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The relationship among registered nurses’ weight status, weight loss regimens, and successful or unsuccessful weight loss
Abstract
To investigate relationships between body mass index (BMI), personality type, weight loss regimens, and successful or unsuccessful weight loss.
Seven hundred and twenty-one registered nurses (RNs) were recruited from the American Academy of Nurse Practitioners, the membership of a nursing honor society, and RNs at a large state university. Participants completed the Myers-Briggs Type Indicator (MBTI), a demographic survey (age, gender, height, weight, ethnicity, education status, disability, shift work hours, and prescription medication use), and questions related to their weight status, weight loss attempts, and motivation.
RNs who had a lower BMI were more successful in losing weight than RNs who had a higher BMI. They were also more successful in their weight loss attempts if they did not use a diet regimen.
RNs who were successful in losing weight did not use a specified dietary regimen.
... The use of the MBTI is well established in the organizational context [15][16][17][18]; however, in the clinical context, it is still scarce [19,20], even more so in the obese population subjected to weight loss interventions [21,22]. ...
... It is expected that all MBTI profiles occur at the same frequency; however, we were surprised by a higher prevalence of only two typological profiles, ISFJ and ESFJ, in both groups, in the same way that Zitkus [21] had shown these profiles as the most common profiles in an obese population. ...
... Not a lot has been said about the association of personality typology according to MBTI, obesity and suicide. Ziktus' [21] study shows association between weight and MBTI types, and that introverted people present more weight. ...
Objectives
To determine the personality types of women in treatment for obesity and the associations among their personality characteristics, eating behaviour and suicide risk. Subjects: Sixty women in pharmacological treatment for obesity (clinical group: CG) and 60 women post-bariatric gastric bypass surgery (surgical group: SG) were evaluated.Methods
This was an observational and transversal study conducted in a specialized outpatient unit. Personality types were evaluated through the Myers–Briggs Type Indicator (MBTI) test. A semi-structured questionnaire that investigated sociodemographic and lifestyle characteristics was applied, along with the Binge Eating Scale (BES) and the Columbia-Suicide Severity Rating Scale (C-SSRS).ResultsAmong the 16 possible personality types, the ISFJ (Introversion, Sensing, Feeling, Judging) and ESFJ (Extraversion, Sensing, Feeling, Judging) types were more frequent. In the SG, 32% of the participants presented with the ISFJ type, and 18.3% presented with the ESFJ type. In the CG, 33% presented with the ISFJ type and 25% presented with the ESFJ type. There was a higher prevalence of binge eating behaviour in the CG (Cohen’s d: − 0.47; p < 0.0001) and a higher tendency to graze in the SG (p = 0.005). Participants with introverted attitudes showed a higher prevalence of severe binging (13.3% vs 3.3%, p = 0.07), suicidal thoughts throughout life (STTL) (69.5% vs 45.1%, p = 0.007), and recent suicidal thoughts (RSTs) (30.4% vs 11.7%, p = 0.01) in comparison to extraverted participants. BMI was associated with a higher chance of STTL (37.96 ± 6.41 kg/m2 with STTL vs 33.92 ± 4.68 kg/m2 without STTL; p = 0.01) in the CG compared to the SG. RSTs were associated with BMI in the SG (34.47 ± 3.86 kg/m2 with RSTs vs 30.61 ± 5.72 kg/m2 without RSTs; p = 0.01). In the multivariable analysis, personality type (ISFJ) was an independent predictor of STTL (OR: 3.6; CI 1.3–10.2; p = 0.01) and Suicidal Behaviour (SB) (OR: 9.7; CI 2.44–38.9; p = 0.001). Conversely, while BMI was an independent factor associated with binge eating, personality type was not.Conclusions
Women who were in pharmacological treatment for obesity or were post-bariatric surgery present specific types of personality. Introversion was associated with a higher BMI and a higher risk of suicidal thoughts.Level of evidenceLevel V, cross-sectional descriptive study.
... Reported prevalence of overweight and obesity among nurses internationally ranges between 54.5% and 79.1% (Miller et al., 2008;Zitkus, 2011;Bogossian et al., 2012;Goon et al., 2013). Prevalence has been observed to be lowest in the United States of America (USA) (54.5% (Miller et al., 2008); 57% (Zitkus, 2011)), followed by the UK (59.1%), ...
... Reported prevalence of overweight and obesity among nurses internationally ranges between 54.5% and 79.1% (Miller et al., 2008;Zitkus, 2011;Bogossian et al., 2012;Goon et al., 2013). Prevalence has been observed to be lowest in the United States of America (USA) (54.5% (Miller et al., 2008); 57% (Zitkus, 2011)), followed by the UK (59.1%), Australia (61.3%) and New Zealand (61.8%) (Bogossian et al., 2012), and highest in South Africa (79.1%) (Goon et al., 2013). ...
... Prevalence of overweight and obesity among nurses in Scotland is not known. International studies comparing obesity prevalence among nurses with the general population have been equivocal, reporting higher prevalence in the UK, Australia and New Zealand (Bogossian et al., 2012), comparable prevalence in South Africa (Goon et al., 2013) and lower prevalence in the USA (Miller et al., 2008;Zitkus, 2011). Prevalence estimates have, however, been based on non-representative samples and to the best of our knowledge no studies have compared prevalence of overweight and obesity among nurses to other healthcare professionals. ...
Background:
Increasing prevalence of overweight and obesity represents a global pandemic. As the largest occupational group in international healthcare systems nurses are at the forefront of health promotion to address this pandemic. However, nurses own health behaviours are known to influence the extent to which they engage in health promotion and the public's confidence in advice offered. Estimating the prevalence of overweight and obesity among nurses is therefore important. However, to date, prevalence estimates have been based on non-representative samples and internationally no studies have compared prevalence of overweight and obesity among nurses to other healthcare professionals using representative data.
Objectives:
To estimate overweight and obesity prevalence among nurses in Scotland, and compare to other healthcare professionals and those working in non-heath related occupations.
Design:
Cross-sectional study using a nationally representative sample of five aggregated annual rounds (2008-2012) of the Scottish Health Survey.
Setting:
Scotland.
Participants:
13,483 adults aged 17-65 indicating they had worked in the past 4 weeks, classified in four occupational groups: nurses (n=411), other healthcare professionals (n=320), unqualified care staff (n=685), and individuals employed in non-health related occupations (n=12,067).
Main outcome measures:
Prevalence of overweight and obesity defined as Body Mass Index≥25.0.
Methods:
Estimates of overweight and obesity prevalence in each occupational group were calculated with 95% confidence intervals (CI). A logistic regression model was then built to compare the odds of being overweight or obese with not being overweight or obese for nurses in comparison to the other occupational categories. Data were analysed using SAS 9.1.3.
Results:
69.1% (95% CI 64.6, 73.6) of Scottish nurses were overweight or obese. Prevalence of overweight and obesity was higher in nurses than other healthcare professionals (51.3%, CI 45.8, 56.7), unqualified care staff (68.5%, CI 65.0, 72.0) and those in non-health related occupations (68.9%, CI 68.1, 69.7). A logistic regression model adjusted for socio-demographic composition indicated that, compared to nurses, the odds of being overweight or obese was statistically significantly lower for other healthcare professionals (Odds Ratio [OR] 0.45, CI 0.33, 0.61) and those in non-health related occupations (OR 0.78, CI 0.62, 0.97).
