Thinness and obesity: a model of food consumption, health concerns, and social pressure

The increasing concern of the policy maker about eating behaviour has focused on the spread of obesity and on the evidence of people dieting despite being underweight. As the latter behaviour is often attributed to the social pressure to be thin, some governments have already taken actions to ban ultra-thin ideals and models. This paper proposes a theoretical framework to assess whether increasing the ideal body weight is socially desirable, both from a welfare and a health point of view. We first show that being underweight and being overweight are possible outcomes of a rational eating model. Then, assuming that people are heterogeneous in their healthy weights but exposed to the same ideal body weight, we show that increasing the thin ideal weight can be welfare improving, but may exacerbate the obesity epidemic.     

绍兴市0~2岁婴幼儿超重和肥胖现状及影响因素研究

【目的】 了解绍兴市0~2岁婴幼儿超重肥胖流行现状及影响因素,为早期干预提供理论依据。 【方法】 按照随机整群抽样的方法,调查7 985名婴幼儿,以WHO身高标准体重为肥胖的判断标准。 【结果】 0~2岁婴幼儿总的肥胖检出率为2.64%,男童2.99%,女童 2.24%,总的超重检出率为9.83%,男童10.50%,女童9.06%,男女童之间肥胖超重检出率差异均有统计学意义(χ²_肥胖=4.424,χ²_超重=4.687,P均<0.05)。1岁以内婴儿年龄越小肥胖检出率越高,18月以后随年龄增加肥胖检出率呈上升趋势,各年龄组之间的超重及肥胖检出率差异有统计学意义(χ²_肥胖=173.627,χ²_超重=161.542,P值均<0.01)。肥胖影响因素有高出生体重、家庭人口多、父母BMI、家长对子女肥胖的态度。 【结论】 绍兴市婴幼儿肥胖检出率处于较高水平,高出生体重、家庭人口多、父母BMI、家长对子女肥胖的态度是本次调查婴幼儿肥胖的影响因素。     

Biomarkers and functional foods for obesity and diabetes

Obesity has reached epidemic proportions in many countries around the world. Because of the close relationship between obesity and type 2 diabetes, an epidemic of diabetes is close behind the obesity epidemic. Preventing and treating obesity is becoming an increasing priority. In the United States, over 60 % of the adult population is overweight or obese and thus at increased risk of developing diabetes and cardiovascular disease. While the aetiology of obesity and diabetes is complex, diet clearly plays an important role both in the development and management of these diseases. There is interest in functional foods that could help in prevention and/or management of obesity and type 2 diabetes. This could involve food products that help management of 'hunger' or that increase 'satiety'. It could also involve foods that contribute to more inefficient use of ingested energy (i.e. foods that stimulate energy expenditure more than would be expected from their energy content). As the concept of insulin sensitivity becomes generally more accepted by health care professionals and the public, foods may be targeted towards maximizing insulin sensitivity and towards 'prevention' of diabetes. In addition to foods that impact upon body weight, these may include foods that affect the glucose and/or insulin levels that are seen either following the ingestion of food or later in the day. The present paper reviews the complex aetiology of obesity and diabetes and considers a potential role for functional foods in prevention and treatment of obesity and diabetes.     

温州市城区居民超重和肥胖流行现状分析

目的了解温州城区居民的超重和肥胖流行情况,为开展肥胖防治工作提供科学依据。方法采用多阶段抽样方法,抽取温州市3个城区9个街道4106名≥35岁的人作为调查对象。结果人群标化超重率为35.13%,标化肥胖率为8.36%。随着年龄的增长,超重和肥胖患病率呈上升趋势,随着文化程度增高呈下降趋势。家务及离退休人员的超重及肥胖患病率较高,服务行业及干部职员超重和肥胖患病率较低。结论温州市超重、肥胖患病率处于全国大城市水平,其患病率受年龄、职业和文化程度的影响。     

Risk factors for overweight and obesity: results from the 2001 National Health Survey

