The cost of lifestyle health risks: obesity

OBJECTIVE: The objective of this study was to provide employers interested in lifestyle health initiatives a resource for estimating their members' obesity-related costs stratified by demographics and business sector. METHOD: Claims-level medical costs attributable to obesity are estimated. Data come from 61 U.S. employers' health plan members' claims experienced between January 2000 and December 2004. RESULTS: Diagnosed, nondrug medical expenses attributable to obesity account for 21.3% of lifestyle and 2.8% of all medical costs for those aged 19 to 64 years. Obesity costs for children under 19 years are negligible. Up to age 64 years, females' obesity costs markedly exceed males'. At particular risk for high obesity costs are women, those aged 55 to 64 years, and healthcare sector members. CONCLUSIONS: Obesity is a costly lifestyle health risk and self-insured employers should take action with or without policy aid such as the HeLP Act S2558.     

Overweight and obesity in women: health risks and consequences

The evidence for the adverse effects of obesity on women's health is overwhelming and indisputable. Obesity, especially abdominal obesity, is central to the metabolic syndrome and is strongly related to polycystic ovary syndrome (PCOS) in women. Obese women are particularly susceptible to diabetes, and diabetes, in turn, puts women at dramatically increased risk of cardiovascular disease (CVD). Obesity substantially increases the risk of several major cancers in women, especially postmenopausal breast cancer and endometrial cancer. Overweight and obesity are associated with elevated mortality from all causes in both men and women, and the risk of death rises with increasing weight. Curbing the twin epidemics of obesity and diabetes calls for not only changes in diet and lifestyle at individual levels but also changes in policy, physical and social environment, and cultural norms.     

Trainee health care professionals'' knowledge of the health risks associated with obesity

BACKGROUND: Trainee nurses, doctors and dietitians will direct the future of obesity treatment and prevention. To do so effectively, they must have sufficient knowledge regarding the health risks associated with obesity and feel that part of their professional role is to counsel obese patients regarding these risks. METHODS: An online survey collected data on professional roles, training needs and the Obesity Risk Knowledge-10 (ORK-10) scale from 38 dietetic, 88 nursing (Diploma), 74 nursing (Masters) and 389 medical students. RESULTS: Final-year dietetic students demonstrated higher ORK-10 scale scores than final-year nursing (Dip), nursing (MSc) and medical students (P < 0.001). The majority of students agreed that part of their profession's role was to counsel obese patients about the health risks associated with obesity. Dietetic students were more satisfied with the teaching they had received than each of the other student groups (P < 0.05). CONCLUSION: Future health care professionals recognize their responsibility to communicate health risk information to obese patients. Dietetic students have a sound knowledge base to support them in this. Educators of trainee nurses and doctors may like to respond to their students' lower levels of knowledge and desire for more training.     

Managing external risks to health technology assessment programs

OBJECTIVES: The aim of this study was to develop a guide to identifying and managing risks for health technology assessment (HTA) programs and to obtain opinions on this topic from HTA agencies. METHODS: The risks and approaches to their management were compiled, drawing on experiences from HTA programs and the risk assessment literature. Opinion on this classification was obtained from members of the International Network of Agencies for Health Technology Assessment (INAHTA). RESULTS: Twenty-one risks for HTA programs were identified under the categories Formulation of HTA Questions, Preparation of the HTA Product, Dissemination, and Contracting. For each risk area, potential consequences and suggested management approaches were outlined. Responses from ten HTA programs indicated substantial agreement regarding the risks that had been identified and on the importance of risk management for their own operations. CONCLUSIONS: Prudent management of HTA programs should take into account the risks related to external factors.     

Comparative assessment of air pollution-related health risks in Houston

BACKGROUND: Airborne emissions from numerous point, area, and mobile sources, along with stagnant meteorologic conditions, contribute to frequent episodes of elevated air pollution in Houston, Texas. To address this problem, decision makers must set priorities among thousands of individual air pollutants as they formulate effective and efficient mitigation strategies. OBJECTIVES: Our aim was to compare and rank relative health risks of 179 air pollutants in Houston using an evidence-based approach supplemented by the expert judgment of a panel of academic scientists. METHODS: Annual-average ambient concentrations by census tract were estimated from the U.S. Environmental Protection Agency's National-scale Air Toxics Assessment and augmented with measured levels from the Houston monitoring network. Each substance was assigned to one of five risk categories (definite, probable, possible, unlikely, uncertain) based on how measured or monitored concentrations translated into comparative risk estimates. We used established unit risk estimates for carcinogens and/or chronic reference values for noncarcinogens to set thresholds for each category. Assignment to an initial risk category was adjusted, as necessary, based on expert judgment about the quality and quantity of information available. RESULTS: Of the 179 substances examined, 12 (6.7%) were deemed definite risks, 9 (5.0%) probable risks, 24 (13.4%) possible risks, 16 (8.9%) unlikely risks, and 118 (65.9%) uncertain risks. CONCLUSIONS: Risk-based priority setting is an important step in the development of cost-effective solutions to Houston's air pollution problem.     