Conclusions:
Prevalence of overweight and obesity among Scottish nurses is worryingly high, and significantly higher than those in other healthcare professionals and non-health related occupations. High prevalence of overweight and obesity potentially harms nurses' own health and hampers the effectiveness of nurses' health promotion role. Interventions are therefore urgently required to address overweight and obesity among the Scottish nursing workforce.
... 2014). As for nurses, the prevalence of overweight increased as high as 54.5% and 79.1% in United States of America (Zitkus 2011) and South Africa (Goon et al. 2013), respectively. A study conducted by Coomarasamy et al. (2014) in Malaysia among a total of 1086 nurses shows that 50.6% were either pre-obese (33.5%) or obese (17.1%). ...
ABSTRAK Berat badan berlebihan dan obesiti telah menjadi satu isu global yang dibimbangi. Lebih daripada 1.9 bilion orang dewasa di seluruh dunia menghadapi berat badan berlebihan dan lebih daripada 650 juta yang obes pada tahun 2016. Jururawat Malaysia juga tidak terkecuali daripada masalah berat badan berlebihan. Kajian telah dijalankan untuk mengkaji kelaziman berat badan berlebihan dan hubungan antara tabiat pemakanan dan berat badan berlebihan di antara jururawatan yang kerja shif di Pusat Perubatan Universiti Kebangsaan Malaysia. Sebanyak 280 responden telah menyertai kajian ini dan tabiat pemakanan dikaji menggunakan Tabiat Pemakanan Belanda Versi Melayu. Indeks jisim badan telah dikategorikan mengikut "Clinical Practice Guidelines 2004". Hasil kajian menunjukkan 68.5% daripada jururawat mempunyai berat badan berlebihan (37.1%) atau obes (31.4%). BMI jururawat tidak menunjukkan hubungan dengan data sosio-demografi kecuali umur (r=0.156). Apabila umur meningkat, indeks jisim badan akan meningkat. Manakala, kajian menunjukkan ketiadaan hubungan di antara tabiat pemakanan secara emosi dan secara pengaruh luar tetapi tabiat pemakanan secara kawal menunjukkan hubungan yang ketara dengan indeks jisim badan (F = 6.056, p = 0.003). Kesimpulannya, tabiat pemakanan secara terkawal paling diamalkan oleh jururawat dengan tujuan untuk mencapai berat badan ideal tetapi usaha tersebut tidak berhasil dan menyebabkan berat badan meningkat. Jururawat yang berat badan berlebihan atau obes akan meninggalkan imej buruk kepada masyarakat serta merendahkan kayakinan masyarakat terhadap jururawat. Selain itu, masalah berat badan berlebihan akan menjejaskan prestasi kerja jururawat serta kualiti penjagaan kepada pesakit. Isu ini perlu ditangani dengan segera. Oleh itu, gaya hidup dan tabiat pemakanan yang sihat di antara jururawat harus digalakkan di hospital. ABSTRACT Overweight and obesity have become a global concern and estimated with more than 1.9 billion adults worldwide were overweight and more than 650 million were obese in 2016. Nurses in Malaysia were no exception to overweight and obesity. This research was conducted with the aim to identify the prevalence of overweight among nurses on shift duty in a teaching hospital and to understand the relationship between abnormal eating behavior and body mass index. A total of 280 respondents participated in this research and Dutch Eating Behavior Questionnaire was used. Body Mass Index (BMI) score was categorized according to Clinical Practice Guidelines 2004. Results showed that 68.5% of the nurses were either overweight (37.1%) or obese (31.4%). The nurses' BMI does not showed any association with socio-demographic data except age (r=0.156). As age increases, the nurses' BMI also increase. This research also showed that there was no association between emotional and external eating behavior to BMI. However, there was a statistically significant differences in BMI for restraint eating (F=6.056, p=0.003). In conclusion, restraint eating behavior was the most practiced form of eating behavior in an attempt to achieve the ideal body weight but unfortunately lead to overweight among the nurses. Overweight or obese nurses will have a negative impression to the society and even reduce their confidence towards nurses' health education. Overweight or obesity also ruined the nurses' working performance and quality of care for patients. This issue requires immediate action and interventions to promote healthy lifestyles and eating habits among nurses should be conducted in the hospital.
... 2014). As for nurses, the prevalence of overweight increased as high as 54.5% and 79.1% in United States of America (Zitkus 2011) and South Africa (Goon et al. 2013), respectively. A study conducted by Coomarasamy et al. (2014) in Malaysia among a total of 1086 nurses shows that 50.6% were either pre-obese (33.5%) or obese (17.1%). ...
ABSTRACT
Overweight and obesity have become a global concern and estimated with more
than 1.9 billion adults worldwide were overweight and more than 650 million
were obese in 2016. Nurses in Malaysia were no exception to overweight and
obesity. This research was conducted with the aim to identify the prevalence of
overweight among nurses on shift duty in a teaching hospital and to understand
the relationship between abnormal eating behavior and body mass index. A
total of 280 respondents participated in this research and Dutch Eating Behavior
Questionnaire was used. Body Mass Index (BMI) score was categorized according
to Clinical Practice Guidelines 2004. Results showed that 68.5% of the nurses
were either overweight (37.1%) or obese (31.4%). The nurses’ BMI does not
showed any association with socio-demographic data except age (r=0.156). As age
increases, the nurses’ BMI also increase. This research also showed that there was
no association between emotional and external eating behavior to BMI. However,
there was a statistically significant differences in BMI for restraint eating (F=6.056,
p=0.003). In conclusion, restraint eating behavior was the most practiced form of
eating behavior in an attempt to achieve the ideal body weight but unfortunately
lead to overweight among the nurses. Overweight or obese nurses will have a
negative impression to the society and even reduce their confidence towards
nurses’ health education. Overweight or obesity also ruined the nurses’ working
performance and quality of care for patients. This issue requires immediate action
and interventions to promote healthy lifestyles and eating habits among nurses
should be conducted in the hospital.
Keywords: eating behavior, nurse, overweight
... However, this knowledge may not translate into sustainable change (Ross et al., 2017). Several research studies support that nurses do not practice positive health behavior and that a large percentage of nurses are overweight or obese (Nahm, Warren, Zhu, Minjeong, & Brown, 2012;Zitkus, 2011). For example, Nahm et al. (2012) reported a mean body mass index (BMI) of 28.2 kilograms (kg)/meters (m) 2 and a 59.2% prevalence of overweight/obesity in a sample of 183 nurses. ...
