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Medical Consequences of Obesity
Abstract
Obesity is an epidemic disease that threatens to inundate health care resources by increasing the incidence of diabetes, heart disease, hypertension, and cancer. These effects of obesity result from two factors: the increased mass of adipose tissue and the increased secretion of pathogenetic products from enlarged fat cells. This concept of the pathogenesis of obesity as a disease allows an easy division of disadvantages of obesity into those produced by the mass of fat and those produced by the metabolic effects of fat cells. In the former category are the social disabilities resulting from the stigma associated with obesity, sleep apnea that results in part from increased parapharyngeal fat deposits, and osteoarthritis resulting from the wear and tear on joints from carrying an increased mass of fat. The second category includes the metabolic factors associated with distant effects of products released from enlarged fat cells. The insulin-resistant state that is so common in obesity probably reflects the effects of increased release of fatty acids from fat cells that are then stored in the liver or muscle. When the secretory capacity of the pancreas is overwhelmed by battling insulin resistance, diabetes develops. The strong association of increased fat, especially visceral fat, with diabetes makes this consequence particularly ominous for health care costs. The release of cytokines, particularly IL-6, from the fat cell may stimulate the proinflammatory state that characterizes obesity. The increased secretion of prothrombin activator inhibitor-1 from fat cells may play a role in the procoagulant state of obesity and, along with changes in endothelial function, may be responsible for the increased risk of cardiovascular disease and hypertension. For cancer, the production of estrogens by the enlarged stromal mass plays a role in the risk for breast cancer. Increased cytokine release may play a role in other forms of proliferative growth. The combined effect of these pathogenetic consequences of increased fat stores is an increased risk of shortened life expectancy.
... High body mass index (BMI) and weight gain are acknowledged as primary global epidemic health problems and are associated with an increasing prevalence of hypertension, diabetes, and cardiovascular and cerebrovascular diseases. 1 The health complications of obesity are the results of two factors: the heightened mass of adipose tissue and the raised secretion of pathogenetic products from enlarged fat cells. Moreover, high BMI is associated with an increasing prevalence of hypertension which is the chief cause of cardiovascular mortality and disability in Western countries. ...
... Moreover, high BMI is associated with an increasing prevalence of hypertension which is the chief cause of cardiovascular mortality and disability in Western countries. 1,2 In 2017, the number of patients with cardiovascular diseases (CVDs) reached a record 485 million worldwide, resulting in 17.8 million deaths, therefore placing a heavy burden on the global medical system. 1 Weight loss is commonly recommended in obese patients as one of the primary measures for preventing and treating hypertension, diabetes, improvement of blood lipids, reduction in blood glucose, and CVD. However, weight loss is very often followed by weight gain, which is commonly called "weight cycling," which results in BMI variability and fluctuations. ...
... 1,2 In 2017, the number of patients with cardiovascular diseases (CVDs) reached a record 485 million worldwide, resulting in 17.8 million deaths, therefore placing a heavy burden on the global medical system. 1 Weight loss is commonly recommended in obese patients as one of the primary measures for preventing and treating hypertension, diabetes, improvement of blood lipids, reduction in blood glucose, and CVD. However, weight loss is very often followed by weight gain, which is commonly called "weight cycling," which results in BMI variability and fluctuations. ...
In today's world, high variability of body mass index (BMI) is known as a significant global health problem that can lead to many negative impacts on the cardiovascular system, including atrial fibrillation (AF) and coronary heart disease. The current systematic review aims to elucidate the effect of variability in BMI on the risk of cardiovascular outcomes. Four databases, including PubMed, Scopus, MEDLINE, and CENTRAL, were searched. All related articles up to 10 June 2022, were obtained. Titles, abstracts, and full texts were reviewed. After screening abstracts and full texts, four articles were included in our study. In these four cohort studies, 7,038,873 participants from the USA and South Korea were involved. These articles generally considered the BMI and outcomes including cardiovascular disease, AF, and coronary heart disease. All these articles reported an association between the variability of BMI and increased risk of cardiovascular outcomes. Due to the negative impact of the high variability of BMI on the risk of cardiovascular outcomes, health policymakers and practitioners should pay more attention to the significant role of BMI in health problems and physicians might better check the variability of BMI visits to visit.
... It has not been clearly determined how genetic variables have interactions with environmental and dietary aspects to accelerate their incidence [22,23]. It has been reveal that genes associated with pathways of carbohydrate, lipid and amino acid metabolism, as well as glycan biosynthesis, pathways in the metabolism of cofactors and vitamins, ubiquitin mediated proteolysis, pathways of signal transduction, interactions of neuroactive ligand-receptor, pathways of nervous system, and neurodegenerative perturbation pathways are upregulated in obesity in comparison to normal persons [24]. Obversely, genes associated with molecules of cell adhesion, cytokine-cytokine receptor interaction, insulin signaling and immune system pathways undergo downregulation in obesity. ...
... Genes implicated in signal transduction, actin cytoskeleton regulation, processing and presentation of antigen, complement and coagulation cascades, axon guidance and pathways of neurodegenerative disorders are upregulated in type 2 diabetic subjects with family history of diabetes in contradistinction to diabetic subjects devoid of any family history. Genes connected with pathways of oxidative phosphorylation, immune, nervous system and metabolic diseases are upregulated in diabetic subjects with diabetes family history, but not in diabetes devoid of any family history [24]. On the contrary, genes related in lipid and amino acid pathways, ubiquitin mediated proteolysis, signal transduction, insulin and PPAR signaling pathways are downregulated in individuals with diabetes and concomitant family history. ...
... Genetic predisposition contributes immensely to obesity as determined by familial aggregation, twin and adoption studies [22,23]. Obesity results from energy intake, mainly accumulated as triglycerides surpassing energy expenditure [24]; and influenced by age, diet, developmental stage, genes and physical activity [25]. The prevalence increase of obesity correlates with type 2 diabetes prevalence, impaired glucose tolerance [26] and numerous complications of both disorders, such as arthritis, hypertension, sleep apnoea, cardiovascular disorders and organ perturbations [27]. ...
The extant COVID-19 pandemic has resulted in an expansive mortality due to the SARS-CoV-2. The SARS-CoV-2 is encompassed by a lipid bilayer that enhances fusion of the viral membrane to the host cell, replication, endocytosis, exocytosis and role of lipid metabolism in viral infectivity. In the absence of appropriate drugs and vaccines, there are never-ending opportunities for antiviral treatments. Consumption of diets suffused with carbohydrates and saturated fats contribute to obesity and diabetes prevalence, oxidative stress and comorbidities development as risk factors for COVID-19 pandemic as an emergency public health enigma. COVID-19 outbreak has invariably constituted a severe challenge to global public health system with resultant deficient approaches to stem the disorder but carbohydrates may provide accelerated diagnostics, appropriate, effective and efficient vaccines and therapeutic regimen. This paper provides a set of themes and modalities for analysing carbohydrate-lipid interactions as extrapolated to the issues and challenges of SARS-CoV-2, the causative agent of the COVID-19 pandemic.
... Dolaşan kan hacmindeki artış, artan vazokonstrüksiyon ve artmış olan kalp atım hacmi HT gelişimine neden olur. Hiperinsülinemiye bağlı böbreklerden sodyum emiliminin artması da tansiyonu yükseltir ve obez bireylerde HT varlığında ventrikül duvar kalınlığı, kalp boşluklarının hacmi ve sonucunda da kalp yetmezliği riski artar (Bray, 2004). ...
... Obezitede abdominal obezite, glukoz intoleransı, dislipidemi ve HT gibi metabolik problemlerin birleşimi olarak tanımlan metabolik sendrom gelişebilmektedir (Demirel ve diğ., 2017). Dislipidemiyle ilişkili olarak; hiperinsülinemi ve abdominal obezite subkütan yağ dokusundan serbest yağ asitlerinin atılmasıyla karaciğerden sentez ve salınımı artan Very Low Density Lipoprotein (VLDL) ve Low Density Lipoprotein (LDL) artışı gözlenirken High Density Lipoprotein (LHD) düzeyinde ise azalma gözlenmektedir (Klop ve diğ., 2013;Kalan ve Yeşil, 2010;Bray, 2004). Ayrıca kilo alımının diyabet riskini artırdığı bilinmekte, insüline bağlı glikoz alımının da insülin direncine neden olarak, hiperinsülinemi ve pankreatik beta hücrelerinde harabiyetin başlamasıyla Tip 2 diyabete yol açtığı görülmektedir (Kalan ve Yeşil, 2010). ...
The research was carried out with the aim of determining the opinions of individuals
who underwent bariatric surgery about their nutritional behavior. In the research conducted in qualitative design and phenomenological design, data were collected by in-depth interview method. The data collection process was concluded with a total of 13 participants, 10 female and 3 male. The data of the research were collected by the researcher with the "Personal Data Collection Form" and "In-depth Interview Form", which were created in line with the literature data. The analysis of the data was made using thematic analysis and content analysis method using the MAXQDA 2022 program. The findings obtained as a result of the research,
'motivation to undergo surgery', 'post-operative nutritional behavior', 'changes in post-operative nutritional behavior', 'difficulties', 'coping', 'expectations from life after surgery', 'changes in mood', ' life changes', 'reasons for weight gain', 'support product', 'diagnosed mental illness' were gathered under 11 main themes. Three categories were created in the theme of postoperative nutritional behavior and the participants; They mentioned that they were fed only with liquid for the first 2 months after the surgery, they switched to puree nutrition in the 2nd and 3rd months, and that they started to consume meat in the 8th and 9th months. Participants who experienced changes in their eating behavior after surgery; They stated various changes in physical activity patterns, water consumption rates, maintaining old habits, diets and food consumption. In addition to these, individuals who have some difficulties after surgery, in 16 codes; It was observed that they faced many difficulties such as intense stomach cramps, disgust, vomiting, self-vomiting, weakness, inability to eat, and loss of strength. In order to overcome all these difficulties, individuals are in the theme of coping; they experience positive emotions such as being determined, feeling strong, receiving support from close circles, seeing surgery as a second chance, and considering getting expert support; In addition to these, they also stated that they experienced negativities such as crying, having panic attacks, removing people from their lives and coping with chronic diseases. It has been observed that individuals who expect to get their lives on the road and to get rid of diseases after the surgery, actually realize that this situation has nothing to do with the surgery. In addition, individuals who experience changes in their emotional states; It was determined that they were happy, disappointed, regretted the operation, and thought of being a burden developed. Participants who experienced significant changes in their lives during the post-operative period; It was seen that they were more free in their choice of clothes, they experienced a significant increase in their self-confidence by being praised, they improved in family relations, they had ease in moving and they felt energetic, their sleep improved and they did not experience health problems. Participants; It was determined that they gained weight due to genetic predisposition, having an overweight childhood, eating irregularly, having an illness, psychological problems, life course, quitting sports, and deliberately gaining weight in order to have surgery. It was concluded that the participants who used supplements such as drugs and herbalife to lose weight did not benefit from them, and it was observed that the individuals with panic attacks and epilepsy diagnoses before the surgery continued to have these conditions after the surgery. In conclusion; It is recommended that awareness issues related to nutrition after bariatric surgery should be included in in-service training programs.
... Obesity embodies a group of conditions generated by several factors, including genetic elements, environmental conditions, and psychosocial in uences (Aronne 2009). The interaction between these factors, coupled with an imbalance in energy intake and expenditure, causes an increase in the size of fat cells and their number (Bray 2004). The clinical markers of obesity present themselves as a metabolic disturbance that leads to dysfunction of tissues (Anderson et al. 2016). ...
... Despite growing in size, it is generally underdiagnosed (Kroner 2009). As was already said, regardless of the external conditions, a genetic component has been demonstrated to in uence the development or, in some cases, the lack of development (Bray 2004). Several research works have revealed a link between the onset of T2D and a variety of illnesses, including neurological conditions like dementia, Alzheimer's, and Parkinson's (Li and Huang 2016). ...
The population is increasingly obese, which is linked to the emergence of numerous health issues. Numerous risk factors are present along with the metabolic syndrome. Genetic components, environmental factors, and psychosocial impacts are some of the causes that contribute to obesity. Increases in diabetes mellitus, coronary heart disease, some malignancies, and sleep-related breathing issues have all been linked to an increase in obese cases. Type 2 diabetes (T2D) mellitus due to obesity has been shown to cause brain alterations that may lead to cognitive impairment. A correlation between T2D and an increased risk for neurodegenerative diseases such as dementia, Parkinson’s disease (PD), and Alzheimer’s disease (AD) was observed. Thus, understanding the connection between these diseases may aid in halting or delaying their prevalence. In this report, we studied the impact of a high-fat diet (HFD) on the development of obesity and diabetes and its effect on brain weight. In the two experimental groups, an evaluation was conducted on a cohort of 143 mice from eight different collaborative Cross (CC) mouse lines. For the entire 12 weeks experiment period, the mice were kept on either the high-fat diet (HFD) or chow diet (CHD). Throughout the experiment, the body weight of each mouse was recorded on weeks zero, 6, and 12, while the host's response to a glucose load and clearance was measured using the intraperitoneal glucose tolerance test (IPGTT) at two time points, week 6 and 12. These results were then converted to the area under the curve (AUC) values. At week 12, mice were culled, their brains were removed, and then evaluated. The results have revealed that HFD has a different impact on obesity and T2D development, as well as on brain weight among the different CC lines, and varies depending on the sex. Finally, we applied machine learning (ML) approaches to explore aspects of brain weight changes, using sex, diet, initial body weight, and area under the curve (AUC) as an indicator for T2D development and severity at weeks 6 and 12 at the end-stage of the experiment, while variation in efficiency exists between different host genetic backgrounds. This emphasizes a personalized/precision medicine approach. Altogether, it illustrates the power of the CC mice in identifying susceptible genes to personalized/precision of co and multimorbidity of T2D and obesity in future studies.
... An imbalance between the intake of energy f rom f ood and energy expenditure is what def ines obesity. Theref ore, the excess energy stored in f at cells which eventually leads to weight gain i.e., obesity (Bray, 2004). Currently, the World Health Organization (WHO) and many other national and international organizations have f ormally classif ied obesity as a disease (Müller et al., 2017). ...
... The increased mass of f at itself is the f undamental cause of the impairments, which consist of the stigma of obesity and psychosocial issues (bad body picture perception, low self -esteem, depression, and reduced quality of lif e) and even osteoarthritis. In contrast, the second category included risks associated with metabolic abnormalities brought on by excess f at, such as diabetes mellitus, gallbladder disease, hypertension, cardiovascular disease, problems related to reproductive health (f rom inf ertility to subf ertility, such as polycystic ovarian syndrome), and certain cancers (Bray, 2004). Besides this, obesity not only threatens to inundate the health care sources by increasing dif ferent clinical Bandyopadhyay et al. ...