腹型与匀称型青少年肥胖症相关实验指征的比较

目的比较腹型与匀称型青少年单纯性肥胖症的相关实验指征。方法抽样调查两省市青少年学生11460名,选择其中年龄、性别、体重相匹配的31名匀称型重度肥胖者（对照组）及39名腹型肥胖者（研究组）为研究对象,分别检测血压（Bp）、血脂、瘦素（LP）、空腹血糖（FPG）、空腹胰岛素（FINS）、血尿酸（UA）,计算胰岛素敏感指标（ISI）,并行肝脏B超检查,比较两组间的差异及各因素相关性。结果研究组脂肪肝异常发生率（P=0．04）,血甘油三脂（P〈0．001）和载脂蛋白B（P〈0．005）,及FINS、LP和UA（P〈0．001）均显著高于对照组;载脂蛋白A（P〈0．005）和IsI（P〈0．001）均显著低于对照组。IJP与FINS呈明显正相关（P〈0．001）,与ISI呈明显负相关（P〈0．001）。UA与FINS（P〈0．001）呈明显正相关,与ISI（P〈0．001）呈明显负相关。结论腹型肥胖症青少年发生内分泌及心血管性疾病的危险性高于匀称型肥胖症青少年。     

The value and limitations of the body mass index (BMI) in the assessment of the health risks of overweight and obesity

--The Body Mass Index (BMI) is used as a measure of overweight and obesity. In epidemiological studies age, sex and ethnic background all have to be taken into consideration, particularly when determining the health risk caused by the amount of body fat. --Caution should be observed when using the BMI as a measure for interpreting overweight and obesity as body composition can be highly variable yet have the same BMI. Therefore, BMI is not a reliable measurement of body composition in individuals particularly in older and younger people. --Excess body fat in the visceral depot poses a separate health risk. The BMI does not give any insight into regional body fat distribution. Waist circumference is a valid index of visceral fat accumulation and can therefore be used as an indicator of health risks associated with visceral obesity.     

A framework for integrated environmental health impact assessment of systemic risks

Traditional methods of risk assessment have provided good service in support of policy, mainly in relation to standard setting and regulation of hazardous chemicals or practices. In recent years, however, it has become apparent that many of the risks facing society are systemic in nature – complex risks, set within wider social, economic and environmental contexts. Reflecting this, policy-making too has become more wide-ranging in scope, more collaborative and more precautionary in approach. In order to inform such policies, more integrated methods of assessment are needed. Based on work undertaken in two large EU-funded projects (INTARESE and HEIMTSA), this paper reviews the range of approaches to assessment now in used, proposes a framework for integrated environmental health impact assessment (both as a basis for bringing together and choosing between different methods of assessment, and extending these to more complex problems), and discusses some of the challenges involved in conducting integrated assessments to support policy.     

