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PubMed2002

Differential response to NPY of PVH and dopamine-responsive VMH neurons in overweight rats.

Neuronal responses to neuropeptide Y and dopamine were recorded in brain slices of hypothalamic paraventricular (PVH) and ventromedial (VMH) nuclei in normal and hyperphagic overweight rats reared in small litters of three pups. NPY significantly activated PVH neurons of normal rats, but inhibited neurons of overweight rats. In the VMH, a significantly higher coincidence of inhibition induced by NPY and dopamine was found in overweight rats. Similar neuronal responses were evoked by a NPY Y5 receptor agonist. Effects of NPY could be blocked by a Y1 receptor antagonist. The altered response of PVH neurons to the feeding-inducing NPY and the increased inhibition by NPY and dopamine in the VMH might contribute to the persisting hyperphagia and overweight of postnatally overnourished rats.

Action Potentials↗
PubMedDate not supplied

Overweight and obesity in the context of heart failure: implications for practice and future research.

Heart failure (HF) is a major cardiovascular disorder, public health concern, and growing epidemic that affects approximately 5,000,000 people in the United States with 550,000 new cases reported annually. The clinical and economic impact of HF is associated with high hospitalization and early readmission rates. Recognizing factors that contribute to increasing the risk for HF, particularly the persistent rise in prevalence of overweight and obesity, may be imperative to reducing the burdens of this poorly prognostic disease process. Overweight and obesity have been associated with increased morbidity and mortality, and have incited extensive interest in therapeutic interventions. However, within the last decade, studies have illustrated the positive effects of overweight and obesity on survival after the onset of HF, which has prompted a variance of opinion within the healthcare community. This article reviews data supporting both the negative and positive effects of overweight and obesity in relationship to HF with implications for future research, and describes recommendations for practice as it relates to lifestyle modification through diet, exercise, and cognitive-behavioral therapy.

Activities of Daily Living↗
PubMed2003

Smoking and overweight as predictors of hospitalization for back disorders.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: To study the relationship of smoking and overweight with severe back disorders leading to hospitalization. SUMMARY OF BACKGROUND DATA: Many epidemiological studies have shown an association between smoking or overweight and back pain, but the results are still equivocal. Longitudinal studies are few. METHODS: A cohort of metal industry employees (n = 902) was studied for lifestyle, work history, and health in 1973 by questionnaire and interview. The weight of the subjects was measured and body mass index (kg/m2) was calculated. Based on intensity and duration, smoking was categorized as: never smoked (reference), stopped smoking, smoked 9 pack-years. Information on hospital admissions from 1973 to 2000 from the Finnish Hospital Discharge Register was linked to the data. Seventy-five individuals had been admitted to hospital because of back disorders. Intervertebral disc disorders and other common back disorders were analyzed separately. Cox proportional hazards regression was used to estimate the time between the assessment of potential risk factors and the first hospitalization for a back disorder. RESULTS: The rate ratio of heavy smokers (>9 pack-years) for hospitalization because of intervertebral disc disorders was 3.4 (95% confidence interval 1.3-9.0) as compared with never-smokers, allowing for other risk factors. Accordingly, the rate ratio of body mass index >27.5 kg/m2 was 2.7 (1.1-6.45) as compared with people with normal weight. The results retained when patients with chronic back disease at baseline were excluded from the analyses. Other back-related diagnoses of hospitalization were not consistently associated with smoking or overweight. CONCLUSION: Heavy smoking and overweight predicted hospitalization for intervertebral disc disorders.

Aged↗
PubMed2005

Current treatment approaches to overweight in adolescents.