OBJECTIVES: A significant rise in the proportion of overweight and obese adults has produced a serious health epidemic in Australia and worldwide. The current research aimed to identify sociodemographic and behavioural predictors of overweight and obesity among a large representative sample of Australian adults. STUDY DESIGN: We used the National Health Survey conducted by the Australian Bureau of Statistics in 2001. The survey involved a stratified multistage area sample of private dwellings and face-to-face interviews. METHODS: We analysed data from 8643 females and 7600 males who responded to the 2001 National Health Survey. Multinomial logistic regression examined the association of being overweight or obese versus a healthy weight with a range of sociodemographic and behavioural variables. RESULTS: Fewer females than males were overweight while similar proportions were obese. For females and males, overweight and obesity were significantly associated with older age, being born in Australia, not being in a marriage-like relationship, low education, physical inactivity, and being a non/ex-smoker. High household incomes are protective from obesity but not from being overweight. Additionally, females with high levels of area social disadvantage and males in professional or white-collar occupations were more likely to be overweight or obese than a healthy weight. CONCLUSIONS: Reductions in mortality and morbidity associated with overweight and obesity may be achieved by targeting health promotion strategies to high-risk groups such as those who are older, single, Australian born, socioeconomically disadvantaged, physically inactive, and non-smokers.     

桂林市城市居民高血压流行现状及其危险因素分析

目的了解桂林市城市居民高血压流行情况,分析其危险因素,为桂林市高血压综合防治提供科学依据. 方法采取多阶段分层随机整群抽样的方法,通过问卷调查和体格检查,对桂林市城区5197名18岁以上常住居民高血压患病及其危险因素的流行水平进行分析. 结果桂林市城市居民高血压患病率为25.07%,标化率为22.76%.高血压知晓率,治疗率,控制率分别为61.16%,53.80%,29.70%.不同年龄,文化程度,婚姻状态患病率差别有统计学意义(P<0.01).多因素非条件logistic回归分析,年龄,经济收入,身体锻炼,超重肥胖,中心性肥胖是高血压的主要影响因素. 结论桂林市城市居民高血压患病率处于较高水平,需开展对全人群和高危人群的综合干预.加强对中老年人,超重肥胖,中心性肥胖人群的健康教育,提倡健康的生活方式,对高血压及并发症的防治具有重要意义.     

中国学龄儿童超重肥胖流行特征及其干预对策

中国儿童超重及肥胖已进入全面流行阶段，且呈现出明显的区域差异。学龄儿童超重及肥胖的影响因素多样复杂，需要对不同年龄段和不同地区儿童采取针对性措施，综合考量生理、社会、家庭与行为因素的影响，加强学校—医疗机构—家庭联动，以积极应对儿童肥胖流行的严峻形势。     

Overweight and Obesity among Women by Economic Stratum in Urban India

Using data of the third round of the National Family Health Survey (NFHS) 2005-2006, this study examined the prevalence of overweight and obesity among women from different economic strata in urban India. The study used a separate wealth index for urban India constructed using principal components analysis (PCA). The result shows that prevalence of overweight and obesity is very high in urban areas, more noticeably among the non-poor households. Furthermore, overweight and obesity increase with age, education, and parity of women. The results of multinomial logistic regression show that non-poor women are about 2 and 3 times more at risk of being overweight and obese respectively. Marital status and media exposure are the other covariates associated positively with overweight and obesity. Thus, the growing demand which now appears before the Government or urban health planners is to address this rising urban epidemic with equal importance as given to other issues in the past.Key words: Body mass index, Economic status, Urban women, India     

Combating childhood obesity: a survey of laws affecting the built environments of low-income and minority children

Childhood overweight and obesity have reached epidemic proportions, with nearly one of every three children in the USA being affected. That factors in the built environment are closely correlated to childhood obesity has become increasingly evident. Negative built environment factors disproportionately affect poor and minority children. This paper examines the current research on the state of childhood overweight and obesity and surveys the built environment factors that have been linked to the problem. Analyzing the built environment from a legal perspective, this paper identifies how zoning, legislation, public/private partnerships, and contracts are being used at the local, state, and federal levels to combat the epidemic of childhood obesity. Using these tools, local, state, and federal government agencies are increasing access to healthy food, decreasing the density of unhealthy food sources, and increasing physical activity resources for children. Whereas some of the programs are geared toward minority and low-income children, many apply to children across the socioeconomic and demographic spectrum.     

