Parent-focused change to prevent obesity in preschoolers: Results from the KAN-DO study

Objective

The study presents the immediate post-intervention results of Kids and Adults Now — Defeat Obesity!, a randomized controlled trial to enhance healthy lifestyle behaviors in mother-preschooler (2-5 years old) dyads in North Carolina (2007-2011). The outcomes include change from baseline in the child's diet, physical activity and weight, and in the mother's parenting behaviors, diet, physical activity, and weight.

Method

The intervention targeted parenting through maternal emotion regulation, home environment, feeding practices, and modeling of healthy behaviors. 400 mother-child dyads were randomized.

Results

Mothers in the intervention arm, compared to the control arm, reduced instrumental feeding (− 0.24 vs. 0.01, p < 0.001) and TV snacks (−.069 vs. − 0.24, p = 0.001). There were also improvements in emotional feeding (p = 0.03), mother's sugary beverage (p = 0.03) and fruit/vegetable (p = 0.04) intake, and dinners eaten in front of TV (p = 0.01); these differences were not significant after adjustment for multiple comparisons.

Conclusion

KAN-DO, designed to maximize the capacity of mothers as agents of change, improved several channels of maternal influence. There were no group differences in the primary outcomes, but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers' diets. Long-term follow-up will address whether these short-term trends ultimately improve weight status.     

The relationship between television viewing and obesity in young children: a review of existing explanations

It has often been proposed that young (three to six years old) children’s television viewing habits contribute to early‐onset obesity. Three explanations that link television viewing patterns of young children with the development of obesity are considered. First, television viewing displaces time available for physical activity, reduces energy expenditure relative to energy intake and leads to obesity. Second, the cognitive immaturity of young children increases their susceptibility to persuasive intent of advertisements for foods of poor nutritional quality. Such food advertisements are broadcast often during children’s television programmes and lead to unhealthy food preferences, and dietary imbalances associated with obesity. Third, activity displacement combined with susceptibility to persuasive intent of televised food advertisements predispose young children to early‐onset obesity. Research evidence in support of each explanation is questionable, because of conceptual and methodological shortfalls in existing research. How future research might address shortfalls is considered.     

Perceived barriers to weight maintenance among university students in Kuwait: the role of gender and obesity

Objective

To investigate the barriers to weight maintenance among university students in Kuwait by gender and obesity.

Methods

A sample of 530 students was selected at convenience from four universities in Kuwait (2 public and 2 private). The age of students ranged from 19 to 26 years. A self-reported pretested questionnaire was used to obtain the barriers, which were divided into barriers to healthy eating and barriers to physical activity. Weight and height were based on self-reporting, and the students were grouped into non-obese and obese according to the WHO classification. The response options to barriers were: very important, somewhat important and not important.

Results

The main barriers to healthy eating for both genders were: “Do not have skills to plan, shop for, prepare or cook healthy foods” and “Not having time to prepare or eat healthy food”. In general, there were no significant differences between men and women in barriers to healthy eating. There were highly significant differences between men and women regarding barriers to physical activity (P values ranged from <0.001 to <0.016). “Not having time to be physically active” and “The climate is not suitable for practising exercise” were the main barriers reported. Obese men were more likely to face barriers to healthy eating than non-obese men. There were no significant differences between obese and non-obese women regarding barriers to healthy eating and physical activity.

Conclusion

The findings of this study can be utilized in intervention activities to promote a healthy lifestyle and to combat obesity in Kuwait, and maybe in other Arab countries.     

Estimates of the energy deficit required to reverse the trend in childhood obesity in Australian schoolchildren

Objectives: To estimate: 1) daily energy deficit required to reduce the weight of overweight children to within normal range; 2) time required to reach normal weight for a proposed achievable (small) target energy deficit of 0.42 MJ/day; 3) impact that such an effect may have on prevalence of childhood overweight. Methods: Body mass index and fitness were measured in 31,424 Australian school children aged between 4.5 and 15 years. The daily energy deficit required to reduce weight to within normal range for the 7,747 (24.7%) overweight children was estimated. Further, for a proposed achievable target energy deficit of 0.42 MJ/day, the time required to reach normal weight was estimated. Results: About 18% of children were overweight and 6.6% obese; 69% were either sedentary or light active. If an energy deficit of 0.42 MJ/day could be achieved, 60% of overweight children would reach normal weight and the current prevalence of overweight of 24.7% (24.2%–25.1%) would be reduced to 9.2% (8.9%–9.6%) within about 15 months. Conclusions: The prevalence of overweight in Australian school children could be reduced significantly within one year if even a small daily energy deficit could be achieved by children currently classified as overweight or obese.     