PURPOSE OF REVIEW: The prevalence of overweight among adolescents aged 12 to 19 in the United States has steadily increased since the 1960s. The purpose of this review is to familiarize primary care clinicians with the most recent primary care, pharmacotherapy, and surgical options for the treatment of overweight in adolescence. RECENT FINDINGS: Initial treatment of the overweight adolescent should involve a comprehensive approach that facilitates changes in diet, exercise, and behavior that engage the entire family as participants and role models. For adolescents in whom a comprehensive program of diet, exercise, and behavior modification is unsuccessful, referral to a multidisciplinary team to explore further options, which may include medication and bariatric surgery, should be considered. Experience with medication for use in weight loss and bariatric surgery in adolescents is limited. Currently, two medications, orlistat and sibutramine, have been approved by the United States Food and Drug Administration for long-term use in adolescents. Bariatric surgery is currently recommended only for adolescents who are severely overweight (body mass index>or=40) and have comorbid conditions. This intervention should be considered only after failure of other comprehensive interventions and intense medical and psychologic evaluation by a specialty referral center. SUMMARY: More research is needed to clarify the roles and timing of diet, exercise, behavior modification, pharmacotherapy, and surgical intervention. Also, long-term studies are needed to further determine the benefits and risks of pharmacotherapy and bariatric surgery in adolescents.

Adolescent↗
PubMed2005

The deep inferior epigastric perforator flap for breast reconstruction in overweight and obese patients.

The authors retrospectively reviewed the computerized records of 71 women undergoing 80 deep inferior epigastric perforator (DIEP) flap reconstructions after mastectomy over a 1-year period. There were 33 normal, 26 overweight, and 12 obese patients. No statistically significant difference in flap complications was found between groups. Overall fat necrosis rates were 11.4 percent for the normal-weight patients, 6.7 percent for the overweight patients, and 6.7 percent for the obese patients. Postoperative hospital time was similar for all groups. The occurrence of abdominal wall fascial laxity was uncommon and similar for all groups. Large (>900 g) reconstructions were completed without prohibitive complications in the reconstruction flap. The DIEP flap represents a significant advance in autologous breast tissue reconstruction. Although concerns regarding fat necrosis rates in DIEP flaps have been voiced, the authors did not see an increasing rate of fat necrosis in their overweight and obese patients, and their overall rate of fat necrosis is comparable to rates reported for free transverse rectus abdominis myocutaneous (TRAM) flaps. Also, increasing body mass index did not seem to affect the rate of delayed complications of the abdominal wall, such as abdominal wall hernia or bulging. Although it was not statistically significant, the authors did observe a trend toward increased wound-healing complications with increasing body mass index. Their data also support the claim that the complete sparing of the rectus abdominis muscles afforded by the DIEP flap avoids abdominal wall fascial bulging or defects often seen in obese TRAM reconstruction patients. Because flap and wound complication rates are similar or superior to those of other autologous tissue reconstruction techniques and the occurrence of abdominal wall defects is all but eliminated, the DIEP flap likely represents the preferred autologous breast reconstruction technique for overweight and obese patients.

Adult↗
PubMed2006

Use of the anterolateral thigh flap as an alternative to the rectus flap in obese and overweight patients.

INTRODUCTION: Oncologic reconstruction in obese patients can be challenging. Donor tissues, such as the rectus flap, can be excessively bulky and result in significant cosmetic and functional deformities. Although the use of the anterolateral thigh (ALT) flap as an alternative to the radial forearm flap has been extensively described, few studies have evaluated the use of the ALT flap as an alternative to the rectus flap. The purpose of this study was to evaluate our experience with the ALT flap in overweight or obese patients. METHODS: A retrospective review was conducted of all ALT flaps performed over a 2-year period at Memorial Sloan-Kettering Cancer Center. All patients with a body mass index (BMI) >25 kg/m2 were identified and evaluated. RESULTS: Twenty-seven patients underwent ALT flap reconstruction during the study period. Of these, 11 patients were overweight (BMI, 25.1-30 kg/m2) or obese (BMI, >30 kg/m2). Reconstructions were performed for a variety of oncologic defects, including head and neck (n = 7), extremity (n = 2), chest wall (n = 1), and abdominal wall (n = 1). Complications were, in general, mild and infrequent. One patient experienced a minor infection, 1 patient had partial flap loss, and 2 patients had partial skin graft loss at the donor site. There were no flap losses. CONCLUSIONS: The ALT flap is a safe and reliable flap for reconstruction of diverse defects in overweight or obese patients. Large flaps can be designed and tailored to the defect by harvesting variable amounts of skin, subcutaneous tissues, fascia, and muscle. The ALT flap may be a good alternative to the rectus flap in overweight or obese patients.

Adult↗
PubMed1995

Recommended body mass index cutoff values for overweight screening programmes in Australian children and adolescents: comparisons with North American values.