The occurrence and intensity of both natural and human-made disasters are bound to increase, posing significant risks to humanity. In Malaysia’s healthcare setting, a variety of procedures and practices for managing safety, health, and emergency management are implemented to ensure the comfort and protection of hospital personnel, patients, and visitors. The presence of chemical, biological, radiological, and nuclear (CBRN) hazards pose a grave risk to the health and well-being of healthcare personnel in Malaysia. The aim of this review article is to draw attention to practical implications and provide a thorough summary of the literature on CBRN hazard management in Malaysian healthcare.
... An imbalance between the intake of energy f rom f ood and energy expenditure is what def ines obesity. Theref ore, the excess energy stored in f at cells which eventually leads to weight gain i.e., obesity (Bray, 2004). Currently, the World Health Organization (WHO) and many other national and international organizations have f ormally classif ied obesity as a disease (Müller et al., 2017). ...
... The increased mass of f at itself is the f undamental cause of the impairments, which consist of the stigma of obesity and psychosocial issues (bad body picture perception, low self -esteem, depression, and reduced quality of lif e) and even osteoarthritis. In contrast, the second category included risks associated with metabolic abnormalities brought on by excess f at, such as diabetes mellitus, gallbladder disease, hypertension, cardiovascular disease, problems related to reproductive health (f rom inf ertility to subf ertility, such as polycystic ovarian syndrome), and certain cancers (Bray, 2004). Besides this, obesity not only threatens to inundate the health care sources by increasing dif ferent clinical Bandyopadhyay et al. ...
Background: The imbalance between the energy ingested in f ood and expended can lead to obesity. It is regarded as one of the most prominent but ignored public health issues of today and threatens to inundate the health care resources through increasing clinical consequences and additionally as a f inancial burden. Hence, the identity of individuals with health dangers using easy, surrogate measures to estimate excess adiposity becoming very important. In this regard, the purpose of this study is to evaluate the incidence of obesity, considering commonly used obesity measures, and also to discern the best obesity predictor among the adult Bengalee f emales of West Bengal, India. Research Method: Participants included 210 healthy adult Bengalee women (mean age 43.06 ± 3.4 years). Following standard procedure, anthropometric measures were taken f or height, weight, hip circumf erence, and waist circumf erence. Waist-to-hip and waist-to-stature ratios were then computed. A f at monitor was used to calculate body f at percentage. Results: Out of all the adiposity measures, Waist Circumf erenc e (r = 0.78, P<0.001), Hip Circumf erence (r = 0.74, P<0.001), and Waist Hip Ratio (r = 0.72, P<0.001), the results showed that Waist Stature Ratio had the largest positive connection (r = 0.88, P<0.001) with Percent Body f at. Conclusion: Theref ore, the current study indicated that among Asian Indian middle-aged women, WSR may be the most appropriate marker f or PBF.
... [2] Obesity increases the complexity of surgical intervention, can increase operative time and can be associated with worse outcomes. [3][4][5] Laparoscopic cholecystectomy (LC) is one of the most frequently perfor med surgical procedures worldwide. [6] Given that obesity is a well-recognised risk factor for gallstone disease, it is common to perform LC on overweight and obese patients. ...
... [6] Given that obesity is a well-recognised risk factor for gallstone disease, it is common to perform LC on overweight and obese patients. [3] In the UK, over 40% of patients undergoing cholecystectomy have a body mass index (BMI) of 30 kg/m 2 and above. [7] Obesity can increase the technical difficulty of any laparoscopic procedure -the increased abdominal wall adiposity can make access to the abdominal cavity challenging and provide resistance to port movement. ...
Background
The role of a very low-calorie diet (VLCD) before cholecystectomy in obese patients is unclear. This study evaluated whether VLCD could be used as a risk mitigation strategy for this high-risk patient cohort.
Patients and Methods
A systematic review and meta-analysis was performed (PROSPERO ID CRD42022374610). The primary outcome was to determine the impact of pre-operative VLCD on the operative findings and ease of dissection during laparoscopic cholecystectomy (LC).
Results
Two studies were included with a total of 84 patients. VLCD was associated with a significantly easier Calot’s dissection (MD: −0.58 (95% confidence interval [CI] [ −1.03, -0.13], P = 0.01) and was associated with a significantly higher rate of pre-operative weight loss (MD; 2.92 (95% CI [2.23, 3.62], P = 0.00001).
Conclusions
The published evidence regarding VLCD before cholecystectomy in obese patients is limited. After acknowledging the limitations of the data, VLCD is associated with a significantly higher rate of weight loss preoperatively and directly impacts the ease of intraoperative dissection of Calot’s triangle. Routine use of VLCD should be considered for all obese patients undergoing elective LC.
... The mechanisms by which HDL influences diabetes are believed to be related to HDL function and its major apolipoprotein, apoA-I (41)(42)(43). They regulate glucose metabolism by improving insulin sensitivity and increasing insulin secretion (44). Kaplan-Meier curve of ALT/HDL-C ratio quintiles over time. ...
... As a new index, the specific mechanism by which the ALT/ HDL-C ratio leads to diabetes remains unclear. However, numerous studies have shown that ALT and HDL are both associated with IR (36,44), suggesting that the mechanism by which the ALT/HDL-C ratio leads to diabetes may be closely related to IR. As we know, IR, as a pathogenic driver of metabolic diseases, is defined as reduced sensitivity of target organs to the action of insulin (56). ...
Objective
Both alanine aminotransferase (ALT) and high-density lipoprotein cholesterol (HDL-C) are closely related to glucose homeostasis in the body, and the main objective of this study was to investigate the association between ALT to HDL-C ratio (ALT/HDL-C ratio) and the risk of diabetes in a Chinese population.
Methods
The current study included 116,251 participants who underwent a healthy physical examination, and the study endpoint was defined as a diagnosis of new-onset diabetes. Multivariate Cox regression models and receiver operator characteristic curves were used to assess the association of the ALT/HDL-C ratio with diabetes onset.
Results
During the average observation period of 3.10 years, a total of 2,674 (2.3%) participants were diagnosed with new-onset diabetes, including 1,883 (1.62%) males and 791 (0.68%) females. After fully adjusting for confounding factors, we found a significant positive association between the ALT/HDL-C ratio and the risk of diabetes [Hazard ratios 1.06, 95% confidence intervals: 1.05, 1.06], and this association was significantly higher in males, obese individuals [body mass index ≥ 28 kg/m ² ] and individuals aged < 60 years (All P interaction < 0.05). In addition, the ALT/HDL-C ratio was significantly better than its components ALT and HDL-C in predicting diabetes in the Chinese population.
Conclusion
There was a positive relationship between ALT/HDL-C ratio and diabetes risk in the Chinese population, and this relationship was significantly stronger in males, obese individuals, and individuals younger than 60 years old.
... Excess body fat underlies 64% of cases of diabetes in men and 77% of cases in women [22]. Health consequences fall into two broad categories: those attributable to the effects of increased fat mass (such as osteoarthritis, obstructive sleep apnea, social stigmatization) and those due to the increased number of fat cells (diabetes, cancer, cardiovascular disease, non-alcoholic fatty liver disease) [2,23]. Increases in body fat alter the body's response to insulin, potentially leading to insulin resistance. ...
... Increases in body fat alter the body's response to insulin, potentially leading to insulin resistance. Increased fat also creates a proinflammatorystate [24,25] and a prothrombotic state [23,26]. This studied aimed to matured some inflammatory and Biochemical parameter and compared results between lean and obese women. ...
The present study aims to detecting several biochemical markers and cytokines in obese and normal lean Iraqi women. Forty women (20 obese and 20 lean) were chosen from different areas in Baghdad city there ages ranges between 20-37 years and body mass index (BMI) between 20.75-35.6 Kg/m². The study showed a high significant increment in Fasting Blood Glucose (FBG), serum cholesterol and Homeostasis Model Assessment (HOMA) in obese women as compared with lean and a significant increment in HDL (High Density Lipoprotein) in lean women when compared with obese ones. A significant correlation coefficient (r) was noticed between BMI and studied parameters, FBG, cholesterol, triglyceride, insulin, HOMA, high sensitive C Reactive Protein (hs-CRP), Tumor Necrosis Factor alfa (TNF-α) and IL-6.
... Obesity itself is a health risk factor that influences the development and progression of various diseases, such as dyslipidemia, ischemic heart disease, hypertension, type 2 diabetes mellitus, and sleep apnea-hypopnea syndrome, thus worsening patients' quality of life, limiting their activities, and causing psychosocial problems. There is a direct relationship between body mass index (BMI) and morbidity and mortality risks in obese patients, which derives from associated pathologies and makes obesity itself a disease [1][2][3]. ...
... Obese patients often tire of following a low-calorie diet for long periods of time. A continuous feeling of hunger is the main cause of dietary treatment failure [1,4]. Percutaneous electroneurostimulation of the T6 dermatome (PENS T6) has been shown to reduce appetite and improve diet compliance, leading to significantly greater weight loss than hypocaloric diet alone and maintained for at least 1 year after treatment in patients with BMI > 30 kg/m 2 [5][6][7]. ...
The pathogenesis of obesity has been linked to alterations in gut microorganisms. The aim of this study was to investigate the effect of Lactobacillus kefiri, together with PENS T6 and a hypocaloric diet, on weight loss, hypertension and laboratory glycemic and lipid profile. A prospective non-randomized study was conducted involving adult patients with a body mass index (BMI) > 30 kg/m2. Patients were divided into two groups: those undergoing PENS-T6 and hypocaloric diet (PENS-Diet Group) and those undergoing the same PENS-T6 scheme and hypocaloric diet, but additionally receiving probiotics including Lactobacillus kefiri (PENS-Diet + L. kefiri Group). Weight loss was assessed at the end of the treatment, and analytical glycemic and lipid profile, and microbiological analysis of feces were performed before and after treatment. The addition of Lactobacillus kefiri to PENS T6 and a low-calorie diet, increases weight loss and further improves the glycemic and lipid profile. L. kefiri also causes a further improvement in obesity-associated dysbiosis, mainly by increasing the muconutritive (Akkermansia muciniphila) and regulatory (Bifidobacterium spp.) microbiome, and the Phylum Bacteroidetes (Prevotella spp.) and decreasing the Firmicutes/Bacteroidetes ratio.
... Body weight is a sum total of the physiological composition of the body including; fluids, muscle, bone and fats. Despite the contributions of muscle and bone mass to body weight, it is the sum of body fat that determines the adverse health conditions associated with obesity (1). Body weight alone could not account for the whole body fat since people who are tall or athletic would have more of bone or muscle mass. ...
Purpose: The aim of the present study was to evaluate body weight perception and its relationship with anthropometric indices and blood glucose of undergraduate students in Port Harcourt. Methodology: The study involved a total of 600 undergraduate students aged 18-35 years (including 249 males and 351 females). Body weight perception was assessed using a structured questionnaire. The anthropometric indices (weight, height, waist, hip and shoulder circumference and foot length) of each subject were measured using standard methods while the ratios were calculated. Findings: The average BMI of undergraduates was 23.66±0.13kg/m2. There was no significant gender difference in BMI, hip circumference and foot length. Waist circumference and waist-to-hip ratio were significantly higher in males while waist-to-height ratio was significantly higher in females. There was significant correlation between BMI and hip circumference, shoulder circumference and waist circumference but no significant correlation exists between BMI and foot length. The incidence of obesity amongst undergraduates in Port Harcourt was as low as 3.3% using the measured BMI even when only 1.5% admitted being obese. The actual BMI classified overweight was 25.7% as against perceived overweight of 19.8%. Only 56.3% perceived themselves to be within the normal weight whereas up to 67.5% were actually normal weight. The incidence of underweight was 3.5% but as many as 22.3% of undergraduates perceived they were underweight. Unique Contribution of Theory, Practice and Policy: Waist-to-height ratio therefore was more useful in assessing abdominal size in females while waist-to-hip ratio was more useful in assessing abdominal size in young adult males. Amongst the anthropometric indices, foot length was a poor tool in assessing body weight.
... There are a number of factors which can contribute to becoming obese such as eating a high calorie diet (high fat diet), not getting enough physical exercise, genetics, medical conditions and being on medications. Obesity is also thought to trigger changes to the metabolism of the body (Bray, 2004 (Boedtkjer and Aalkjaer, 2013). Sodium, an electrolyte (mineral) found mostly in the body fluids outside the cells, is very important for maintaining blood pressure (Grillo et al., 2019). ...
This article centres on the effects of selected plant extract and sap on hypertensive subjects and its comparison with a reference drug, Eplerenone which is thought to be of standard.
... Obesity is a chronic disease [13,26] which results from a positive energy balance regulated by a complex interaction between endocrine tissues and the central nervous system [6,19]. It has a multifactorial etiology that includes genetic, environmental, socioeconomic, and behavioural or psychological influences [37,27,17]. ...
Obesity is an etiologically complex and multifactorial phenotype, underpinned by genetic, environmental, socioeconomic and behavioural or psychological factors. Worldwide prevalence of obesity is reaching epidemic or pandemic proportions, which has resulted in an increased prevalence of obesity-related co-morbidities and financial burden that needs effective interventions. The prevalence of obesity varies significantly across the world, and several studies have been conducted in this regard in different regions on different age groups, but studies on the tribal female population of Northeast India are underrepresented, being mostly limited to schoolchildren. Under these circumstances, the present study was conducted to assess the prevalence of obesity among the tribal females of Tripura, Northeast India.
To achieve this purpose, the present study was conducted on 114 adult Tripuri females of Northeast India. Data were collected on anthropometric variables – height, weight, waist circumference (WC), and hip circumference (HC) – by using the standard technique. Then, from these anthropometric measurements, a number of indices – waist-stature ratio (WSR), body mass index (BMI), conicity index (CI) and waist-hip ratio (WHR) were calculated. The necessary descriptive and inferential statistics were calculated by using SPSS version 18.
The present study vindicated that only 22% women were overweight as per BMI, but 88% and 72% women were in the high-risk category on the basis of WHR and WSR respectively. Moreover, 86% of the females were biconic, which indicates higher prevalence of central obesity among the studied population.
Therefore, it can be concluded that anthropometric variables can be used as one of the efficient tools to assess obesity and health status of the Tripuri women. More in-depth studies using large samples and other different anthropometric indicators are required for better insightful approach towards ethnic group specific public health policy making.
... Obesity predisposes to the development of other non-communicable diseases 32,33 (NCDs) such as T2DM . It is defined as a body mass index 2 (BMI) of greater than or equal to 30kg/m and results from an abnormal increase in deposition of fat in adipocytes which then secretes abnormal pathogenic products that induce 34 changes in the body . Currently, obesity is mainly treated with lifestyle modification which includes dietary 35 restrictions and exercise . ...
