Prevalence of overweight and obesity in China: Results from a cross-sectional study of 441 thousand adults, 2012–2015

ObjectivesObesity has become a global health public problem. The study aims to examine the latest prevalence of overweight and obesity in China.MethodsData came from the China Hypertension Survey (CHS), a nationally representative cross-sectional study among residents aged ≥18 years from October 2012 to December 2015. Overweight and obesity were defined as 25 ≤ BMI < 30 kg/m² and BMI ≥ 30 kg/m² according to the WHO classifications, respectively.ResultsThe data of 441 306 participants were analyzed. The prevalence of overweight and obesity was 28.1% and 5.2% respectively. The prevalence of overweight and obesity varied considerably across provinces. The prevalence of overweight was the highest in Beijing, which was 2.8 fold of the lowest in Guangxi (40.9% vs. 14.6%). The prevalence of obesity was the highest in Tianjin, which was 9.4 fold of the lowest in Hainan (12.2% vs. 1.3%). There was a striking north-south gradient with the prevalence higher in Northeast and Northwest China and lower in Southeast China. Multivariate logistic regression analysis indicated that sex, age, education, smoking, marital status and family history of cardiovascular disease were significantly associated with overweight and obesity.ConclusionsOverweight and obesity are highly prevalent among Chinese adults, and their prevalence varies greatly among different population subgroups and provinces. National and provincial obesity control and prevention strategies should be public health priorities in China.     

Impact of diagnosis of overweight and obesity on weight management among hospitalized patients

BackgroundObesity is a growing epidemic associated with a 30% increase in general mortality. Despite this, diagnosis and treatment is still deficient. A large number of patients with overweight and obesity enter hospitals daily; therefore, the hospital setting could be used as a scenario for intervention in this population.ObjectivesTo determine the frequency of diagnosis and treatment of overweight/obesity in hospitalized patients and to identify the factors involved in the probability of offering a diagnosis and treatment.MethodsCross-sectional data from 316 patients aged 18 years and over admitted in the Department of Internal Medicine during 2016–2017 period. Logistic regression was used to estimate the relationship between the possible predictors and the diagnosis of overweight and/or obesity and the development of a treatment.ResultsOnly 10.8% of the population was diagnosed (overweight 2.6%, obesity 18.8%). Patients with a BMI >40 kg/m² had a greater probability of being diagnosed (OR = 1.87; 95% CI, 2.2–19.4; p = 0.001). Only 4.4% of the population received treatment (overweight 3.2%, obesity 5.6%) and the only factor that increased the probability of receiving treatment was having been diagnosed with overweight/obesity in the medical record (OR = 2.28; 95% CI, 2.31–41.94; p = 0.002).DiscussionDespite the high prevalence of overweight and obesity among hospitalized patients, there is no adequate diagnosis and treatment. Future research should be directed at strategies that increase medical recognition of overweight/obesity as well as identifying the long-term benefits of diagnosing overweight/obesity for the reduction and control of body weight.     

Risk factors for overweight and obesity in French adolescents: Physical activity,sedentary behavior and parental characteristics

ObjectiveWe determined the prevalence by age and sex and associated factors of overweight and obesity in French adolescents.MethodsWe conducted a cross-sectional study of 2385 adolescents aged 11–18 y (1213 boys and 1172 girls) from middle and high schools in the Aquitaine region (southwest France) in 2004–2005. Weight and height were measured, and adolescents filled in a questionnaire about their characteristics and those of their parents. Overweight and obesity were defined according to the age- and sex-specific body mass index cutoff points of the International Obesity Task force.ResultsPrevalence of overweight (obesity included) was greater in boys and younger children. The odds ratio (OR) for an adolescent being overweight increased with parents' being overweight (at least one parent overweight, OR 1.97, 1.48–2.62, P < 0.0001), low paternal socioeconomic status (OR 1.78, 1.22–2.60, P < 0.01) and sedentary behavior (22 h/wk, OR 1.33, 1.02–1.74, P < 0.05), and decreased with physical activity of parents (at least one parent active, OR 0.67, 0.51–0.89, P = 0.01).ConclusionOur data support the hypothesis that parental overweight and low socioeconomic status and adolescents' sedentary behavior are strong risk factors for adolescent overweight and obesity, and that parents active lifestyle is associated with a lower risk of overweight in their adolescents.     