OBJECTIVE: Guidelines for screening children and adolescents for overweight have recently been published by a North American Expert Committee. As Australian clinicians might uncritically adopt these recommendations, we explore the consequences of applying North American body mass index (BMI) cutoff values to an Australian population. METHODOLOGY: The Australian BMI cutoffs were calculated using the methods recommended from height and weight data for 8492 schoolchildren aged 7-15 years old. RESULTS: Smoothed Australian BMI cutoffs were similar to those derived from the first United States National Health and Nutrition Examination Survey (NHANES-I) values for whites. However, the NHANES-I cutoffs would result in systematic misclassification. Among 7 year olds, the NHANES-I 85th percentile cutoff would wrongly classify 4.6% of normal males and 9.1% of normal females as 'at risk of overweight'. At age 14 years, the NHANES-I 95th percentile cutoff would misclassify 3.5% of children as 'overweight' instead of 'at risk of overweight'. CONCLUSION: Australian screening programmes should use BMI cutoffs appropriately derived from local measurements, and these are given for Australian children.

Adolescent↗
PubMed2005

Evidence of a possible link between obesogenic food advertising and child overweight.

A recent review of the literature concluded that advertising of foods on television may influence children's food choices and encourage unhealthy diets, but the review acknowledged there was a lack of clear evidence in coming to this conclusion. The present paper examines ecological evidence for a link between advertising to children and the risk of overweight using data from surveys of advertising on children's television and estimates of the prevalence of overweight among children, in the USA, Australia and eight European countries. A significant association was found between the proportion of children overweight and the numbers of advertisements per hour on children's television, especially those advertisements that encourage the consumption of energy-dense, micronutrient-poor foods (r = 0.81, P < 0.005). A weaker, negative association was found between the proportion of children overweight and the number of advertisements encouraging healthier diets (r = -0.56, P < 0.10). The quantity of advertising on children's television appears to be related to the prevalence of excess body weight among children. Furthermore, the content of the advertising appears to have a specific effect. The findings justify the need for taking precautionary measures to reduce children's exposure to obesogenic marketing practices.

Advertising↗
PubMed2004

Prevalence and trends in overweight in Mexican-american adults and children.

Overweight and obesity have been increasing in many countries. Our objective is to describe the trends in overweight and obesity occurring in the Mexican-American population in the United States. Data on measured height and weight for Mexican Americans come from the following surveys: the Hispanic Health and Nutrition Examination Survey (HHANES, 1982-84), the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94), and NHANES 1999-2002. In 1999-2002, 73% of Mexican-American adults were overweight and 33% were obese. Obesity increased between NHANES III and NHANES 1999-2002, from 24% to 27% for men and from 35% to 38% for women. Increases were also seen for children and adolescents. The Mexican-American population in the United States, both children and adults, is showing trends in overweight and obesity over time that are similar to those seen in other segments of the U.S. population and indeed in many countries.

Adolescent↗
PubMed1978

Nature, nurture, and childhood overweight.

The relative importance of dietary and familial factors in determining weight in early infancy were studied in 203 5-year-old children. Their age at weaning, energy intake in infancy and at 5 years, and maternal percentage expected weight were studied in relation to their percentage expected weight. Neither the estimated energy intake in infancy nor the intake at 5 years correlated significantly with their percentage expected weight at 5 years. Overweight 5-year-olds had not been weaned earlier than normal-weight 5-year-olds. There was a significant correlation between the percentage expected weights of the mothers and those of their children at 5 years of age, although the children of overweight mothers did not have higher energy intakes than the children of underweight mothers. A familial, perhaps genetically determined, tendency to overweight seems to be more important in determining whether a child will be overweight at 5 years old than early weaning and overfeeding in infancy.

Anthropometry↗
PubMed2001

Prevalence and trends in overweight and obesity in three cross sectional studies of British Children, 1974-94.