The global epidemic of metabolic syndrome (MetS) constitutes a major public health concern as it affects both
the developed and the developing nations, and cuts across all age groups. MetS is a cluster of several risk
correlates of cardio-metabolic diseases that predispose to the development of cardiovascular disease and type 2
diabetes mellitus. Despite being a huge problem, no single standalone treatment for MetS exists. Current
treatment modalities target the individual risk factors with pharmacotherapy that usually has to be taken for life.
In addition to the burden of cost and problems with drug compliance, there is usually the possibility of cumulative
toxic side effects from the medications Natural products and herbal medicines have been speculated to have a
better safety profile and are more available and affordable. Cucumis sativus L., commonly known as cucumber,
belongs to the family Cucurbitaceae which grows both as a wild and cultivated species in the tropics that is
usually consumed either raw or cooked as a vegetable. It has historically been recognised and used as a laxative,
anthelminthic, and antipyretic, treatment for eye diseases and scorpion stings. Research has shown that the
vegetable plant has antioxidant, anti-inflammatory and cytotoxic effects. In this narrative review, we highlight the
beneficial effects of C. sativus against the components of MetS to make a case for its consideration as a holistic
natural treatment option for the syndrome, thus, reducing the risks associated with the prolonged use of orthodox
medications.
... In obesity, fat tissue is characterized by chronic, low-grade inflammation predisposed to insulin resistance and metabolic syndrome and CV events (14)(15)(16). There is evidence that, the presence of metabolic syndrome is associated with high circulating leptin and IL-6 and is inversely associated with adiponectin. ...
... The principal cause of obesity is a longstanding imbalance between ingested and expended calories, which leads to fat accumulation [21]. One of the major contributors to increased obesity is an unbalanced diet, for example, the so called "Western diet". ...
In the context of the increasing number of obese individuals, a major problem is represented by obesity and malnutrition in children. This condition is mainly ascribable to unbalanced diets characterized by high intakes of fat and sugar. Childhood obesity and malnutrition are not only associated with concurrent pathologies but potentially compromise adult life. Considering the strict correlation among systemic metabolism, obesity, and skeletal muscle health, we wanted to study the impact of juvenile malnutrition on the adult skeletal muscle. To this aim, 3-week-old C56BL/6 female and male mice were fed for 20 weeks on a high-fat. high-sugar diet, and their muscles were subjected to a histological evaluation. MyHCs expression, glycogen content, intramyocellular lipids, mitochondrial activity, and capillary density were analyzed on serial sections to obtain the metabolic profile. Our observations indicate that a high-fat, high-sugar diet alters the metabolic profile of skeletal muscles in a sex-dependent way and induces the increase in type II fibers, mitochondrial activity, and lipid content in males, while reducing the capillary density in females. These data highlight the sex-dependent response to nutrition, calling for the development of specific strategies and for a systematic inclusion of female subjects in basic and applied research in this field.
... Obesity is the leading cause of various diseases, including high blood pressure, diabetes, cardiovascular disease, stroke, breast cancer, and colon cancer [4,5]. Therefore, it is crucial to make efforts to control and maintain a healthy body weight. ...
Background
Obesity is an abnormal and potentially dangerous condition caused by excess body fat accumulation. The number of people with obesity is increasing worldwide. Obesity is the primary cause of various diseases; therefore, it is crucial to make efforts to control and maintain a healthy body weight. Identifying the factors that influence men with obesity to attempt to control and not control their weight is essential. The objective of this study was to create a prediction model for weight control experience among Korean men in their 30s and 40s.
Methods
We analyzed data from the 2022 Community Health Survey and included 12,311 men who were overweight or obese. The men were divided into two groups based on their weight control experience: 1) Yes group (n = 9,405) and 2) No group (n = 2,906). Chi-square and independent t-tests were used to compare general and health-related characteristics between the groups. Decision tree analysis was used to build a prediction model for weight control experience. A split-sample test was conducted to validate the model.
Results
Several predictive models were generated based on the total number of participants, age, and body mass index as the first separating factors. The major factors affecting weight control among men with obesity in their 30s and 40s in Korea include subjective body shape, age, body mass index, education level, completion of hypertension management education, awareness of blood glucose levels, and smoking status. Subjective body shape was confirmed to significantly affect weight control experience.
Conclusions
It is necessary to support individuals in maintaining and managing an ideal weight by promoting a desirable perception of their body shape. In addition, there is an urgent need to provide obesity prevention and management education to those who have no weight control experience, particularly those at high risk, as identified in this study.
... www.nature.com/scientificreports/ diseases 12,[20][21][22] . Considering the profound effect stress has on eating behavior, its long-term health consequences, in addition to the high global prevalence of cardiovascular and metabolic disease [23][24][25] , it is crucial for the scientific community to establish and investigate stress-related overeating behavior interventions. ...
Stress-related overeating can lead to excessive weight gain, increasing the risk of metabolic and cardiovascular disease. Mindfulness meditation has been demonstrated to reduce stress and increase interoceptive awareness and could, therefore, be an effective intervention for stress-related overeating behavior. To investigate the effects of mindfulness meditation on stress-eating behavior, meditation-naïve individuals with a tendency to stress-eat (N = 66) participated in either a 31-day, web-based mindfulness meditation training or a health training condition. Behavioral and resting-state fMRI data were acquired before and after the intervention. Mindfulness meditation training, in comparison to health training, was found to significantly increase mindfulness while simultaneously reducing stress- and emotional-eating tendencies as well as food cravings. These behavioral results were accompanied by functional connectivity changes between the hypothalamus, reward regions, and several areas of the default mode network in addition to changes observed between the insula and somatosensory areas. Additional changes between seed regions (i.e., hypothalamus and insula) and brain areas attributed to emotion regulation, awareness, attention, and sensory integration were observed. Notably, these changes in functional connectivity correlated with behavioral changes, thereby providing insight into the underlying neural mechanisms of the effects of mindfulness on stress-eating.
Clinical trial on the ISRCTN registry: trial ID ISRCTN12901054
... Furthermore, decreased cholesterol levels through statin medication or lifestyle intervention were associated with lower CVD risk [55]. Comparing the results based on work shifts total cholesterol as well as low-density lipoprotein (LDL) in shift workers were significantly higher compared to day workers [54]. Regarding the work schedule, the prevalence of fixed night-time shifts has been proven to be associated with sleep deficit, high cardiovascular risk, and association with coronary heart disease [55]. ...
Background
Nurses as the largest group of health workers have a very stressful job which can cause number of diseases specially increase cardiovascular risk factors. This study aims to investigate the overall epidemiology of cardiovascular disease (CVD) risk factors among nurses.
Method
We searched all four main databases such as Scopus, PubMed, Embase and Web of Sciences from the beginning of 2000 to March 2022 with appropriate Mesh Terms. We also searched Google scholar. Then we applied inclusion and exclusion criteria and after selection the studies the Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of included studies. Comprehensive Meta-analysis and R software was used for analysis.
Results
Finally, 22 articles with a total number of 117922 nurses were included. Among all risk factors, sedentary lifestyle and lack of regular physical activity with a prevalence of 46.3% (CI 95%, 26.6–67.2) was regarded as the main prevalent risk factor among nurses. The mean systolic blood pressure (SBP) measured in the study population was 121.31 (CI 95%, 114.73–127.90) and the mean diastolic blood pressure (DBP) was 78.08 (CI 95%, 74.90–81.25). Also family history of cardiovascular disease (41.9%; 95% IC: 29.8–55.1%), being overweight (33.3%; 95% IC: 24.7–43.2%), and alcohol consumption (24.6%; 95% IC: 16.4–35.2%) was found among the participants.
Conclusion
S tudy results revealed that sedentary lifestyle was the main prevalent CVD risk factor among nurses followed by family history of cardiovascular disease, being overweight and alcohol consumption. Furthermore, among nurses with shift works almost all risk factors got higher score representing the worse condition in comparison with day workers’ nurses. This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors.
1. What was already known?
In general, many studies have emphasized the impact of the nursing profession on the incidence of some cardiovascular patients. Also, different shifts of nurses can have a double effect.
2. What are the new findings?
In this study, the mean for sedentary lifestyle was reported to be 46.3% which represented the most prevalent risk factor for cardiovascular risk factors among study population.
3. What is their significance?
This study enables learning the associated risk factors of CVD among nurses to facilitate interventional programs with a view to reduce the exposure of nursing staff particularly those who work in shifts to cardiovascular risk factors. This information can comprise essential tools for health human resource management contributing to advance nursing.
... Studies have shown that callitrichids kept in captivity had higher body mass than their wild counterparts, a fact considered a consequence of differences in diet and physical activity (Filomeno Encarnación & Heymann 1998, Araújo et al. 2000. With obesity, these NHP are prone to develop skeletal abnormalities, heart disease, diabetes, and cancer, all of which can affect animal's well-being and longevity (Bray 2004). ...
Type-2 diabetes mellitus (T2DM) is characterized by defects in insulin secretion and combined peripheral resistance to the hormone. Several non-human primates (NHP) species develop T2DM, mainly captive animals with reduced physical activity and incorrect feeding. This case report describes the T2DM treatment of a black-eared marmoset (Callithrix penicillata) by diet reformulation and metformin oral administration. An adult female was diagnosed with T2DM after hyperglycemia and high serum fructosamine associated with glycosuria and obesity. Metformin hydrochloride (125mg/animal, orally, q24h) associated with feeding intervention was started. After 26 days, a significant reduction in weight, glycemia, and serum fructosamine could be observed, showing satisfactory results for the adopted therapy. Metformin is considered a safe drug for T2DM treatment due to its low hypoglycemia risk. The new diet consisted of sweet potato, squash, and varied fruits offered twice daily. In addition, thawed-mice newborns, egg whites, and small portions of pelleted primate food. In the present report, metformin use, associated with a low glycemic index diet, was effective in treating this particular marmoset and may present a potential for T2DM treatment in other NHPs.
... Obesity leads to hyperplasia and hypertrophy of adipocytes as well as some metabolic complications including osteoarthritis and psychosocial dysfunction, diabetes, high blood pressure, cardio disease, liver diseases, infertility, and even some cancers are all result of later (WHO, 2021 andBray, 2004). Rats fed high-fat diet (HFD) showed a significant increase in body weight, glucose, insulin, and leptin (Caroline et al., 2021). ...
... Individuals living with obesity are at an increased risk of morbidity from type 2 diabetes, hypertension, coronary artery disease, and some cancers (Jensen et al., 2014). This obesogenic state stems from a chronic energy balance where energy intake exceeds energy expenditure (Bray, 2004). The control of energy intake is a complex system that involves behavioural, environmental, and physiological factors (N. A. King et al., 2012) that is mainly regulated in the hypothalamus and brainstem (Harrold, Dovey, Blundell, & Halford, 2012;Parker & Bloom, 2012). ...
... This is one of the major public health problems worldwide owing to its high prevalence and consequential morbidity & mortality. Globally 44% diabetes mellitus, 7% of ischemic heart diseases & 41% of certain cancers are attributable to overweight and obesity in 2015 [5] . ...
Obesity is spreading widespread among people worldwide and it is starting to overtake malnutrition and infectious diseases as the main cause of poor health. Obesity is specifically linked to diabetes mellitus, coronary heart disease and a few types of cancer and breathing problems. Cinnamomum tamala and Curcuma longa were the ingredients of a decoction from an authentic text and this review's objective was to investigate how the herbal formula of decoction from the Rasaratna Samuccya effective to treat obesity. Information about obesity was acquired from Ayurvedic scriptures, contemporary texts and earlier research studies (from primary and secondary sources). A survey of the literature was done on those two herbs in the selected decoction and examined for their Pancha Padārtha (5 elements of herb) and pharmacological qualities regarding in the management of obesity. Ayurvedic Pancha Padārtha study has revealed that selected herbal formula has anti-obese quality because of their compatibility with Lēkhana (scraping quality), Shōshana (absorbing quality) Guna and Shleshma Prakurti. The majority of studies have demonstrated the anti-obesity effects of herbal formula, reviewed articles have also highlighted additional qualities that aid in lowering excess fat in obese individuals. According to the literature review and Pancha Padārtha analysis, selected herbal formula is useful in the treatment of obesity.
... I soggetti affetti da sovrappeso e obesità possono inoltre sviluppare più facilmente sintomi come dolori articolari/osteoartrosi [76], reflusso gastro-esofageo [77], incontinenza urinaria [78] e limitazioni funzionali come ridotta mobilità [79]. ...
... Due to the mechanism of action, all SGLT2 inhibitors may cause urinary tract infections, genital mycotic infections, and dehydration. They are contraindicated in severe renal impairment (eGFR < 30 ml/min/1.73m 2 ), end-stage renal disease, and dialysis (123)(124)(125)(126). ...
... Due to the mechanism of action, all SGLT2 inhibitors may cause urinary tract infections, genital mycotic infections, and dehydration. They are contraindicated in severe renal impairment (eGFR < 30 ml/min/1.73m 2 ), end-stage renal disease, and dialysis (123)(124)(125)(126). ...
... Due to the mechanism of action, all SGLT2 inhibitors may cause urinary tract infections, genital mycotic infections, and dehydration. They are contraindicated in severe renal impairment (eGFR < 30 ml/min/1.73m 2 ), end-stage renal disease, and dialysis (123)(124)(125)(126). ...
... Weakness in the lower extremities can lead to challenges in everyday activities and regular movements. Enhancing PA levels might be crucial to fighting overweight and obesity, diminishing the risk of injury, and improving the quality of life [27][28][29]. However, details regarding the relationship between PA, body composition variables, and the prevalence of foot and knee deformities are still lacking among healthy adults. ...
Knee and foot deformities refer to structural abnormalities in the knee and foot bones, joints, ligaments, or muscles. Various factors, including genetics, injury, disease, or excessive use, can cause these deformities. These musculoskeletal conditions can significantly impact individuals' quality of life. This study examined foot and knee deformities in 231 young healthy adults (165 men, 66 women) aged 22.6 ± 4.9 years and their association with physical activity and body composition. The postural assessment was performed by two Physiotherapists, with the subject standing in three views: side, anterior, and posterior. Physical activity (Baecke's Habitual Physical Activity Questionnaire) and body composition (InBody 770) were assessed. Results showed that the most common foot deformity was pes planus, while the genu recurvatum was the most common knee deformity among the individuals. Physical activity level was negatively associated with knee and foot deformities. Conversely, body composition differed with the presence of genu recurvatum. These findings present a starting point to understand the occurrence of knee and foot postural alterations according to the individuals' body composition and physical activity profiles, which could support the deployment of tailored interventions among healthy adults. In addition, early detection of postural changes is crucial in mitigating their negative long-term impact on physical well-being.
