Improving reproductive performance in overweight/obese women with effective weight management

Obesity and overweight are common conditions in the developed countries and they carry many health consequences, including some reproductive disorders. There is a very high prevalence of obese women in the infertile population and many studies have highlighted the link between obesity and infertility. A large proportion of infertile women have polycystic ovary syndrome (PCOS) which is also linked with increased risk of obesity and other metabolic anomalies. The association between obesity and/or PCOS and hyperinsulinaemia, hyper androgenism and abnormal secretion of other hormones, such as leptin, underlies many reproductive disorders observed in this population. It has been demonstrated that weight loss can improve the fertility of obese women through the recovery of spontaneous ovulation, whereas others will have improved response to ovarian stimulation in infertility treatment. Therefore, it is proposed that following the initial assessment of infertility and body mass index or other measurement of obesity, various weight management interventions, including diet, exercise or pharmacotherapeutic approaches, should be considered for overweight and obese infertile women.     

Asthma and obesity

The prevalence and incidence of asthma have increased among obese children and adults, particularly among women. Obesity seems to be a predisposing factor for the development of asthma, but the underlying mechanisms of its influence are still uncertain. Various hypotheses have been proposed to explain the link between obesity and asthma such as a common genetic predisposition, developmental changes, altered lung mechanics, the presence of a systemic inflammatory process, and an increased prevalence of associated comorbid conditions. Over‐diagnosis of asthma does not seem to be more frequent in obese compared to non‐obese subjects, but the added effects of obesity on respiratory symptoms can affect asthma control assessment. Obesity can make asthma more difficult to control and is associated with a reduced beneficial effect of asthma medications. This could be due to a change in asthma phenotype, particularly evidenced as a less eosinophilic type of airway inflammation combined to the added effects of changes in lung mechanics. Weight loss is associated with a universal improvement of asthma and should be part of asthma management in the obese patient. Additional research should be conducted to better determine how obesity influences the development and clinical expression of asthma, establish the optimal management of asthma in this population and determine how obesity affects long‐term asthma outcomes in these patients.     

Obesity: genetic, molecular, and environmental aspects

Obesity has emerged as one of the most serious public health concerns in the 21st century. Obese children tend to become obese adults. The dramatic rise in pediatric obesity closely parallels the rapid increase in the prevalence of adult obesity. As overweight children become adults they face the multitude of health problems associated with obesity at younger ages. The morbidity and mortality associated with obesity continue to increase. Obesity is one of the leading causes of preventable death. Complications of obesity include cardiovascular risks, hypertension, dyslipidemia, endothelial dysfunction, type 2 diabetes mellitus and impaired glucose tolerance, acanthosis nigricans, hepatic steatosis, premature puberty, hypogonadism and polycystic ovary syndrome, obstructive sleep disorder, orthopedic complications, cholelithiasis and pseudotumor cerebri. Genetic and molecular and environmental factors play an important role in the assessment and management of obesity.     

European Guidelines for Obesity Management in Adults

Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient''s obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management.Key Words: European guidelines, Obesity management, Multidisciplinary, Primary care, OMTF, COMs     

Obesity pandemics and the modification of digestive bacterial flora

Environmental factors, such as social networks, have an influence on obesity pandemics. The gut microbial flora (microbiota) plays a role in converting nutrients into calories. Variations in microbiota composition are found in obese humans and mice. The microbiota from an obese mouse confers an obese phenotype when transferred to an axenic mouse. There is a large body of experimental evidence and empirical data in the food industry showing that both antibiotics and probiotics, which modify the gut microbiota, can act as growth promoters, increasing the size and weight of animals. The current obesity pandemic may be caused, in part, by antibiotic treatments or colonization by probiotic bacteria. Using metagenomics and microarray analysis, studies of microbiota modifications after antibiotic and probiotic intake may identify the modifications associated with increased size and weight. Epidemiological studies recording these factors in an obese population may be able to link obesity with the absorption of microbiota modifiers.     