OBJECTIVES: To report trends in overweight and obesity, defined by new internationally agreed cut-off points, in children in the United Kingdom. DESIGN: Three independent cross sectional surveys. SETTING: Primary schools in England and Scotland. PARTICIPANTS: 10 414 boys and 9737 girls in England and 5385 boys and 5219 girls in Scotland aged 4 to 11 years. MAIN OUTCOME MEASURES: Prevalence and change in prevalence of overweight and obesity, as defined by the international obesity task force, in 1974, 1984, and 1994, for each sex and country. RESULTS: Little change was found in the prevalence of overweight or obesity from 1974 to 1984. From 1984 to 1994 overweight increased from 5.4% to 9.0% in English boys (increase 3. 6%, 95% confidence interval 2.3% to 5.0%) and from 6.4% to 10.0% in Scottish boys (3.6%, 1.9% to 5.4%). Values for girls were 9.3% to 13. 5% (4.1%, 2.4% to 5.9%) and 10.4% to 15.8% (5.4%, 3.2% to 7.6%), respectively. The prevalence of obesity increased correspondingly, reaching 1.7% (English boys), 2.1% (Scottish boys), 2.6% (English girls), and 3.2% (Scottish girls). CONCLUSION: These results form a base from which trends can be monitored. The rising trends are likely to be reflected in increases in adult obesity and associated morbidity.

Body Mass Index↗
PubMed2005

Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes.

CONTEXT: The benefit of weight reduction for cardiovascular disease (CVD) outcomes remains uncertain. OBJECTIVE: To examine the effects of baseline body mass index on major CVD outcomes and diabetes over a 20 year follow up, and of weight change in the first five years over the subsequent 15 years. DESIGN AND SETTING: A prospective study of British men followed up for 20 years. PARTICIPANTS: Men aged 40-59 years with no diagnosis of CVD or diabetes (n = 7176) of whom 6798 provided full information on weight change five years later. OUTCOME MEASURES: Major CVD events (fatal and non-fatal myocardial infarction and stroke, angina, "other" CVD deaths) and diabetes. RESULTS: During the 20 year follow up there were 1989 major CVD events and 449 incident cases of diabetes in the 7176 men. Risk of major CVD and diabetes increased significantly with increasing overweight and obesity. During the 15 year follow up, weight gain was associated with increased risk of CVD and diabetes. Weight loss was associated with lower risk of diabetes than the stable group irrespective of initial weight. No significant cardiovascular benefit was seen for weight loss in any men, except possibly in considerably overweight (BMI 27.5-29.9 kg/m(2)) younger middle aged men (RR = 0.42; 95% CI 0.22 to 0.81). CONCLUSION: Long term risk of CVD and diabetes increased significantly with increasing overweight and obesity. Weight loss was associated with significant reduction in risk of diabetes but not CVD, except possibly in considerably overweight younger men. Duration and severity of obesity seem to limit the cardiovascular benefits of weight reduction in older men.

Adult↗
PubMed2005

[Electrocardiographic and echocardiographic findings in children with overweight and obesity].

BACKGROUND AND OBJECTIVE: Obesity is associated with cardiovascular risk factors and heart failure. SUBJECTS AND METHOD: Thirty children with overweight or obesity were matched with 30 healthy children. Corrected QT interval (QTc) and QT dispersion (QTd), left ventricular mass, left ventricular mass index, fractional shortening and fractional ejection, were measured. RESULTS: QTc and QTd were significantly greater in patients with overweight or obesity than in the control group. Left ventricular mass and left ventricular mass index were significantly higher in overweight or obese children than in controls. CONCLUSIONS: Children with overweight-obesity have an increase of corrected QT and QT interval dispersion and of the volume and mass of the left ventricle and a greater risk of arrhythmia, in relation to controls. These results make consider the need for a special cardiac monitoring of obese children, especially in the severe forms.

Body Weight↗
PubMed2006

Smoking and overweight: negative prognostic factors in stage III epithelial ovarian cancer.