... Body weight is a sum total of the physiological composition of the body including; fluids, muscle, bone and fats. Despite the contributions of muscle and bone mass to body weight, it is the sum of body fat that determines the adverse health conditions associated with obesity (1). Body weight alone could not account for the whole body fat since people who are tall or athletic would have more of bone or muscle mass. ...
Background to the study: Influences from the media has increased the consciousness of young adults about their body weight and size. The aim of the present study was to evaluate body weight perception and its relationship with anthropometric indices of undergraduate students in Port Harcourt. Material and methods: The study involved a total of 600 undergraduate students aged 18-35 years (including 249 males and 351 females). Body weight perception was assessed using a structured questionnaire. The anthropometric indices (weight, height, waist, hip and shoulder circumference and foot length) of each subject were measured using standard methods while the ratios were calculated. Results and discussion: The average BMI of undergraduates was 23.66±0.13kg/m 2. There was no significant gender difference in BMI, hip circumference and foot length. Waist circumference and waist-to-hip ratio were significantly higher in males while waist-to-height ratio was significantly higher in females. There was significant correlation between BMI and hip circumference, shoulder circumference and waist circumference but no significant correlation exists between BMI and foot length. The incidence of obesity amongst undergraduates in Port Harcourt was as low as 3.3% using the measured BMI even when only 1.5% admitted being obese. The actual BMI classified overweight was 25.7% as against perceived overweight of 19.8%. Only 56.3% perceived themselves to be within the normal weight whereas up to 67.5% were actually normal weight. The incidence of underweight was 3.5% but as many as 22.3% of undergraduates perceived they were underweight. Conclusion: In conclusion, there is a similarity between actual BMI and perceived BMI amongst undergraduates. Using both the actual and perceived BMI classifications, more of the males were within the underweight and normal weight classes whereas overweight and obesity were commoner in the females. Although there was gender similarity in BMI, waist-to-height ratio was significantly higher in females whereas waist-to-hip ratio was significantly higher in males. Waist-to-height ratio therefore was more useful in assessing abdominal size in females while waist-to-hip ratio was more
... Obesity refers to excessive storage of energy in the form of fat in a person. Hyperplasia and hypertrophy of fat cells result in an increase in the secretion of pathogenetic products such as free fatty acids and peptides from the fat cells to the extent they exert an adverse effect on health and shorten life expectancy (Bhale, Patil & Mahat, 2014;Bray 2004;Letchuman et al., 2010). This is due to the strong association of obesity in developing clustering of metabolic abnormalities including an increase in blood glucose, triglycerides, blood pressure, abdominal circumference, and a decrease in high-density lipoprotein cholesterol (HDL-C), all of which are related to weight gain thus, increases the risk of various non-communicable diseases and mortality (Bhale et al., 2014;Çakmakci, Uras & Tozun, 2010;Ginsberg et al., 2010;Han & Lean, 2016;Thomas et al., 2013;Yang & Barouch, 2007). ...
... The affirming and negating versions of each segment were written to be minimally different and to reflect contrasting ideas about fatness from real news media (Saguy, 2013;Frederick et al., 2020). These ideas mirror the mixed body of scientific evidence on weight and health: while fatness has been linked to increased risk of serious health conditions and mortality (Bray, 2004), the evidence falls short of establishing a causal influence and suggests that fatness can even be protective (Campos et al., 2006). ...
Being fat is often described as a “disease”—a form of linguistic framing that may exacerbate bias against fat people rather than reduce it as intended. Framing fatness as a matter of equal treatment and respect (“fat rights”) may be more effective for bias reduction. In a preregistered experiment ( N = 401), we directly compared the effects of disease and fat-rights framing on attitudes toward fat people. Participants read a news article that affirmed or negated (a) the claim that fatness is a disease and (b) the unacceptability of weight discrimination, and then expressed their attitudes toward fat people. Disease-affirming articles yielded more negative attitudes than disease-negating articles, but only for participants who explicitly recognized that the article influenced their attitudes. For these participants, fat-rights framing also had a significant impact: those who read a disease-affirming article expressed less negative attitudes toward fat people when the article also affirmed rather than negated fat rights. These results show that language can shift public opinion about fatness when people are aware of its persuasive power. Our findings support a social-pragmatic account of linguistic framing and have implications for real-world anti-bias efforts.
... Obesity is a pathological condition characterized by a body mass index (BMI) of 30 kg/m 2 or higher, calculated by dividing weight in kilograms by height in square meters (Apovian, 2016). It poses a growing challenge to public health worldwide and is associated with severe comorbidities such as hyperlipidemia, diabetes mellitus, arterial hypertension, atherosclerosis, and an increased risk for developing metabolic syndrome, a cluster of conditions associated with higher morbidity and mortality (Bray, 2004;Mozaffarian et al., 2011;Li et al., 2020). High-fat diet (HFD) is commonly used as an experimental animal model to study diet-induced obesity, which is characterized by a caloric intake ranging from 30% to 75% from fat (Li et al., 2020). ...
... In addition, insulin resistance, a common consequence of obesity, is a gateway to diabetes and other complications. 26 The participants in this study reported that as their health deteriorated, CRAIG ET AL. ...
Objective
Obesity and many of its comorbidities can be improved by nutritional therapy, lifestyle modification, pharmacotherapy, and surgical intervention. Relatively little is known about patients' preferences for the range of obesity treatments. The present study was undertaken to identify factors that may influence these preferences. By evaluating patient‐preferred treatment options and factors influencing patients, treatment adherence and efficacy may be improved. Our objective was to identify factors that influence patient preferences and subsequent choice of obesity treatment among those seeking treatment for obesity‐related complications.
Methods
Participatory action research, using purposeful sampling, was used to recruit 33 patients with obesity complications. Recruitment took place in specialist clinics for non‐alcoholic fatty liver disease, diabetes, hypertension, and chronic kidney disease. Sixteen males and 17 females aged 18–70 years with a BMI>35 kg/m ² were recruited. Prior to the interview, participants watched a 60‐min video explaining nutritional therapies, pharmacotherapies, and surgical therapies in equipoise. Data were collected in one‐to‐one semi‐structured interviews using zoom or the telephone; reflective thematic analysis was used.
Results
Four themes emerged: 1) structural factors, 2) autonomy, 3) interaction with formal care, and 4) the emotional and physical consequences of obesity. 39% of participants preferred nutritional therapy with support from medical professionals. 27% chose bariatric surgery. 24% chose pharmacotherapy alone, while 6% chose pharmacotherapy combined with nutritional therapy, 3% of participants wanted no intervention.
Conclusion
The challenges can be addressed by increasing support for healthcare professionals toward enhancing both their knowledge and the health literacy of patients. Future research should focus on improving access to treatment pathways for patients as well as developing health literacy programs and educational programs for healthcare professionals.
... Obesity is a disease characterized by excess body fat, where 95% of these causes are multifactorial, such as eating habits, sedentary lifestyle, genetic, psychological, social, cultural and economic (Chaves et al., 2011). Besides being a risk factor triggering several other chronic diseases such as cardiovascular, respiratory, diabetes mellitus, among others (Bray, 2004;Choukem et al., 2020), obesity has been causing large consumption of economic resources of both public (Barbany;Foz, 2002;Finkelstein;Strombotne, 2010) and private health systems (Canella;Novaes;Levy, 2015). According to Dobbs et al. (2014), these costs were estimated at 2.8% (US$ 2.0 trillion) of the World Gross In Brazil, the cost of obesity represents 8.05% of hospital costs (Coutinho;Lins, 2015), or 2.4% of the national GDP (Dobbs et al., 2014), representing R$ 175.2 billion (US$ 44.42 billion) in 2019 (World Bank, 2020). ...
Background: Obesity is a risk factor that triggers other chronic diseases such as cardiovascular, respiratory and diabetes mellitus, among others. However, this scenario can be improved with the use of remote monitoring technologies bringing economic benefits, clinical effectiveness and a better follow-up of users. Objective: Conduct a cost-utility economic assessment of the impact of remote monitoring technology for biomedical signals in preventing obesity in children, within the scope of primary health care, in rural areas. Methods: The study was based on assistance with remote monitoring of 296 children. An economic evaluation was carried out based on health costs, clinical utilities and quality-adjusted life years (QALYs). The cost-utility analysis (CUA) was obtained from the direct costs divided by the QALYs. To check if there is a statistically significant difference in clinical utility between the conventional system and the use of Free Living Energy Expenditure Monitoring System® (FLEEM System®), the Kolmogorov-Smirnov normality test (p <0.05) and the Wilcoxon test were applied. Results: The direct annual cost to care for a child using remote monitoring was R$ 541.31 (US$ 137.25) against the conventional practice of R$ 801.96 (US$ 203.34). The average value of 0.06 for the utility and 3.72 QALYs gained from the intervention. CUA was R$ -70.07 (US$ -17.77) per QALY gained from the perspective of remote monitoring. Conclusions: Remote monitoring represents a 32.50% economic gain for the health system, the negative CUA result means that the FLEEM System® can save R$ 70.07 (US$ 17.77) per QALY gained.
... Hyperinsulinemic euglycemic clamp (HEC) is known to be the "gold standard" for the measurement of insulin sensitivity. However, the realization that it is time and money consuming led to the developent of a simplified approach in quantification of insulin sensitivity [1].Various indices of insulin sensitivity/resistance using the data from oral glucose tolerance test (OGTT) were proposed in last 20 years.There are two groups of insulin sensitivity indices: (1) Indices calculated by using fasting plasma concentrations of insulin, glucose and triglycerides, (2) indices calculated by using plasma concentrateions of insulin and glucose obtained during 120 min of a standard (75 g glucose) OGTT [2].Several researchers have suggested that IR already exists before blood glucose abnormalities in diabetic patients and that hyperinsulinemia occurs before IGT shows several pathophysiological abnormalities [3].Therefore, several scholars have suggested that the T2DM process should be divided into the following three phases:hyperinsulinemia stage,prediabetes stage (IGT, IFG), and diabetes stage. In other words, hyperinsulinemia and IGT are both reserve forces of T2DM. ...
... For obese adults who also smoke, the chance of death rises even more (Francischi et al., 2000). Obesity has also been linked to biliary illnesses, osteoarthritis, cardiovascular disease, and some types of cancer (Bray, 2004;Thande et al., 2008). ...
According to statistics compiled by the World Health Organization (WHO), around one billion persons are overweight today, with another 300 million being obese. Based on these data, it is clear that obesity has become a huge international problem, impacting nations of all economic levels. Estimates predict that by 2025, Brazil would rank fifth in the world in obesity prevalence, up from its current rate of roughly 13%. Although certain herbal treatments are indicated for therapy, many other natural items are utilized without consideration to their safety or effectiveness in preventing or reducing weight gain. Notable among these is the African plant Hoodia gordonii, whose commercial powder was sold freely until it was banned in February 2007 by the Brazilian National Sanitary Surveillance Agency (ANVISA) due to a lack of scientific proofs of its efficacy and safety. Moreover, its putative association with leptin and insulin involved in neuroendocrine control of hunger and satiety is not well understood, nor is its method of action in suppressing desire and thirst.
Background & objectives: This study was conducted to assess the burden of overweight and obesity among UG medical students by measurement of body fat mass percentage (BF%) and to evaluate the validity of BF% as a clinical marker of obesity by its correlation with BMI.
Methods: The research was conducted as a cross sectional, observational study using the principle of Bioelectric Impedance Analysis for measurement of body fat
Results: There were 237 males (55.5%) and 187 females (44.5 %) among the study participants. The burden of overweight and obesity among the students was found to be 26% and 9.8 % respectively according to WHO global BMI criteria whereas it was 18.8 % and 35.7 % respectively, if the Asian criterion was used. This abnormality was pervasive across all the four years of UG MBBS students. The startling finding is that students who were labeled as ‘Normal’ using the BMI criterion were found to be obese by BF% assessment (43%) and even ‘Underweight’ students were found to have more than normal levels of BF% (15.2%). Measurement of waist circumference (WC) showed that 146 (34.8%) of the students had WC higher than normal. Likewise, 145 (34.5%) of the students had Waist-Hip Ratio higher than normal. Abnormalities of all above parameters put the students at risk of NCDs.
Conclusion: The study shows a high burden of overweight and obesity in medical students. Using body fat percentage as a clinical marker of adiposity is more desirable than using BMI only to screen clinical obesity.
This study investigates the risk of chronic kidney disease (CKD) across four metabolic phenotypes: Metabolically Healthy-No Obesity (MH-NO), Metabolically Unhealthy-No obesity (MU-NO), Metabolically Healthy-Obesity (MH-O), and Metabolically Unhealthy-Obesity (MU-O). Data from the Tehran Lipid and Glucose Study, collected from 1999 to 2020, were used to categorize participants based on a BMI ≥ 30 kg/m² and metabolic health status, defined by the presence of three or four of the following components: high blood pressure, elevated triglycerides, low high-density lipoprotein, and high fasting blood sugar. CKD, characterized by a glomerular filtration rate < 60 ml/min/1.72 m². The hazard ratio (HR) of CKD risk was evaluated using Cox proportional hazard models. The study included 8731 participants, with an average age of 39.93 years, and identified 734 incidents of CKD. After adjusting for covariates, the MU-O group demonstrated the highest risk of CKD progression (HR 1.42–1.87), followed by the MU-NO group (HR 1.33–1.67), and the MH-O group (HR 1.18–1.54). Persistent MU-NO and MU-O posed the highest CKD risk compared to transitional states, highlighting the significance of exposure during early adulthood. These findings emphasize the independent contributions of excess weight and metabolic health, along with its components, to CKD risk. Therefore, preventive strategies should prioritize interventions during early-adulthood.
Semaglutide is an anti-diabetes and weight loss drug that decreases food intake, slows gastric emptying, and increases insulin secretion. Patients begin treatment with low-dose semaglutide and increase dosage over time as efficacy plateaus. With increasing dosage, there is also greater incidence of gastrointestinal side effects. One reason for the plateau in semaglutide efficacy despite continued low food intake is due to compensatory actions whereby the body becomes more metabolically efficient to defend against further weight loss. Mitochondrial uncoupler drugs decrease metabolic efficiency, therefore we sought to investigate the combination therapy of semaglutide with the mitochondrial uncoupler BAM15 in diet-induced obese mice. Mice were fed high-fat western diet (WD) and stratified into 6 treatment groups including WD control, BAM15, low-dose semaglutide without or with BAM15, and high-dose semaglutide without or with BAM15. Combining BAM15 with either semaglutide dose decreased body fat and liver triglycerides, which was not achieved by any monotherapy, while high-dose semaglutide with BAM15 had the greatest effect on glucose homeostasis. This study demonstrates a novel approach to improve weight loss without loss of lean mass and improve glucose control by simultaneously targeting energy intake and energy efficiency. Such a combination may decrease the need for semaglutide dose escalation and hence minimise potential gastrointestinal side effects.