Obesity and cancer. A review of epidemiological studies on the relationship of obesity to cancer of the colon, rectum, prostate, breast, ovaries, and endometrium

Cancer of the colon, rectum, prostate, breast, ovaries and endometrium may be associated with obesity. The present paper reviews both prospective and retrospective studies of the potential associations between obesity and these cancers. This research is especially difficult because of the complex interrelations between weight and diet, physical activity, cigarette smoking, and other conditions. Epidemiological studies of body weight are subject not only to biases of sampling, selection, and confounding but also to marked difficulties in definition and measurement. Bearing in mind the methodological shortcomings, there is a distinct and reproducible association between obesity and cancer of the endometrium and postmenopausal breast cancer. The studies of cancer of the colon, rectum, prostate, and ovaries are too inconclusive to elucidate whether obesity implies an increased risk. It is recommended that future studies in this field include a standardised assessment of the distribution of fat tissue, the onset and duration of the condition, and the associated confounding factors. It is concluded that obesity, especially in females, should be avoided as a part of the general cancer preventive effort.     

Association of stress and depression with regional fat distribution in healthy middle-aged men

We examined whether the association of regional fat distribution with stress, defined in terms of vital exhaustion, and depression varies according to the total amount of body fat accumulation in healthy middle-aged men (n=64). Regional fat distribution was measured using the waist-to-hip circumference ratio (WHR), and the total amount of body fat accumulation was measured using the body mass index (BMI). The results indicate that WHR in lean men was associated with characteristics contrary to those in moderately obese men. In lean men WHR tended to be associated with a high level of stress, while in moderately obese men an association was found with a low level of stress and a low level of depressive symptomatology. The present results support the suggestion that there is a difference between abdominal obesity at different degrees of generalized obesity, and they are likely to further our understanding about the differing risk for cardiovascular disorders posed by abdominal obesity in lean men compared to abdominal obesity in moderately obese men.Partial support of this research by a grant to K. R. from Emil Aaltonen's Foundation and a grant to A. H. from Signe and Ane Gyllenberg Foundation is gratefully acknowledged.     

Measurement of total RBC volume relative to lean body mass for diagnosis of polycythemia

An elevated total RBC volume (TRCV) in milliliters per kilogram of body weight has been an essential criterion for determining whether a person is polycythemic. This may be misleading in obese subjects as the TRCV per kilogram of fat is only one-tenth that of the TRCV of the lean body mass (LBM). Various formulas based on surface area have been used to account for this difference, but they are not always reliable. Direct measurement of TRCV per kilogram of lean body mass was obtained originally in studies in which body composition was determined by the combined body density and total body water measurement method. This is impractical as a routine procedure, but simple-to-use instruments are now available for direct measurement of a person's body composition and percentage of fat by impedance technology. Thus, the TRCV can be obtained by a direct measurement that discounts the effects of fat, and a graph has been designed to normalize the TRCV to milliliters per kilogram of LBM. The TRCV for men and women has been established as 36 mL/kg LBM; when it is more than 43 mL/kg LBM, a diagnosis of polychthemia can be made with confidence.     

Body Fat Assessment Method Using CT Images with Separation Mask Algorithm

In recent years, the number of obese population in Korea has been growing up along with the economic development, environmental factors, and the change in life style. Considering the growth of obese population and the adverse effect of obesity on health, it is getting more important to prevent and diagnose the obesity with the quantitative measurement of body fat that has become an important indicator for obesity. In this study, we proposed a procedure for the automated fat assessment from computed tomography (CT) data using image processing technique. The proposed method was applied to a single-CT image as well as CT-volume data, and results were correlated to those of dual-energy X-ray absorptiometry (DEXA) that is known as the reliable method for evaluating body fat. Using single-CT images, correlation coefficients between DEXA and the automated assessment and DEXA and the manual assessment were 0.038 and 0.058, respectively (P > 0.05). Hence, there was no significant correlation between three methods using the proposed method with single-CT images. On the other hand, in case of CT-volume data, the above correlation coefficients were increased to 0.826, 0.812, and 0.805, respectively (P < 0.01). Thus, DEXA and the proposed methods with CT-volume data showed highly significant correlation with each other. The results suggest that the proposed automated assessment using CT-volume data is a reliable method for the evaluation of body fat. It is expected that the clinical application of the proposed procedure will be helpful to reduce the time for the quantitative evaluation of patient’s body fat.     