OBJECTIVE: Smoking and overweight are associated with poorer prognosis in several cancer types. The prognostic effect of smoking and body mass index (BMI) on ovarian cancer is unknown. METHODS: Ovarian cancer cases were from the Danish MALOVA (MALignant OVArian cancer) study. Information on smoking status and BMI was obtained from a personal interview conducted closely after primary surgery. Cox regression models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for ovarian cancer-specific death in relation to smoking variables and BMI. RESULTS: A total of 295 women with stage III epithelial ovarian cancer were identified and followed to death or for a median of 7.3 years (range, 5.4-9.5 years). Median survival time for normal-weight never smokers was 2.8 years (95% CI, 2.3-3.2) compared with 1.2 years (95% CI, 0.8-2.3) for overweight current smokers. Current smokers had a significantly increased risk of ovarian cancer death compared with never smokers in multivariate Cox analysis (HR, 1.65; 95% CI, 1.22-2.24). The negative effect of smoking diminished with increasing time since a former smoker had stopped smoking (HR, 0.89; 95% CI, 0.80-0.98 per 5 years since stop of smoking). Overweight women also had an increased risk of ovarian cancer death (HR, 1.83; 95% CI, 1.38-2.42) compared with normal-weight women. CONCLUSION: Smoking at the time of diagnosis and premorbid overweight were negative prognostic factors for ovarian cancer-specific survival. The negative effect of smoking decreased with increasing time since stop of smoking.

Adult↗
PubMed2005

Overweight and obesity among schoolchildren in Sana'a City, Yemen.

AIM: To estimate the prevalence of overweight and obesity among schoolchildren in Sana'a City (Yemen) and to examine the association with lifestyle and some socioeconomic factors. METHODS: A cross-sectional study was done in public and private schools in Sana'a City during 2002-2003. We selected 1,253 students by the multistage random sampling technique. Weights and heights were measured to calculate body mass index (BMI = weight/height2). Data about age, sex, education level of the parents, food consumption and lifestyle was also collected. RESULTS: The mean age of the children was 12.6 +/- 2 years. Overweight was 6.2% and obesity was 1.8%. The prevalence of overweight and obesity was higher among private schoolchildren (p<000), females (p = 0.002), children with a sedentary lifestyle (p = 0.001) and children with a family history of obesity (p = 0.013). Also there is a positive association of overweight/obesity with the education level of the parents (p = 0.013 for the father and p = 0.19 for the mother) and consumption of unhealthy foods. CONCLUSION: Prevalence of overweight and obesity is low and positively associated with the education level of the father, private schooling, sedentary lifestyle, and with students who took unhealthy meals.

Adolescent↗
PubMed2005

Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment.

The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.

Adolescent↗
PubMed1995

Combined renal effects of overweight and hypertension.

The existence of a direct relationship between body mass and arterial pressure is well recognized; however, the effect of obesity on known target organs of hypertension is not clearly understood. We undertook the present studies to assess the influence of obesity on renal function and urinary albumin excretion in 40 normotensive subjects and 80 nevertreated hypertensive patients matched for age, sex, arterial pressure level, and known duration of hypertension in whom an oral glucose tolerance test was within normal limits. Glomerular filtration rate and effective renal plasma flow (expressed as absolute values or values normalized for height) were increased in overweight compared with lean subjects whether normotensive or hypertensive. Glomerular filtration rate was positively correlated with protein intake (as assessed from urinary excretion of urea) and fasting serum insulin level. Urinary excretion of albumin but not IgG and beta 2 microglobulin was higher in hypertensive patients compared with normotensive subjects. The overweight condition clearly enhanced the influence of arterial pressure on albuminuria; in fact, a steeper regression line between albumin excretion rate and arterial pressure was found in overweight compared with lean subjects. These results indicate that the overweight condition is associated with renal hyperfiltration and hyperperfusion, irrespective of the presence of hypertension, and that obesity magnifies the effect of hypertension on albuminuria, thus raising the possibility of an increased susceptibility of obese hypertensive patients to the development of renal damage.

Adolescent↗
PubMed2004

Factors associated with overweight and obesity among Kuwaiti kindergarten female teachers.

Levels of overweight and obesity among Kuwaiti women are high, and the objective of this study was to explore factors that may be responsible. A sample of 461 Kuwaiti kindergarten female teachers was studied; weight and height were measured, and the classification of overweight or obese taken as having a Body Mass Index of 25-30 or >30, respectively. This revealed that 41.2 and 19.7% of the teachers were overweight or obese, respectively. Factors found to be significantly associated with overweight and obesity among the teachers included age, marital status, parents living at home, subjects' parental obesity, number of obese relatives, exercise, last dental check-up and dental status.

Adult↗