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PubMed1997

Differential effects of GH stimulation on fasting and prandial metabolism and plasma IGFs and IGF-binding proteins in lean and obese sheep.

The effect of body condition per se on plasma IGFs and IGF-binding proteins (IGFBPs) and the whole-body metabolic responses to recombinant DNA-derived bovine GH (rbGH) in both the fed and the fasted state were determined in lean and dietary obese sheep (n = 6/group). Sheep at zero-energy balance and equilibrium body weight were injected s.c. for 12 days with 100 micrograms/kg rbGH immediately before their morning feeding. Before GH treatment, fasting plasma concentrations of insulin (17.0 +/- 1.9 vs 7.5 +/- 0.7 microU/ml), IGF-I (345 +/- 25 vs 248 +/- 10 ng/ml), glucose (52.6 +/- 1.1 vs 48.3 +/- 0.7 mg/dl), and free fatty acid (FFA) (355 +/- 45 vs 229 +/- 24 nmol/ml) were greater (P < 0.05) and those of GH (1.1 +/- 0.2 vs 2.6 +/- 0.3 ng/ml) were lower (P < 0.05) in obese than in lean sheep. Fasting concentrations of IGF-II and glucagon were not affected (P > 0.05) by obesity. GH concentrations were increased equivalently by 6-9 ng/ml in lean and obese sheep during GH treatment. GH caused an immediate and a marked fivefold increase in the fasting insulin level in obese sheep but only minimally affected insulin concentration in lean sheep. The increment in fasting glucose during GH treatment was greater (P < 0.05) in obese (8-12 mg/dl) than in lean (2-5 mg/dl) sheep. Frequent measurements in the first 8 h after feeding and injection of excipient (day 0) or the first (day 1) sixth (day 6) and twelfth (day 12) daily injection of GH showed that prandial metabolism in both groups of sheep was affected minimally by GH. However, GH treatment on day 1 (not days 6 or 12) acutely attenuated the feeding-induced suppression of plasma FFA in both groups of sheep and this effect was significantly greater in obese than in lean sheep. Although obese sheep were hyposomatotropic, the basal and GH-induced increases in plasma IGF-I concentrations were greater (P < 0.05) in obese than in lean sheep. Plasma IGF-II was unaffected by obesity and was not increased by GH stimulation. Western ligand blotting showed that IGFBP-3 accounted for approximately 50-60% of the plasma IGF-I binding capacity in sheep respectively both before and during GH treatment. Basal plasma levels of IGFBP-2 were lower (P < 0.05) and those of IGFBP-3 greater (P < 0.05) in obese compared with lean sheep. GH increased the level of IGFBP-3 equally in lean and obese sheep, but suppressed the expression of IGFBP-2 more (P < 0.05) in lean than in obese sheep. We concluded that the diabetogenic-like actions of GH in sheep were exaggerated markedly by obesity, and were expressed more during the fasted than the fed states. The effects of GH stimulation on the endocrine pancreas may be selective for beta-cells and preferentially enhanced by obesity. GH regulation of IGF-I and the IGFBPs differs in lean and obese sheep.

Analysis of Variance↗
PubMed2006

The association between obesity and the diagnosis of androgen deficiency in symptomatic ageing men.

OBJECTIVE: To determine the influence of obesity on the diagnosis of age-related androgen deficiency (AD) in symptomatic men according to current Australian guidelines. DESIGN, SETTING AND PARTICIPANTS: A community-based cohort of healthy ageing men with symptoms suggestive of AD was studied between May 2001 and February 2003. Men were classified as obese or non-obese according to body mass index (BMI) or waist circumference (WC). MAIN OUTCOME MEASURE: Diagnosis of AD according to Endocrine Society of Australia (ESA) guidelines. RESULTS: 223 men aged 54-86 years with mean BMI 27.3 +/- 0.2 kg/m2 (range 20.5-36.2 kg/m2) were recruited; 99 men were obese (BMI > or = 30.0 kg/m2 or WC > or = 102 cm) and 124 men were non-obese. Obese men had lower total testosterone (TT) (12.7 +/- 0.4 v 15.0 +/- 0.4 nmol/L); P < 0.001) and calculated free testosterone (275.7 +/- 7.8 v 299.3 +/- 7.4 pmol/L); P = 0.03) levels than non-obese men. TT levels < 8 nmol/L were recorded in 12% of obese men and 1% of non-obese men. Applying the ESA guidelines for the diagnosis of age-related AD, 15 obese men (15%) and 4 non-obese men (3%) were classified as being eligible for androgen therapy supported by the Pharmaceutical Benefits Scheme (PBS); the relative risk in obese men was 1.92 (95% CI, 1.44-2.55; P < 0.001). CONCLUSION: Obesity is an important determinant of serum TT levels in ageing men. Almost one in seven obese men but only one in 30 non-obese men in our study were eligible for PBS-supported androgen therapy according to Australian guidelines. Although obese men are more likely to have biochemical hypoandrogenism, the clinical implications of this remain uncertain. Studies of testosterone therapy in this group of ageing men are needed to determine whether androgen replacement is beneficial.