Mental health, family function and obesity in African-American women

CONTEXT: African-American women are disproportionately affected by obesity and its related diseases. How psychological and psychosocial factors that affect this population differ across weight categories remains poorly understood. PURPOSE: To determine whether poor mental health and family functioning are associated with obesity in African-American women. METHODS: African-American women patients aged 21-65 years were interviewed at three primary care centers. Four well-established assessment tools were used to measure general mental and physical health status, family functioning, depressive symptoms and anxiety levels. Demographics, health behaviors and family and personal histories of overweight were assessed. RESULTS: Among 113 patients, after controlling for age and parity, obese women had significantly higher anxiety levels, poorer perception of their physical health, more often were overweight as a child, had overweight parents or siblings and experienced more psychosocial problems in their family growing up, compared to overweight and normal weight women. CONCLUSIONS: The observed findings of poor mental health, perception of physical health and family function in obese African-American women support a need for clinical attention and further study.     

Effect of weight reduction on cardiovascular risk factors and CD34-positive cells in circulation

Being overweight or obese is associated with an increased risk for the development of non-insulin-dependent diabetes mellitus, hypertension, and cardiovascular disease. Dyslipidemia of obesity is characterized by elevated fasting triglycerides and decreased high-density lipoprotein-cholesterol concentrations. Endothelial damage and dysfunction is considered to be a major underlying mechanism for the elevated cardiovascular risk associated with increased adiposity. Alterations in endothelial cells and stem/endothelial progenitor cell function associated with overweight and obesity predispose to atherosclerosis and thrombosis. In our study, we analyzed the effect of a low calorie diet in combination with oral supplementation by vitamins, minerals, probiotics and human chorionic gonadotropin (hCG, 125-180 IUs) on the body composition, lipid profile and CD34-positive cells in circulation. During this dieting program, the following parameters were assessed weekly for all participants: fat free mass, body fat, BMI, extracellular/intracellular water, total body water and basal metabolic rate. For part of participants blood chemistry parameters and circulating CD34-positive cells were determined before and after dieting. The data indicated that the treatments not only reduced body fat mass and total mass but also improved the lipid profile. The changes in body composition correlated with the level of lipoproteins responsible for the increased cardiovascular risk factors. These changes in body composition and lipid profile parameters coincided with the improvement of circulatory progenitor cell numbers. As the result of our study, we concluded that the improvement of body composition affects the number of stem/progenitor cells in circulation.     

The Impact of Feet Callosities,Arm Posture,and Usage of Electrolyte Wipes on Body Composition by Bioelectrical Impedance Analysis in Morbidly Obese Adults

ObjectiveThis study evaluated the impact of feet callosities, arm posture, and use of electrolyte wipes on body composition measurements by bioelectrical impedance analysis (BIA) in morbidly obese adults.Methods36 morbidly obese patients (13 males, aged 28–70 years, BMI 41.6 ± 4.3 kg/m²) with moderate/severe feet callosities participated in this study. Body composition (percent body fat (%BF)) was measured while fasting using multi-frequency BIA (InBody 720®), before and after removal of callosities, with and without InBody® electrolyte wipes and custom-built auxiliary pads (to assess arm posture impact). Results from BIA were compared to air displacement plethysmography (ADP, BodPod®).ResultsMedian %BF was significantly higher with auxiliary pads than without (50.1 (interquartile range 8.2) vs. 49.3 (interquartile range 9.1); p < 0.001), while no differences were found with callosity removal (49.3 (interquartile range 9.1) vs. 50.0 (interquartile range 7.9); NS) or use of wipes (49.6 (interquartile range 8.5) vs. 49.3 (interquartile range 9.1); NS). No differences in %BF were found between BIA and ADP (49.1 (IQR: 8.9) vs. 49.3 (IQR: 9.1); NS).ConclusionArm posture has a significant impact on %BF assessed by BIA, contrary to the presence of feet callosities and use of electrolyte wipes. Arm posture standardization during BIA for body composition assessment is, therefore, recommended.Key Words: Bioelectrical impedance, Body composition, Morbid obesity, Callosities, Fat mass, Standardization     

Is cortisol involved in upper-body obesity?