Overweight and obesity in Eastern Morocco: Prevalence and associated risk factors among high school students

BackgroundOverweight and obesity in children and adolescents have become a major public health problem affecting most countries worldwide. The purpose of the study was to assess the prevalence and risk factors of overweight and obesity among public high school students in Eastern Morocco.MethodsA cross-sectional survey was conducted between February and May 2014 among a sample of 2271 students (1086 girls and 1185 boys). References from the International Obesity Task Force (IOTF) were used to determine the prevalence of overweight and obesity.ResultsThe prevalence of overweight and obesity reached 12.2% (14.2% in girls vs 10.4% in boys, P < 0.01) and 3.0% (3.1% in girls vs 2.8% in boys), respectively. Risk factors associated with overweight and obesity were urban residence (OR = 1.76; [1.18–2.63]; P < 0.01), father's income ≥ 5000 MAD (OR = 1.32; [1.02–1.70]; P < 0.05), father's overweight (including obesity) (OR = 1.87; [1.38–2.54]; P < 0.001) and female sex (OR = 1.31; [1.02–1.68]; P < 0.05).ConclusionThe prevalence of overweight/obesity has reached an alarming rate among high school students in the Eastern region of Morocco. The findings of the present study suggest an urgent need to set up a strategy to prevent and combat this epidemic.     

Trends in pneumococcal meningitis hospitalizations following the introduction of the 13-valent pneumococcal conjugate vaccine in the United States

BackgroundThe 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in 2010 in the U.S. and its impact on pneumococcal meningitis (PM) is unknown. We assessed the impact of PCV13 on PM hospitalization rates 4 years after the vaccine was introduced.MethodsThis was a retrospective analysis of the National Inpatient Sample from 2008–2014. Patients with an ICD-9-CM code for PM (320.1) were identified and rates calculated using US Census data as the denominator. Data weights were used to derive national estimates. We examined three time periods: 2008–2009 (late post-PCV7), 2010 (transition year), and 2011–2014 (post-PCV13).ResultsDuring the study period, there were 10,493 hospitalizations due to PM in the U.S. Overall, PM incidence decreased from 0.62 to 0.38 cases per 100,000 over this time (39% decrease; P < 0.01). Among children <2 years, the average annualized PM rate decreased by 45% from 2.19 to 1.20 per 100,000 (P = 0.10). Annual PM rates decreased in those aged 18–39 years (0.25–0.15 cases per 100,000; P = 0.02) and 40–64 years (0.95–0.54 cases per 100,000; P = 0.03). A total of 1016 deaths were due to PM, and the case fatality rate was variable over the study period (8.3%–11.2%; P = 0.96).ConclusionFollowing the introduction of PCV13, hospitalization rates for PM decreased significantly with no subsequent improvements in case-fatality rate.     

Prévalence de l’hypertension artérielle en population générale à la Martinique

BackgroundSince 1996, arterial hypertension has been recognized as one of the main health priorities in Martinique. However, its prevalence in the general population has never been measured. Furthermore, obesity is increasing in many countries and studies have shown that hypertension is more frequent in obese people than in people with normal body mass index. The objective of this survey is to measure hypertension prevalence in the general population and to study the link between hypertension, weight status and socioeconomic level.MethodsCross-sectional study of randomly selected homes in randomly selected geographical islets. All household members in these homes constituted the eligible population. Arterial hypertension was defined as systolic pressure greater than 140 mmHg and/or diastolic pressure greater than 90 mmHg and/or antihypertensive treatment. Weight status was estimated using the body mass index.ResultsStudy concerned 1504 persons aged 16 years or older with a sex-ratio of 0.7 and an average age of 48.3 years for men and 48.5 years for women, p = 0.88. The prevalence rate of hypertension is 29% [IC_95%: 25.9–31.8] in the sample and declines to 22.5% [IC_95%: 20.1–25.1] using weighted data. The prevalence rate is 33.1% [IC_95%: 30.2–36.6] for overweight and 20.1% [IC_95%: 17.8–22.6] for obesity. Being overweight is more frequent among persons with hypertension than among ones with normal blood pressure, 73.0 versus 47.4%; p < 0.001. In those with hypertension, overweight does not differ significantly between men and women, but the prevalence of obesity is greater among women than among men (35.7 versus 20.6 %, p < 0.05).ConclusionThe high prevalence of both hypertension and obesity in the general Martinican population has been confirmed by this study. Prevention actions are required to decrease the cardiovascular risk in this population.     