Most people have some dissatisfaction or concern about body weight, fatness, or obesity, either personally or professionally. This book shows how the popular understanding of obesity is often at odds with scientific understandings, and how misunderstandings about people with obesity can further contribute to the problem. It describes, in an approachable way, interconnected debates about obesity in public policy, medicine and public health, and how media and social media engage people in everyday life in those debates. In chapters considering body fat and fatness, genetics, metabolism, food and eating, inequality, blame and stigma, and physical activity, this book brings separate domains of obesity research into the field of complexity. By doing so, it aids navigation through the minefield of misunderstandings about body weight, fatness, and obesity that exist today, after decades of mostly failed policies and interventions.
Soybean-based fermented foods are commonly consumed worldwide, especially in Asia. These fermented soy-products are prepared using various strains of Bacillus, Streptococcus, Lactobacillus, and Aspergillus. The microbial action during fermentation produces and increases the availability of various molecules of biological significance, such as isoflavones, bioactive peptides, and dietary fiber. These dietary bio active compounds are also found to be effective against the metabolic disorders such as obesity, diabetes, and cardiovascular diseases (CVD). In parallel, soy isoflavones such as genistein, genistin, and daidzin can also contribute to the anti-obesity and anti-diabetic mechanisms, by decreasing insulin resistance and oxidative stress. The said activities are known to lower the risk of CVD, by decreasing the fat accumulation and hyperlipidemia in the body. In addition, along with soy-isoflavones fermented soy foods such as Kinema, Tempeh, Douchi, Cheonggukjang/Chungkukjang, and Natto are also rich in dietary fiber (prebiotic) and known to be anti-dyslipidemia, improve lipolysis, and lowers lipid peroxidation, which further decreases the risk of CVD. Further, the fibrinolytic activity of nattokinase present in Natto soup also paves the foundation for the possible cardioprotective role of fermented soy products. Considering the immense beneficial effects of different fermented soy products, the present review contextualizes their significance with respect to their anti-obesity, anti-diabetic and cardioprotective roles.
The main objectives of this systematic review and meta-analysis study include evaluating the methodological quality of existing randomized controlled trials (RCTs) for weight loss and features of online intervention [OI]s in each trial, examining the associations between the methodological quality, intervention features and the effectiveness of OIs, and comparing the effectiveness of OIs and other intervention modalities through systematic review and meta-analysis. Systematic searches were conducted using PubMed, Cochrane Library, CINAHL, and PsycINFO in the past two decades (2000 through 2019). Inclusion criteria includes Online intervention (intervention modality), middle-aged adults with overweight or obesity, at least six months or longer study period, an RCT, and 70% plus retention rate. Risk of Bias was assessed using Miller et al. in (Hester, Miller (eds) Handbook of alcoholism treatment approaches: Effective alternatives (3rd ed.). Allyn & Bacon, Boston, 2003)’s Methodological Quality Rating Scale (MQRS) and GRADE. MOOSE guidelines was referred for data synthesis. In total, 29 OIs were evaluated using 10 criteria for methodological quality and eight criteria for intervention features. Results revealed that the mean methodological quality score of the RCTs was 12.1 (out of 16), and the mean intervention features score was 6.6 (out of 8). RCTs with higher scores were more effective in weight loss than those with lower scores. Results of meta-regression showed that methodological quality was more important than intervention features to increase the effectiveness. Results of meta-analysis showed that OIs were significantly more effective than controls. Compared to OIs only, OIs with interactions with others and professionals were more effective. The study limitation includes assessing ‘effectiveness’ based on weight only due to lack of other indicators to compare between studies; some results are self-reported; and feedback from intervention participants were hard to review. Nevertheless, this study may contribute to improving the effectiveness of existing OIs for weight loss considering methodological quality and better intervention features.
Background
Obesity is increasingly recognized as a significant factor in the susceptibility of older adults to falls and related injuries. While existing literature has established a connection between obesity and reduced postural stability during stationary stances, the direct implications of obesity on walking dynamics, particularly among the older adults with sarcopenia, are not yet comprehensively understood.
Objective
Firstly, to investigate the influence of obesity on steady-state and proactive balance, as well as gait characteristics, among older adults with sarcopenic obesity (SO); and secondly, to unearth correlations between anthropometric characteristics and balance and gait parameters in the same demographic.
Methods
A cohort of 42 participants was categorized into control (CG; n = 22; age = 81.1 ± 4.0 years; BMI = 24.9 ± 0.6 kg/m²) and sarcopenic obese (SOG; n = 20; age = 77.7 ± 2.9 years; BMI = 34.5 ± 3.2 kg/m²) groups based on body mass index (BMI, kg/m²). Participants were assessed for anthropometric data, body mass, fat and lean body mass percentages (%), and BMI. Steady-state balance was gauged using the Romberg Test (ROM). Proactive balance evaluations employed the Functional Reach (FRT) and Timed Up and Go (TUG) tests. The 10-m walking test elucidated spatiotemporal gait metrics, including cadence, speed, stride length, stride time, and specific bilateral spatiotemporal components (stance, swing, 1 st and 2 nd double support, and single support phases) expressed as percentages of the gait cycle.
Results
The time taken to complete the TUG and ROM tests was significantly shorter in the CG compared to the SOG ( p < 0.05). In contrast, the FRT revealed a shorter distance achieved in the SOG compared to the CG ( p < 0.05). The CG exhibited a higher gait speed compared to the SOG ( p < 0.05), with shorter stride and step lengths observed in the SOG compared to the CG ( p < 0.05). Regarding gait cycle phases, the support phase was longer, and the swing phase was shorter in the SOG compared to the CG group ( p < 0.05). LBM (%) showed the strongest positive correlation with the ROM (r = 0.77, p < 0.001), gait speed (r = 0.85, p < 0.001), TUG (r = −0.80, p < 0.001) and FRT (r = 0.74, p < 0.001).
Conclusion
Obesity induces added complexities for older adults with sarcopenia, particularly during the regulation of steady-state and proactive balance and gait. The percentage of lean body mass has emerged as a crucial determinant, highlighting a significant impact of reduced muscle mass on the observed alterations in static postural control and gait among older adults with SO.
Health campaigns often emphasise the association between excess weight and poor health. Past research suggests that whether an individual's excess weight is viewed as harmful is partially explained by the quantity of excess weight. The present research explored whether the purported cause of excess weight also influences its perceived harmfulness. Across two studies (total N = 577), participants read information about target individuals whose excess weight was caused by different factors (unhealthy lifestyle vs. medical condition). Participants rated the extent to which the target's weight was harmful and also recommended health‐related behaviours to the target. For the target with overweight, when her weight was described as being caused by unhealthy behaviours as opposed to a medical condition, her weight was rated as more harmful, and she was recommended to engage in more healthy behaviours. For the target with obesity, her weight was viewed as harmful irrespective of its described cause. Compared with the target with overweight, the weight of the target with obesity was rated as more harmful and she was recommended to diet more. Perceptions of the harmfulness of ‘overweight’ are influenced by the purported cause of that overweight, whereas obesity itself is viewed as harmful, regardless of the cause.
Dual‐energy x‐ray absorptiometry (DXA) scanning is used for objective determination of body composition, but instrumentation is expensive and not generally available in customary clinical practice. Anthropometric surrogates are often substituted as anticipated correlates of absolute and relative body fat content in the clinical management of obesity and its associated medical risks. DXA and anthropometric data from a cohort of 9230 randomly selected American subjects, available through the ongoing National Health and Nutrition Examination Survey, was used to evaluate combinations of surrogates (age, height, total weight, waist circumference) as predictors of DXA‐determined absolute and relative body fat content. Multiple regression analysis yielded linear combinations of the 4 surrogates that were closely predictive of DXA‐determined absolute fat content (R ² = 0.93 and 0.96 for male and female subjects). Accuracy of the new algorithm was improved over customary surrogate‐based predictors such as body mass index. However prediction of relative body fat was less robust (R ² less than 0.75), probably due to the nonlinear relation between degree of obesity (based on body mass index) and relative body fat. The paradigm was validated using an independent cohort from the National Health and Nutrition Examination Survey, as well as two independent external subject groups. The described regression‐based algorithm is likely to be a sufficiently accurate predictor of absolute body fat (but not relative body fat) to substitute for DXA scanning in many clinical situations. Further work is needed to assess algorithm validity for subgroups of individuals with “atypical” body construction.
Objective: To examine the relation between adult weight change and the risk for clinical diabetes mellitus among middle-aged women. • Design: Prospective cohort study with follow-up from 1976 to 1990. • Setting: 11 U.S. states. • Participants: I'll 281 female registered nurses aged 30 to 55 years who did not have diagnosed diabetes mellitus, coronary heart disease, stroke, or cancer in 1976. • Outcome Measures: Non-insulin-dependent diabetes mellitus. • Results: 2204 cases of diabetes were diagnosed during 1.49 million person-years of follow-up. After adjustment for age, body mass index was the dominant predictor of risk for diabetes mellitus. Risk increased with greater body mass index, and even women with average weight (body mass index, 24.0 kg/m 2) had an elevated risk. Compared with women with stable weight (those who gained or lost less than 5 kg between age 18 years and 1976) and after adjustment for age and body mass index at age 18 years, the relative risk for diabetes mellitus among women who had a weight gain of 5.0 to 7.9 kg was 1.9 (95% CI, 1.5 to 2.3). The corresponding relative risk for women who gained 8.0 to 10.9 kg was 2.7 (CI, 2.1 to 3.3). In contrast, women who lost more than 5.0 kg reduced their risk for diabetes mellitus by 50% or more. These results were independent of family history of diabetes. • Conclusion: The excess risk for diabetes with even modest and typical adult weight gain is substantial. These findings support the importance of maintaining a constant body weight throughout adult life and suggest that the 1990 U.S. Department of Agriculture guidelines that allow a substantial weight gain after 35 years of age are misleading.
Abdominal-visceral fat has emerged as a significant correlate of hyperinsulinemia, increased plasma triglyceride levels, decreased HDL levels, and elevated blood pressure. Abdominal obesity is a phenotypic companion for a cluster of metabolic abnormalities characterized by decreased insulin sensitivity, which is compensated by increased insulin secretion and diminished hepatic insulin extraction, with resultant hyperinsulinemia. Hyperinsulinemia is the most significant metabolic variable in these associations. Abdominal obesity, on the other hand, results from interactions between genetic, environmental, and neuroendocrine mechanisms, and each of these can affect insulin dynamics and the metabolic profile independently. Abdominal obesity and its associated insulin resistance are predictive of a myriad of disorders, including glucose intolerance, NIDDM, salt-sensitive hypertension, hyperapobetalipoproteinemia, hypoalphalipoproteinemia, and coronary heart disease. Again, the etiology of these disorders is contingent on other factors, both genetic and environmental, and it is possible that abdominal obesity and/or insulin resistance operate as provocative or exacerbating factors. What is so peculiar about fat deposition around the waist? Its anatomic location and α/β-adrenoceptor sensitivity suggest that FFA flux from this tissue may play a major role in suppressing hepatic insulin clearance and creating peripheral insulin resistance. How visceral fat can mediate or exacerbate insulin resistance and the associated metabolic changes is still far from clear. Glucocorticoids and the sex hormones are both involved in directly influencing abdominal obesity. Glucocorticoids seem to act at the level of influencing preadipocyte recruitment and filling, while perinatal and peripubertal sex hormones play major roles in influencing both insulin dynamics and fat deposition. Whether these two types of hormones interact in some manner is uncertain. The existence of putative 'obesity genes' in inbred rodents suggests that such genes might be responsible for obesity in humans as well, and some of these genes may be responsible for regional fat deposition. Clearly, genes encoding for such proteins as LPL or the fat cell β-adrenergic receptor would play a role in regional adiposity. Glucokinase has emerged as an early candidate for NIDDM, and others are likely to follow. If such an obesity gene, or series of genes, responsible for the obesity phenotype exists, its identity, regulatory aspects, and interactions between the gene products in promoting obesity represent important areas for future research. The coexistence of hyperinsulinemia and impaired glucose tolerance in abdominal obesity suggests that insulin resistance is the underlying abnormality. Efforts to identify the exact locus of the insulin resistance have not been successful. It seems clear that neither decreased insulin receptor number nor alterations in glucose transporter number or structure can explain this insulin resistance. The mechanism connecting the regulation of hepatic insulin extraction to the compensatory peripheral hyperinsulinemia of insulin resistance is also another area for future investigation. The modes of insulin release and coupling of insulin secretion to insulin demand appear to be at fault. Might insulin secretion pulsatilities and response dynamics be early markers of β- cell secretory dysfunction in those abdominally obese individuals with a strong predisposition to NIDDM, and if so, what are the factors responsible for these responses? In abdominally obese women, the degree of capillary rarefaction is correlated with the decline in insulin-mediated peripheral glucose utilization. Increased androgenic activity has also been demonstrated, and this in turn is highly correlated with the reductions in capillarization and in insulin sensitivity. These relationships suggest potential roles for androgens in the pathogenesis of the reduced capillarization, in regulating muscle fiber metabolism, in influencing compositional features, and in the insulin resistance that characterizes abdominally obese women. Does capillary rarefaction influence in vivo insulin sensitivity, and if so, how might this be modulated by androgenization?
To investigate the relation between obesity, fat distribution, and weight gain through adulthood and the risk of non-insulin-dependent diabetes mellitus (NIDDM).
We analyzed data from a cohort of 51,529 U.S. male health professionals, 40-75 years of age in 1986, who completed biennial questionnaires sent out in 1986, 1988, 1990, and 1992. During 5 years of follow-up (1987-1992), 272 cases of NIDDM were diagnosed among men without a history of diabetes, heart disease, and cancer in 1986 and who provided complete health information. Relative risks (RRs) associated with different anthropometric measures were calculated controlling for age, and multivariate RRs were calculated controlling for smoking, family history of diabetes, and age.
We found a strong positive association between overall obesity as measured by body mass index (BMI) and risk of diabetes. Men with a BMI of > or = 35 kg/m2 had a multivariate RR of 42.1 (95% confidence interval [CI] 22.0-80.6) compared with men with a BMI < 23.0 kg/m2. BMI at age 21 and absolute weight gain throughout adulthood were also significant independent risk factors for diabetes. Fat distribution, measured by waist-to-hip ratio (WHR), was a good predictor of diabetes only among the top 5%, while waist circumference was positively associated with the risk of diabetes among the top 20% of the cohort.
These data suggest that waist circumference may be a better indicator than WHR of the relationship between abdominal adiposity and risk of diabetes. Although early obesity, absolute weight gain throughout adulthood, and waist circumference were good predictors of diabetes, attained BMI was the dominant risk factor for NIDDM; even men of average relative weight had significantly elevated RRs.