Nurses often struggle with maintaining a healthy lifestyle. While nurses are often assumed to have the knowledge to participate in health-promoting behaviors, this knowledge may not translate into sustainable change in behavior. The purpose of this descriptive study was to compare nurses' health behaviors with residents in the community where the nurses were employed. Participants ( N = 166) completed the Health Promoting Lifestyle Profile-II survey (HPLP-II) along with a demographic survey. The HPLP-II consists of six dimensions of a health-promoting lifestyle: (a) spiritual growth, (b) health responsibility, (c) physical activity, (d) nutrition, (e) interpersonal relations, and (f) stress management. Both groups scored the highest in spirituality followed by interpersonal relations. However, scores for the other HPLP-II dimensions ranked differently between the two groups. Nurses scored higher in health responsibility while the community participants scored higher on nutrition. Both groups scored the lowest on stress management and physical activity. Significant differences between groups were found only on the health responsibility dimension of the HPLP-II survey with nurses scoring higher. While nurses overall did not do any better than the general population in participating in a healthy lifestyle, patient stakeholders feel strongly that nurses should role model healthy behaviors. Employers need to be better prepared to support nurses to participate in a healthy lifestyle. Success can come from even small incremental changes (e.g., walking groups, team challenges, taking stairs) within the work environment. Furthermore, evidence-based practice teams that include administration, management, and staff are positioned to contribute through education and development of innovative workplace wellness programs.
... [32] Reported prevalence of overweight and obesity among nurses internationally ranges between 54.5% and 79.1%. [33][34][35][36] Research has found that qualified nurses in the UK have poor health-related behaviours. In a study on nurses in England, it was found that just under half (45.4%) of the nurses did not meet government physical activity guidelines, over half (58.0%) did not consume the recommended five portions of fruit or vegetables each day, and over a third (36.3%) ate foods high in fat and sugar content on a daily basis and thus it was suggested that individuals' healthbehaviours may be driving the pattern of overweight and obesity observed. ...
Nursing professionals play an extremely significant role in healthcare delivery. They are involved in multiple occupational activities, which cause stress and can lead to detrimental effects on their personal health. Nurses may often have to alter their dietary and lifestyle behaviour to meet the several urgent demands of their profession. This can put them at risk to various chronic health conditions that can further influence their occupational chores. This paper highlights the lifestyle and eating patterns, weight and health status of nurses; and the impact of these on the professional role of nurses. As very few studies are available on the dietary intakes and activity patterns of nurses, more research is needed on these aspects. An understanding of all these issues is important to plan suitable diet and lifestyle-related interventions for nurses so as to promote optimum health and productivity among them.
... There are reports that patients given advice that leads to a caloric deficit may lose more weight than those given a specific calorie goal. For example, in one study, nurses were more successful in weight loss attempts if they did not use a specific diet regimen [48]. Tate and coworkers [49] demonstrated that making just one change, the replacement of caloric beverages with non-caloric beverages as a weight loss strategy, can lead to weight loss. ...
Although the treatment of both adult and pediatric obesity in primary care is in its infancy, there is a growing base of evidence that patient-centered strategies, used by clinicians alone or in combination with other health-care professionals or community programs, can be effective. This paper presents, using the 5 As framework (Ask, Advise, Agree/Assess, Assist, and Arrange), behavioral strategies that assist patients making lifestyle changes for weight management.
... 15Y17 Nurses following the DASH (Dietary Approaches to Stop Hypertension) eating pattern, another dietary approach based primarily on plant foods and including a focus on reduced sodium intake, have also demonstrated lowered risks for heart disease and stroke. 18 A report by Zitkus 19 suggests we reconsider how we traditionally approach dietary change with nurses. She observed that nurses were more successful in weight loss attempts if they did not use a specific diet regimen. ...
An estimated 8 to 15 million Americans perform shift work that may encourage lifestyle choices that negatively affect health. We present 2 patient cases elucidating some of the issues faced by shift workers and provide counseling strategies for changing dietary behaviors.
Background
Several studies have reported the prevalence of overweight and obesity in various countries but the global prevalence of nurses with overweight and obesity remains unclear. A consolidation of figures globally can help stakeholders worldwide improve workforce development and healthcare service delivery.
Objective
To investigate the global prevalence of overweight and obesity among nurses.
Design
Systematic review with meta‐analysis.
Setting
29 different countries across the WHO‐classified geographical region.
Participants
Nurses.
Methods
Eight electronic databases were searched for articles published from inception to January 2023. Two independent reviewers performed the article screening, methodological appraisal and data extraction. Methodological appraisal was conducted using Newcastle‐Ottawa Scale (NOS). Inter‐rater agreement was measured using Cohen's Kappa. Meta‐analyses were conducted to pool the effect sizes on overweight, obesity and waist circumference using random effects model and adjusted using generalised linear mixed models and Hartung–Knapp method. Logit transformation was employed to stabilise the prevalence variance. Subgroup analyses were performed based on methodological quality and geographical regions. Heterogeneity was assessed using the I ² statistic.
Results
Among 10,587 studies, 83 studies representing 158,775 nurses across 29 countries were included. Based on BMI, the global prevalence of overweight and obesity were 31.2% ( n = 55, 95% CI: 29%–33.5%; p < .01) and 16.3% ( n = 76, 95% CI: 13.7%–19.3%, p < .01), respectively. Subgroup analyses indicated that the highest prevalence of overweight was in Eastern Mediterranean ( n = 9, 37.2%, 95% CI: 33.1%–41.4%) and that of obesity was in South‐East Asia ( n = 5, 26.4%, 95% CI: 5.3%–69.9%). NOS classification, NOS scores, sample size and the year of data collected were not significant moderators.
Conclusions
This review indicated the global prevalence of overweight and obesity among nurses along with the differences between regions. Healthcare organisations and policymakers should appreciate this increased risk and improve working conditions and environments for nurses to better maintain their metabolic health.
Patient or Public Contribution
Not applicable as this is a systematic review.
Registration
PROSPERO (ref: CRD42023403785) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403785 .
Tweetable Abstract
High prevalence of overweight and obesity among nurses worldwide.
Objective
To estimate obesity prevalence among healthcare professionals in England and compare prevalence with those working outside of the health services.
Design
Cross-sectional study based on data from 5 years (2008–2012) of the nationally representative Health Survey for England.
Setting
England.
Participants
20 103 adults aged 17–65 years indicating they were economically active at the time of survey classified into four occupational groups: nurses (n=422), other healthcare professionals (n=412), unregistered care workers (n=736) and individuals employed in non-health-related occupations (n=18 533).
Outcome measure
Prevalence of obesity defined as body mass index ≥30.0 with 95% CIs and weighted to reflect the population.
Results
Obesity prevalence was high across all occupational groups including: among nurses (25.1%, 95% CI 20.9% to 29.4%); other healthcare professionals (14.4%, 95% CI 11.0% to 17.8%); non-health-related occupations (23.5%, 95% CI 22.9% to 24.1%); and unregistered care workers who had the highest prevalence of obesity (31.9%, 95% CI 28.4% to 35.3%). A logistic regression model adjusted for sociodemographic composition and survey year indicated that, compared with nurses, the odds of being obese were significantly lower for other healthcare professionals (adjusted OR (aOR) 0.52, 95% CI 0.37 to 0.75) and higher for unregistered care workers (aOR 1.46, 95% CI 1.11 to 1.93). There was no significant difference in obesity prevalence between nurses and people working in non-health-related occupations (aOR 0.94, 95% CI 0.74 to 1.18).
