Childhood obesity treatment: targeting parents exclusively v. parents and children

There is a consensus that interventions to prevent and treat childhood obesity should involve the family; however, the extent of the child's involvement has received little attention. The goal of the present study was to evaluate the relative efficacy of treating childhood obesity via a family-based health-centred intervention, targeting parents alone v. parents and obese children together. Thirty-two families with obese children of 6-11 years of age were randomised into groups, in which participants were provided for 6 months a comprehensive educational and behavioural programme for a healthy lifestyle. These groups differed in their main agent of change: parents-only v. the parents and the obese child. In both groups, parents were encouraged to foster authoritative parenting styles (parents are both firm and supportive; assume a leadership role in the environmental change with appropriate granting of child's autonomy). Only the intervention aimed at parents-only resulted in a significant reduction in the percentage overweight at the end of the programme (P=0.02) as well as at the 1-year follow-up meeting. The differences between groups at both times were significant (P<0.05). A greater reduction in food stimuli in the home (P<0.05) was noted in the parents-only group. In both groups, the parents' weight status did not change. Regression analysis shows that the level of attendance in sessions explained 28 % of the variability in the children's weight status change, the treatment group explained another 10 %, and the improvement in the obesogenic load explained 11 % of the variability. These results suggest that omitting the obese child from active participation in the health-centred programme may be beneficial for weight loss and for the promotion of a healthy lifestyle among obese children.     

Length of hospital stays among obese individuals

OBJECTIVES: We examined lengths of hospital stay among individuals categorized according to weight status. METHODS: We used data from the First National Health and Nutrition Examination Survey Epidemiologic Followup Survey to estimate length-of-stay differences. RESULTS: Individuals with body mass indexes (BMIs) of 35 kg/m2 or above, those with BMIs of 30 to 34 kg/m2, and those with BMIs of 25 to 29 kg/m2 had crude length-of-stay rates greater than those of normal-weight individuals. Association between BMI and length of stay varied over time. CONCLUSIONS: Obese individuals experience longer hospital stays than normal-weight individuals.     

代谢正常肥胖人群的临床表型分析

目的:了解代谢正常肥胖个体(MHO)的临床特点.方法:收集180例体检人群资料,其中正常对照组、代谢正常肥胖组和肥胖伴代谢综合征组各60例.观察空腹血糖(FDG)、糖负荷后2小时血糖(2hBG)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、血肌酐(SCr)、低密度脂蛋白胆固醇(LDL-C)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转移酶(GGT)、估算的肾小球滤过率(eGFR)、体质指数(BMI)和其他躯体指标的差异.结果:MHO组BMI、腰围、ALT、GGT均明显高于正常对照组(P<0.05),低于肥胖伴代谢综合征组(P<0.01).MHO组收缩压、舒张压、FBG、2hBG、TG、HDL-C、LDL-C、AST、eGFR与正常对照组比较均无明显差异(P>0.05),明显低于肥胖伴代谢综合征组(P<0.01).多元逐步回归分析提示TG、BMI为ALT、GGT的主要影响因素.结论:MHO个体具有发生代谢异常风险,并非健康的无害状态.     

Attenuated interoceptive sensitivity in overweight and obese individuals

ObjectivePerceiving internal signals of hunger and satiety is related to the regulation of food intake. Recent data suggest that interoception (perception of bodily signals) and interoceptive sensitivity (sensitivity for internal signals) might be a crucial variable for the regulation of behavior associated with feelings of satiety. It is yet unclear whether interoceptive sensitivity is altered in overweight and obese participants.Design and methodsWe therefore examined interoceptive sensitivity among 75 overweight and obese women and men using a heartbeat detection task and compared them to normal weight controls. We hypothesized that overweight and obesity would be related to attenuated interoceptive sensitivity.ResultsInteroceptive sensitivity was higher in normal weight participants as compared to overweight and obese participants. Additionally, we found a negative correlation coefficient between the BMI and interoceptive sensitivity in the overweight and obese group only.ConclusionsIn accordance with our hypotheses, we found evidence for reduced interoceptive sensitivity in overweight and obese individuals. Interoceptive sensitivity presumably interacts with the regulation of food intake in everyday life in part by facilitating the detection of bodily changes accompanying satiety. Overweight and obese individuals might experience greater difficulties in accurately detecting such signals due to reduced interoceptive sensitivity.     

Portrayals of overweight and obese individuals on commercial television

OBJECTIVES: This study examined the distribution and individual characteristics of body types on prime-time television. METHODS: Five episodes of each of the 10 top-rated prime-time fictional programs on 6 broadcast networks during the 1999-2000 season were quantitatively analyzed. RESULTS: Of 1018 major television characters, 14% of females and 24% of males were overweight or obese, less than half their percentages in the general population. Overweight and obese females were less likely to be considered attractive, to interact with romantic partners, or to display physical affection. Overweight and obese males were less likely to interact with romantic partners and friends or to talk about dating and were more likely to be shown eating. CONCLUSIONS: Overweight and obese television characters are associated with specific negative characteristics.     

