Does the fat-but-fit paradigm hold true for all-cause mortality when considering the duration of overweight/obesity? Analyzing the WATCH (Weight,Activity and Time Contributes to Health) paradigm

BackgroundPhysical activity has been shown to attenuate the association between overweight/obesity and mortality. Much less is known, however, on how the duration of overweight/obesity potentially alters this association, which was the purpose of this study.MethodsThe 1999–2006 NHANES was used and 11,057 adults (ages 36–85) were evaluated. Eight mutually exclusive groups were created: (1) physically active, normal weight now and 10 years ago; (2) physically inactive, normal weight now and 10 years ago; (3) physically active, overweight/obese now but normal weight 10 years ago; (4) physically inactive, normal weight now but overweight/obese 10 years ago; (5) physically active, overweight/obese now but normal weight 10 years ago; (6) physically inactive, overweight/obese now but normal weight 10 years ago; (7) physically active, overweight/obese now and 10 years ago; and (8) physically inactive, overweight/obese now and 10 years ago.ResultsAfter adjustments, only those individuals that were inactive were at a significantly increased risk for all-cause mortality independent of overweight/obesity status (Groups 2, 4, 6, 8).ConclusionIn alignment with the Exercise is Medicine initiative®, our results provide support for clinicians to perform routine assessments of physical activity, and to further promote physical activity among all individuals regardless of body mass status.     

A systematic review and meta-analysis on the effects of yoga on weight-related outcomes

IntroductionOverweight and obesity are among the most important modifiable risk factors for chronic diseases and premature death. The aim of this review was to systematically assess and analyze the effects of yoga on weight-related outcomes.MethodsMedline/PubMed, Scopus, and the Cochrane Library were screened through March 2015 for randomized controlled trials on yoga for weight-related outcomes in the general population or overweight/obese individuals. Risk of bias was assessed using the Cochrane risk of bias tool on the following domains: selection bias, performance bias, detection bias, attrition bias, reporting bias, and other bias.ResultsOut of 445 records identified during literature search, 30 trials with a total of 2173 participants were included. No effects on weight, body mass index, body fat percentage or waist circumference were found. In studies with healthy adult participants an effect of yoga compared to usual care was found regarding waist/hip ratio (SMD =‐ − 1.00; 95% CI =‐ − 1.44, − 0.55; p < 0.001). In studies with overweight/obese participants only, effects relative to usual care were found for body mass index (SMD = − 0.99; 95% CI = − 1.67, − 0.31; p = 0.004). Effects however were not robust against selection bias; and publication bias could not be ruled out. No intervention-related adverse events were reported.ConclusionsDespite methodological drawbacks, yoga can be preliminarily considered a safe and effective intervention to reduce body mass index in overweight or obese individuals.     

The association between discrepant weight perceptions and objectively measured physical activity

BackgroundSome individuals perceive themselves as being normal weight, despite having an excess body fat percentage (e.g., underestimate weight). Conversely, other individuals perceive themselves as being overweight, despite having a normal body fat percentage (e.g., overestimate weight). When perceived and actual weight statuses are incongruent, individuals possess a discrepant weight perception. The association between discrepant weight perceptions and engagement in moderate-to-vigorous physical activity (MVPA) has not been thoroughly investigated, which was this study's purpose.MethodsFor this cross-sectional study, data from the 2003–2006 National Health and Nutrition Examination Survey were utilized (N = 5462 adults). MVPA was assessed via accelerometry. Based on measured body mass index and whether participants considered themselves as overweight, underweight, or about the right weight, we classified individuals as accurate perception, overestimate weight (discrepant), or underestimate weight (discrepant). A negative binomial logistical regression was used to assess the association between discrepant weight perception (independent variable) and engagement in MVPA (outcome variable).ResultsFemales who said that they are normal weight, but were in fact overweight based on body mass index, engaged in 13% less MVPA (rate ratio = .87, 95% confidence interval: .769–.999, P = .05). Also, older adults (> 60 yrs) who said that they are normal weight, but were overweight based on body mass index, engaged in 23% less MVPA (rate ratio = .77, 95% confidence interval: .616–.965, P = .025).ConclusionDiscrepant weight perceptions were associated with less objectively measured MVPA. Interventions should take weight perceptions into consideration when designing and evaluating intervention impact.     

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.     