Using a Very Low Energy Diet to Achieve Substantial Preconception Weight Loss in Women with Obesity: A Review of the Safety and Efficacy

Obesity in women of reproductive age is common. Emerging evidence suggests that maternal obesity not only increases the risk of adverse pregnancy outcomes but also has an enduring impact on the metabolic health of the offspring. Given this, management of obesity prior to pregnancy is critically important. Almost all international guidelines suggest that women with obesity should aim to achieve weight loss prior to pregnancy. However, current pre-conception weight loss therapies are sub-optimal. Lifestyle modification typically results in modest weight loss. This may assist fertility but does not alter pregnancy outcomes. Bariatric surgery results in substantial weight loss, which improves pregnancy outcomes for the mother but may be harmful to the offspring. Alternative approaches to the management of obesity in women planning pregnancy are needed. Very low energy diets (VLEDs) have been proposed as a possible tool to assist women with obesity achieve weight loss prior to conception. While VLEDs can induce substantial and rapid weight loss, there are concerns about the impact of rapid weight loss on maternal nutrition prior to pregnancy and about inadvertent exposure of the early fetus to ketosis. The purpose of this review is to examine the existing literature regarding the safety and efficacy of a preconception VLED program as a tool to achieve substantial weight loss in women with obesity.     

The link between obesity and the built environment. Evidence from an ecological analysis of obesity and vehicle miles of travel in California

AIMS: Obesity and physical inactivity are known to be risk factors for many chronic diseases including hypertension, coronary artery disease, diabetes, and cancer. We sought to explore the association between an indicator of transportation data (Vehicle Miles of Travel, VMT) at the county level as it relates to obesity and physical inactivity in California. METHODS: Data from the California Health Interview Survey 2001 (CHIS 2001), the US 2000 Census, and the California Department of Transportation were merged to examine ecological correlations between vehicle miles of travel, population density, commute time, and county indicators of obesity and physical inactivity. Obesity was measured by body mass index (BMI). Physical inactivity was based on self-reported behaviors including walking, bicycling, and moderate to vigorous activity. The unit of analysis was the county. Thirty-three counties in California with population size greater than 100,000 persons per county were retained in the analyses. RESULTS: CHIS 2001 statewide obesity prevalence ranged from 11.2% to 28.5% by county. Physical inactivity ranged from 13.4% to 35.7%. Daily vehicle miles of travel ranged from 3.3 million to 183.8 million per county. By rank bivariate correlation, obesity and physical inactivity were significantly associated (p<0.01). Furthermore, by rank analysis of variance, the highest mean rank obesity was associated with the highest rank of VMT (p<0.01). Similar rank patterns were observed between obesity and physical inactivity and commute time. Associations between VMT and physical inactivity were examined but failed to reach statistical significance. CONCLUSION: This analysis adds to the growing evidence supporting the association between VMT (a measure of automobile transportation) and obesity. An urban design characterized by over dependence on motorized transportation may be related to adverse health effects.     

The relationships between indicators of physical activity, indicators of sedentary behaviour and adiposity in French adults: the FLVS II study

Increasing habitual physical activity and decreasing sedentary behaviour have both been identified as targets for the prevention of unhealthy weight gain and obesity. To improve health monitoring in the context of nutrition-related disease prevention, there is a need to better define relevant indicators of sedentary behaviour. The aim of this study was to investigate the relationships between indicators of physical activity, indicators of sedentary behaviour and body fat in French adults. We analysed cross-sectional data from a community-based survey in northern France (213 men, age: 44±5 years; 192 women, age: 42±4 years; mean±SD). Physical activity and sedentary behaviour during the past year were assessed using the Modifiable Activity Questionnaire. Indicators of physical activity were leisure-time and occupational physical activity, indicators of sedentary behaviour during leisure were reading and “screen viewing” (including time spent watching television/video, playing video games, and using a computer). Body-fat percentage was assessed using bio-impedance analysis. In univariate analysis (Spearman rank correlations), reading and screen viewing were not significantly correlated; reading was positively associated with leisure-time physical activity in women and negatively associated with occupational physical activity in men. In multivariate analyses (stepforward regression models) stratified by gender and educational level, independent predictors of percent body fat included, in women, screen viewing (positive association), occupational physical activity (positive association) and leisure-time activity (negative association), but not reading; in men, only reading was associated with percent body fat, with a negative relationship in those with a high educational level. Relationships between indicators of sedentary lifestyle and body fat differ according to gender and type of sedentary pasttime. The data emphasise that sedentary lifestyle represents a complex set of behaviours and that various sedentary behviours may have distinct effects with regard to health outcomes. These results point out the need to assess selected indicators of sedentary behaviour when considering health monitoring in public health nutrition.     