Conclusions
High obesity prevalence among nurses and unregistered care workers is concerning as it increases the risks of musculoskeletal conditions and mental health conditions that are the main causes of sickness absence in health services. Further research is required to better understand the reasons for high obesity prevalence among healthcare professionals in England to inform interventions to support individuals to achieve and maintain a healthy weight.
The purpose of this study was an investigation of the relationship between the Myers-Briggs Type Indicator personality profiling (MBTI), academic performance and student satisfaction in nursing students. The participants were 109 college students in Daejeon, Korea. All the students were administered three instruments, the MBTI, academic performance and student satisfaction scale. Descriptive statistics t-test, ANOVA, and Pearson correlations technique were used to analyze the data with the SPSS Win 15.0 program. Judging types scored higher in academic performance than perceiving types. Extrovert types scored higher in student satisfaction than introvert types. This finding indicates that students’ academic achievement levels and student satisfaction were different according to their MBTI personality types in nursing students.
Objective: This is a study to evaluate the personality types based on Myers-Briggs Type Indicator (MBTI) in patients with chronic vascular or tension-type headache. Methods: This was a cross-sectional study conducted on 210 patients with tension-type and vascular headache in the Mashhad city, northeast of Iran. Patients were selected through convenience nonprobability method from December 2010 to January 2012. They were asked to fill demographic questionnaire and MBTI. Data were analyzed with SPSS using Mann-Whitney U, Chi-square and Fisher exact test. Results: The mean age of participants was 33.7 ± 8.2. Patients with vascular headache were mostly female, had higher levels of education, experienced more attacks per month and had shorter duration of headache until seeking treatment compared to the patients with tension-type headache. There was a significant difference in the distribution of personality types and frequency of each personality dimension between two groups. Patients with vascular headaches were significantly more introverted, sensing, thinking and judgmental, as compared to extraversion, intuitional, feeling, and perceiving among the tension-type headaches. Conclusion: Since there was a significant difference in the personality type of the different headache patients, further neuropsychological studies may throw light on the etiology of these chronic headaches.
The information contained in this presentation was obtained from multiple sources. It is the responsibility of the user to update themselves on current medical concepts and treatments as well as the current medical practices in the states where they practice as a healthcare professional.
Considerable research on preventive health care behaviors has been conducted in different segments of the population. Although nurses are the largest group of direct health care providers (3 million), little is known about their preventive health care behaviors. As the average age of nurses working in the United States (US) increases (mean age 47 years), maintaining their health to ensure they can continue to provide optimal health care to others becomes a greater priority.
This descriptive online study examined registered nurses' dietary and exercise practices, weight status, stress levels, and preferred preventive health strategies using a sample of nurses recruited from a community-based, urban teaching hospital (n = 183; mean age 47 ± 11.3 years).
The majority of participants (72.2%, n = 122) reported a lack of exercise, and more than half (53.8%, n = 91) had an irregular meal pattern. The average body mass index (BMI) was 28.3 ± 6.8, and 59.2% (n = 100) were either overweight (n = 47) or obese (n = 53). BMI had a significant inverse relationship with having a regular meal schedule and the amount of time spent exercising. Participants who reported greater stress had more irregular meal schedules. The most frequently used stress-release method was eating (n = 32), followed by exercise (n = 31).
Nurses are fully aware of measures that should be taken for healthy living. Their knowledge, however, has not been well translated into their own self-care. As nursing shortages loom, maintaining the health of the aging nursing workforce is essential to retention. Further research is needed to identify factors that may motivate nurses to better care for themselves and measures that can be implemented by employers to initiate and sustain these preventive health care behaviors.
The Myers-Briggs Type Indicator (MBTI) was submitted to a descriptive reliability generalization (RG) analysis to characterize the variability of measurement error in MBTI scores across administrations. In general, the MBTI and its scales yielded scores with strong internal consistency and test-retest reliability estimates, although variation was observed.
Background
Family history of breast cancer is an established risk factor for this disease and is used to identify women at higher risk, although the impact of risk factors for breast cancer among women with a family history is not well defined.
Purpose
Using a modified extended log-incidence Pike model, we prospectively examined the impact of risk factors for breast cancer among women with and without a family history of the disease.
Methods
Data analyzed were obtained prospectively from the Nurses' Health Study. Two thousand two hundred forty-nine incident cases of invasive breast cancer were identified in a cohort of 89 132 women aged 30–55 years in 1976 followed biennially through 1990 (1.1 million person-years of follow-up). With the use of proportional hazards models, we evaluated the association between risk factors for breast cancer and risk among women with and those without a family history of the disease. We then fit a modified extended log-incidence Pike model to these data.
Results
Among women with a family history of breast cancer, reproductive risk factors had associations that were different from those observed among women without a family history of the disease. In particular, we observed little protection from later age at menarche, no protection from multiple births when compared with nulliparity, nor from early, as compared with later, age at first birth. Fitting these data to a model of breast cancer incidence on the basis of reproductive risk factors, we observed an adverse effect of first pregnancy on risk of breast cancer among women with a family history of breast cancer that was approximately 50% greater in magnitude than among women without a family history. Additional births after the first birth conveyed little protection for women with a family history. History of benign breast disease, past use of oral contraceptives, and use of postmenopausal hormones showed relative risks that did not differ between women with a family history and those without a family history of the disease.
Conclusions
We observed a consistent increase in risk of breast cancer among women with a mother or sister history of the disease that was exacerbated by first pregnancy. Among women with a family history of breast cancer, the adverse effect of pregnancy persisted so that to age 70 years, parous women were at higher risk of breast cancer than nulliparous women. Among women without a family history of the disease, first pregnancy was associated with a smaller increase in risk, and early pregnancy and higher number of births were each associated with reduced breast cancer incidence. [J Natl Cancer Inst 1996; 88:365–71]
Over 34% of adults aged 20 years and older are obese, but there has been no significant change in the prevalence since 2003-2004. The increasing trend in obesity over the last 25 years is a result of a shift in the entire BMI distribution and an increase in the prevalence of those who are extremely obese. In addition, disparities continue to exist. Non-Hispanic black and Mexican-American women continue to experience a higher prevalence of obesity than their non-Hispanic white counterparts. Although approximately two-thirds of obese individuals have been told by a health care provider that they are "overweight," obesity is extremely difficult to treat and the prevalence of obesity is not declining. Nonetheless, even without reaching ideal weight, research has shown that a moderate amount of weight loss can be beneficial in terms of reducing risk factors, such as high blood pressure. Maintenance of weight loss, however, remains difficult.
Background:
The possible advantage for weight loss of a diet that emphasizes protein, fat, or carbohydrates has not been established, and there are few studies that extend beyond 1 year.
Methods:
We randomly assigned 811 overweight adults to one of four diets; the targeted percentages of energy derived from fat, protein, and carbohydrates in the four diets were 20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%. The diets consisted of similar foods and met guidelines for cardiovascular health. The participants were offered group and individual instructional sessions for 2 years. The primary outcome was the change in body weight after 2 years in two-by-two factorial comparisons of low fat versus high fat and average protein versus high protein and in the comparison of highest and lowest carbohydrate content.