Do obese individuals gain weight more easily than nonobese individuals?

A review of studies done on human subjects who were overfed under controlled conditions for periods ranging from 2 to 12 wk shows that the energy cost of induced weight gain is a function of initial body weight and of lean body mass, body fat, and percent body fat. Therefore, bigger and fatter people need to eat more to gain a given amount of weight than do those who are thin. A likely explanation is that obese individuals tend to put on a large proportion of fat, a high-energy tissue, whereas thin people tend to gain more lean, which is a low-energy tissue.     

Accuracy of self-reports of food intake in obese and normal-weight individuals: effects of parental obesity on reports of children's dietary intake

The purpose of this investigation was to determine the accuracy of dietary-intake information of normal-weight vs overweight parents in their reports of their children's food intake. Subjects were 36 families with either normal-weight (n = 20) or overweight (n = 16) children aged 4-9 y. Unobtrusive observers recorded the types and amounts of food eaten by the children at one meal. The next day families were visited in their homes and were asked to provide dietary-intake information from the previous day on their child. Results indicated that parental reports of the dietary intake of their children correlated significantly with the observers' measures of food intake. Neither the father's, the mother's, nor the family's obesity status had an effect on the accuracy of recalled information. The results indicated that the lack of differences consistently observed in dietary intake between obese and normal-weight children could not be explained by differential accuracy of recalled dietary information.     

Normal insulin sensitivity in lean offspring of obese parents

OBJECTIVE: Offspring of diabetic or hypertensive patients are insulin resistant at a prediabetic/prehypertensive stage. We tested the hypothesis that insulin action may be impaired in the offspring of obese nondiabetic parents. RESEARCH METHODS AND PROCEDURES: Twenty-one lean offspring of nonobese subjects [(OL) 22 +/- 3 years of age] were matched to 23 lean offspring of obese subjects (OOb) by gender distribution, age, BMI, and waist circumference. Anthropometry, oral glucose tolerance, in vivo insulin sensitivity [by a euglycemic insulin clamp (6 pmol/min per kilogram(FFM); where FFM represents fat-free mass)], and thermogenesis (by indirect calorimetry) were measured in each subject. The study subjects were from a population of 267 nuclear families (one offspring and both his/her parents) in which there was statistically significant (chi2 = 30.2, p = 0.001) concordance of BMI between parents and offspring. RESULTS: In comparing OOb with OL, no statistically significant difference or trend toward a difference was detected in fasting plasma glucose and insulin concentrations, glucose and insulin responses to oral glucose, insulin sensitivity [metabolism value = 45 +/- 12 (OOb) vs. 47 +/- 17 micro mol/min per kilogram(FFM) (OL)], insulin-induced inhibition of protein and lipid oxidation, stimulation of glucose oxidation and nonoxidative glucose disposal, respiratory quotient, resting energy expenditure, and glucose-induced thermogenesis. DISCUSSION: The metabolic similarity between lean offspring of obese parents and those of nonobese parents suggests that insulin resistance and its correlates are not co-inherited with the predisposition to develop obesity.     

Food cue-elicited brain potentials in obese and healthy-weight individuals

The main objective of this study was to investigate, by means of event-related potentials (ERPs), whether obese individuals process food-related information differently as compared to normal-weight individuals. Because amplitudes of late positive ERP components (P3, LPP) reflect motivational tendencies, obese participants were expected to display enlarged P3 and LPP amplitudes towards food pictures. Obese and normal-weight adults were exposed to pictures of food and control items, while EEG was recorded. Subjective levels of food craving and hunger were also assessed. While there were no differences in ERP amplitudes between obese and normal-weight individuals, significantly larger P3 and LPP amplitudes were elicited by pictures of food items as compared to control pictures. Positive correlations were found between P3 and LPP amplitudes and self-reported increases of hunger. It was concluded that food-related information is processed differently in the brain as compared to non-food-related information, in a manner that reflects the natural motivational value of food. In the present study, there was no indication of an electrophysiological or subjective hyper-reactivity to food cues in obese adults.     

Zinc in hair and serum of obese individuals in Taiwan

Zinc concentrations in both serum and hair were assessed in 135 obese patients (51 males, 84 females) and in 57 controls (28 males, 29 females) to study the correlation between Zn and obesity. The body mass index (wt/ht2) was also measured to evaluate its relationship to the Zn level in obese individuals. The serum and hair Zn contents in obese patients were markedly lower than in normal control subjects by 22 and 34%, respectively. The Zn content was inversely related to the body mass index. Thus Zn may play an important metabolic role in the development of obesity.     