Impact of obesity and diabetes mellitus in critically ill patients with SARS-CoV-2

PurposeEvaluate the associations of obesity and diabetes with the risk of mortality in critically ill patients infected with SARS-CoV-2.Materials and methodsThis cohort study included 115 adult patients admitted to the ICU with SARS-CoV-2 pneumonia. Anthropometric variables and biochemical (C-reactive protein, ferritin, leukocyte, neutrophils, and fibrinogen) were measured. Multivariate logistic regression analyses were used to investigate the associations.ResultsMean age was 50.6 ± 11.2 years, 68.7% were male. Median BMI was 30.9 kg/m². All patients had invasive mechanical ventilation. Patients with diabetes had increased risk of mortality with OR of 2.86 (CI 95% 1.1–7.4, p = 0.026); among those patients who, in addition to diabetes had obesity, the risk was de 3.17 (CI 95% 1.9–10.2, p = 0.038). Patients with obesity had 1.25 times greater risk of developing a severe SARS-CoV-2 infection (95% CI 1.09–1.46, p = 0.025). Negative correlation was observed between BMI and the PaO2/FiO2 ratio (r = ?0.023, p < 0.05). Obese patients required more days of mechanical ventilation and longer hospital stay compared to non-obese patients.ConclusionsDiabetes and obesity are risk factors for increasing severity of SARS-CoV-2 infection, and they are both associated with an increase in mortality.     

Cost-effectiveness of a 3-antigen versus single-antigen vaccine for the prevention of hepatitis B in adults in the United States

ObjectivesThe first 3-antigen hepatitis B vaccine was approved by the United States (US) Food and Drug Administration in November 2021 and was recommended by the Centers for Disease Control and Prevention in 2022. We estimated the cost-effectiveness of this 3-antigen vaccine (PreHevbrio™) relative to the single-antigen vaccine, Engerix-B^TM, to prevent hepatitis B virus (HBV) infection among US adults.MethodsA cost-effectiveness model was developed using a combined decision-tree and Markov structure to follow 100,000 adults over their remaining lifetimes after vaccination with either the 3-antigen or single-antigen vaccine. Outcomes from societal and healthcare sector perspectives were calculated for adults aged 18–44, 45–64, and ≥65 years; adults with diabetes; and adults with obesity. Seroprotection rates were obtained from the phase 3, head-to-head PROTECT trial (NCT03393754). Incidence, vaccine costs, vaccine adherence rates, direct and indirect costs, utilities, transition probabilities, and mortality were obtained from published sources. Health outcomes and costs (2020 USD) were discounted 3% annually and reported by vaccine and population. One-way sensitivity and scenario analyses were conducted.ResultsIn the model, the 3-antigen vaccine led to fewer HBV infections, complications, and deaths compared with the single-antigen vaccine in all modeled populations due to higher rates and faster onset of seroprotection. Compared with the single-antigen vaccine, the 3-antigen vaccine had better health outcomes, more quality-adjusted life-years (QALYs), and lower costs in adults aged 18–64 years, adults with diabetes, and adults with obesity (dominant strategy). For adults aged ≥65 years, the 3-antigen vaccine was cost-effective compared with the single-antigen vaccine ($26,237/QALY gained) below common willingness-to-pay thresholds ($50,000-$100,000/QALY gained). In sensitivity analyses, results were sensitive to vaccine cost per dose, incidence, and age at vaccination.ConclusionThe recently approved 3-antigen vaccine is a cost-saving or cost-effective intervention for preventing HBV infection and addressing the long-standing burden of hepatitis B among US adults.     