BMI and depressive symptoms: The role of media pressures

Obese and overweight individuals experience higher risk for depression and emotional distress. One factor that may contribute to depression in obese or overweight individuals is exposure to unrealistic images in the media. Indeed, overall media consumption is associated with body image dissatisfaction in adolescents and young adults. Despite these compelling links, prior work has not examined the mediating effect of media pressures on the link between BMI and depression. In the present study, young adults (N = 743) completed an online survey assessing demographic information, perceived pressure from the media to conform to a certain body standard, and symptoms of depression. Structural equation modeling analyses indicated a direct effect of BMI on media pressure, a direct effect of media pressure on depressive symptoms, and an indirect effect of BMI on depressive symptoms mediated by media pressures. Findings indicate that higher BMI levels are associated with greater depressive symptoms when there is greater perceived media pressure on body image. Results suggest the need for clinicians to assess media consumption and perceived pressure to conform to physical appearance standards in individuals who are obese or overweight as well as individuals at risk for eating disorders.     

The association of circulating endocannabinoids with appetite regulatory substances in obese women

BackgroundsEndocannabinoids especially anadamide (AEA) and 2‑arachidonoylglycerol (2-AG) together with appetite modulators have recently been of great importance in body weight regulation and obesity incidence. The present study was carried out to investigate AEA and 2-AG levels and their association with leptin, insulin, orexin – A, and anthropometric indices in obese women.MethodsThe demographic and anthropometric data of 180 overweight/ obese women with mean age 34.2 ± 8.27 years old, and mean BMI 32.54 ± 3.73 kg/m² were evaluated. The plasma levels of anadamide and 2‑arachidonoylglycerol levels and also serum levels of leptin, insulin and orexin- A concentrations were measured. Pearson and spearmen correlation tests along with hieratical regression test were used to assess the association of endocannabinoids levels with anthropometric indices and appetite modulators.ResultsSignificant correlations were revealed between AEA and 2-AG with leptin, BMI, waist circumference (WC) and body fat percent (BF%) (P < 0.001). 2-AG levels correlated positively with mean insulin levels (P < 0.001). Neither AEA nor 2-AG correlated significantly with serum orexin - A levels. Leptin, insulin, BMI, WC, and BF% were significant independent predictors of AEA and 2-AG in the hierarchical regression model (P < .001) and explained 65% and 68% of variance in AEA and 2-AG respectively (P < 0.001).ConclusionThe findings showed that levels of AEA and 2-AG were associated with BMI, WC, BF%, and leptin and insulin levels. Also, BMI, WC, BF%, leptin and, insulin levels can have predictive value for determining AEA and 2-AG.     

Social anxiety and disordered overeating: An association among overweight and obese individuals

ObjectiveThe study objectives were to evaluate the relationship between social anxiety, binge eating, and emotional eating in overweight and obese individuals and to evaluate the relationship between weight and social anxiety.MethodsUsing an internet based survey, overweight and obese men and women (n = 231; mean age = 36.0 ± 12.8; mean BMI = 33.7 kg/m² ± 6.7) completed several self-report measures including: social anxiety, social physique anxiety, binge eating, and emotional eating. The relationships among variables were evaluated using Spearman's correlations, ANOVAs, and linear and logistic regression equations.ResultsClinically significant levels of social anxiety were reported in 59% of participants, and binge eating disorder criteria were met by 13%. Social anxiety was significantly associated with binge eating (r = .36; OR = 1.06, CI = 1.02–1.10) and emotional eating (r = .46; β = 0.36), but was not associated with restrained eating. The association between social physique anxiety and emotional and binge eating did not remain significant in regression equations. BMI was associated with binge eating (r = .19) but not emotional eating. Level of social anxiety was not significantly higher among extremely obese participants, compared to overweight and obese participants.ConclusionsIn this study, social anxiety was associated with binge eating and emotional eating in overweight and obese men and women. When appropriate, interventions could address social anxiety as a barrier to normative eating patterns and weight loss.     