Child and adolescent obesity in the 21st century: an Australian perspective

The early 21st century has seen the development of a global epidemic of obesity in both developed and developing countries. In Australia at least one in five children and adolescents are overweight or obese, with rapid rises in prevalence apparently continuing. Similar trends are seen in other countries. Child and adolescent obesity is associated with both immediate and long-term medical and psychosocial problems, including a clustering of risk factors for the development of cardiovascular disease and diabetes. Thus, obesity poses a major health problem for the paediatric population. Major environmental and societal changes have led to a decrease in physical activity, a rise in sedentary behaviour and the consumption of high fat and high-energy foods, all in turn influencing the development of obesity. Effective management involves a multimodal approach with a developmentally aware approach, involvement of the family, a focus on healthy food choices, incorporation of physical activity and a decrease in sedentary behaviour all being important. Ultimately, however, the obesity epidemic requires a major focus on primary prevention. Australia has a national strategy for the prevention of overweight and obesity that depends upon intersectoral and intergovernmental cooperation, supported by adequate resourcing and significant community ownership.     

School- and family-based interventions to prevent overweight in children

There have been only a few controlled studies on the prevention of overweight and obesity in children and adolescents. These studies differ in relation to strategy, setting, duration, focus, variables of outcome and statistical power, and therefore do not allow general conclusions to be made about the value of preventive measures. All school-based interventions aimed at the prevention of overweight and obesity show some improvement of health knowledge and health-related behaviours. Short-term effects on nutritional state seem to be more pronounced in girls than in boys. School-based interventions can reduce the incidence of overweight. There is evidence that families of intermediate and high socio-economic status as well as intact families benefit more from treatment than families sharing other characteristics. Selected prevention in obese children is most successful when children are treated together with their parents. However, there are social barriers limiting the success of family-based interventions. Although some positive effects have been reported, simple interventions in a single area (e.g. a school health education programme) are unlikely to work on their own. The development of effective preventive interventions probably requires strategies that affect multiple settings simultaneously. At present there is no concerted action, rather many strategies in health promotion that are followed in isolation. Faced with the epidemic of overweight there is a need for national campaigns and action plans on childhood overweight and obesity. It is tempting to speculate that this strategy will also increase the value of isolated approaches (e.g. in schools and families).     

Children at high risk for overweight: a classification and regression trees analysis approach

OBJECTIVE: Early identification of children at high risk for childhood overweight is a major challenge in fighting the obesity epidemic. We tried to identify the most powerful set of combined predictors for childhood overweight at school entry. RESEARCH METHODS AND PROCEDURES: A classification and regression trees analysis on risk factors for childhood overweight in 4289 children 5 to 6 years of age participating in the obligatory school entry health examination 2001/2002 in Bavaria, Germany, was performed. Parental questionnaires asked for children's weight at birth and 2 years, breastfeeding history, maternal smoking in pregnancy, parental education, parental overweight/obesity, nationality, and number of older siblings. Overweight was defined according to sex- and age-specific BMI cut-points proposed by the International Obesity Task Force. RESULTS: Prevalence of overweight was 11% among the entire study population. Although high early weight gain >10,000 grams was found in about one-half of the overweight children, its positive predictive value reached only 25%, indicating that one of four children with a high early weight gain is overweight at school entry. The best reliable set of predictors included high early weight gain and obese parents and accounted for a likelihood ratio of 3.6, with a corresponding positive predictive value of 40%, and was found in 4% of all children. DISCUSSION: A combination of predictors available at 2 years of age could improve predictability of overweight at school entry. However, corresponding low positive predictive values indicate a precision of the prediction that might be insufficient for targeting intervention programs for identified high-risk children.     

Confronting the epidemic: the need for global solutions

The growth in the global epidemic of obesity is fundamentally linked to economic factors. The rising prevalence of overweight and obesity has occurred during a period when the real cost of the main components of many processed foods has declined significantly,partly due to state subsidies in the protected markets of Western economies. It is suggested that the vigorous promotion of foods high in fats and sugars, and intensive marketing to children, have aggravated the problems of obesity. The metabolic syndrome, a recent feature of the epidemic, now is a marker for the health impact of obesity both in the US and other countries. The IOTF suggests that global populations will continue to become progressively heavier if present consumption forecasts are sustained, with obesity imposing a burden of social and economic costs that no country, least of all developing countries with limited resources, can afford. Commitments to deliver effective action are needed from non-health sectors such as culture and education, commerce and trade, development,planning, and transport. Only a comprehensive and integrated international approach, based on an effective implementation of the WHO global strategy on diet, physical activity and health, offers any real hope of arresting the public health catastrophe unfolding throughout the world.     