肥胖相关基因多态性对儿童期肥胖发生风险及持续状态的影响

目的前瞻性分析肥胖相关基因多态性对儿童期肥胖发生及持续状态的影响.方法基于北京市儿童青少年代谢综合征(BCAMS)研究,对部分仍在校者进行6年后随访,测量身高和体重,以随访到的780名儿童青少年为研究对象.采用盐析法从外周血白细胞中提取DNA.通过查阅文献和专家研讨,确定6个基因的7个多态性位点(SNP),其中FTO rs9939609分型使用ABI-5700实时定量PCR仪,其他6个SNP位点(FTO rs6499640、FAIM2 rs7138803、NPCIrs1805081、MC4R rs 17782313、BDNF rs6265、GNPDA2 rs10938397)的分型使用ABI PrismsTM-7900实时荧光定量PCR仪.采用中国肥胖问题工作组推荐的BMI分类标准判定超重和肥胖.计量资料组间比较采用独立样本t检验,分类资料组间比较采用x2检验.采用多因素logistic回归分析肥胖相关基因多态性对儿童期肥胖发生风险和持续状态的影响.结果随访6年肥胖累积发病率为8.5%,基线肥胖的儿童青少年有65.1%随访6年后仍持续肥胖.FTO rs9939609基因型TT、TA和AA组肥胖发病率依次升高(趋势检验x2=8.030,P<0.05);控制随访时点年龄、性别和城乡居住地后,携带FTO rs9939609A等位基因者相对于无该等位基因者发生肥胖的OR值及95%CI为2.42(1.31 ～ 4.47).与基线非肥胖且不携带rs9939609A等位基因组比较,携带rs9939609A等位基因组、基线肥胖组、基线肥胖同时携带rs9939609 A危险等位基因组随访时点罹患肥胖的风险分别为OR=2.07 (95% CI:0.95 ～ 4.47)、OR=22.01 (95%CI:13.27 ～ 36.49)和OR=45.95 (95%CI:24.00～87.94).其他SNP与肥胖的关联无统计学意义(P>0.05).综合分析多个SNP的共同效应发现,遗传危险得分每增加1个单位,肥胖的发病风险增加16.42倍(95%CI:3.59～75.10,P<0.001).结论FTO rs9939609对儿童期新发肥胖及肥胖的持续状态都具有一定影响.多个肥胖相关基因的综合效应对肥胖发病的影响不可忽视.     

中小学生家长肥胖知识态度行为与子女超重肥胖的关系

了解宁夏7~18岁儿童青少年的营养状况及其与家长健康知识、态度及行为之间的关系,为儿童青少年超重肥胖干预提供理论依据.方法 采用分层整群随机抽样方法,从宁夏银川和吴忠市,按年级分层随机抽取66个班3 027名学生及其家长作为调查对象,对学生进行体格检查和问卷调查,同时对其家长进行问卷调查.结果 7~18岁儿童青少年超重和肥胖检出率分别为9.4%和6.0%.家长肥胖相关知识的12道题中,“应多吃蔬菜水果”答对率居首位,为98.2%;“中国居民膳食宝塔中越在底层的食物越应该多吃”答对率最低,仅为39.5%.家长对子女体重的认知与子女真实体重之间的Kappa值为0.24,一致性不高,超重肥胖儿童的家长容易低估孩子的真实体重,尤其是男生更容易被家长低估,性别间差异有统计学意义(Z=-8.47,P<0.01).多因素Logistic回归分析显示,儿童超重肥胖与性别为男、独生子女、剖宫产、父母超重或肥胖和家长低估孩子的体重呈正相关,与出生体重≤2 499 g呈负相关.结论 宁夏儿童青少年超重肥胖检出率较高,家长对子女体重的低估与儿童超重肥胖相关.应针对家长健康知识的薄弱环节进行健康教育,有助于提升儿童超重肥胖的干预效果.     

Obesity and health risks

Childhood obesity is multi-factorial in etiology. Several factors contribute to the etiology of childhood obesity, and childhood obesity is itself associated with significant morbidity. This article focuses on the health risks of childhood obesity and on the prenatal and childhood influences that contribute to the genesis of childhood obesity.     

New mechanisms and the anti-inflammatory role of curcumin in obesity and obesity-related metabolic diseases

Purpose  

A metabolic abnormality such as obesity is a major obstacle in the maintenance of the human health system and causes various chronic diseases including type 2 diabetes, hypertension, cardiovascular diseases, as well as various cancers. This study was designed to summarize the recent scientific knowledge regarding the anti-obesity role of curcumin (diferuloylmethane), which is isolated from the herb curcuma longa, known to possess anti-inflammatory activities. However, little is known about its exact underlying molecular mechanisms in the treatment of obesity and metabolic diseases. Furthermore, cell cultures, animal models of obesity, and few human clinical and epidemiological studies have added the promise for future therapeutic interventions of this dietary compound.     

激素补充疗法的益处与风险:WHI研究分析

女性健康启动项目(women's health initiative,WHI)是目前唯一的一项评估绝经后妇女使用激素补充疗法的益处和风险的安慰剂对照临床试验研究.尽管WHI主要是在有发病高危因素的中老年妇女中进行,可能无法反映激素补充疗法正常使用的实际情况,但它首次表明了激素补充疗法治疗的相对风险(即静脉血栓和乳腺癌,以及老年妇女中的心肌梗死和中风)和益处及其绝对风险.已被证实的激素补充疗法益处如:治疗更年期综合征,减少骨质疏松性骨折和结肠癌发病风险,似乎对较早使用激素补充疗法治疗的年轻妇女效果更好;心血管疾病风险可以通过使用经皮激素补充疗法而降低,但这还未被如同WHI中的安慰剂对照研究证实.该文通过对比不同年龄组,就激素补充疗法的益处和风险对WHI的研究结果进行讨论分析.     