Accuracy of self-reports of food intake in obese and normal-weight individuals: effects of obesity on self-reports of dietary intake in adult females

The purpose of this study was to determine the accuracy of self-reported 24-h dietary recalls of overweight and normal-weight adults. Forty female college students (21 overweight, 19 normal weight) consumed a lunch meal at the university cafeteria while being unobtrusively observed. The following day subjects returned to the lab and completed a 24-h recall of their food intake. Accuracy of recalls was assessed by comparing directly observed intake with self-reported intake. Correlated t tests comparing observed and reported intake found a significant amount of overreporting of consumption for the entire sample. When analyses were conducted on individual groups (normal weight vs overweight), no between-group differences were found. A series of one-way analyses of variance (ANOVA) (normal weight vs overweight) and a multivariate ANOVA were performed for total calories, nutrients, and the amount of over- and underreporting. No significant differences between groups were observed.     

Neural-based valuation of functional foods among lean and obese individuals

Functional foods may contribute to establish healthy eating habits and reduce obesity and related comorbidities. Differences in the brain mechanisms underpinning the valuation of functional foods in individuals with excess weight may inform the development of attractive functional foods. We aimed to compare brain function during the Willingness to Pay task for functional vs standard foods between individuals with healthy weight (HW), overweight (OW), and obesity (OB). We hypothesized that, in participants with OB, willingness to pay for functional foods would evoke greater activation/connectivity in brain regions previously associated with subjective value. Thirty-six HW, 19 OW, and 20 OB adults performed a functional magnetic resonance imaging–Willingness to Pay task that requires them to decide how much they would pay for presented standard and functional food images tasted in a previous buffet. Whole-brain analyses compared task-related activation and connectivity between participants with OB, OW, and HW. Individuals with OB, relative to HW, showed more similar willingness to pay for functional and standard food. At the brain level, they also showed hyperactivation in the ventral posterior cingulate cortex and the right angular gyrus, as well as an increased functional connectivity between the ventral posterior cingulate cortex and the intraparietal cortices to the valuation of the functional vs the standard foods. Increased willingness to pay for functional foods in people with excessive weight may be driven by recruitment of brain regions that direct attention to internal goals.     

Ecologic correlates of obesity in rural obese adults

OBJECTIVE: We examined relationships of individual and environmental factors with obesity and trying to lose weight in rural residents. METHODS: The joint contributions of individual and environmental factors on obesity status (obese vs. morbidly obese) and trying to lose weight (yes vs. no) were evaluated using generalized estimating equations. Patients at 29 clinics in rural areas (N = 414, M age 55.0 years (SD = 15.4), 66.3% female) completed anthropometric assessments of weight and height along with survey assessments of individual sociodemographics and trying to lose weight. Rural environments were assessed on aggregated physician access, and sociodemographic context. RESULTS: Most participants (70%, M BMI = 38.3) were obese and 30% morbidly obese. A majority (73%, n = 302) of the sample was trying to lose weight. Compared to obese, morbidly obese participants were more likely to be younger, disproportionately female, not have private insurance, have more comorbid conditions, and rate themselves in worse health in comparison to their obese peers. Compared to not trying to lose weight, trying to lose weight participants were more likely to be younger, disproportionately female, have fewer comorbid conditions, and have attempted to lose weight more times through exercise. Few relationships were seen between environmental variables and obesity or trying to lose weight. CONCLUSIONS: There was no consistent pattern of relationships between environment factors and obesity or trying to lose weight was seen. Unique aspects of rural living may not be captured by traditionally available neighborhood measures.     

Occupational problems and barriers reported by individuals with obesity

Background: Even if occupational therapists meet many people with obesity in the course of their work, a majority of them do not seem to view weight management as within their area of professional practice.

Aim: To explore the occupational problems and barriers among persons with severe obesity from an occupational therapy perspective.

Materials and methods: The study used the Canadian Model of Occupation and Engagement (CMOP-E) and Canadian Occupational Performance Measure (COPM) to identify and analyze prioritized occupational performance problems and barriers perceived by 63 individuals with obesity.

Results: The occupational problems individuals with obesity most frequently prioritized comprised playing with (grand)children, purchasing clothes, implementing regular meals and going to the swimming pool, while the barriers they most frequently described were dyspnea, musculoskeletal disorders, narrow chairs and seats, fear of glances and comments from others, and social anxiety.

Conclusion: Persons with obesity struggle with a large variety of occupational performance problems, which occur in the dynamic relationship between these individuals, their environment and their occupation. Occupational therapists have the skills to take more active role in helping persons with obesity to perform valued occupations and establish healthier everyday routines.