在校大学生对超重肥胖的认知情况及减肥行为调查

目的了解在校大学生对超重肥胖的认知情况及减肥行为现状,为今后健康教育提供科学依据。方法采用随机整群抽样的方法,在全国10个省市15所大学中随机选取2599名在校大学生作为调查对象,采用问卷调查的方法收集大学生对超重肥胖的认知及减肥行为等信息。结果男生的超重肥胖率（12.8%）明显高于女生（2.9%）;女生中体重过低的占34.6%,明显高于男生（12.1%）。33.2%的大学生采取过减肥措施,女生（43.5%）明显高于男生（23.6%）。51.5%减过肥的大学生采取的是＂适量运动＋控制饮食＂的减肥方式,但仍有29.1%主要靠＂节食＂来减肥,尤其是女生（33.0%）。有54.1%＂超重肥胖＂的大学生未采取过任何减肥措施,男生比例（57.5%）明显高于女生（37.1%）。有27.1%＂体重过低＂的大学生曾经减过肥,女生（31.4%）高于男生（15.9%）。在曾经减过肥的大学生中,只有11.2%的大学生处于超重肥胖,18.6%的大学生处于体重过低的情况,女生中这种情况更加严重。结论在校大学生对自身的超重肥胖有不正确认识,因关注程度不足而未采取任何减肥措施的现象在＂超重肥胖＂男生中非常突出;因过分追求体型消瘦而盲目减肥的现象在＂体重过轻＂女生中尤为突出。建议引导在校大学生进行科学健康的减肥,养成健康的生活方式。     

昆山市农村居民肥胖的流行病学研究

目的：了解昆山市农村居民肥胖和超重的流行现状与影响因素。探讨其预防与控制措施。方法：对昆山市慢性病基线流行病学调查资料进行流行病学与统计学分析。结果：昆山市35周岁以上农村居民肥胖和超重合计现患率为37.8%，其中肥胖现患率为15.2%。不同性别，年龄，职业，文化程度人群肥胖和超重现患率有显著差别，其中女性，45-54岁年龄组，职业为教师，医务人员，干部及文化程度稍高人群为高危人群，肥胖超重与高血压等慢性病患病呈显著相关。结论：肥胖超重已成为高流行的慢性病危险因素。对此应采取综合措施加以预防与控制。     

北京市朝阳区成年居民超重肥胖流行现状及其与主要慢性病的关系

目的 了解北京市朝阳区成年居民超重、肥胖流行情况及其与主要慢性病的关系。方法 采用多阶段随机抽样的方法,抽取朝阳区13个街乡18岁以上常住居民共39 000人进行问卷调查和身体测量。用χ2检验比较不同特征居民间超重率及肥胖率的差异,采用单因素方差分析比较不同BMI人群的主要慢性病指标的差异,用多因素Logistic回归分析超重肥胖与慢性病的关系。结果 朝阳区成人超重率为38.97%,肥胖率为19.66%;城市居民超重率（χ2 = 114.74,P＜0.05）、肥胖率（χ2 = 373.83,P＜0.05）低于农村居民;男性超重率（χ2 = 101.55,P＜0.05）、肥胖率（χ2 = 22.37,P＜0.05）高于女性,超重组患高血压、糖尿病及血脂异常的风险是正常组的1.50～1.84倍,肥胖组患病风险是正常组的2.06～3.20倍。超重、肥胖组患1种、2种、3种疾病的聚集率均高于体重正常组,差异有统计学意义（P＜0.001）。结论 朝阳区居民超重肥胖流行状况严重。随着BMI水平的升高,成人患高血压等慢性病的风险升高,应积极开展超重肥胖防控工作。     

Dietary Patterns as Characterized by Food Processing Levels and Their Association with the Health Outcomes of Rural Women in East Africa

