of dropout is 'last observation carried forward' (LOCF). This method, although intuitively appealing, requires restrictive assumptions to produce valid statistical conclusions. We review the need for obesity trials, the assumptions that must be made regarding missing data in such trials, and some modern statistical methods for analysing data containing missing repeated measurements. These modern methods have fewer limitations and less restrictive assumptions than required for LOCF. Moreover, their recent introduction into current releases of statistical software and textbooks makes them more readily available to the applied data analyses.

A novel soy-based meal replacement formula for weight loss among obese individuals: a randomized controlled clinical trial

OBJECTIVE

To assess the efficacy and safety of a low calorie soy-based meal replacement program for the treatment of obesity.

DESIGN

A 12-week prospective randomized controlled clinical trial.

SETTING

Outpatient weight control research unit.

SUBJECTS

One hundred obese (28

INTERVENTION

Participants were randomized to either the meal replacement treatment group (n=50; 240 g/day, 1200 kcal/day) or control group (n=50). Both groups at baseline received a single dietary counseling session and a pamphlet describing weight loss practices.

MAIN OUTCOME MEASURES

Weight, body fat, serum lipid concentrations.

RESULTS

: By intent-to-treat analysis, the treatment group lost significantly more weight than the control group (7.00 vs 2.90 kg; P<0.001) and had a greater change in total (22.5 vs 6.8 mg/dl; P=0.013) and LDL cholesterol (21.2 vs 7.1 mg/dl; P<0.009). Among completers only, the treatment group again lost more weight (7.1 kg; n=37 vs 2.9 kg; n=37; P=0.0001) and had a greater reduction in total cholesterol (26.1 mg/dl; n=37 vs 6.7 mg/dl; P=0.0012) and a greater change in LDL cholesterol (21.6 vs 5.5 mg/dl; P=0.0025). (For any given degree of weight loss, the reduction in LDL cholesterol was significantly greater in the treatment group.) Treatment was well tolerated and no serious side effects were detected.

CONCLUSIONS

Use of this soy-based meal replacement formula was effective in lowering body weight, fat mass and in reducing LDL cholesterol beyond what could be expected given the weight lost.

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Key Words Collapse

MESH Headings

• Adult
• Blood Pressure
• Body Constitution
• Cholesterol/blood
• Cholesterol, HDL/blood
• Cholesterol, LDL/blood
• Dietary Fiber/administration & dosage
• Energy Intake
• Female
• Food, Formulated/adverse effects
• Humans
• Male
• Middle Aged
• Obesity/diet therapy
• Obesity/physiopathology
• Soybean Proteins/administration & dosage
• Glycine max
• Weight Loss

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Grants Collapse

Affiliation(s)

D B Allison Department of Biostatistics and Center for Research on Clinical Nutrition, University of Alabama at Birmingham, Birmingham, Alabama 35294-0022, USA
G Gadbury
L G Schwartz
R Murugesan
J L Kraker
S Heshka
K R Fontaine
S B Heymsfield

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Bodyweight gain associated with atypical antipsychotics: epidemiology and therapeutic implications

Atypical antipsychotic medications are associated with different adverse effects and efficacy profiles compared with conventional antipsychotics (i.e. less extrapyramidal symptoms, improved-efficacy against negative symptoms and cognitive deficits, and most often a greater ability to improve patients' quality of life). However, the atypical antipsychotics may be associated with clinically significant bodyweight gain, increasing the risk of medical comorbidity, including diabetes mellitus, hypertension, cardiovascular disease and hyperlipidaemia. This literature review assesses the various bodyweight gain liabilities associated with atypical antipsychotics, as well as the effects of bodyweight gain on quality of life. The issue of prevention and management of this often neglected adverse effect is also examined. Most studies reviewed indicate that clozapine and olanzapine are associated with more bodyweight gain than the other atypical antipsychotics. There are potential factors that place certain patients at greater risk for bodyweight gain, including low pretreatment body mass index, young age and being of female gender. Furthermore, bodyweight gain associated with the use of atypical antipsychotics has been reported to be associated with clinical improvement, although this has not been substantiated widely. It is unclear whether increased medical comorbidity, including diabetes mellitus, coronary artery disease and/or elevated triglyceride levels, is secondary to the bodyweight gain associated with atypical antipsychotics, or the result of the agents themselves. A patient's quality of life may be greatly affected by excessive bodyweight gain; either by increased comorbid medical illness, an increased relapse rate associated with noncompliance, or the social stigma associated with being obese. However, most studies reveal that treatment with atypical antipsychotic medications is associated with improved quality of life compared with that achieved with conventional antipsychotic medications. Because bodyweight is an important health risk associated with atypical antipsychotics, prevention and effective management of bodyweight are paramount in preventing comorbid medical illness, relapse and possible noncompliance.