Obesity is a major health problem that can be defined as an excess of body fat, associated with hypertension, diabetes and coronary heart disease. Several groups have evaluated the clinical significance of variations in fat cell distribution on these complications. A frequently used index of fat cell distribution is the waist to hips ratio (W/H). A high W/H ratio is said to reflect upper body fat cell distribution while a low waist to hips ratio reflects a lower body type fat cell distribution. Studies have shown that those whose W/H ratio indicate upper body fat cell distribution had a higher prevalence of diabetes and hypertension than those with the lower type. Over the years cortisol has attracted considerable interest as a possible factor in the development and maintenance of obesity. The clinical findings associated with upper body type of obesity are in many ways similar to those of the hypercortisol state. Our hypothesis is that upper body obesity forms a unique subgroup of the obese population and their regional fat distribution is associated with mild cortisol excess. In humans, studies have reported that some obese subjects hypersecrete cortisol and have an increase in the cortisol production rate. Although recent studies would tend to discount any influence of cortisol in human obesity, several factors should be taken into consideration. It is difficult to measure cortisol economy in obese subjects because among other things the measurements are less than precise; and cortisol secretion changes during the day and in response to outside stimuli. Further, obesity is a heterogeneous disorder and not all obese subjects may have the same disorder.(ABSTRACT TRUNCATED AT 250 WORDS)     

Regulation of body weight in humans

The mechanisms involved in body weight regulation in humans include genetic, physiological, and behavioral factors. Stability of body weight and body composition requires that energy intake matches energy expenditure and that nutrient balance is achieved. Human obesity is usually associated with high rates of energy expenditure. In adult individuals, protein and carbohydrate stores vary relatively little, whereas adipose tissue mass may change markedly. A feedback regulatory loop with three distinct steps has been recently identified in rodents: 1) a sensor that monitors the size of adipose tissue mass is represented by the amount of leptin synthesized by adipose cells (a protein encoded by the ob gene) which determines the plasma leptin levels; 2) hypothalamic centers, with specific leptin receptors, which receive and integrate the intensity of the signal; and 3) effector systems that influence the two determinants of energy balance, i.e., energy intake and energy expenditure. With the exception of a few very rare cases, the majority of obese human subjects have high plasma leptin levels that are related to the size of their adipose tissue mass. However, the expected regulatory responses (reduction in food intake and increase in energy expenditure) are not observed in obese individuals. Thus obese humans are resistant to the effect of endogenous leptin, despite unaltered hypothalamic leptin receptors. Whether defects in the leptin signaling cascade play a role in the development of human obesity is a field of great actual interest that needs further research. Present evidences suggest that genetic and environmental factors influence eating behavior of people prone to obesity and that diets that are high in fat or energy dense undermine body weight regulation by promoting an overconsumption of energy relative to need.     

Copability,coping, and learning as focal concepts in the evaluation of computerised diabetes disease management

Introduction: Within diabetes care, the majority of health decisions are in the hands of the patient. Therefore, the concepts of disease management and self-care represent inescapable challenges for both patient and healthcare professionals, entailing a considerable amount of learning. Thus, a computerised diabetes disease management systems (CDDM) is to be seen not merely as tools for the medical treatment, but also as pedagogical tools to enhance patient competence. Hypothesis: The unfortunate lack of success for most knowledge-based systems might be related to the problem of finding an adequate way of evaluating the systems from their development through the implementation phase to the daily clinical practice. The following presents the initial methodological considerations for evaluating the usefulness of a CDDM system called DiasNet, which is being implemented as a learning tool for patients. The evaluation of usefulness of a CDDM, we claim, entails clinical assessment taking into account the challenges and pitfalls in diabetes disease management. Results: Drawing on activity theory, we suggest the concept of copability as a supplement to ‘usability’ and ‘utility’ when determining ‘usefulness’. We maintain that it is necessary to ask how well the user copes with the new situation using the system. As ways to measure copability of DiasNet the concepts of coping and learning are discussed, as well as ways this methodology might inform systems development, implementation, and daily clinical practice.     