Recognizing disordered eating in primary care patients with obesity

ObjectiveIn clinical practice, behavioral approaches to obesity treatment focus heavily on diet and exercise recommendations. However, these approaches may not be effective for patients with disordered eating behaviors. Little is known about the prevalence of disordered eating behaviors in primary care patients with obesity or whether they affect difficulty making dietary changes.MethodsWe conducted a telephone interview of 337 primary care patients aged 18–65 years with BMI ≥ 35 kg/m² in Greater Boston, 2009–2011 (58% response rate, 69% women). We administered the Three-Factor Eating Questionnaire R-18 (scores 0–100) and the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) (scores 0–100). We measured difficulty making dietary changes using four questions regarding perceived difficulty changing diet (Scores 0–10).Results50% of the patients reported high emotional eating (score > 50) and 28% reported high uncontrolled eating (score > 50). Women were more likely to report emotional [OR = 4.14 (2.90, 5.92)] and uncontrolled eating [OR = 2.11 (1.44, 3.08)] than men. African-Americans were less likely than Caucasians to report emotional [OR = 0.29 (95% CI: 0.19, 0.44)] and uncontrolled eating [OR = 0.11 (0.07, 0.19)]. For every 10-point reduction in QOL score (IWQOL-lite), emotional and uncontrolled eating scores rose significantly by 7.82 and 5.48, respectively. Furthermore, participants who reported emotional and uncontrolled eating reported greater difficulty making dietary changes.SummaryDisordered eating behaviors are prevalent among obese primary care patients and disproportionately affect women, Caucasians, and patients with poor QOL. These eating behaviors may impair patients' ability to make clinically recommended dietary changes. Clinicians should consider screening for disordered eating behaviors and tailoring obesity treatment accordingly.     

Weight and body mass index among female contraceptive clients

ObjectivesAs obesity may affect the efficacy of some contraceptives, we examined weight, body mass index (BMI) and prevalence of obesity among female contraceptive clients at 231 U.S. health centers. A secondary aim was to analyze differences in contraceptive method use by obesity status.Study designCross-sectional study using de-identified electronic health record data from family planning centers. We analyzed contraceptive visits made by 147,336 females aged 15–44 years in 2013.ResultsA total of 46.1% of clients had BMI ≥ 25. Mean body weight was 154.4 lb (S.D.= 41.9); mean BMI was 26.1 (S.D.= 6.6). A total of 40% had BMI ≥ 26, when levonorgestrel emergency contraception may become less effective. Obese clients had higher odds of using a tier 1 or tier 3 contraceptive method and had lower odds of using a tier 2 or hormonal method than non-obese clients.ConclusionsAbout half of contraceptive clients would be categorized as overweight or obese. Contraceptive method choices differed by obesity status.ImplicationsAbout half of contraceptive clients in this study population were overweight or obese. Contraceptive method choices differed by obesity status. All women — regardless of body size — should receive unbiased, evidence-based counseling on the full range of contraceptive options so that they can make informed choices.     

Lack of private health insurance is associated with higher mortality from cancer and other chronic diseases,poor diet quality,and inflammatory biomarkers in the United States