Results:
At 6 months, participants assigned to each diet had lost an average of 6 kg, which represented 7% of their initial weight; they began to regain weight after 12 months. By 2 years, weight loss remained similar in those who were assigned to a diet with 15% protein and those assigned to a diet with 25% protein (3.0 and 3.6 kg, respectively); in those assigned to a diet with 20% fat and those assigned to a diet with 40% fat (3.3 kg for both groups); and in those assigned to a diet with 65% carbohydrates and those assigned to a diet with 35% carbohydrates (2.9 and 3.4 kg, respectively) (P>0.20 for all comparisons). Among the 80% of participants who completed the trial, the average weight loss was 4 kg; 14 to 15% of the participants had a reduction of at least 10% of their initial body weight. Satiety, hunger, satisfaction with the diet, and attendance at group sessions were similar for all diets; attendance was strongly associated with weight loss (0.2 kg per session attended). The diets improved lipid-related risk factors and fasting insulin levels.
Conclusions:
Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize. (ClinicalTrials.gov number, NCT00072995.)
To examine trends in overweight prevalence and body mass index of the US adult population.
Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight.
Between 6000 and 13,000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANES II), and 1988 to 1991 (NHANES III phase 1).
In the period 1988 to 1991, 33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg.
These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight.
Overweight and obesity are increasing dramatically in the United States and most likely contribute substantially to the burden of chronic health conditions.
To describe the relationship between weight status and prevalence of health conditions by severity of overweight and obesity in the US population.
Nationally representative cross-sectional survey using data from the Third National Health and Nutrition Examination Survey (NHANES III), which was conducted in 2 phases from 1988 to 1994.
A total of 16884 adults, 25 years and older, classified as overweight and obese (body mass index [BMI] > or =25 kg/m2) based on National Institutes of Health recommended guidelines.
Prevalence of type 2 diabetes mellitus, gallbladder disease, coronary heart disease, high blood cholesterol level, high blood pressure, or osteoarthritis.
Sixty-three percent of men and 55% of women had a body mass index of 25 kg/m2 or greater. A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women. With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m2 and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8) and women (PR, 12.9; 95% CI, 5.7-28.1) and gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2) and women (PR, 5.2; 95% CI, 2.9-8.9). Prevalence ratios generally were greater in younger than in older adults. The prevalence of having 2 or more health conditions increased with weight status category across all racial and ethnic subgroups.
Based on these results, more than half of all US adults are considered overweight or obese. The prevalence of obesity-related comorbidities emphasizes the need for concerted efforts to prevent and treat obesity rather than just its associated comorbidities.
To assess the prevalence of clinically significant weight loss among women and whether this is associated with smaller long-term weight gains.
Six-year follow-up of young and middle-aged women in the Nurses' Health Study II.
A total of 47,515 women who did not report a pregnancy, or a diagnosis of cancer or cardiovascular disease any time between 1989 and 1995.
Self-reported weights in 1989, 1991, 1993 and 1995, dietary intake, physical activity, inactivity, history of weight cycling and smoking.
Between 1989 and 1991, 9% of the women lost > or =5% of their 1989 weight (6% lost 5--9.9% and 3% lost > or =10%). The proportion who lost > or =10% of their weight increased with category of body mass index (BMI, kg/m(2)) from 0.4% among women with a BMI <22 to 9% among women with a BMI > or =30 in 1989. Women who lost > or =5% of their weight between 1989 and 1991 gained more weight between 1991 and 1995 than their peers and the difference increased across categories of BMI in 1989. However, due to their large weight losses, women who lost > or =5% of their weight between 1989 and 1991 overall gained less weight than their peers between 1989 and 1995 (P<0.001). Moreover, women who engaged in 5 or more hours per week of vigorous physical activity gained approximately 0.5 kg less than their inactive peers (P<0.001).
Although most women who lost a clinically significant amount of weight regained most of it, they gained less weight over the entire 6 y period than their peers.
Public health officials and organizations have disseminated health messages regarding the dangers of obesity, but these have not produced the desired effect.
To estimate the expected number of years of life lost (YLL) due to overweight and obesity across the life span of an adult.
Data from the (1) US Life Tables (1999); (2) Third National Health and Nutrition Examination Survey (NHANES III; 1988-1994); and (3) First National Health and Nutrition Epidemiologic Follow-up Study (NHANES I and II; 1971-1992) and NHANES II Mortality Study (1976-1992) were used to derive YLL estimates for adults aged 18 to 85 years. Body mass index (BMI) integer-defined categories were used (ie, <17; 17 to <18; 18 to <19; 20 to <21; 21 to 45; or > or =45). A BMI of 24 was used as the reference category.
The difference between the number of years of life expected if an individual were obese vs not obese, which was designated YLL.
Marked race and sex differences were observed in estimated YLL. Among whites, a J- or U-shaped association was found between overweight or obesity and YLL. The optimal BMI (associated with the least YLL or greatest longevity) is approximately 23 to 25 for whites and 23 to 30 for blacks. For any given degree of overweight, younger adults generally had greater YLL than did older adults. The maximum YLL for white men aged 20 to 30 years with a severe level of obesity (BMI >45) is 13 and is 8 for white women. For men, this could represent a 22% reduction in expected remaining life span. Among black men and black women older than 60 years, overweight and moderate obesity were generally not associated with an increased YLL and only severe obesity resulted in YLL. However, blacks at younger ages with severe levels of obesity had a maximum YLL of 20 for men and 5 for women.
Obesity appears to lessen life expectancy markedly, especially among younger adults.
The effects of shift work on physiological function through disruption of circadian rhythms are well described. However, shift work can also be associated with specific pathological disorders. This article reviews the evidence for a relationship between specific medical disorders and working at night or on shift systems. The strongest evidence exists for an association with peptic ulcer disease, coronary heart disease and compromised pregnancy outcome.
To describe changes in the distribution of waist circumference (WC) and abdominal obesity (AO) in white, black, and Mexican-American adults from 1988 through 2000.
Nationally representative cross-sectional surveys of adults 20 to 79 years of age were examined using data from U.S. National Health and Nutrition Examination Surveys of 1988 to 1994 and 1999 to 2000. AO was defined as WC > or =102 cm in men and > or 88 cm in women.
There was a gradient of increasing WC and AO with increasing age in both study periods in whites and blacks. In men, the average increase between the study periods in overall WC in whites, blacks, and Mexican Americans were 3, 3.3, and 3.4 cm, respectively. The corresponding values in women were 2.4, 5.3, and 3.7 cm, respectively. In men, the percentage change in prevalence of AO between 1988 and 2000 ranged from 5.5% in Mexican-American men to 8.2% in white men. In women, there was a 1.7% decrease in AO in Mexican Americans, whereas there was an increase of 6.3% for whites and 7% for blacks.