Body composition and serum levels of adiponectin, vascular endothelial growth factor, and interleukin-6 in patients with rheumatoid arthritis

Aim. To investigate differences in body composition and body mass index (BMI) in patients with rheumatoid arthritis (RA) and their correlations with serum production of adiponectin, interleukin-6 (IL-6), and vascular endothelial growth factor (VEGF). Methods. The study included 83 patients (age 53±5 years) with RA treated with methotrexate. We determined their BMI, fat mass, and fat-free mass using bioimpedance analysis, and serum concentrations of adiponectin, VEGF, and IL-6 using immunoassay analysis. Results. Normal BMI was found in 39 (47%), overweight and obesity in 26 (31%), and underweight in 18 (22%) patients. Concentration of adiponectin was lower in overweight/obese patients than in patients with normal BMI (2.1 [0.8-3.9] μg/mL vs 8.9 (7.2-11.3) μg/mL). In underweight patients, it was moderately increased (12.7 [9.3-14.8] μg/mL) and the correlation between the concentrations of adiponectin and IL-6 was positive (r=0.4; P=0.01). Concentrations of VEGF and IL-6 were increased in all groups with RA. The overweight/obese group showed a negative correlation between the concentrations of adiponectin and VEGF (r=- 0.34; P=0.04), a positive correlation between VEGF concentration and fat mass (r=0.39; P=0.02), and a negative correlation between adiponectin concentration and fat mass (r=- 0.23; P=0.02). Conclusion. Inflammatory and angiogenesis activation was found in RA patients with all types of body composition, but only in those with obesity and overweight there was a direct antagonism between adiponectin and VEGF. Further research is needed to identify possible regimens of metabolic correction in different variations of body composition.     

Association between Nutrient Intake and Obesity in Type 2 Diabetic Patients from the Korean National Diabetes Program: A Cross-Sectional Study

The aim of the study was to assess the association between usual dietary nutrient intake and obesity in Korean type 2 diabetic patients. We examined 2,832 type 2 diabetic patients from the Korean National Diabetes Program cohort who completed dietary assessment and clinical evaluation in this cross-sectional study. In men, higher dietary fiber intake was associated with a lower odds of being obese (P_trend = 0.003) and in women, higher protein intake was associated with a lower odds of being obese (P_trend = 0.03) after adjustment for age, diabetes duration, HbA1c, alcohol drinking, income, education level, and calorie intake. In men, higher fiber intake was associated with lower odds of obesity after further adjustment for diastolic blood pressure, physical activity, and possible confounding nutritional intake and medication. The multivariable adjusted odds ratio for the highest quintile of fiber intake was 0.37 (P_trend < 0.001). In women, protein intake was not associated with obesity after further adjustment. In conclusion, higher intake of dietary fiber is associated with lower odds of being obese in type 2 diabetic men, suggesting a role for dietary fiber in the management and prevention of obesity in type 2 diabetes (ClinicalTrials.gov: NCT 01212198).     

In Pursuit of Empirically Supported Assessment for Use in Medical Settings

Psychological assessment in the medical setting presents many opportunities and challenges. On the question of what constitutes empirically supported assessment practice, there are few clear answers and perhaps fewer exemplars. The goal of this article was not to review the current status of empirically supported assessment in medical settings, but rather to highlight some areas of measurement innovation that may move this field toward its promise of a more stable evidence base supporting the use of patient‐reported outcome measures for clinical research, patient education, and clinical care. In addition, assessment in the medical setting provides one very unique opportunity that many psychologists are not honed in on: the use of psychological assessment to assess quality health care. This is an emerging reality that poses significant methodological puzzles and opens doors for those committed to psychological assessment.