The risk for breast cancer and the sex hormone abnormalities noted in breast cancer patients have been demonstrated in women with upper body fat obesity. The objective of this study was to determine if the visceral component of upper body fat obesity was correlated with breast cancer risk.
A case-control study of 40 consecutively enrolled women with breast cancer and 40 community-based age, weight, and waist circumference-matched control subjects was conducted. The areas of visceral fat, subcutaneous fat, and total fat were measured using computed tomography at the L-4 vertebral body. Calculations of relative risk for breast cancer were based on these fat compartments.
Patients with breast cancer had a significantly greater visceral fat area (P = 0.01), visceral-to-total-fat area ratio (VT ratio) (P < 0.001) and significantly lower subcutaneous-to-visceral-fat area ratio (SV ratio) (P < 0.001) compared with the matched controls. The relative risk for breast cancer increased with increasing VT ratio (< or = 0.24 = 1.0; > 0.24 = 9.5) (P < 0.0001) and decreasing SV ratio (> or = 3.64 = 1.0; < 3.64 = 8.5) (P = 0.0002).
Visceral obesity, as assessed by computed tomography, was a significant risk factor for breast cancer in women matched for age, weight, and waist circumference. Comparing the VT ratio for both groups, breast cancer patients had 45% more visceral fat compared with matched control subjects.
The spectrum of nonalcoholic fatty liver disease ranges from fatty liver alone to nonalcoholic steatohepatitis. Most previous studies have short follow-up and have not carefully delineated different histological types when determining clinical outcomes. The aim of this study was to compare clinical characteristics and outcomes of patients with different types of nonalcoholic fatty liver.
All liver biopsy specimens from 1979 to 1987 with fat accumulation were assessed for inflammation, ballooning degeneration, Mallory hyaline, and fibrosis. Biopsy specimens were also assessed for histological iron and hepatitis C RNA. Outcomes were cirrhosis, mortality, and liver-related mortality.
Of 772 liver biopsy specimens, complete data were available in 132 patients. Fatty liver (type 1) did not differ from the other three types combined with respect to gender, race, age, or obesity. Cirrhosis was more common in the other types combined (22%) than fatty liver alone (4%; P </= 0.001). Overall mortality, histological iron, and hepatitis C did not differ between groups. Most of the liver-related deaths were in type 4.
The outcome of cirrhosis and liver-related death is not uniform across the spectrum of nonalcoholic fatty liver. These poor outcomes are more frequent in patients in whom biopsies show ballooning degeneration and Mallory hyaline or fibrosis.
Recent guidelines for treatment of overweight and obesity include recommendations for risk stratification by disease conditions and cardiovascular disease (CVD) risk factors, but the role of physical inactivity is not prominent in these recommendations.
To quantify the influence of low cardiorespiratory fitness, an objective marker of physical inactivity, on CVD and all-cause mortality in normal-weight, overweight, and obese men and compare low fitness with other mortality predictors.
Prospective observational data from the Aerobics Center Longitudinal Study.
Preventive medicine clinic in Dallas, Tex.
A total of 25714 adult men (average age, 43.8 years [SD, 10.1 years]) who received a medical examination during 1970 to 1993, with mortality follow-up to December 31, 1994.
Cardiovascular disease and all-cause mortality based on mortality predictors (baseline CVD, type 2 diabetes mellitus, high serum cholesterol level, hypertension, current cigarette smoking, and low cardiorespiratory fitness) stratified by body mass index.
During the study period, there were 1025 deaths (439 due to CVD) during 258781 man-years of follow-up. Overweight and obese men with baseline CVD or CVD risk factors were at higher risk for all-cause and CVD mortality compared with normal-weight men without these predictors. Using normal-weight men without CVD as the referent, the strongest predictor of CVD death in obese men was baseline CVD (age- and examination year-adjusted relative risk [RR], 14.0; 95% confidence interval [CI], 9.4-20.8); RRs for obese men with diabetes mellitus, high cholesterol, hypertension, smoking, and low fitness were similar and ranged from 4.4 (95% CI, 2.7-7.1) for smoking to 5.0 (95% CI, 3.6-7.0) for low fitness. Relative risks for all-cause mortality in obese men ranged from 2.3 (95% CI, 1.7-2.9) for men with hypertension to 4.7 (95% CI, 3.6-6.1) for those with CVD at baseline. Relative risk for all-cause mortality in obese men with low fitness was 3.1 (95% CI, 2.5-3.8) and in obese men with diabetes mellitus 3.1 (95% CI, 2.3-4.2) and as slightly higher than the RRs for obese men who smoked or had high cholesterol levels. Low fitness was an independent predictor of mortality in all body mass index groups after adjustment for other mortality predictors. Approximately 50% (n = 1674) of obese men had low fitness, which led to a population-attributable risk of 39% for CVD mortality and 44% for all-cause mortality. Baseline CVD had population attributable risks of 51% and 27% for CVD and all-cause mortality, respectively.
In this analysis, low cardiorespiratory fitness was a strong and independent predictor of CVD and all-cause mortality and of comparable importance with that of diabetes mellitus and other CVD risk factors.
Obesity is a major health problem in the United States, but the number of obesity-attributable deaths has not been rigorously estimated.
To estimate the number of deaths, annually, attributable to obesity among US adults.
Data from 5 prospective cohort studies (the Alameda Community Health Study, the Framingham Heart Study, the Tecumseh Community Health Study, the American Cancer Society Cancer Prevention Study I, and the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study) and 1 published study (the Nurses' Health Study) in conjunction with 1991 national statistics on body mass index distributions, population size, and overall deaths.
Adults, 18 years or older in 1991, classified by body mass index (kg/m2) as overweight (25-30), obese (30-35), and severely obese (>35).
Relative hazard ratio (HR) of death for obese or overweight persons.
The estimated number of annual deaths attributable to obesity varied with the cohort used to calculate the HRs, but findings were consistent overall. More than 80% of the estimated obesity-attributable deaths occurred among individuals with a body mass index of more than 30 kg/m2. When HRs were estimated for all eligible subjects from all 6 studies, the mean estimate of deaths attributable to obesity in the United States was 280184 (range, 236111-341153). Hazard ratios also were calculated from data for nonsmokers or never-smokers only. When these HRs were applied to the entire population (assuming the HR applied to all individuals), the mean estimate for obesity-attributable death was 324 940 (range, 262541-383410).
The estimated number of annual deaths attributable to obesity among US adults is approximately 280000 based on HRs from all subjects and 325000 based on HRs from only nonsmokers and never-smokers.
Although hepatic steatosis is seen with increasing frequency in clinical practice, its prevalence and risk factors are unknown.
To investigate the prevalence of and risk factors for hepatic steatosis, such as alcohol consumption and obesity.
Cross-sectional, observational study.
Participants in the Dionysos Study.
257 participants assigned to one of four categories (67 controls, 66 obese persons, 69 heavy drinkers, and 55 obese heavy drinkers).
Ethanol intake, assessed by a validated questionnaire and expressed as daily (g/d) and lifetime (kg) consumption, and body mass, expressed as body mass index. Biochemical tests of liver and metabolic function and hepatic ultrasonography were done.
The prevalence of steatosis was increased in heavy drinkers (46.4% [95% CI, 34% to 59%]) and obese persons (75.8% [CI, 63% to 85%]) compared with controls (16.4% [CI, 8% to 25%]). Steatosis was found in 94.5% (CI, 85% to 99%) of obese heavy drinkers. Compared with controls, the risk for steatosis was higher by 2.8-fold (CI, 1.4-fold to 7.1-fold) in heavy drinkers, 4.6-fold (CI, 2.5-fold to 11.0-fold) in obese persons, and 5.8-fold (CI, 3.2-fold to 12.3-fold) in persons who were obese and drank heavily. In heavy drinkers, obesity increased the risk for steatosis by twofold (CI, 1.5-fold to 3.0-fold) (P < 0.001), but heavy drinking was associated with only a 1.3-fold (CI, 1.02-fold to 1.6-fold) increase in risk in obese persons (P = 0.0053). Elevated alanine aminotransferase and triglyceride levels are the most reliable markers of steatosis.
Steatosis is frequently encountered in healthy persons and is almost always present in obese persons who drink more than 60 g of alcohol per day. Steatosis is more strongly associated with obesity than with heavy drinking, suggesting a greater role of overweight than alcohol consumption in accumulation of fat in the liver.
Type 2 diabetes mellitus is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known.
We randomly assigned 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index [weight in kilograms divided by the square of the height in meters], 31) with impaired glucose tolerance to either the intervention group or the control group. Each subject in the intervention group received individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity. An oral glucose-tolerance test was performed annually; the diagnosis of diabetes was confirmed by a second test. The mean duration of follow-up was 3.2 years.
The mean (+/-SD) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group (P<0.001 for both comparisons between the groups). The cumulative incidence of diabetes after four years was 11 percent (95 percent confidence interval, 6 to 15 percent) in the intervention group and 23 percent (95 percent confidence interval, 17 to 29 percent) in the control group. During the trial, the risk of diabetes was reduced by 58 percent (P<0.001) in the intervention group. The reduction in the incidence of diabetes was directly associated with changes in lifestyle.
Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.
Overweight and obesity in adulthood are linked to an increased risk for death and disease. Their potential effect on life expectancy and premature death has not yet been described.
To analyze reductions in life expectancy and increases in premature death associated with overweight and obesity at 40 years of age.
Prospective cohort study.
The Framingham Heart Study with follow-up from 1948 to 1990.
3457 Framingham Heart Study participants who were 30 to 49 years of age at baseline.
Mortality rates specific for age and body mass index group (normal weight, overweight, or obese at baseline) were derived within sex and smoking status strata. Life expectancy and the probability of death before 70 years of age were analyzed by using life tables.
Large decreases in life expectancy were associated with overweight and obesity. Forty-year-old female nonsmokers lost 3.3 years and 40-year-old male nonsmokers lost 3.1 years of life expectancy because of overweight. Forty-year-old female nonsmokers lost 7.1 years and 40-year-old male nonsmokers lost 5.8 years because of obesity. Obese female smokers lost 7.2 years and obese male smokers lost 6.7 years of life expectancy compared with normal-weight smokers. Obese female smokers lost 13.3 years and obese male smokers lost 13.7 years compared with normal-weight nonsmokers. Body mass index at ages 30 to 49 years predicted mortality after ages 50 to 69 years, even after adjustment for body mass index at age 50 to 69 years.
Obesity and overweight in adulthood are associated with large decreases in life expectancy and increases in early mortality. These decreases are similar to those seen with smoking. Obesity in adulthood is a powerful predictor of death at older ages. Because of the increasing prevalence of obesity, more efficient prevention and treatment should become high priorities in public health.
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.
Although weight loss improves risk factors for cardiovascular and metabolic disease, it is unclear whether intentional weight loss reduces mortality rates.
To examine the relationships among intention to lose weight, weight loss, and all-cause mortality.
Prospective cohort study using a probability sample of the U.S. population.
Interviewer-administered survey.
6391 overweight and obese persons (body mass index > or = 25 kg/m2) who were at least 35 years of age.
Intention to lose weight and weight change during the past year were assessed by self-report in 1989. Vital status was followed for 9 years. Hazard rate ratios (HRRs) were adjusted for age, sex, ethnicity, education, smoking, health status, health care utilization, and initial body mass index.
Compared with persons not trying to lose weight and reporting no weight change, those reporting intentional weight loss had a 24% lower mortality rate (HRR, 0.76 [95% CI, 0.60 to 0.97]) and those with unintentional weight loss had a 31% higher mortality rate (HRR, 1.31 [CI, 1.01 to 1.70]). However, mortality rates were lower in persons who reported trying to lose weight than those in not trying to lose weight, independent of actual weight change. Compared with persons not trying to lose weight and reporting no weight change, persons trying to lose weight had the following HRRs: no weight change, 0.80 (CI, 0.65 to 0.99); gained weight, 0.94 (CI, 0.65 to 1.37); and lost weight, 0.76 (CI, 0.60 to 0.97).
Attempted weight loss is associated with lower all-cause mortality, independent of weight change. Self-reported intentional weight loss is associated with lower mortality rates, and weight loss is associated with higher mortality rates only if it is unintentional.
Quality of life, particularly health-related quality of life, has been defined as the “physical, psychological, and social domains of health, seen as distinct areas that are influenced by a person's experiences, beliefs, expectations, and perceptions” (1). This definition makes it explicit that quality of life includes not only objective indicators but also subjective appraisals of well-being. Further, the growing interest in assessing quality of life re?ects the recognition that health is much more than the absence of disease.
Obesity is a fundamental disorder of energy balance in which excessive energy stores accumulate in the form of fat in response to sustained high energy intake and/or low expenditure. While genetic factors influence obesity through endocrine mechanisms, the majority of endocrine changes observed in obese subjects are consequences of obesity. The endocrine mechanisms giving rise to disturbances of fat distribution, and by which obesity gives rise to its principal complications-diabetes, cardiovascular disease, and female reproductive dysfunction-are becoming clear. In this chapter we consider the unusual primary endocrine causes of obesity, including recently described genetic syndromes, and then focus on the more common alterations in endocrine function that are characteristic of obesity-disturbances in insulin secretion and action, adrenocortical function, sex steroid secretion, the growth hormone insulinlike growth factor and pituitary-thyroid axes. The evidence that these changes play a role in either the determination of corpulence or the perpetuation of the obese state is considered.
Background: Although hepatic steatosis is seen with increasing frequency in clinical practice, its prevalence and risk factors are unknown. Objective: To investigate the prevalence of and risk factors for hepatic steatosis, such as alcohol consumption and obesity. Design: Cross-sectional, observational study. Setting: Participants in the Dionysos Study. Patients: 257 participants assigned to one of four categories (67 controls, 66 obese persons, 69 heavy drinkers, and 55 obese heavy drinkers). Measurements: Ethanol intake, assessed by a validated questionnaire and expressed as daily (g/d) and lifetime (kg) consumption, and body mass, expressed as body mass index. Biochemical tests of liver and metabolic function and hepatic ultrasonography were done. Results: The prevalence of steatosis was increased in heavy drinkers (46.4% [95% Cl, 34% to 59%]) and obese persons (75.8% [CI, 63% to 85%]) compared with controls (16.4% [Cl, 8% to 25%]). Steatosis was found in 94.5% (Cl, 85% to 99%) of obese heavy drinkers. Compared with controls, the risk for steatosis was higher by 2.8-fold (Cl, 1.4-fold to 7.1-fold) in heavy drinkers, 4.6-fold (Cl, 2.5-fold to 11.0-fold) in obese persons, and 5.8-fold (Cl, 3.2-fold to 12.3-fold) in persons who were obese and drank heavily. In heavy drinkers, obesity increased the risk for steatosis by twofold (Cl, 1.5-fold to 3.0-fold) (P < 0.001), but heavy drinking was associated with only a 1.3-fold (Cl, 1.02-fold to 1.6-fold) increase in risk in obese persons (P = 0.0053). Elevated alanine aminotransferase and triglyceride levels are the most reliable markers of steatosis. Conclusions: Steatosis is frequently encountered in healthy persons and is almost always present in obese persons who drink more than 60 g of alcohol per day. Steatosis is more strongly associated with obesity than with heavy drinking, suggesting a greater role of overweight than alcohol consumption in accumulation of fat in the liver.