Aged↗
PubMed1999

Periodic health examination, 1999 update: 1. Detection, prevention and treatment of obesity. Canadian Task Force on Preventive Health Care.

OBJECTIVES: (1) To evaluate the evidence relating to the effectiveness of methods to prevent and treat obesity, and (2) to provide recommendations for the prevention and treatment of obesity in adults aged 18 to 65 years and for the measurement of the body mass index (BMI) as part of a periodic health examination. OPTIONS: In adults with obesity (BMI greater than 27) management options include weight reduction, prevention of further weight gain or no intervention. OUTCOMES: The long-term (more than 2 years) effectiveness of (a) methods to prevent obesity and (b) methods to treat obesity. EVIDENCE: MEDLINE was searched for articles published from 1966 to April 1998 that related to the prevention and treatment of obesity; additional articles were identified from the bibliographies of review articles and the listings of Current Contents. Selection criteria were used to limit the analysis to prospective studies with at least 2 years' follow-up. BENEFITS, HARM AND COSTS: Health benefits of weight reduction were evaluated in terms of alleviation of symptoms, improved management of obesity-related diseases and a reduction in major clinical outcomes. The health risk of weight-reduction methods were briefly evaluated in terms of increased mortality and morbidity. VALUES: The recommendations of this report reflect the commitment of the Canadian Task Force on Preventive Health Care to provide a structured, evidence-based appraisal of whether a manoeuvre should be part of a periodic health examination. RECOMMENDATIONS: (1) PREVENTION: There is insufficient evidence to recommend in favour of or against community-based obesity prevention programs; however, because of considerable health risks associated with obesity and the limited long-term effectiveness of weight-reduction methods, the prevention of obesity should be a high priority for health care providers (grade C recommendation). (2) TREATMENT: (a) For obese adults without obesity-related diseases, there is insufficient evidence to recommend in favour of or against weight-reduction therapy because of a lack of evidence supporting the long-term effectiveness of weight-reduction methods (grade C recommendation); (b) for obese adults with obesity-related diseases (e.g., diabetes mellitus, hypertension), weight reduction is recommended because it can alleviate symptoms and reduce drug therapy requirements, at least in the short term (grade B recommendation). (3) Detection: (a) for people without obesity-related diseases, there is insufficient evidence to recommend the inclusion or exclusion of BMI measurement as part of a periodic health examination, and therefore BMI measurement is left to the discretion of individual health care providers (grade C recommendation); (b) for people with obesity-related diseases, BMI measurement is recommended because weight reduction should be considered with a BMI of more than 27 (grade B recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care. SPONSORS: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.

Adolescent↗
PubMed2002

[Obesity in Danish hospitals--attitudes in the year 2000].

INTRODUCTION: The aim was to investigate the attitudes towards obesity of those responsible for the treatment at Danish hospitals. MATERIALS AND METHODS: A questionnaire was sent to the heads of departments of internal medicine at all Danish hospitals where such exist (n = 64). RESULTS: Eighty-nine per cent of the questionnaires were answered. Sixteen per cent believed that obesity is a self-imposed, life-style disease, and 56% answered "perhaps". 66% believed that obesity is a chronic condition or disease, and 32% thought that obese patients should be followed up life-long. Most believed that diseases would be prevented or improved, if obesity were treated, and 72% believed that it was possible to treat obesity. Thirty-five percent answered "perhaps" to whether it is worth the effort to treat obesity, as weight loss seldom lasts in the long term, and 25% answered "perhaps" to whether loss of weight in the obese incurs health risk. Fifty per cent believed that more resources were needed for the treatment of obesity, and that research in obesity should be given more attention, whereas only a few answered in the negative (6-9%). Thirty-three per cent believed that there was a need for public obesity clinics. Only 15% thought that Danish doctors are sufficiently trained to treat obesity, and only 9% answered "no" to whether better treatment of obesity required altered attitudes to obesity among Danish health care personnel. DISCUSSION: The heads of departments of internal medicine at Danish hospitals had different attitudes to obesity, but most believed that there is a need for altered attitudes, information, and training of Danish doctors and other health care personnel in the treatment of obesity.