The use of anti-obesity medications in people with mental illness as an adjunct to lifestyle interventions — Effectiveness,tolerability and impact on eating behaviours: A 52-week observational study

ObjectiveThe increasing prevalence of obesity and metabolic syndrome in people with mental illness (MI) is a global health priority. Anti-obesity medications (AOMs) may help with reducing medication induced hunger and weight gain when lifestyle changes are insufficient. Our aim is to evaluate the effectiveness, tolerability, impact on eating behaviours and psychiatric safety of AOMs in this population.MethodsWe conducted an observational study of 244 adults with MI with at least two risk factors for metabolic syndrome attending an obesity management clinic. Participants received standardised diet, exercise and psychological care, in addition to AOMs tailored to each participant’s circumstances. Baseline and 12-month assessments encompassing physical, metabolic and psychological parameters were compared.ResultsOver the course of the study, the average weight loss was 11.79 kg (12.1%), decrease in BMI was 3.90 kg/m² and reduction in waist circumference was 12.6 cm. Participants with good glycaemic control increased from 28.6% to 80.7%, hypercholesterolaemia reduced from 85.2%–29.9% and hypertension rates reduced from 88.9%–52.0%. Depression, anxiety and stress levels for the sample decreased significantly (all p < .01). Eating behaviours improved (all p < .001) at follow-up. Psychiatric side effects including deterioration of mood (28.2%) and suicidality (30.8%) were primarily experienced by those on topiramate.ConclusionsAOMs can be effective in achieving clinically meaningful weight loss, improved metabolic co-morbidities and eating behaviours in people living with MI, when combined with a comprehensive lifestyle program. The majority of AOMs are well tolerated but topiramate appears more likely to negatively impact mental health.     

A simple multilevel approach for analysing geographical inequalities in public health reports: The case of municipality differences in obesity

The epidemiological analysis of geographical inequalities in individual outcomes is a fundamental theme in public health research. However, many traditional studies focus on analysing area differences in averages outcomes, disregarding individual variation around such averages. In doing so, these studies may produce misleading information and lead researchers to draw incorrect conclusions. Analysing individual and municipality differences in body mass index (BMI) and overweight/obesity status, we apply an analytical approach based on the multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). This analytical approach may be viewed as a reorganization of existing multilevel modelling concepts in order to provide a systematic approach to simultaneously considering both differences between area averages and individual heterogeneity around those averages. In doing so, MAIHDA provides an improved approach to the quantification and understanding of geographical inequalities as compared with traditional approaches.     

Effects of diet-induced obesity in the development of lymphedema in the animal model: A literature review

BackgroundObesity poses deleterious consequences on every organ system, especially the lymphatic network. However, the underlying cellular mechanisms through which obesity causes lymphatic dysfunction remains unclear. We aimed to summarize experimental studies that evaluated the effect of obesity on the lymphatic system on animal models.MethodsWe used the following terms to search the Ovid EMBASE, Ovid MEDLINE(R), Cochrane, and Scopus databases: “lymphedema”, “lymphatic diseases”, “lymphatic system/complications* ”, “lymphatic system/injuries* ”, “lymphatic system/abnormalities* ”, AND “obesity/complications* ”, “diet/high-fat”, “adipogenesis” and “lipid metabolism disorder”. From a total of 166 articles identified in the initial search, 13 met our eligibility criteria.ResultsLong-term exposure to high-fat diet in mice demonstrated significant amount of adipose tissue deposition which sets off an inflammatory cascade resulting in disruption of the chemokine gradient, inhibition of lymphangiogenesis, and changes in gene expression of lymphatic endothelial cells, that alter vessel permeability and induce cell death. Reduced contractile properties of lymphatic collectors, dilated capillaries, increased tissue pressure, and reduced hydraulic conductivity collectively contribute to reduced impaired lymphatic drainage. Aerobic exercise has shown reversal of lymphatic dysfunction in the obese and pharmacological interventions targeting T-cells, iNOS and VEGFR-3 signaling have the potential to combat acquired lymphedema.ConclusionScientists should focus their future experiments on developing therapies that regulate expression of T-cell derived cytokines and VEGFR-3 expression whereas clinicians are urged to counsel their patients to reduce weight through aerobic exercise.     