Despite increased understanding of the need for screening and treatment for obesity, this study indicates increasing prevalence of AO in white and black Americans. Without concerted effort to reduce the prevalence of overall obesity, the increasing prevalence of AO is likely to lead to increased prevalence of metabolic syndromes in the United States. Our results highlight the need to design evidence-based programs that show promise for long-term health behavior changes to facilitate the prevention of AO and related comorbidities.
As the prevalence of obesity increases in the United States, concern over the association of body weight with excess mortality has also increased.
To estimate deaths associated with underweight (body mass index [BMI] <18.5), overweight (BMI 25 to <30), and obesity (BMI > or =30) in the United States in 2000.
We estimated relative risks of mortality associated with different levels of BMI (calculated as weight in kilograms divided by the square of height in meters) from the nationally representative National Health and Nutrition Examination Survey (NHANES) I (1971-1975) and NHANES II (1976-1980), with follow-up through 1992, and from NHANES III (1988-1994), with follow-up through 2000. These relative risks were applied to the distribution of BMI and other covariates from NHANES 1999-2002 to estimate attributable fractions and number of excess deaths, adjusted for confounding factors and for effect modification by age.
Number of excess deaths in 2000 associated with given BMI levels.
Relative to the normal weight category (BMI 18.5 to <25), obesity (BMI > or =30) was associated with 111,909 excess deaths (95% confidence interval [CI], 53,754-170,064) and underweight with 33,746 excess deaths (95% CI, 15,726-51,766). Overweight was not associated with excess mortality (-86,094 deaths; 95% CI, -161,223 to -10,966). The relative risks of mortality associated with obesity were lower in NHANES II and NHANES III than in NHANES I.
Underweight and obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category. The impact of obesity on mortality may have decreased over time, perhaps because of improvements in public health and medical care. These findings are consistent with the increases in life expectancy in the United States and the declining mortality rates from ischemic heart disease.
To better understand health disparities, we compared US weight gain trends across sociodemographic groups between 1986 and 2002.
We analyzed mean and 80th-percentile body mass index (BMI), calculated from self-reported weight and height, for subpopulations defined by education, relative income, race/ethnicity, and gender. Data were from the Behavioral Risk Factor Surveillance System, a random-digit-dialed telephone survey (total sample=1.88 million adult respondents).
Each sociodemographic group experienced generally similar weight gains. We found no statistically significant difference in increase in mean BMI by educational attainment, except that individuals with a college degree gained less weight than did others. The lowest-income group gained as much weight on average as the highest-income group, but lowest-income heavier individuals (80th percentile of BMI) gained weight faster than highest-income heavier individuals. We found no differences across racial/ethnic groups except that non-Hispanic Blacks gained more weight than other groups. Women gained more weight than men.
We found fewer differences, especially by relative income and education, in weight gain across subpopulations than we had expected. Women and non-Hispanic Blacks gained weight faster than other groups.
Sustained depressive mood is a gateway symptom for a major depressive disorder. This paper investigated whether the association between depressive mood and obesity differs as function of sex, age, and race in US adults after controlling for socio-economic variables of martial status, employment status, income level and education level.
A total of 44,800 nationally representative respondents from the 2001 Behavioral Risk Factor Surveillance Survey were studied. Respondents were classified as having experienced a depressive mood if they felt sad, blue, or depressed at least for 1 week in the previous month. The depressive mood was operationalized in terms of duration and sustenance, both defined based on number of days with depressive mood: 7+ and 14+ days. Age groups were classified as young (18-64 years) and old (65+ years). Obesity status was classified as: not overweight/obese (BMI<25); overweight (25<or=BMI<30); obese (BMI>or=30).
Prevalence of prior-month depressive mood was 14.3 and 7.8% for 7+ and 14+ days, respectively. Controlling for race and socio-economic variables, both young overweight and obese women were significantly more likely to have experienced depressive mood than nonoverweight/nonobese women. Young overweight, but not obese, men were significantly more likely to have experienced depressive mood than nonoverweight/nonobese men. Young obese women were also significantly more likely to have a sustained depressive mood than nonoverweight/nonobese women. For old respondents, depressive mood and its sustenance were not associated with obesity in either sex.
The relationship between the depressive mood and obesity is dependent upon gender, age, and race. Young obese women, Hispanics in particular, are much more prone to depressive mood than nonobese women. Future studies testing associations between depression and obesity should be sensitive to the influence of these demographic and socio-economic variables.
The prevalence of overweight in children and adolescents and obesity in adults in the United States has increased over several decades.
To provide current estimates of the prevalence and trends of overweight in children and adolescents and obesity in adults.
Analysis of height and weight measurements from 3958 children and adolescents aged 2 to 19 years and 4431 adults aged 20 years or older obtained in 2003-2004 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Data from the NHANES obtained in 1999-2000 and in 2001-2002 were compared with data from 2003-2004.
Estimates of the prevalence of overweight in children and adolescents and obesity in adults. Overweight among children and adolescents was defined as at or above the 95th percentile of the sex-specific body mass index (BMI) for age growth charts. Obesity among adults was defined as a BMI of 30 or higher; extreme obesity was defined as a BMI of 40 or higher.
In 2003-2004, 17.1% of US children and adolescents were overweight and 32.2% of adults were obese. Tests for trend were significant for male and female children and adolescents, indicating an increase in the prevalence of overweight in female children and adolescents from 13.8% in 1999-2000 to 16.0% in 2003-2004 and an increase in the prevalence of overweight in male children and adolescents from 14.0% to 18.2%. Among men, the prevalence of obesity increased significantly between 1999-2000 (27.5%) and 2003-2004 (31.1%). Among women, no significant increase in obesity was observed between 1999-2000 (33.4%) and 2003-2004 (33.2%). The prevalence of extreme obesity (body mass index > or =40) in 2003-2004 was 2.8% in men and 6.9% in women. In 2003-2004, significant differences in obesity prevalence remained by race/ethnicity and by age. Approximately 30% of non-Hispanic white adults were obese as were 45.0% of non-Hispanic black adults and 36.8% of Mexican Americans. Among adults aged 20 to 39 years, 28.5% were obese while 36.8% of adults aged 40 to 59 years and 31.0% of those aged 60 years or older were obese in 2003-2004.
The prevalence of overweight among children and adolescents and obesity among men increased significantly during the 6-year period from 1999 to 2004; among women, no overall increases in the prevalence of obesity were observed. These estimates were based on a 6-year period and suggest that the increases in body weight are continuing in men and in children and adolescents while they may be leveling off in women.
To compare the effectiveness of four commercial weight loss diets available to adults in the United Kingdom.
Six month multicentre randomised unblinded controlled trial.
Community based sample of otherwise healthy overweight and obese adults.
Dr Atkins' new diet revolution, Slim-Fast plan, Weight Watchers pure points programme, and Rosemary Conley's eat yourself slim diet and fitness plan.
Weight and body fat changes over six months.
All diets resulted in significant loss of body fat and weight over six months. Groups did not differ significantly but loss of body fat and weight was greater in all groups compared with the control group. In an intention to treat analysis, average weight loss was 5.9 kg and average fat loss was 4.4 kg over six months. The Atkins diet resulted in significantly higher weight loss during the first four weeks, but by the end was no more or less effective than the other diets.