ObjectiveThe lack of health insurance reduces access to care and often results in poorer health outcomes. The present study simultaneously assessed the effects of health insurance on cancer and chronic disease mortality, as well as the inter-relationships with diet, obesity, smoking, and inflammatory biomarkers. We hypothesized that public/no insurance versus private insurance would result in increased cancer/chronic disease mortality due to the increased prevalence of inflammation-related lifestyle factors in the underinsured population.MethodsData from the Third National Health and Nutrition Examination Survey participants (NHANES III;1988–1994) were prospectively examined to assess the effects of public/no insurance versus private insurance and inflammation-related lifestyle factors on mortality risk from cancer, all causes, cardiovascular disease (CVD) and diabetes. Cox proportional hazards regression was performed to assess these relationships.ResultsMultivariate regression analyses revealed substantially greater risks of mortality ranging from 35% to 245% for public/no insurance versus private insurance for cancer (HR = 1.35; 95% CI = 1.09,1.66), all causes (HR = 1.54; 95% CI = 1.39,1.70), CVD (HR = 1.62; 95% CI = 1.38,1.90) and diabetes (HR = 2.45; 95% CI = 1.45,4.14). Elevated CRP, smoking, reduced diet quality and higher BMI were more prevalent in those with public insurance, and were also associated with increased risks of cancer/chronic disease mortality.DiscussionInsurance status was strongly associated with cancer/chronic disease mortality after adjusting for lifestyle factors. The results suggest that inadequate health insurance coverage results in a substantially greater need for preventive strategies that focus on tobacco control, obesity, and improved dietary quality. These efforts should be incorporated into comprehensive insurance coverage programs for all Americans.     

Disability,more than multimorbidity,was predictive of mortality among older persons aged 80 years and older

ObjectiveIn this study, we evaluate the impact of disability and multimorbidity on the risk of all-cause death in a population of frail older persons living in community.Study Design and SettingWe analyzed data from the Aging and Longevity Study in the Sirente geographic area, a prospective cohort study that collected data on all subjects aged 80 years and older (n = 364). The main outcome measure was all-cause mortality over 4-year follow-up.ResultsA total of 150 deaths occurred. Sixty-seven subjects (44.6%) died in the nondisabled group compared with 83 subjects (55.3%) in the disabled group (P < 0.01). Thirty-nine subjects (31.7%) died among subjects without multimorbidity compared with 111 subjects (46.0%) with two or more diseases (P < 0.01). When examining the combined effect of multimorbidity and disability, the effect of disability on the risk of death was higher than that of multimorbidity. After adjusting for potential confounders, relative to those without disability and multimorbidity, disabled subjects showed an increased risk of death when multimorbidity was associated (hazard ratio [HR] = 3.91; 95% confidence interval [CI] = 1.53–10.00) and in absence of multimorbidity (HR = 2.36; 95% CI = 0.63–8.83).ConclusionOur results show that disability exerts an important influence on mortality, independently of age and other clinical and functional variables.     

Joint association of body mass index and central obesity with cardiovascular events and all-cause mortality in prediabetic population: A prospective cohort study

ObjectiveTo assess the joint association of body mass index (BMI) and central obesity with cardiovascular events and all-cause mortality in prediabetic population.MethodsAltogether 18,703 participants with prediabetes completed follow-up between June 2006 and December 2015 were included in the analyses. Prediabetes was defined as fasting plasma glucose level 5.6–6.9 mmol/L, and without history of diabetes or currently use of hypoglycemic agents. Participants were classified according to the baseline status of BMI as well as the absence/presence of central obesity. We examined these associations in men and women separately.ResultsThe mean age was 51.5 ± 11.1 years, and 85.6% (N = 16,002) were male. During a median follow up of 9.0 (interquartile range 8.7–9.2) years, 848 and 88 major CV events occurred in men and women, respectively. Besides, 1111 men and 89 women died. Compared with men of BMI 22–23.9 kg/m² and without central obesity, the risk of CV events was increased among men with higher BMI and central obesity (HR 1.32 (95% CI: 1.05–1.67) for BMI 24–27.9 kg/m² and 1.31 (1.03–1.66) for BMI ≥ 28 kg/m², respectively); and the risk of all-cause mortality was the lowest among men of BMI 24–27.9 kg/m² but without central obesity (0.75, 0.61–0.92). We found no such association in women.ConclusionAmong men with prediabetes, both BMI and waist circumference should be included when evaluating the risks of major CV events and mortality. Measurement of adiposity constitutes a simple and cost-effective strategy to identify those at high-risk population in prediabetes.     