The measurement of plasma lipid levels is now commonly used to assess the risk of coronary heart disease (CHD). Several epidemiological studies have shown that there is a significant positive relationship between blood cholesterol levels and deaths associated with CHD (1-3). In the Multiple Risk Factor Intervention Trial (MRFIT), Stamler et al. (4) showed that in a sample of 356, 222male subjects, increased blood cholesterol levels were associated with a progressive increase in CHD mortality. However, despite the fact that numerous studies have shown this relationship, Genest et al. (5) have reported that nearly 50% of patients having ischemic heart disease (IHD) have plasma cholesterol levels equal to or even lower than those of healthy subjects.
Although obesity is a well-recognized risk factor for gallstones, the excess risks associated with higher levels of obesity and recent weight change are poorly quantified. We evaluated these issues in the Nurses' Health Study. Among 90,302 women aged 34-59 y at baseline followed from 1980 to 1988, 2122 cases of newly diagnosed symptomatic gallstones occurred during 607,104 person-years of follow-up. From 1980 to 1986, 488 cases of newly diagnosed unremoved gallstones were documented. We observed a striking monotonic increase in gallstone disease risk with obesity; women with a body mass index (BMI) greater than 45 kg/m2 had a sevenfold excess risk compared with those whose BMI was less than 24 kg/m2. Women with a BMI greater than 30 kg/m2 had a yearly gallstone incidence of greater than 1% and those with a BMI greater than or equal to 45 kg/m2 had a rate of approximately 2%/y. Recent weight loss was associated with a modestly increased risk after adjustment for BMI before weight loss. Current smoking was an independent risk factor; women smoking greater than or equal to 35 cigarettes/d had a relative risk of 1.5 (95% CI 1.2-1.9).
To determine whether obesity preceded knee osteoarthritis and was thus a possible cause.
Cohort study with weight and other important variables measured in 1948 to 1951 (mean age of subjects, 37 years) and knee arthritis evaluated in 1983 to 1985 (mean age of subjects, 73 years).
Population-based participants; a subset (n = 1420) of the Framingham Heart Study cohort.
For those subjects in the Framingham Study having knee radiographs taken as part of the 18th biennial examination (1983 to 1985), we examined Metropolitan Relative Weight, a measure of weight adjusted for height at the onset of the study (1948 to 1951). Relative risks were computed as the cumulative incidence rate of radiographic knee osteoarthritis in the heaviest weight groups at examination 1 divided by the cumulative rate in the lightest 60% weight groups at examination 1. Relative risks were adjusted for age, physical activity level, and uric acid level.
In 1983 to 1985, 468 subjects (33%) had radiographic knee osteoarthritis. For men, the risk of knee osteoarthritis was increased in those in the heaviest quintile of weight at examination 1 compared with those in the lightest three quintiles (age-adjusted relative risk, 1.51; 95% confidence interval [CI], 1.14 to 1.98); risk was not increased for those in the second heaviest quintile (relative risk, 1.0). The association between weight and knee osteoarthritis was stronger in women than in men; for women in the most overweight quintile at examination 1, relative risk was 2.07 (95% CI, 1.67 to 2.55), and for those in the second heaviest group, relative risk was 1.44 (95% CI, 1.11 to 1.86). This link between obesity and subsequent osteoarthritis persisted after controlling for serum uric acid level and physical activity level, and was strongest for persons with severest radiographic disease. Obesity at examination 1 was associated with the risk of developing both symptomatic and asymptomatic osteoarthritis.
These results and other corroborative cross-sectional data show that obesity or as yet unknown factors associated with obesity cause knee osteoarthritis.
Recent investigations of the relation of mortality to weight have involved more than 4 million insured persons in a study by insurance companies and over 1 million men and women in a study by the American Cancer Society. These studies present a large volume of information on the effects of underweight and overweight on death rates of healthy middle-class Americans, free of the confounding effects of low socioeconomic status and associated health impairments. However, only the American Cancer Society's study separates findings by smoking status. These investigations indicate that the lowest mortality occurs among persons somewhat underweight and that mortality rises steadily as weight increases. The study of insured persons shows that among underweight persons mortality is relatively high initially but declines with time, whereas among overweight persons mortality is low initially but increases to distinctly higher levels after about 15 years.
The relation between body weight and overall mortality remains controversial despite considerable investigation.
We examined the association between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and both overall mortality and mortality from specific causes in a cohort of 115,195 U.S. women enrolled in the prospective Nurses' Health Study. These women were 30 to 55 years of age and free of known cardiovascular disease and cancer in 1976. During 16 years of follow-up, we documented 4726 deaths, of which 881 were from cardiovascular disease, 2586 from cancer, and 1259 from other causes.
In analyses adjusted only for age, we observed a J-shaped relation between body-mass index and overall mortality. When women who had never smoked were examined separately, no increase in risk was observed among the leaner women, and a more direct relation between weight and mortality emerged (P for trend < 0.001). In multivariate analyses of women who had never smoked and had recently had stable weight, in which the first four years of follow-up were excluded, the relative risks of death from all causes for increasing categories of body-mass index were as follows: body-mass index < 19.0 (the reference category), relative risk = 1.0; 19.0 to 21.9, relative risk = 1.2; 22.0 to 24.9, relative risk = 1.2; 25.0 to 26.9, relative risk = 1.3; 27.0 to 28.9, relative risk = 1.6; 29.0 to 31.9, relative risk = 2.1; and > or = 32.0, relative risk = 2.2 (P for trend < 0.001). Among women with a body-mass index of 32.0 or higher who had never smoked, the relative risk of death from cardiovascular disease was 4.1 (95 percent confidence interval, 2.1 to 7.7), and that of death from cancer was 2.1 (95 percent confidence interval, 1.4 to 3.2), as compared with the risk among women with a body-mass index below 19.0. A weight gain of 10 kg (22 lb) or more since the age of 18 was associated with increased mortality in middle adulthood.
Body weight and mortality from all causes were directly related among these middle-aged women. Lean women did not have excess mortality. The lowest mortality rate was observed among women who weighed at least 15 percent less than the U.S. average for women of similar age and among those whose weight had been stable since early adulthood.
Although 40% of US women indicate they are currently trying to lose weight, the association between intentional weight loss and longevity is unknown. The authors analyzed prospective data from 43,457 overweight, never-smoking US white women aged 40-64 years who in 1959-1960 completed a questionnaire that included questions on weight change direction, amount, time interval, and intentionality. Vital status was determined in 1972. Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight. Women who died within the first 3 years of follow-up were excluded. Analyses were stratified by preexisting illness and adjusted for age, beginning body mass index, alcohol intake, education, physical activity, and health conditions. In women with obesity-related health conditions (n = 15,069), intentional weight loss of any amount was associated with a 20% reduction in all-cause mortality, primarily due to a 40-50% reduction in mortality from obesity-related cancers; diabetes-associated mortality was also reduced by 30-40% in those who intentionally lost weight. In women with no preexisting illness (n = 28,388), intentional weight loss of > or = 20 lb (> or = 9.1 kg) that occurred within the previous year was associated with about a 25% reduction in all-cause, cardiovascular, and cancer mortality; however, loss of < 20 lb (< 9.1 kg) or loss that occurred over an interval of > or = 1 year was generally associated with small to modest increases in mortality. The association between intentional weight loss and longevity in middle-aged overweight women appears to depend on their health status. Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality, whereas among women with no preexisting illness, the association is equivocal.
To examine the relation between adult weight change and the risk for clinical diabetes mellitus among middle-aged women.
Prospective cohort study with follow-up from 1976 to 1990.
11 U.S. states.
114,281 female registered nurses aged 30 to 55 years who did not have diagnosed diabetes mellitus, coronary heart disease, stroke, or cancer in 1976.
Non-insulin-dependent diabetes mellitus.
2204 cases of diabetes were diagnosed during 1.49 million person-years of follow-up. After adjustment for age, body mass index was the dominant predictor of risk for diabetes mellitus. Risk increased with greater body mass index, and even women with average weight (body mass index, 24.0 kg/m2) had an elevated risk. Compared with women with stable weight (those who gained or lost less than 5 kg between age 18 years and 1976) and after adjustment for age and body mass index at age 18 years, the relative risk for diabetes mellitus among women who had a weight gain of 5.0 to 7.9 kg was 1.9 (95% CI, 1.5 to 2.3). The corresponding relative risk for women who gained 8.0 to 10.9 kg was 2.7 (CI, 2.1 to 3.3). In contrast, women who lost more than 5.0 kg reduced their risk for diabetes mellitus by 50% or more. These results were independent of family history of diabetes.
The excess risk for diabetes with even modest and typical adult weight gain is substantial. These findings support the importance of maintaining a constant body weight throughout adult life and suggest that the 1990 U.S. Department of Agriculture guidelines that allow a substantial weight gain after 35 years of age are misleading.
Our aim was to examine the association between body mass index at age 18 and subsequent primary ovulatory infertility.
A nested case-control study was conducted within a cohort of 116,678 female registered nurses residing in 14 U.S. states. Cases comprised 2527 married nulliparous nurses unable to become pregnant for at least 1 year because of ovulatory disorder; controls comprised 46,718 married parous nurses with no history of infertility. The risk of ovulatory infertility for women at different levels of body mass index at age 18 was compared with that for women whose body mass index at age 18 was 20 to 21.9 (median for the cohort). Logistic regression was used to adjust for age at infertility or first birth, year of birth, age at menarche, physical activity during ages 18 to 22, smoking at ages 15 to 19, ethnicity, alcohol use at ages 18 to 22, use of oral contraceptives before age 22, and diagnosis of diabetes mellitus.
Multivariate relative risks for infertility were: 1.2 (body mass index < 16), 1.1 (body mass index 16 to 17.9), 1.0 (body mass index 18 to 19.9), 1.0 (referent body mass index 20 to 21.9), 1.1 (body mass index 22 to 23.9), 1.3 (body mass index 24 to 25.9), 1.7 (body mass index 26 to 27.9), 2.4 (body mass index 28 to 29.9), 2.7 (body mass index 30 to 31.9), and 2.7 (body mass index > or = 32). The relative risks for all categories of body mass index above 23.9 were statistically significantly elevated. Greater body mass index at age 18 was a predictor of ovulatory infertility in women with and without a diagnosis of polycystic ovary syndrome.
These findings suggest that elevated body mass index at age 18, even at levels lower than those considered to be obese, is a risk factor for subsequent ovulatory infertility.
Several studies have examined the association between body mass index and infertility. We compared body mass index in 597 women diagnosed with ovulatory infertility at seven infertility clinics in the United States and Canada with 1,695 primiparous controls who recently gave birth. The obese women (body mass index > or = 27) had a relative risk of ovulatory infertility of 3.1 [95% confidence interval (CI) = 2.2-4.4], compared with women of lower body weight (body mass index 20-24.9). We found a small effect in women with a body mass index of 25-26.9 or less than 17 [relative risk (RR) = 1.2, 95% CI = 0.8-1.9; and RR = 1.6, 95% CI = 0.7-3.9, respectively). We conclude that the risk of ovulatory infertility is highest in obese women but is also slightly increased in moderately overweight and underweight women.
Overweight in adolescents may have deleterious effects on their subsequent self-esteem, social and economic characteristics, and physical health. We studied the relation between overweight and subsequent educational attainment, marital status, household income, and self-esteem in a nationally representative sample of 10,039 randomly selected young people who were 16 to 24 years old in 1981. Follow-up data were obtained in 1988 for 65 to 79 percent of the original cohort, depending on the variable studied. The characteristics of the subjects who had been overweight in 1981 were compared with those for young people with asthma, musculoskeletal abnormalities, and other chronic health conditions. Overweight was defined as a body-mass index above the 95th percentile for age and sex.
In 1981, 370 of the subjects were overweight. Seven years later, women who had been overweight had completed fewer years of school (0.3 year less; 95 percent confidence interval, 0.1 to 0.6; P = 0.009), were less likely to be married (20 percent less likely; 95 percent confidence interval, 13 to 27 percent; P < 0.001), had lower household incomes ($6,710 less per year; 95 percent confidence interval, $3,942 to $9,478; P < 0.001), and had higher rates of household poverty (10 percent higher; 95 percent confidence interval, 4 to 16 percent; P < 0.001) than the women who had not been overweight, independent of their base-line socioeconomic status and aptitude-test scores. Men who had been overweight were less likely to be married (11 percent less likely; 95 percent confidence interval, 3 to 18 percent; P = 0.005). In contrast, people with the other chronic conditions we studied did not differ in these ways from the nonoverweight subjects. We found no evidence of an effect of overweight on self-esteem.
Overweight during adolescence has important social and economic consequences, which are greater than those of many other chronic physical conditions. Discrimination against overweight persons may account for these results.
To review the major data collected over the past 8 yr regarding energy expenditure in relationship to obesity and the development of obesity in the Pima Indian population.
The different components of 24-h energy expenditure (i.e., the RMR, the thermic effect of food, and the energy cost of spontaneous physical activity) were measured in a respiratory chamber after a few days on a weight-maintenance diet.
Fat-free body mass, the major determinant of RMR, explains 82% of its variance. However, an extra 7% of the variance in RMR observed between people is related to family membership. The variability of RMR for a given body size and composition is of importance, because a low metabolic rate is a major risk factor for weight gain in man. Also, genetic factors seem to be the cause of the familial aggregation of metabolic rate in man.
The high prevalence of obesity and NIDDM in the Pima Indian community might be the consequence of a "thrifty genotype." The increasing evidence that obesity cannot always be attributed to gluttony and sloth forces us to consider obesity as a "real metabolic disease" that needs to be treated as such, using new behavioral and pharmacological therapies.
Body weight is closely related to several known cardiovascular risk factors, but it may also have an independent effect on the risk of coronary heart disease (CHD). In this study, we analyzed the association between body mass index (BMI) and smoking, serum cholesterol, and blood pressure at baseline, as well as how BMI and the other risk factors are related to CHD mortality.