Estimating the consequences of anti-psychotic induced weight gain on health and mortality rate

Many anti-psychotic medications produce marked weight gain. In this study, we estimate the expected impact of degrees of antipsychotic-induced weight gain on selected mortality rate and incidence rates of impaired glucose tolerance (IGT) and hypertension (HTN) among US adults. Using raw data from 5209 respondents from the Framingham Heart Study's public use data set and national statistics on population demographics, we estimated the expected effect of weight gain on number of deaths and incident cases of IGT and HTN for a 10-year period commencing in 1999. Results indicated that the estimated deleterious effects of weight gain were greater for people with higher BMIs at baseline, for greater degrees of weight gain, for men than women, and for older than younger persons. Because there is a 'U-shaped' relation between BMI and mortality rate, small to moderate weight gains among people with baseline BMIs less than 23 were predicted to decrease mortality rates, whereas weight gains among people with baseline BMIs above that level were expected to increase mortality rates. However, the relations of IGT and HTN with BMI are monotonically increasing. Thus, the anticipated effect of weight gain on IGT and HTN is deleterious regardless of baseline BMI. Because it is unclear whether the beneficial effects of the atypical agents on, for example, reducing suicide mortality, outweigh the putative increase in mortality due to weight gain, we estimate the beneficial effects due to decreased death from suicide with the potential deleterious effects due to a 10-kg weight gain. We found that 492 suicide deaths per 100,000 schizophrenic patients would be prevented over 10 years with the use of clozapine compared to 416 additional deaths due to antipsychotic induced weight gain. Although this estimate is rather crude and should be seen only as offering a sense of the likely situation, results suggest that the lives saved via clozapine may essentially be offset by the deaths due to weight gain. As we discuss, it is not possible to provide definitive estimates of the effect of antipsychotic-induced weight gain on health and mortality, but our findings suggest that the magnitude of weight gains induced by many antipsychotic agents is likely to have important deleterious effects on mortality and health.

Behavioral approaches to the problems of obesity

Obesity is a complex and increasingly prevalent disorder that can confer a number of medical, social, and psychological difficulties. As a result, an array of treatment strategies falling under the generic umbrella of "behavior therapy" have been developed and continue to be refined and expanded. In this article, different behavioral approaches to the problems of obesity are outlined and reviewed, specifically, those that target (a) body weight or composition, (b) lifestyle factors and other health-related variables, and (c) related psychological variables such as self-esteem and assertiveness, as well as negative attitudes toward obese persons held by nonobese individuals. For each of these targets of change, approaches to both individual- and group-level interventions are considered. Suggestions for future research and clinical work are offered. Throughout, the importance of conceptualizing obesity as a multifaceted problem is underscored. The necessity for explicit target goals when attempting to modify behavior is also highlighted.

Obesity in North America. An overview

The terms "obesity" and "overweight" mean different things to different people. This article discusses such issues as prevalence, morbidity, mortality, and psychosocial effects. Definitions and various classifications of obesity are discussed also.

Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study

OBJECTIVES

This study sought to test the relationships between relative body weight and clinical depression, suicide ideation, and suicide attempts in an adult US general population sample.

METHODS

Respondents were 40,086 African American and White participants interviewed in a national survey. Outcome measures were past-year major depression, suicide ideation, and suicide attempts diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The primary predictor was relative body weight, treated both continuously (i.e., body mass index [BMI]) and categorically in logistic regression analyses. Covariates included age, income and education, disease status, and drug and alcohol use.

RESULTS

Relative body weight was associated with major depression, suicide attempts, and suicide ideation, although relationships were different for men and women. Among women, increased BMI was associated with both major depression and suicide ideation. Among men, lower BMI was associated with major depression, suicide attempts, and suicide ideation. There were no racial differences.

CONCLUSIONS

Differences in BMI, or weight status, were associated with the probability of past-year major depression, suicide attempts, and suicide ideation. Longitudinal studies are needed to differentiate the causal pathways and mechanisms linking physical and psychiatric conditions.

Antipsychotic-induced weight gain: a comprehensive research synthesis

OBJECTIVE

The purpose of this study was to estimate and compare the effects of antipsychotics-both the newer ones and the conventional ones-on body weight.