Overweight and obesity are rapidly rising in Sub-Saharan Africa including in rural areas. However, most studies focus on urban centers, and have attributed this epidemic to the consumption of processed foods without their clear characterization. This study investigated food intake patterns defined by food processing levels and their association with overweight/obesity in rural areas. Four 24-h dietary recalls, anthropometric measurements, and socio-demographic characteristics were collected from 1152 women in Kenya, Tanzania, and Uganda. The PCA method was used to extract patterns characterized by food processing levels. The association between patterns and overweight/obesity was ascertained with regression models. The overweight/obesity rate was 47%, 42%, 26%, and 38% in Kenya, Tanzania, Uganda, and East Africa (as pooled data), respectively. Several patterns were identified, yet a “plant-based pattern” largely characterized by unprocessed and minimally processed foods and a “purchase pattern” mainly distinguished by highly processed foods were dominant. The “plant-based pattern” was inversely or not associated with overweight/obesity, while the “purchase pattern” had a positive association or no association. A clear distinction on processed foods as healthy and unhealthy should be made based on their nutrient provision to avoid their mischaracterization as unhealthy. Policies to reverse consumption of unhealthy processed foods while promoting healthy ones should be pursued.     

Health care costs in old age are related to overweight and obesity earlier in life

Obesity is responsible for at least 90 billion dollars in direct U.S. health care costs annually. A high proportion of people who were overweight or obese at younger ages survives past age sixty-five to experience adverse consequences. The determinants of obesity are complex and multifactorial, with genetic, biological, behavioral, social, and environmental contributors. The effects of adverse weight in older age have negative implications for healthy aging and lead to greater societal expenditures. Given the high costs and ineffectiveness of existing programs to treat obesity, perhaps the only solution to the obesity epidemic is primary prevention of weight gain beginning in youth.     

南通市2010年小学生肥胖现状及影响因素分析

[目的]了解南通市小学生单纯性肥胖的流行情况,探讨影响儿童肥胖的相关因素。[方法]采用分层整群随机抽样的方法,收集南通市区及所辖市县1～6年级7所小学15972名小学生身高、体重资料,并对肥胖相关影响因素进行多因素Logistic回归分析。[结果]南通市小学生超重检出率为8.40%,肥胖检出率为4.77%,其中城镇肥胖率为5.76%(男7.75%,女3.32%),乡村肥胖率为3.42%(男4.31%,女2.35%),城镇小学生肥胖率高于乡村小学生(P﹤0.001)。无论城市或乡村小学生男生肥胖率均高于女生(P﹤0.01)。南通市小学生单纯性肥胖危险因素有:父亲超重肥胖,母亲超重肥胖,家庭人均月收入高,出生体重﹥4kg,食欲好,进食速度快,常吃甜饮料。保护因素有:母亲文化程度是大学或以上文化,经常进行户外活动。[结论]南通市小学生肥胖发生与环境因素与遗传因素关系密切,提示在小学阶段采取健康教育、运动锻炼及饮食调整等综合措施方面进行干预,为成年后的生命质量奠定良好的基础。     

A shift from underweight to overweight and obesity in Asian children and adolescents with congenital heart disease

Background: In Western countries, obesity is a common problem in children with congenital heart disease (CHD). However, this problem may have racial difference, and little is known about the shift of this trend as patients grow up. The present study sought to investigate the prevalence and trends of being underweight, overweight and obesity in an Asian CHD cohort using a 5‐year citywide school survey database. Methods: Patient group consisted of 705 first grade elementary school students (children) and 219 first grade senior high school students (adolescents), while 18753 healthy children and 15014 healthy adolescents served as controls. Body mass index (BMI) percentile was calculated to define underweight (BMI < 15^th percentile) and overweight (BMI 85^th–95^th percentile)/obesity (BMI ≥ 95^th percentile). Results: In CHD children, the prevalence of underweight and overweight/obesity was 21.0% (control 16%, P < 0.001) and 14.5% (control 19.8%, P < 0.001), respectively. Children with moderate to severe CHD, especially cyanotic CHD, were more underweight and less overweight/obese than children with non‐cyanotic CHD. The prevalence of underweight (23.3%) and overweight/obesity (26.5%) in CHD adolescents became close to that in controls. From childhood to adolescence, different shifts in BMI distribution were noted; controls became more underweight and overweight/obese for males and more underweight and less overweight/obese for females, while CHD patients became more overweight/obese for both genders, including cyanotic CHD. Conclusions: In this Asian CHD cohort, we demonstrates a shift of BMI distribution from more underweight and less overweight/obese compared with healthy children, to a pattern similar to that in healthy adolescents.