A total of 16 113 men and women aged 30 to 59 years were examined in eastern Finland in either 1972 or 1977. Serum cholesterol and blood pressure had a positive association and smoking had a negative association with BMI. During the 15-year prospective follow-up, mortality from CHD was positively associated with BMI. The BMI-associated risk ratio of CHD mortality, adjusted for age and study year, estimated from the Cox proportional hazards model was 1.04 (per kg/m2) (P < .001) among men. Inclusion of smoking in the model increased the risk ratio for BMI, whereas inclusion of serum cholesterol and blood pressure decreased it. In the model that included age, study year, and all three major cardiovascular risk factors, the BMI-associated risk ratio was 1.03 (P = .027). Among women, the BMI-associated risk ratio of CHD mortality adjusted for age and study year was 1.05 (P = .023) and the multifactorial adjusted risk ratio was 1.03 (P = .151).
Obesity is an independent risk factor for CHD mortality among men and also contributes to the risk of CHD among women. Part of the BMI-associated risk of CHD mortality is mediated through other known cardiovascular risk factors. By preventing overweight, a substantial part of CHD mortality may be prevented.
The relationship between obesity and increased risks of morbidity and mortality is well established. Less is known about the impact of obesity on functional health status and subjective well-being.
We examined health-related quality of life (HRQL), measured by the Medical Outcomes Study Short Form-36 Health Survey (SF-36), and clinical characteristics of 312 consecutive persons seeking outpatient treatment for obesity at a university-based weight management center. SF-36 scores were adjusted for sociodemographic factors and various comorbidities, including depression, to better estimate the effect of obesity on HRQL. Health-related quality of life of the obese patients was then compared with that of the general population and with a sample of patients who have other chronic medical conditions.
Compared with general population norms, participants who had a mean body-mass index (BMI) of 38.1 reported significantly lower scores (i.e., more impairment) on all eight quality-of-life domains, especially bodily pain and vitality. The morbidly obese (mean BMI, 48.7) reported significantly worse physical, social, and role functioning, worse perceived general health, and greater bodily pain than did either the mildly (mean BMI, 29.2) or moderately to severely obese (mean BMI, 34.5). The obese also reported significantly greater disability due to bodily pain than did patients with other chronic medical conditions.
Obesity profoundly affects quality of life. Bodily pain is a prevalent problem among obese persons seeking weight loss and may be an important consideration in the treatment of this population.
Insulin resistance has been hypothesized to unify the clustering of hypertension, glucose intolerance, hyperinsulinemia, increased levels of triglyceride and decreased HDL cholesterol, and central and overall obesity. We tested this hypothesis with factor analysis, a statistical technique that should identify one factor if a single process underlies the clustering of these risk variables. From 2,458 nondiabetic subjects of the Framingham Offspring Study, we collected clinical data, fasting and 2-h postchallenge glucose and insulin levels, and fasting lipid levels. We performed factor analyses separately for men and women in the entire population and among subgroups with features of the insulin resistance syndrome. Subjects ranged in age from 26 to 82 years (mean age 54); 53% were women, 13.4% had impaired glucose tolerance, 27.6% had hypertension, 40% were obese, and 11.6% were hyperinsulinemic, defined by elevated fasting insulin levels. Underlying the clustering of these risk variables were three factors. Fasting and 2-h postchallenge insulin levels, fasting triglyceride and HDL cholesterol levels, BMI, and waist-to-hip ratio were associated with one factor. Fasting and 2-h levels of glucose and insulin were associated with a second factor. Systolic blood pressure, diastolic blood pressure, and BMI were associated with a third factor. Results were similar for men and women and for all subgroups. These results were consistent with more than one independent physiological process underlying risk variable clustering: a central metabolic syndrome (characterized by hyperinsulinemia, dyslipidemia, and obesity), glucose intolerance, and hypertension. Glucose intolerance and hypertension were linked to the central syndrome through shared correlations with insulin levels and obesity. Insulin resistance (reflected by hyperinsulinemia) alone did not appear to underlie all features of the insulin resistance syndrome.
The effect of age on optimal body weight is controversial, and few studies have had adequate numbers of subjects to analyze mortality as a function of body-mass index across age groups.
We studied mortality over 12 years among white men and women who participated in the American Cancer Society's Cancer Prevention Study I (from 1960 through 1972). The 62,116 men and 262,019 women included in this analysis had never smoked cigarettes, had no history of heart disease, stroke, or cancer (other than skin cancer) at base line in 1959-1960, and had no history of recent unintentional weight loss. The date and cause of death for subjects who died were determined from death certificates. The associations between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and mortality were examined for six age groups in analyses in which we adjusted for age, educational level, physical activity, and alcohol consumption.
Greater body-mass index was associated with higher mortality from all causes and from cardiovascular disease in men and women up to 75 years of age. However, the relative risk associated with greater body-mass index declined with age. For example, for mortality from cardiovascular disease, the relative risk associated with an increment of 1 in the body-mass index was 1.10 (95 percent confidence interval, 1.04 to 1.16) for 30-to-44-year-old men and 1.03 (95 percent confidence interval, 1.02 to 1.05) for 65-to-74-year-old men. For women, the corresponding relative risk estimates were 1.08 (95 percent confidence interval, 1.05 to 1.11) and 1.02 (95 percent confidence interval, 1.02 to 1.03).
Excess body weight increases the risk of death from any cause and from cardiovascular disease in adults between 30 and 74 years of age. The relative risk associated with greater body weight is higher among younger subjects.
Relationships between 2-year changes in body composition (estimated from computed tomography-validated anthropometry based on sagittal trunk diameter, weight, and height), adipose tissue (AT) distribution, and cardiovascular risk factors (blood pressure, lipids, glucose, insulin, uric acid) were examined in 842 treated adults with severe obesity with weight changes from -95.5 to +30.6 kg. Although the change (delta) of visceral AT mass (expressed in % total AT) for a given change in body mass index (delta BMI) was 6-fold larger in men than in women, delta waist and delta waist/hip were similar in both sexes. In men, risk factor changes were similarly related to delta waist, delta bodyweight, and delta BMI, whereas in women, delta bodyweight seemed to be the single independent variable with the highest explanatory power. In multivariate regressions adjusted for delta BMI and baseline conditions, delta visceral AT mass was more strongly associated with risk factor changes than were delta waist and delta waist/hip. When using a three-compartment model (lean body mass, subcutaneous and visceral AT masses) plus neck and thigh girths (indicators of subcutaneous AT distribution), risk factor changes were related both to delta subcutaneous and delta visceral AT masses but not to delta lean body mass. In agreement with cross-sectional findings, delta neck was positively and delta thigh was negatively related to some risk factor changes. Thus, the use of waist as a single risk factor indicator seems less effective for epidemiological studies than the simple anthropometric measures presented here, which are able to separate the effects of visceral AT mass, subcutaneous AT mass, and subcutaneous AT distribution on metabolic parameters under both cross-sectional and longitudinal conditions.
Background:
The field of "medical outcomes" emphasizes effects of medical treatments on quality of life as seen from the patient's perspective. The increasing incidence of obesity has had tremendous impact on the physical, psychological, social, and economic health of our nation with important longterm implications for the development of future social and health care policies. This study evaluated the effects of clinically severe obesity on overall health status measured in a standardized fashion and the impact of durable weight loss achieved through surgical intervention.
Study design:
Patients scheduled for Roux-en-Y gastric bypass for treatment of obesity were prospectively evaluated. At the preoperative visit, each patient completed Short Form 36 (SF-36). Postoperatively, patients were again asked to complete SF-36, in person or through a telephone interview at an interim point (3 to 12 months) and after their weight had reached a plateau (>18 months).
Results:
The mean body mass index (BMI) was 51+/-10 kg/m2 preoperatively (range 38 to 85 kg/m2). Mean BMI was 45+/-10 kg/m2 (range 33 to 78 kg/m2) at the interim point and 35+/-8 kg/m2 (range 28 to 55 kg/m2) at plateau. The weight change for the group was from 306+/-8 lb (138+/-4 kg) preoperatively to 211+/-55 lb (96+/-25 kg) at the plateau, with the average percent of excess body weight lost being 63+/-23% at the plateau. Preoperatively, patients with clinically severe obesity scored significantly lower than the normal population in all areas except Role Activities (Emotional Factors). At the plateau period, patients demonstrated significant improvement in limitations in all areas compared with preoperative values and scores were the same as (Physical Activities, Role Activities [Physical Factors], General Mental Health, General Health Perceptions), or significantly better than (Social Functioning, Role Activities [Emotional Factors], Bodily Pain, Vitality), the national "normal" population.
Conclusion:
Clinically severe obesity is a chronic disabling disease that results in significantly decreased health status in seven of the eight areas measured by SF-36. This disability resolves with successful weight reduction. In some areas, function even surpasses the national "normal" population. Surgical treatment of clinically severe obesity has a profoundly positive impact on patients' perception of their health status.
Body-mass index (the weight in kilograms divided by the square of the height in meters) is known to be associated with overall mortality. We investigated the effects of age, race, sex, smoking status, and history of disease on the relation between body-mass index and mortality.
In a prospective study of more than 1 million adults in the United States (457,785 men and 588,369 women), 201,622 deaths occurred during 14 years of follow-up. We examined the relation between body-mass index and the risk of death from all causes in four subgroups categorized according to smoking status and history of disease. In healthy people who had never smoked, we further examined whether the relation varied according to race, cause of death, or age. The relative risk was used to assess the relation between mortality and body-mass index.
The association between body-mass index and the risk of death was substantially modified by smoking status and the presence of disease. In healthy people who had never smoked, the nadir of the curve for body-mass index and mortality was found at a body-mass index of 23.5 to 24.9 in men and 22.0 to 23.4 in women. Among subjects with the highest body-mass indexes, white men and women had a relative risk of death of 2.58 and 2.00, respectively, as compared with those with a body-mass index of 23.5 to 24.9. Black men and women with the highest body-mass indexes had much lower risks of death (1.35 and 1.21), which did not differ significantly from 1.00. A high body-mass index was most predictive of death from cardiovascular disease, especially in men (relative risk, 2.90; 95 percent confidence interval, 2.37 to 3.56). Heavier men and women in all age groups had an increased risk of death.
The risk of death from all causes, cardiovascular disease, cancer, or other diseases increases throughout the range of moderate and severe overweight for both men and women in all age groups. The risk associated with a high body-mass index is greater for whites than for blacks.
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.
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.
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.
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.
A common clinical issue is whether overweight patients with abnormal liver function test results should undergo liver biopsy. Although serious liver injury can occur, its prevalence and risk factors are not well known.
Ninety-three consecutive patients with abnormal liver function tests (but without overt liver disease), body mass index (BMI) > 25 kg/m(2), and no alcoholic, viral, autoimmune, drug-induced, or genetic liver disease were retrospectively studied. Clinical, biological, and histological variables were tested for association with septal fibrosis or cirrhosis.
Septal fibrosis was present in 28 patients (30%) including cirrhosis in 10 (11%). Age >/= 50 years (odds ratio [OR], 14.1), BMI >/= 28 kg/m(2) (OR, 5.7), triglycerides >/= 1.7 mmol/L (OR, 5), and alanine aminotransferase (ALT) >/= 2N (OR, 4.6) were independently associated with septal fibrosis. Among histological features, septal fibrosis was strongly associated with necroinflammatory activity (OR, 44). A score combining age, BMI, triglycerides, and ALT had 100% negative predictive value for septal fibrosis when scoring 0 or 1 (100% sensitivity for a specificity of 47%).
Septal fibrosis occurs frequently in overweight patients with abnormal liver function tests. A clinicobiological score combining BMI, age, ALT, and triglycerides could improve selection of patients for liver biopsy.
We report the first large renal biopsy-based clinicopathologic study on obesity-related glomerulopathy.
Obesity was defined as body mass index (BMI)> 30 kg/m2. Obesity-related glomerulopathy (ORG) was defined morphologically as focal segmental glomerulosclerosis and glomerulomegaly (O-FSGS; N = 57) or glomerulomegaly alone (O-GM; N = 14).
Review of 6818 native renal biopsies received from 1986 to 2000 revealed a progressive increase in biopsy incidence of ORG from 0.2% in 1986-1990 to 2.0% in 1996-2000 (P = 0.0001). Mean BMI in ORG was 41.7 (range 30.9 to 62.7). Indications for renal biopsy included proteinuria (N = 40) or proteinuria and renal insufficiency (N = 31). Seventy-one patients with ORG were compared to 50 patients with idiopathic FSGS (I-FSGS). Patients with ORG were older (mean 42.9 vs. 32.6 years, P < 0.001) and more often Caucasian (75% vs. 52%; P = 0.003). ORG patients had a lower incidence of nephrotic range proteinuria (48% vs. 66%; P = 0.007) and nephrotic syndrome (5.6% vs. 54%; P < 0.001), with higher serum albumin (3.9 vs. 2.9 g/dL; P < 0.001), lower serum cholesterol (229 vs. 335 mg/dL; P < 0.001), and less edema (35% vs. 68%; P = 0.003). On renal biopsy, patients with ORG had fewer lesions of segmental sclerosis (10 vs. 39%; P < 0.001), more glomerulomegaly (100% vs. 10%; P < 0.001), and less extensive foot process effacement (40 vs. 75%; P < 0.001). Glomerular diameter in ORG (mean 226 mu) was significantly larger than age- and sex-matched normal controls (mean 168 mu; P < 0.001). Follow-up was available in 56 ORG patients (mean 27 months) and 50 idiopathic FSGS controls (mean 38 months). A total of 75% of ORG patients received angiotensin-converting enzyme (ACE) inhibition or A2 blockade while 78% of the I-FSGS patients received immunosuppressive therapy. ORG patients had less frequent doubling of serum creatinine (14.3% vs. 50%; P < 0.001) and progression to ESRD (3.6% vs. 42%; P < 0.001). On multivariate analysis, presenting serum creatinine and severity of proteinuria were the only predictors of poor outcome in ORG.
ORG is distinct from idiopathic FSGS, with a lower incidence of nephrotic syndrome, more indolent course, consistent presence of glomerulomegaly, and milder foot process fusion. The ten-fold increase in incidence over 15 years suggests a newly emerging epidemic. Heightened physician awareness of this entity is needed to ensure accurate diagnosis and appropriate therapy.
Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities.
To identify and quantify the leading causes of mortality in the United States.
Comprehensive MEDLINE search of English-language articles that identified epidemiological, clinical, and laboratory studies linking risk behaviors and mortality. The search was initially restricted to articles published during or after 1990, but we later included relevant articles published in 1980 to December 31, 2002. Prevalence and relative risk were identified during the literature search. We used 2000 mortality data reported to the Centers for Disease Control and Prevention to identify the causes and number of deaths. The estimates of cause of death were computed by multiplying estimates of the cause-attributable fraction of preventable deaths with the total mortality data.
Actual causes of death.
The leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (365 000 deaths; 15.2%) [corrected], and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000).
These analyses show that smoking remains the leading cause of mortality. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.
Body weight and mortality among women Risk variable clustering in the insulin resistance syndrome . The Framingham Offspring Study
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