Clinically useful weight loss and fat loss can be achieved in adults who are motivated to follow commercial diets for a substantial period. Given the limited resources for weight management in the NHS, healthcare practitioners should discuss with their patients programmes known to be effective.
Clinical trials NCT00327821.
We assessed whether treatment seeking overweight and obese people citing differing reasons for wanting to lose weight also differed in psychosocial characteristics thought to impact on weight loss. Dieting motives, self-esteem, body image, number of dieting attempts in the past two years, and the primary reason for wanting to lose weight were assessed in 106 treatment seeking overweight and obese volunteers (mean (SD) body mass index 35.5 (5.7)kg/m2; age 41.9 (10.8)y). Reasons for wanting to lose weight fell into three broad categories, with 35%, 50%, and 15% of the participants citing appearance, health, and mood, respectively. Participants citing health reasons were happier with their appearance than people citing mood or appearance reasons. Participants citing mood reasons had poorer self-image and self-esteem, a greater preoccupation with being overweight, and had attempted to diet more often than people citing appearance or health. The primary reason for overweight people seeking weight loss may reflect psychosocial differences that impact on successful weight loss. Identifying a person's reasons and motives for weight loss may help in tailoring dietary and psychological components of a weight loss program to the individual.
More than half of adult Americans are overweight or obese, and public health recommendations call for weight loss in those who are overweight with associated medical conditions or who are obese. However, some controversy exists in the lay press and in the medical literature about the health risks of obesity. We review briefly the large body of evidence indicating that higher levels of body weight and body fat are associated with an increased risk for the development of numerous adverse health consequences. Efforts to prevent further weight gain in adults at risk for overweight and obesity are essential. For those whose present or future health is at risk because of their obesity and who are motivated to make lifestyle changes, a recommendation for weight loss is appropriate.
In no sector of therapeutics is the theory so simple as in weight control. The major gap lies in translating this theory into practice. In the final analysis, the answer lies in personal choice, because many diets seem to work, but not universally in all studies. A reduced calorie diet is obviously essential, although the composition remains to be individually tailored. For this, health care professionals must become “personal trainers” and realize the importance of lifestyle prescriptions with regard to diet and exercise in all consultations, fitting them to the needs of patient. It may be argued that medical practitioners do not have the necessary time or behavioral skills for these long-term interventions, which might be better handled by a team of other health professionals. Prevention is, of course, better than treatment, and therefore a major effort must be made to target children, from breast feeding to education throughout schooling. No more surveys are needed; “we know the enemy and it is us.” In the words of the Lancet editorial concerning obesity: “Our public health leaders must replace prevarication with imagination.”
Dietary modulation is an essential part of weight loss and maintaining its reduction. Although simple in behavioral terms (eat less, exercise more), the tremendous difficulty of weight loss and maintenance has inspired many different diet regimens, in search of an easier, more efficient way to lose weight. Contemporary issues in this matter are the composition of diets (low fat versus low carbohydrate), the choice of carbohydrate (the glycemic index), and the role of calcium and dairy products. This article discusses the scientific evidence of the various dietary manipulations for weight loss and the challenges of maintaining a reduced obese state.
Family history of breast cancer is an established risk factor for this disease and is used to identify women at higher risk, although the impact of risk factors for breast cancer among women with a family history is not well defined.
Using a modified extended log-incidence Pike model, we prospectively examined the impact of risk factors for breast cancer among women with and without a family history of the disease.
Data analyzed were obtained prospectively from the Nurses' Health Study. Two thousand two hundred forty-nine incident cases of invasive breast cancer were identified in a cohort of 89,132 women aged 30-55 years in 1976 followed biennially through 1990 (1.1 million person years of follow-up). With the use of proportional hazards models, we evaluated the association between risk factors for breast cancer and risk among women with and those without a family history of the disease. We then fit a modified extended log-incidence Pike model to these data.
Among women with a family history of breast cancer, reproductive risk factors has associations that were different from those observed among women without a family history of the disease. In particular, we observed little protection from later age at menarche, no protection from multiple births when compared with nulliparity, nor from early, as compared with later, age at first birth. Fitting these data to a model of breast cancer incidence on the basis of reproductive risk factors, we observed an adverse effect of first pregnancy on risk of breast cancer among women with a family history of breast cancer that was approximately 50% greater in magnitude than among women without a family history. Additional births after the first birth conveyed little protection for women with a family history. History of benign breast disease, past use of oral contraceptives, and use of postmenopausal hormones showed relative risks that did not differ between women with a family history and those without a family history of the disease.
We observed a consistent increase in risk of breast cancer among women with a mother or sister history of the disease that was exacerbated by first pregnancy. Among women with a family history of breast cancer, the adverse effect of pregnancy persisted so that to age 70 years, parous women were at higher risk of breast cancer than nulliparous women. Among women without a family history of the disease, first pregnancy was associated with a smaller increase in risk, and early pregnancy and higher number of births were each associated with reduced breast cancer incidence.
The scarcity of data addressing the health effects of popular diets is an important public health concern, especially since patients and physicians are interested in using popular diets as individualized eating strategies for disease prevention.
To assess adherence rates and the effectiveness of 4 popular diets (Atkins, Zone, Weight Watchers, and Ornish) for weight loss and cardiac risk factor reduction.
A single-center randomized trial at an academic medical center in Boston, Mass, of overweight or obese (body mass index: mean, 35; range, 27-42) adults aged 22 to 72 years with known hypertension, dyslipidemia, or fasting hyperglycemia. Participants were enrolled starting July 18, 2000, and randomized to 4 popular diet groups until January 24, 2002.
A total of 160 participants were randomly assigned to either Atkins (carbohydrate restriction, n=40), Zone (macronutrient balance, n=40), Weight Watchers (calorie restriction, n=40), or Ornish (fat restriction, n=40) diet groups. After 2 months of maximum effort, participants selected their own levels of dietary adherence.
One-year changes in baseline weight and cardiac risk factors, and self-selected dietary adherence rates per self-report.
Assuming no change from baseline for participants who discontinued the study, mean (SD) weight loss at 1 year was 2.1 (4.8) kg for Atkins (21 [53%] of 40 participants completed, P = .009), 3.2 (6.0) kg for Zone (26 [65%] of 40 completed, P = .002), 3.0 (4.9) kg for Weight Watchers (26 [65%] of 40 completed, P < .001), and 3.3 (7.3) kg for Ornish (20 [50%] of 40 completed, P = .007). Greater effects were observed in study completers. Each diet significantly reduced the low-density lipoprotein/high-density lipoprotein (HDL) cholesterol ratio by approximately 10% (all P<.05), with no significant effects on blood pressure or glucose at 1 year. Amount of weight loss was associated with self-reported dietary adherence level (r = 0.60; P<.001) but not with diet type (r = 0.07; P = .40). For each diet, decreasing levels of total/HDL cholesterol, C-reactive protein, and insulin were significantly associated with weight loss (mean r = 0.36, 0.37, and 0.39, respectively) with no significant difference between diets (P = .48, P = .57, P = .31, respectively).