METHOD

A comprehensive literature search identified 81 English- and non-English-language articles that included data on weight change in antipsychotic-treated patients. For each agent, a meta-analysis and random effects metaregression estimated the weight change after 10 weeks of treatment at a standard dose. A comprehensive narrative review was also conducted on all articles that did not yield quantitative information but did yield important qualitative information.

RESULTS

Placebo was associated with a mean weight reduction of 0.74 kg. Among conventional agents, mean weight change ranged from a reduction of 0.39 kg with molindone to an increase of 3.19 kg with thioridazine. Among newer antipsychotic agents, mean increases were as follows: clozapine, 4.45 kg; olanzapine, 4.15 kg; sertindole, 2.92 kg; risperidone, 2.10 kg; and ziprasidone, 0.04 kg. Insufficient data were available to evaluate quetiapine at 10 weeks.

CONCLUSIONS

Both conventional and newer antipsychotics are associated with weight gain. Among the newer agents, clozapine appears to have the greatest potential to induce weight gain, and ziprasidone the least. The differences among newer agents may affect compliance with medication and health risk.

Is the prevalence of successful weight loss and maintenance higher in the general community than the research clinic?

OBJECTIVE

The prevalence of successful weight loss remains unclear. In 1982, Schachter concluded that in the general population, the rate of "self-cured" obesity approached 63%-much higher than the rate from clinical trials. Several subsequent studies have addressed this issue.

RESEARCH METHODS AND PROCEDURES

Our initial goal was to meta-analyze these studies to evaluate the validity of the original hypotheses and the extent to which additional investigations supported the findings. We began by restating Schachter's hypotheses in precise, testable terms.

RESULTS

A systematic review of these studies found many methodological limitations and much heterogeneity among the samples studied, hypotheses addressed, and operational definitions. Some of these limitations appear to stem from the lack of clear, precise statements of the exact hypotheses tested. Differences among studies are delineated, and we outline why meta-analytic pooling of these data appears inappropriate.

CONCLUSIONS

The current data are inadequate to draw any definite conclusions regarding the cure rate of obesity. Criteria for the adequate study of success rates with "self-cure" in the general population are proposed.

Relative body weight and self-esteem among African Americans in four nationally representative samples

OBJECTIVE

Obesity is an increasingly common health problem among African Americans, especially women, in the United States. However, limited data are available on the psychological correlates of obesity in this population. This study examined the association between self-esteem and relative body weight (RBW) in four large nationally representative samples of African American individuals.

RESEARCH METHODS AND PROCEDURES

Data from The Adolescent Health Care Evaluation Study, The National Longitudinal Survey of Youth, The High School and Beyond, and The National Survey of Black Americans were analyzed. Within each database, regression analyses tested the association between RBW and self-esteem while adjusting for age and sex.

RESULTS

In three of the four databases, there was no significant association between RBW and self-esteem. In the only database detecting a statistically significant effect, the magnitude of the effect was small. The combined effects of RBW and its interaction with age and sex accounted for <2% of the variance in self-esteem across databases.

DISCUSSION

Results suggest that elevated RBW is not associated with a poorer general self-concept, on average, among African American individuals.

Body mass index as a measure of adiposity among children and adolescents: a validation study

OBJECTIVES

To test the hypothesis that in a healthy pediatric population body mass index (BMI) (kilograms per meter square) is a valid measure of fatness that is independent of age for both sexes.

METHODS

Total body fat (TBF) (in kilograms) and percent of body weight as fat (PBF) were estimated by dual energy x-ray absorptiometry (DXA) in 198 healthy Italian children and adolescents between 5 and 19 years of age. We developed multiple regression analysis models with TBF and percent body fat as dependent variables and BMI, age, and interaction terms as independent variables. Separate analyses were conducted for boys and girls.

RESULTS

BMI was strongly associated with TBF (R2 = 0.85 and 0.89 for boys and girls, respectively) and PBF (R2 =0.63 and 0.69 for boys and girls, respectively). Confidence limits on BMI-fatness association were wide, with individuals of similar BMI showing large differences in TBF and in PBF. Age was a significant covariate in all regression models. Addition of nonlinear terms for BMI did not substantially increase the R2 for TBF and PBF models in boys and girls.

CONCLUSION

Our results support the use of BMI as a fatness measure in groups of children and adolescents, although interpretation should be cautious when comparing BMI across groups that differ in age or when predicting a specific individual's TBF or PBF.