Association of sugar-sweetened beverage intake frequency and asthma among U.S. adults, 2013

ObjectivesSugar-sweetened beverage (SSB) intake among U.S. adults is associated with obesity and type 2 diabetes. An association between SSB intake and asthma has been shown among U.S. children and Australian adults, but scant published information exists for U.S. adults. We examined associations between SSB intake and current asthma among U.S. adults, and the role of obesity in this association.MethodsWe analyzed 2013 Behavioral Risk Factor Surveillance System data for 146,990 adults (≥ 18 years) from 23 states and the District of Columbia. We used multivariable logistic regression to estimate associations between current asthma and frequency (none, < 1 time/day, once/day, ≥ 2 times/day) of SSB intake (soda, fruit drink, sweet tea, and sports/energy drink). SSB intake was measured using two questions. Covariates included age, sex, race/ethnicity, education, and smoking. Obesity, based on self-reported height and weight, was assessed as an effect modifier.ResultsOverall, 9.1% of adults reported current asthma: 8.5% of adults who did not consume SSBs had current asthma vs 12.1% of adults who consumed SSBs ≥ 2 times/day. There was no difference in asthma prevalence with SSB intake < 1 time/day (8.7%) or once/day (8.7%). Among non-obese adults, the odds of having current asthma were higher among those who consumed SSBs ≥ 2 times/day (aOR = 1.66, 95%CI = 1.39, 1.99) than non-SSB consumers. However, SSB intake frequency was not associated with asthma among obese adults.ConclusionsFrequent SSB consumption was associated with asthma among non-obese adults. Research on asthma prevention should further consider the potential adverse effects of high SSB intake among U.S. adults.     

Vulnerabilidad de la obesidad definida por el índice de masa corporal,perímetro abdominal y porcentaje de grasa corporal

AimTo ascertain to what extent it is possible to stop being obese (to normalize body mass index [BMI], waist circumference [WC] and/or body fat percentage [BFP]).DesignLongitudinal observational and retrospective study.SiteEleven Spanish health centers.ParticipantsMen and women with BMI ≥ 30 kg/m² (n = 1246) or general obesity (GO), with WC > 102 cm and > 88 cm, respectively (n = 2122) or abdominal obesity (AO) and with BFP > 25% and > 35%, respectively (n = 2436) or excess body fat (EBF), from the PEPAF Study cohort of 4927 participants aged 20-80 years.Main measurementsData from the PEPAF study at baseline and at 6, 12 and 24 months: gender, age, diagnoses of diabetes, hypertension and dyslipidemia, smoking, levels of and compliance with physical activity recommendations, maximum oxygen consumption, weigh, height, WC and three skin-folds (thoracic, umbilical and anterior thigh for men and triceps, suprailiac and anterior thigh for women).ResultsOf 2054 participants with any type of obesity at baseline and valid data at 2 years, 240 (11.6%) had normalized all of their obesity diagnostic indexes. 19.5% (95% confidence interval (95% CI: 17.6-21.4) ceased to have EBF, 12.0% (95% CI: 10.4-13.7) ceased to have AO and 10.5% (95% CI: 8.5-12.7) ceased to have GO.ConclusionsObesity differs from other chronic diseases in that it can be «cured» by normalizing the amount of body fat.     

Prévalence de l’obésité et du surpoids chez les écoliers de primaire à Marrakech,Maroc

BackgroundChildhood obesity is a phenomenon of growing concern today because of its rapid growth worldwide. The aim of our study was to estimate the prevalence of overweight and obesity among school age children in Marrakech.MethodsWe conducted a cross-sectional study of a random sample of 1418 schoolchildren aged 8–15 years in the public sector in Marrakech in May 2011. Trained physicians measured the weight and size of respondents. The body mass index (BMI) was calculated for each child. Overweight was assessed by comparing BMI with World Health Organization (WHO) and International Obesity Task Force (IOTF) references. Statistical analysis was performed using SPSS version 16.0 and using a macro of WHO Anthro for SPSS.ResultsThe mean age was 10.8 ± 1.6 years. The sex ratio (girl/boy) was 1. The prevalence of overweight and obesity were 8 % (95 % CI [6.7, 9.6]) and 3 % (95 % CI [2.2, 4.1] based on WHO reference. This prevalence were respectively 12.2 % (95 % IC [10.5; 14.0]) and 5.4 % (95 % IC [4.3; 6.7]) using the IOTF reference.ConclusionIn the absence of national data, our results reflect the importance of the phenomenon in our context, hence the importance of monitoring the nutritional status on both individual and collective levels and the need to develop strategies for prevention, diagnosis and early treatment before the problem becomes more widespread.     