The efficacy and cost-effectiveness of a community weight management intervention: a randomized controlled trial of the health weight management demonstration

Purpose

The study investigated the efficacy and cost-effectiveness of a cognitive-behavioral weight management program, complemented by an interactive Web site and brief telephone/e-mail coaching.

Methods

In 2006-2007, 1755 overweight, non-active-duty TRICARE beneficiaries were randomized to one of three conditions with increasing intervention intensity: written materials and basic Web access (RCT1), plus an interactive Web site (RCT2), plus brief telephone/e-mail coaching support (RCT3). The study assessed changes in weight, blood pressure, and physical activity from baseline to 6, 12, and 15-18 months. (Study retention was 31% at 12 months.) Average and incremental cost-effectiveness and cost-offset analyses were conducted.

Results

Participants experienced significant weight loss (− 4.0%, − 4.0%, and − 5.3%, respectively, in each RCT group after 12 months and − 3.5%, − 3.8%, and − 5.1%, respectively, after 15 to 18 months), increased physical activity, and decreased blood pressure. Cost-effectiveness ratios were $900 to $1100/quality-adjusted life year (QALY) for RCT1 and RCT2 and $1900/QALY for RCT3. The cost recovery period to the government was 3 years for RCTs 1 and 2 and 6 years for RCT3.

Conclusion

A relatively inexpensive cognitive-behavioral weight management intervention improved patient outcomes. Extrapolation of savings for the entire TRICARE population would significantly reduce direct medical costs.     

An evaluation of prompt access to physiotherapy in the management of low back pain in primary care

BACKGROUND: Disability arising from low back pain (LBP) is a growing problem. Current primary care management of LBP has been criticized for its mechanistic basis and for delays in gaining access to specialist advice. Among recent recommendations made for improved management are functional explanatory models, a rehabilitative approach and early access to physical therapy. It is not known if these recommendations can be implemented in mainstream primary care. OBJECTIVE: The purpose of our study was to examine the feasibility, acceptability and component costs of providing a prompt access physiotherapy service for new episodes of LBP in primary care; to describe outcomes and compare them with other published interventions; and to explore the influence of the service on GPs' approach to LBP. METHODS: Back pain clinics staffed by a physiotherapist were established in a group of demographically representative practices in a typical UK health authority. Adult patients with a new episode of LBP referred by their GPs were managed in accordance with recent recommendations. Data on pain, disability and well-being were collected at recruitment and some 12 weeks later. Patient diaries and interviews with GPs before and after the study provided qualitative data. Comparative costings were derived from national and local sources. RESULTS: A total of 614 patients, representing 3.2% of the adult population, were referred, of whom 522 (85%) were seen at the back pain clinics within 3-4 days, the majority within 72 h. Although this represents less than half the adult patients thought to be presenting to their GPs with LBP, patients exhibited levels of pain and disability comparable with those described in other studies of LBP in primary care. More than 70% of patients required only a single clinic visit and <5% were referred on to specialist orthopaedic or back pain rehabilitation services. At follow-up, levels of improvement were comparable with and time taken off work superior to those seen in other intervention studies of LBP in primary care. Prompt access to physiotherapy in primary care costs less per episode of LBP than conventional management. Qualitative data suggest that patients valued early access to the physiotherapist, particularly for the reassurance provided. Interviews with GPs revealed strong support for the service, in large part based on favourable feedback from patients. CONCLUSIONS: For primary care patients with a new episode of LBP referred by their GP, prompt access to a dedicated physiotherapy service is both feasible and acceptable. Comparison with other published interventions suggests that it is also cost-effective and that a typical Primary Care Trust (PCT) would rapidly recoup the cost of additional physiotherapists. However, questions remain about the availability of sufficient physiotherapists to make such a service available nationally. The influence of the service upon GPs' own approach to the management of LBP is likely to be gradual and to come about largely through positive feedback from patients.     