Each popular diet modestly reduced body weight and several cardiac risk factors at 1 year. Overall dietary adherence rates were low, although increased adherence was associated with greater weight loss and cardiac risk factor reductions for each diet group.
Sleep apnea is a complex clinical syndrome with profound implications for perioperative care. Associations with hypertension, cardiovascular disease, and obesity make the intraoperative care of such patients extremely challenging, and an increased sensitivity to anesthetic agents dramatically increases the difficulty of postoperative care. Understanding the genetic bases for obesity and sleep apnea may have several long-term benefits for anesthesiologists. Because sleep apnea is chronically underdiagnosed, most patients with the disease will not carry a diagnosis at the time they present for anesthetic care. The inclusion of focused risk assessment tools and genetic markers in preoperative screening may increase the sensitivity of existing screening tests and reduce the number of patients who undergo anesthesia with undiagnosed sleep apnea. In addition, a greater insight into the relationship between genetic variance and sleep apnea may ultimately allow anesthesiologists to determine which patients with sleep apnea represent greater perioperative risks and thus which patients require special precautions. Finally, the increasing penetration of genetic knowledge into clinical medicine raises the future possibility that therapeutic options based on genetic diagnoses may allow anesthesiologists to modify either the expression of the disorder or its perioperative risk.
To examine the associations of abdominal fat and obesity with functional limitations and disability in late adulthood.
Longitudinal, cohort study.
African American and white men and women aged 45-64 y at baseline with measured waist circumference, waist-to-hip ratio (WHR), and body mass index (BMI) who participated in the Atherosclerosis Risk in Communities (ARIC) Study (n = 9416).
Self-reported functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) at ages 52-75 y.
Waist circumference, WHR, and BMI were positively associated with functional limitations and ADL and IADL impairment approximately 9 y later among African American and white men and women. For example, in African American women the odds ratios (95% CI) associated with a one standard deviation (s.d.) increment in waist circumference (13.3 cm) for severe functional limitations and ADL and IADL impairment were 2.36 (2.00-2.79), 1.41 (1.25-1.58), and 1.49 (1.34-1.66), respectively. In white women, the odds ratios (95% CI) were 2.66 (2.39-2.96), 1.60 (1.47-1.74), and 1.42 (1.31-1.53), respectively. Similar associations were found in men. A 1 s.d. increment in WHR (0.08 U) and BMI (5.06 kg/m2) produced similar results. The associations of waist circumference and WHR with functional limitations and ADL and IADL impairment were attenuated but, in general, remained statistically significant when BMI was added to the models.
Maintaining a healthy body weight and avoiding increases in abdominal fat should be investigated for their potential to reduce the risk of functional limitations and disability in an aging population.
Excess bodyweight is the sixth most important risk factor contributing to the overall burden of disease worldwide. 1.1 billion adults and 10% of children are now classified as overweight or obese. Average life expectancy is already diminished; the main adverse consequences are cardiovascular disease, type 2 diabetes, and several cancers. The complex pathological processes reflect environmental and genetic interactions, and individuals from disadvantaged communities seem to have greater risks than more affluent individuals partly because of fetal and postnatal imprinting. Obesity, with its array of comorbidities, necessitates careful clinical assessment to identify underlying factors and to allow coherent management. The epidemic reflects progressive secular and age-related decreases in physical activity, together with substantial dietary changes with passive over-consumption of energy despite the neurobiological processes controlling food intake. Effective long-term weight loss depends on permanent changes in dietary quality, energy intake, and activity. Neither the medical management nor the societal preventive challenges are currently being met.
To review available literature regarding weight gain associated with commonly prescribed drugs and adjunctive therapy used to limit weight gain.
Information was retrieved from a MEDLINE English-literature search between 1995 and July 2005, with a major subject heading of weight gain/drug effects excluding complementary alternative medicines. Other limits applied included human subjects and individuals >19 years of age. Additionally, references from retrieved articles were reviewed to identify other literature sources.
Changes in weight are generally reported as a primary or secondary outcome of many studies. Where possible, prospective, randomized, controlled trials were preferred; however, many studies were retrospective or open label. Meta-analyses and recent reviews, especially those providing a detailed description of the proposed mechanism involved in weight gain beyond the scope of this article, were included. Limited information was available from case reports. Studies were categorized by therapeutic area including psychiatry, neurology, diabetes, and other miscellaneous drug therapy. Medications used to intentionally stimulate appetite for weight gain, such as megesterol acetate, were not included.
Weight gain with medication is usually associated with individual agents within a class. The tendency to cause weight gain is often related to differential specificity and sensitivity of binding to receptors involved with appetite regulation.
Clinically significant weight gain is associated with some commonly prescribed medicines. There is wide interindividual variation in response and variation of the degree of weight gain within drug classes. Where possible, alternative therapy should be selected, especially for individuals predisposed to overweight and obesity.
To determine whether people with different educational backgrounds respond differently to a lifestyle intervention program for obese patients with type 2 diabetes.
The study consisted of a 12-month randomized controlled trial of 147 health plan members with type 2 diabetes who were overweight or obese (BMI > or = 27 kg/m(2)). Participants were randomized to lifestyle case management or usual care. Case management (CM) involved group and individual education, support, and referral by registered dietitians. Usual care (UC) participants received educational material. Both groups received ongoing primary care. A post hoc analysis was performed, evaluating the impact of education level on intervention group differences with respect to change in weight and waist circumference.
There was a significant education by group interaction for both changes in weight (p = 0.02) and waist circumference (p = 0.01) during the study period. Contrary to expectations, CM participants with less formal education had greater risk reductions compared with more educated participants. Models predicted that, by 12 months, those with less education in the UC group gained 1.71 kg more in weight and 3.67 cm more in waist circumference than those with greater education. However, by 12 months, those in the CM group with less education lost a model-predicted 3.30 kg more in weight and 4.95 cm more in waist circumference than those with more formal education.
People with varied educational backgrounds may respond differently to a lifestyle intervention for weight management and diabetes control.
Because obesity is associated with an increased risk of multiple health problems, it is important for gastroenterologists and all health care providers routinely to identify, evaluate, and treat patients for obesity in the course of daily practice. Therapy for obesity always begins with lifestyle management and may include pharmacotherapy or surgery. Setting an initial weight loss goal of 10% over 6 months is a realistic target, followed by long-term management.
We use panel data from the National Longitudinal Survey of Youth (NLSY) to examine how body weight changes with age for a cohort moving through early adulthood, to investigate how the age-obesity gradient differs with socioeconomic status (SES) and to study channels for these SES disparities. Our results show first that weight increases with age and is inversely related to SES during childhood. Second, the obesity gradient widens over the lifecycle, consistent with research on other health outcomes. Third, a substantial portion of the "effect" of early life conditions operates through race/ethnicity and the translation of advantaged family backgrounds during childhood into higher levels of subsequent education. By contrast, little of the SES gap appears to propagate through household composition, family income or health behaviors. Fourth, adult SES has independent effects after controlling for childhood status.
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