Weight and health-related quality of life: The moderating role of weight discrimination and internalized weight bias

ObjectivesObesity is an increasingly prevalent public health concern, with associated medical comorbidities and impairment in health-related quality of life (HRQoL). Obese women are frequently victims of weight-related discrimination. The HRQoL impairments among obese people could be related to this discrimination and to internalized weight bias.DesignWe examined the potential moderating role of discrimination (from others) and self-directed (internalized) weight-based discrimination in the association between body mass index (BMI) and HRQoL.MethodsEighty-one women (mean age = 41.1 years; mean BMI = 43.40 kg/m², 97% Caucasian) completed valid and reliable measures of weight bias internalization (weight bias internalization scale), perceived discrimination by others (everyday discrimination scale) and both physical and mental HRQoL (SF-36 Health Survey). Multiple regression analysis was used to test whether internalized weight bias or discrimination moderated the association between BMI and the summary scores for physical and mental HRQoL, controlling for age.ResultsSignificant associations were found between BMI and discrimination (r = .36, p = .002), between internalized weight bias and both mental (r = .61, p < .001) and physical HRQoL (r = .45, p < .001), and between discrimination and physical HRQoL (r = .29, p = .014). A statistically significant interaction was found between BMI and internalized weight bias (b = − .21, SE = .10, p < 0.05) in accounting for the variance in physical HRQoL.ConclusionsThe association between higher BMI and poorer physical HRQoL was found only in individuals reporting high levels of internalized weight bias. Self-discrimination among overweight individuals may be a critical factor in their physical health impairment.     

Does nutritional status interfere with adolescents' body image perception?

Adolescents' body image (BI) may not match their nutritional status. This study selected representative sample of healthy adolescents aged between 12 and 18 from public and private schools. Anthropometric measures were performed in order to calculate the body mass index (BMI) percentile. The silhouette scale proposed by Childress was used to evaluate BI, making it possible to assess BI satisfaction and BI distortion. The sample was composed of 1168 adolescents with a mean age of 14.7 years; 52.9% were female, 50.9% were fair-skinned, 62.4% had consumed or still consume alcohol and 67% attended public school. Male adolescents presented more overweight and obesity (28.4%) (p < 0.05) than the female (17.1%). It was observed that 69.4% were dissatisfied with BI, 91.1% of the obese and 69.8% of those with overweight wished to lose body weight and 82.5% of those underweight wished to gain body weight. BI distortion was identified, since 35% of the adolescents who were underweight did not regard themselves thin, 39.1% of the overweight individuals and 62.1% of the obese did not see themselves in their adequate classifications. Adolescents with overweight/obesity were those who presented higher dissatisfaction with BI, mainly the females. Male individuals presented a greater wish of gaining weight. BI distortion was present in adolescents of all classes of BMI percentile.     

Norms and discriminative validity of the Eating Disorder Examination Questionnaire (EDE-Q)

The first aim of this study was to provide norms for the Eating Disorder Examination Questionnaire (EDE-Q) in a diverse and large clinical sample of individuals with an eating disorder (ED), and a general population sample without an ED. Norms for individuals with obesity without an ED were also provided, as a more relevant comparison group for individuals with binge eating disorder. The second aim was to investigate the discriminative validity of the EDE-Q. A sample of females with an ED (N = 935), women from the general population without an ED (N = 235), and obese females without an ED (N = 321) completed the EDE-Q. Explorative factor analyses did not support the theorized four subscales of the EDE-Q. Norms for EDE-Q global scores were provided for each of the three samples. Within the ED sample, norms were provided separately for patients with different ED diagnoses. Receiver operating characteristic analyses showed the EDE-Q global score to be highly accurate in discriminating individuals with an ED from those without, and moderately accurate in discriminating individuals with binge eating disorder from those with obesity. The presented norms contribute to a more accurate interpretation of EDE-Q scores, providing an index of the severity level of ED psychopathology. Furthermore, these norms can be used to assess clinical significant change during treatment. In addition, this study demonstrates that the EDE-Q, when using its global score, is a valid instrument to assess levels of ED psychopathology.     

A cross-sectional examination of sociodemographic factors associated with meeting physical activity recommendations in overweight and obese US adults

ObjectiveObesity has reached epidemic proportions in the US. Physical activity is an important component of obesity reduction, but little is known about contemporary exercise levels among overweight/obese American adults. In this study, we compared current physical activity levels in overweight and obese US adults to those of normal weight individuals as well as ascertained which sociodemographic factors influence the meeting of physical activity recommendations in these three groups.MethodsWe used national data from 2015 and 2017 Behavioral Risk Factor Surveillance System surveys (n = 726,075). Bivariate analyses were conducted to determine unadjusted physical activity levels in normal weight, overweight, and obese adults. We fit multinomial logistic models to identify associations between sociodemographic factors and meeting physical activity recommendations in our study population.ResultsAround 45% of overweight and 57% of obese adults failed to meet physical activity guidelines compared to 41% of normal weight adults. Age, sex, and race were significantly associated with physical activity levels for both overweight and obese adults. In overweight and obese individuals, associations between sociodemographic factors and physical activity were more similar between the two comparisons of insufficiently active (IA) versus active (A)/highly active (HA) and A versus HA but quite different to those in the inactive (IN) versus IA/A/HA comparison.ConclusionsFuture physical activity interventions should be aimed at increasing the number of overweight and obese US adults who meet physical activity guidelines as well as targeted towards specific sociodemographic groups within the overweight/obese population with low exercise levels.     