Obesity,Health and Quality of Life: A Conversation to Further the Vision in Occupational Therapy

ABSTRACT

Occupational therapy is one of the most powerful professions to support the development of healthy lifestyles, promote health and well-being and empower individuals, communities and populations, especially those impacted by or at risk for obesity. Development of healthy lifestyles enhances and promotes quality of life. This article discusses the need for occupational therapy professionals to explore the many possibilities that enable lifestyle change for people at risk for or who are obese or overweight. Embracing and integrating health promotion and wellness into everyday practice, particularly for those impacted by obesity, is emphasized.     

The link between local environment and obesity: A multilevel analysis in the Lisbon Metropolitan Area,Portugal

Although individual factors have been shown to predict weight gain, contextual determinants have also attracted attention, with some authors stressing the role played by deprivation, urban sprawl, social capital and safety. Recent evidence has implicated environmental factors that facilitate the consumption of excess calories and/or make it more difficult to expend them in routine physical activity. The interrelationships found in some places between physical and social environments (key mediators) and body mass index (BMI), as well as the potential that exists for the development of healthier places, mean that more research is required into the contextual determinants of health.     

The combined used of quantitative and qualitative longitudinal methods in the study of obesity

ObjectiveTo explore the combined use of quantitative and qualitative methods with a longitudinal perspective in the field of obesity diet and physical activity.MethodA systematic scoping review following PRISMA guidelines. The databases searched were Web of Science, PubMed, and ASSIA.Results1592 records were returned from the searches. In total, nine studies met the inclusion criteria and were included in the review. Authors of included studies mixed quantitative and qualitative methods to obtain a deeper understanding of their study subjects, but few documents use longitudinal data. Authors value the combination of methods and try to integrate the results in their conclusions.ConclusionsTotal integration is rarely achieved in the analysis. The origin of this divergence can be found in the lack of theoretical guidance in these articles, but also in the difficulty of working in multidisciplinary teams in the field of obesity.     

The role of resistance training in influencing insulin resistance among adults living with obesity/overweight without diabetes: A systematic review and meta-analysis

The purpose of this study was to systematically examine the independent effect of resistance training (RT) on markers of insulin resistance (IR) (fasting insulin and HOMA-IR) among individuals with overweight/obesity without diabetes. PubMed, SPORTdiscus, SCOPUS, Prospero, and clinicaltrials.gov were searched through December 19, 2022. Article screening was conducted in three phases: title screen (n = 5020), abstract screen (n = 202), and full text screen (n = 73). A total of 27 studies with 402 individual data points were used for the meta-analysis. Comprehensive Meta-Analysis software version 3.0 was used to interpret pre- and post-IR measurements with a random-effects model. Exploratory sub-analyses were conducted on studies for only females, only males, and age (< 40 and ≥ 40 years). RT had a significant effect on fasting insulin (− 1.03, 95 % CI − 1.03, − 0.75 p < 0.001) and HOMA-IR (− 1.05, 95 % CI − 1.33, − 0.76, p < 0.001). Sub-analyses revealed that males had a more pronounced effect compared to females and those < 40 years of age had a more pronounced effect compared to those ≥ 40 years. The results of this meta-analysis illustrate that RT plays an independent role in improving IR among adults with overweight/obesity. RT should continue to be recommended as part of preventive measures among these populations. Future studies examining the effect of RT on IR should consider dose centered on the current U.S. physical activity guidelines.     

Public reaction to the UK government strategy on childhood obesity in England: A qualitative and quantitative summary of online reaction to media reports

This work aimed to summarise public real-time reaction to the publication of the UK government childhood obesity strategy by applying a novel research design method. We used a netnographic technique to carry out thematic analysis of user-generated comments to online newspaper articles related to the strategy. We examined likes/dislikes associated with comments as a proxy of agreement of the wider community with identified themes. To examine media influence on the comments we carried out thematic analysis of online media headlines published about the strategy, and compared these themes with themes identified from comments.Three newspaper articles and 1704 associated comments were included. Three parent themes were identified: paternalism/libertarianism, lobbyist influence and, anecdotal solutions. The comments were largely negative (94%). Commenters were split as to individual responsibilities and the role of the government, some felt that lobbyist influence had won out over the nation’s health and others offered non-evidence based solutions. The ten most liked and disliked comments reflected themes identified in our main analysis. There was parity between themes that emerged from comments and from headlines. This summary of public reaction to the obesity strategy publication may aid translation of public views and receptiveness into practice and inform subsequent government action and policy. Furthermore, the process applied herein may provide a means of informal public engagement.