Geographic variation in the prevalence of obesity, diabetes, and obesity-related behaviors

OBJECTIVE: To examine the variation in the prevalences of obesity and type 2 diabetes in weight loss counseling by health providers and in other potential obesity-related determinants in 100 metropolitan statistical areas in the United States. RESEARCH METHODS AND PROCEDURES: We performed a cross-sectional study using data from the 2000 Behavioral Risk Factor Surveillance System, the largest telephone survey of health behaviors in the United States, of age-adjusted prevalence of obesity, type 2 diabetes, intake of >or=five servings of fruits and vegetables per day, participation in 150 minutes of leisure-time physical activity per week, receipt of weight management advice, and reports of trying to lose or maintain weight among men and women more than 18 years old. RESULTS: The age-adjusted prevalence of obesity ranged from 13.1% to 30.0% and that of type 2 diabetes from 3.3% to 9.2%. Among participants who had visited a physician for a routine checkup in the previous 12 months, 13.1% to 27.1% of all participants recalled receiving advice from a health professional about their weight, and 11.7% to 34.6% of overweight or obese participants recalled receiving advice to maintain or lose weight. DISCUSSION: Significant differences in the prevalence of obesity and self-reported type 2 diabetes and in medical practice patterns regarding weight management advice exist among metropolitan statistical areas. These results suggest important opportunities to investigate reasons for these variations that could potentially be used to mitigate the current epidemic of obesity and to identify areas where obesity and diabetes prevention efforts may need to be targeted.     

Gender, race, and obesity-related quality of life at extreme levels of obesity

OBJECTIVE: Research investigating obesity-related quality of life (QOL) has shown that at increasing levels of overweight, individuals report more impaired QOL. Further, some research has indicated that white women suffer more impairment than men and African Americans. The current study sought to expand the existing literature by investigating an extreme subsample of the obese population. It was expected that participants in the current study would report more impaired obesity-related QOL than in previous research conducted with less obese individuals. It was also hypothesized that race and gender groups would differ in obesity-related QOL and that the relationship between degree of overweight and QOL would not be consistent across race and gender groups. RESEARCH METHODS AND PROCEDURES: Impact of Weight on Quality of Life Questionnaire-Lite Version data were collected from 512 individuals seeking gastric bypass surgery (mean BMI = 53.3) RESULTS: Results confirmed the study hypotheses. In general, white women reported the most QOL impairment, despite having significantly lower BMI than other race/gender groups. Compared with previous studies, the observed relationships between BMI and QOL were somewhat attenuated. DISCUSSION: Various domains of QOL may be differentially affected by degree of obesity; these relationships are not homogeneous throughout the obese population.     

A probabilistic model for silver bioaccumulation in aquatic systems and assessment of human health risks

Silver (Ag) is discharged in wastewater effluents and is also a component in a proposed secondary water disinfectant. A steady-state model was developed to simulate bioaccumulation in aquatic biota and assess ecological and human health risks. Trophic levels included phytoplankton, invertebrates, brown trout, and common carp. Uptake routes included water, food, or sediment. Based on an extensive review of the literature, distributions were derived for most inputs for use in Monte Carlo simulations. Three scenarios represented ranges of dilution and turbidity. Compared with the limited field data available, median estimates of Ag in carp (0.07-2.1 micrograms/g dry weight) were 0.5 to 9 times measured values, and all measurements were within the predicted interquartile range. Median Ag concentrations in biota were ranked invertebrates > phytoplankton > trout > carp. Biotic concentrations were highest for conditions of low dilution and low turbidity. Critical variables included Ag assimilation efficiency, specific feeding rate, and the phytoplankton bioconcentration factor. Bioaccumulation of Ag seems unlikely to result in toxicity to aquatic biota and humans consuming fish. Although the highest predicted Ag concentrations in water (> 200 ng/L) may pose chronic risks to early survival and development of salmonids and risks of argyria to subsistence fishers, these results occur under highly conservative conditions.