Psychological distress as a determinant of changes in body mass index over a period of 10 years

ObjectiveTo examine the longitudinal relationship between psychological distress and body mass index (BMI) changes over a period of five and ten years.MethodData were used from the Dutch, prospective, population based Doetinchem Cohort study over the period 1995/1999 until 2005/2009 (N = 5504). Psychological distress was assessed using the Mental Health Inventory (MHI-5). BMI (kg/m²) was calculated from measured body height and body weight. GEE analyses were used to examine the relationship between psychological distress at baseline and BMI change, and the development of overweight over five years. Linear and logistic regression analyses were used to examine these relations over ten years.ResultsPsychological distress predicted an extra overall increase in BMI of 0.14 kg/m² (95% CI 0.03–0.25) over five years and an increase of 0.18 kg/m² (95% CI 0.01–0.35) over ten years, when comparing psychologically distressed participants to psychologically healthy participants. This was especially the case among persons with normal weight (five years; B = 0.26 kg/m², 95% CI = 0.12–0.40/ten years; B = 0.32 kg/m² 95% CI = 0.11–0.53) and moderate overweight (five years: B = 0.18 kg/m², 95% CI = 0.02–0.35) at baseline. Psychological distress did not predict the development of overweight five and ten years later.ConclusionThe results in this study indicated that psychological distress predicted an increased risk in gaining weight, but did not result in an increased risk for developing overweight.     

A preliminary evaluation of BMI status in moderating changes in body composition and eating behavior in ethnically-diverse first-year college women

The present pilot investigation explored whether BMI status at college entry moderated changes in body composition and eating behavior in a sample of 134 first-time, first-year undergraduate females (40% Black/African American). Participants had their body measurements [i.e. weight, BMI, hip and waist circumference (WC), percent body fat (PBF)] assessed and completed self-report measures of binge eating, night eating, and intuitive eating at both the beginning of the fall and the beginning of the spring semesters of their first year. Results for the 83 completers revealed that overweight/obese students (N = 28) experienced greater gains in weight (p < 0.05), BMI (p < 0.05), and a trend towards increased WCs (p < 0.06) across the first college semester relative to their underweight/normal weight peers (N = 55). Night eating increased (p < 0.05) and intuitive eating declined (p < 0.05) over time in the full sample. Overweight/obese participants indexed greater binge eating scores (p < 0.001) and lower intuitive eating scores (p < 0.01) irrespective of time. Most anthropometric findings were diminished while all eating behavior estimates were retained in subsequent models adjusted for parental income. Preliminary results call attention to the need for continued elucidation of the roles of socioeconomic and regional diversity in affecting both the prevalence of overweight/obesity and the relationship between higher weight and body composition changes among first-year college women. Findings also provide tentative behavioral targets for college wellness programming that may prove useful in promoting healthy weight management while acclimating to the college environment.     

Relationships between depression,gender, and unhealthy weight loss practices among overweight or obese college students

IntroductionUnhealthy weight loss practices are common among female college students. It is unknown if these practices are also most common among women in the subset of overweight or obese college students or if these practices are related to depression. We examined the relationship between gender, depression, and unhealthy weight loss practices among overweight or obese college students.MethodsStudents (body mass index between 25.0 and 34.9 kg/m²) from three Southern California universities (M_age = 22 years, SD = 4; 70% women) were recruited from May 2011 to May 2012 for participation in a weight loss clinical trial (N = 404). Logistic regressions were performed with baseline data to assess the cross-sectional relationship between self-reported unhealthy weight loss practices and gender and depression as measured by the Center for Epidemiologic Studies Depression short form.ResultsTwenty-nine percent of participants reported engaging in at least one unhealthy weight loss behavior (e.g., fasting, purging) over the last 30 days, with no differences by gender. Self-report of at least one unhealthy weight loss behavior was associated with report of symptoms of depression (e^B = 1.14 [confidence interval, CI: 1.08–1.20]), adjusting for potential confounders. Interactions between gender and depression were not significant (e^B = 1.04 [CI: 0.93–1.16]).ConclusionAmong an overweight or obese sample of college students, unhealthy weight loss practices were equally common in both genders, and students with depressive symptomatology were at greatest risk. Obesity interventions targeting overweight or obese college students should educate both men and women about the dangers of unhealthy weight loss practices. In addition, screening for depression can help identify students who would benefit from additional supportive and coping strategies and resources.     