Incidence and potential risk factors of obesity among Tehranian adults

AimEvaluating the incidence of obesity and its risk factors among Tehranian adults.Material & methodsIn this population-based cohort, non-obese participants, aged ≥ 20 years, were followed for development of obesity (Body Mass Index (BMI) ≥ 30). Incidence density and cumulative incidence rates of obesity were calculated for each sex. Cox proportional hazard regression was used to determine the association of potential obesity risk factors including: age, BMI, metabolic syndrome, waist circumference (WC), smoking, marital status, education, and physical activity.ResultA total of 7257 participants (3536 men) were followed for a median of 8 years. At baseline, mean age, BMI and WC were 41.3 ± 14.6 years, 25.1 ± 2.9 kg/m² (24.9 ± 3 kg/m² men and 25.2 ± 3 kg/m² women), and 84.8 ± 9.8 cm (87.06 ± 9.2 cm men and 82.6 ± 9.9 cm women) respectively. During the follow-up, 1345 participants (876 women) developed obesity contributing to cumulative incidences of 31.3% (CI: 29.9%–32.7%), 38.1% (CI: 36.2%–40.1%), and 23.4% (CI: 21.6%–25.3%) for the whole population, women, and men, respectively. Corresponding incidence density rates per 1000 person-year were 25.9 (CI: 24.5–27.3), 33.67 (CI: 31.5–36.0), and 18.0 (CI: 16.5–19.7), respectively. Highest incidence rates were observed during their 40s and 20s for women and men, respectively. Participants with metabolic syndrome, lower educational level, higher BMI and WC, were at higher risk of obesity development in both sexes.ConclusionHigh incidence of obesity was observed among Tehranian adults with higher incidence of obesity in women. Different modifiable variables may act as risk factors for obesity development which should be targeted to control the epidemic of obesity.     

Cost effectiveness of an internet-delivered lifestyle intervention in primary care patients with high cardiovascular risk

ObjectiveTo assess the cost-effectiveness of an online adaptation of the diabetes prevention program (ODPP) lifestyle intervention.MethodsODPP was a before–after evaluation of a weight loss intervention comprising 16 weekly and 8 monthly lessons, incorporating behavioral tools and regular, brief, web-based individualized counseling in an overweight/obese cohort (mean age 52, 76% female, 92% white, 28% with diabetes). A Markov model was developed to estimate ODPP cost effectiveness compared with usual care (UC) to reduce metabolic risk over 10 years. Intervention costs and weight change outcomes were obtained from the study; other model parameters were based on published reports. In the model, diabetes risk was a function of weight change with and without the intervention.ResultsCompared to UC, the ODPP in our cohort cost $14,351 and $29,331 per quality-adjusted life-year (QALY) gained from the health care system and societal perspectives, respectively. In a hypothetical cohort without diabetes, the ODPP cost $7777 and $18,263 per QALY gained, respectively. Results were robust in sensitivity analyses, but enrolling cohorts with lower annual risk of developing diabetes (≤ 1.8%), enrolling fewer participants (≤ 15), or increasing the hourly cost (≥$91.20) or annual per-participant time (≥ 1.45 h) required for technical support could increase ODPP cost to >$20,000 per QALY gained. In probabilistic sensitivity analyses, ODPP was cost-effective in 20–58% of model iterations using an acceptability threshold of $20,000, 73–92% at $50,000, and 95–99% at $100,000 per QALY gained.ConclusionsThe ODPP may offer an economical approach to combating overweight and obesity.