Healthy excessive weight in Portuguese women 4 years after delivery of a liveborn

ObjectiveTo quantify the prevalence of healthy excessive weight and determinants of metabolic profile, considering women's reproductive life.MethodsWe evaluated 1847 mothers of a birth cohort assembled after delivery and reevaluated 4 years later. A healthy profile was defined as the absence of hypertension, diabetes, dyslipidemia, C-reactive protein < 3 mg/l and being below the second tertile of HOMA-IR. Adjusted odds ratios (OR) and confidence intervals (95% CI) were computed using multinomial logistic regression, taking women with normal BMI as the reference category of the outcome.ResultsFour years after delivery, 47% of women had normal BMI, 33% were overweight and 20% obese. In each BMI class, 61%, 33% and 12% presented a healthy metabolic profile, respectively. Family history of CVD/cardiometabolic risk factors was associated with a higher probability of obesity with a not healthy metabolic profile (OR = 1.39 95% CI: 0.98–1.98). Women who breastfed the enrolled child for > 26 weeks and practiced physical exercise were less likely to be obese and metabolically unhealthy (OR = 0.39 95% CI: 0.23–0.68; OR = 0.48 95% CI: 0.33–0.70, respectively), with no effect on healthy excessive weight.ConclusionsThese results support the existence of a healthy excessive weight phenotype in women after motherhood, influenced by anthropometrics, genetic and lifestyles characteristics.     

The associations between overweight,weight change and health related quality of life: Longitudinal data from the Stockholm Public Health Cohort 2002–2010

ObjectiveCross-sectional studies have shown that people with obesity and overweight report lower health related quality of life (HRQoL). With a lack of longitudinal studies, this study aims to assess the association between eight-year weight change and HRQoL measured by the EQ-5D instrument and to investigate whether the association differs with regard to baseline body mass index (BMI).MethodA population-based survey was conducted among a random sample of 31,182 individuals from Stockholm County aged 18–84 years in 2002 and reassessed in 2010 and supplemented by record linkage with regional and national registers. Multivariate Poisson regression and linear regression were conducted with adjustments for socio-demographic and health-related variables and baseline BMI category as effect modifier for the association between weight change and HRQoL.ResultsIndividuals with overweight and obesity respectively have 0.014 and 0.039 lower EQ-5D indexes compared to those being normal weight. Over the eight-year follow-up, 17.6% gained moderately (≥ 5% body weight) and 13.9% gained heavily (≥ 10% body weight) in weight. In the fully adjusted analysis, heavy weight gain was associated with a significantly lower overall EQ-5D index and an increased risk of reporting impairment in all but one EQ-5D dimensions irrespective of baseline BMI category. Weight reduction had no significant preventive effect.ConclusionNext to obesity status itself, weight gain leads to impairment in HRQoL irrespective of BMI category at baseline while eight year weight loss seems not to have the reversed effect on HRQoL, emphasizing the importance of primary prevention of weight gain.     

Relationships between adiposity and postural control in girls during balance tasks of varying difficulty

ObjectiveThis study aimed to examine associations between postural control and body composition in 8–10-year-old girls.MethodsAn observational cross-sectional study was conducted in 47 girls who were healthy-weight/overweight/obese [body mass index (BMI) percentile]. Girls participated in six postural control conditions of varying difficulty (standing with malleoli touching, tandem stance leading with dominant and non-dominant foot, repeated with eyes open and closed). Postural control outcomes included Centre of Pressure (COP) sway area, COP principal and minor axis length and COP maximum velocity. Data were analysed using linear mixed modelling.ResultsBMI percentile was positively associated with COP sway area (p = 0.034) and principal axis (p = 0.030) during tandem stance non-dominant foot leading with eyes closed and COP principal axis during tandem stance dominant foot leading with eyes open (p = 0.045). BMI percentile significantly interacted with postural control conditions of varying difficulty to predict postural control outcomes (p ≤ 0.035), notable for tandem stance positions [all four COP sway outcomes in tandem stance non-dominant foot leading eyes closed; tandem stance dominant foot leading with eyes open and closed (two COP sway outcomes each)].ConclusionsGirls with greater adiposity may have impairments in postural control, but only during more challenging postural control conditions. In contrast, BMI has little role to play in girls’ postural control in easier postural control conditions (standing with feet together). These findings may suggest potential functional or safety considerations when girls with overweight/obesity are performing demanding postural control tasks (such as during sport or physical activity).     

Sustained Active Transportation is associated with a favorable body mass index trajectory across the early school years: Findings from the Quebec Longitudinal Study of Child Development birth cohort

ObjectiveTo determine the extent to which active transportation (AT) to and from school is associated with changes in body mass index (BMI) from kindergarten (6-year-olds) through grade 2 (8-year-olds).MethodsThe sample included 1170 children (50.4% of baseline participants) who were part of the Quebec Longitudinal Study of Child Development (QLSCD), a birth cohort established in 1998 in Quebec, Canada. Data were collected by trained interviewers using structured interviews and measuring height and weight in the home with the person most knowledgeable about the child's health. Relative weight was operationalized as age- and sex-adjusted BMI Z-scores.ResultsGrowth curve analyses showed that using AT to and from school both when in kindergarten and in grade 1 was predictive of a lower BMI Z-score (coeff = - 0.18, SE = 0.09, p = 0.05) in grade 1. Using AT to and from school in kindergarten, grade 1, and grade 2 was predictive of a lower BMI Z-score (coeff = - 0.30, SE = 0.098, p = 0.003) in grade 2. No other covariates were predictive of relative weight across time, although having an overweight or obese mother was associated with a BMI Z-score of 0.39 (SE = 0.07, p < 0.001) across all time points.ConclusionSustained AT is associated with more healthful trajectories of BMI across the early school years.     

Proximity to supermarkets associated with higher body mass index among overweight and obese preschool-age children

ObjectiveThe objective of this study is to examine associations of proximity to food establishments with body mass index (BMI) among preschool-age children.MethodsWe used baseline data from 438 children ages 2–6.9 years with a BMI ≥ 85th percentile participating in a RCT in Massachusetts from 2006 to 2009. We used a geographic information system to determine proximity to six types of food establishments: 1) convenience stores, 2) bakeries, coffee shops, candy stores, 3) full service restaurants, 4) large supermarkets, 5) small supermarkets, and 6) fast-food restaurants. The main outcome was child's BMI.ResultsChildren's mean (SD) BMI was 19.2 (2.4) kg/m²; 35% lived ≤ 1 mile from a large supermarket, 42% lived > 1 to 2 miles, and 22% lived > 2 miles. Compared to children living > 2 miles from a large supermarket, those who lived within 1 mile had a BMI 1.06 kg/m² higher. Adjustment for socioeconomic characteristics and distance to fast-food restaurants attenuated this estimate to 0.77 kg/m². Living in any other distance category from a large supermarket and proximity to other food establishments were not associated with child BMI.ConclusionsLiving closer to a large supermarket was associated with higher BMI among preschool-age children who were overweight or obese.     

Association of self-perceived body image with body mass index and type 2 diabetes—The ADDITION-PRO study

ObjectiveWeight loss is important for prevention of type 2 diabetes and an accurate self-perceived body image can promote weight reduction. We evaluated the association of self-perceived body image with body mass index (BMI) and type 2 diabetes.MethodsData from the Danish ADDITION-PRO cohort study (2009–2011) were used. A total of 2082 men and women attended a health examination including assessment of BMI, waist circumference, the Stunkard scale of self-perceived obesity and an oral glucose tolerance test for assessment of diabetes risk.ResultsMean (SD) age was 66.2 (6.9) years and 24% were obese (BMI ≥ 30 kg/m²). However, only 7% of obese men and 11% of obese women perceived themselves as obese. Among obese women, for a given level of BMI and waist circumference, one unit higher self-perceived body image was associated with 52% (95% CI: 14–73) lower risk of having type 2 diabetes and 45% (95% CI: 12–65) lower risk of having pre-diabetes. Overweight, but not obese, men had a 35% (95% CI: 36–56) lower risk of type 2 diabetes per unit increase in body image.ConclusionsObese individuals seem to underestimate their body shape. However, having a realistic body image (higher self-perceived obesity) is independently associated with lower diabetes risk. Self-perceived body image might serve as a valuable tool for type 2 diabetes risk assessment.