Attitude of Health Personnel↗
PubMed2005

Disease risks of childhood obesity in China.

OBJECTIVE: To estimate the relative risks of dyslipidemia, hypertension, diabetes mellitus, and metabolic syndromes among overweight and obese Chinese children compared with their normal weight counterparts. METHODS: Overweight and obesity were defined by age- and sex-specific BMI classification reference for Chinese children and adolescents. Pediatric metabolic syndrome (MetS) and each risk factor for MetS were defined using the criteria for US adolescents. Definition of hyper-TC, LDL, and dyslipidemia for adults was applied as well. General linear model factor analysis and chi-square test were used to compare the difference in metabolic indicators among normal weight, overweight, and obese groups. Multiple logistic regression analysis was performed to estimate the odds ratio of metabolic abnormalities between obesity, overweight, and normal weight children, after adjustment for living area, family economic level, age, sex, and daily exercise time and TV watching time, as well as different dietary indices in the model. RESULTS: Significant increases in blood lipids, glucose, and blood pressure were found among overweight and obese children as compared with their counterparts with normal weight. By applying WGOC-recommended BMI classification, the risks for hypertriglyceridemia, low HDL and dyslipidemia among overweight children were 1.9, 1.4, and 1.5 times, and was 3.3, 1.5, and 1.8 times among obese groups compared to their counterparts with normal weight after adjustment for age, sex, region, socioeconomic status, physical activity, and dietary intakes. The overweight and obese children (15-17.9 years) had a high-risk of developing hypertension, which was 2.3 and 2.9 times higher than their counterparts with normal weight. Above 90% obese adolescents had abdominal obesity, while less than 1% normal weight ones had abdominal obesity. No obese adolescents were free from any risk factors for MetS, while 36.9% of normal weight adolescents were from the risk factors. 83.3% obese boys and all obese girls had metabolic syndrome, while only 15.5% normal weight boys and 18.8% normal weight girls had metabolic syndrome. Four risk factors for metabolic syndrome were found in 8.3% obese boys while none in normal weight boys and girls. The prevalence of MetS among normal weight, overweight, and obesity groups was 1.5%, 18.3%, and 38.1% respectively. CONCLUSION: The cardiovascular disease (CVD) risk factors are clustered in obese Chinese children. Our observations strongly suggest that efforts should be made to prevent the onset of overweight and its associated diseases during early childhood.

Adolescent↗
PubMedDate not supplied

[Simple obesity in children. A study on the role of nutritional factors].

UNLABELLED: Excessive amount of adipose tissue in children and adolescents and simple obesity in particular constitute a growing health problem throughout the world. Adverse health effects of obesity of children justify the need to look for efficient treatments, among them the dietary treatment. THE AIM OF THE STUDY was to examine the effectiveness of dietary treatment in children with simple obesity on the basis of thorough analysis of their state of nutrition, method of nutrition and eating habits and the impact of other environmental factors. Four research hypotheses were formulated: 1. simple obesity of children is influenced by selected environmental factors such as parents' level of education, familial inclination to obesity and health habits, 2. chosen and accepted by the child and/or its mother/parents programme of dietary treatment in the form of low-energy diet with elements of low glycemic index results in the loss of body mass in children, 3. implemented dietary treatment translates into the modification of basic anthropometric features--body mass, body height, thickness of skin and adipose folds on arm, below shoulder blade (scapula), on abdomen as well as arm circumference and anthropometric parameters of examined children--body mass index BMI, waste-hip ratio, body fat content, 4. implemented dietary treatment has an impact on modification of certain biochemical indicators--lipid profile of children with increased indicators of lipid metabolism. MATERIAL AND METHODS: The research concerned 236 children living in the Mazowsze region with diagnosed simple obesity (relative body mass index rel BMI =20%), directed to Gastroenterological and Endocrinological Unit of the Institute of Mother and Child, after the children and/or their mothers/parents had accepted participating in a ten-week long research programme. The state of nutrition was evaluated on the basis of the examination of 8 basic features and 5 anthropometric parameters and basic biochemical indicators of metabolism of carbohydrates and fats, before and after the beginning of dietary treatment. The assessments of the method of nutrition, including eating habits, proportions of food products in the food ration and nutritional value of daily food rations was conducted on the basis of 10-14-day records of the child's diet before the implementation of dietary treatment and on the basis of randomly selected 3-day records of the child's diet from the diet book after the dietary treatment was introduced. The environmental data were collected on the basis of a questionnaire, constructed for this study. RESULTS: The main risk factors for simple obesity in examined children (n=236) aged 3-15 yrs were familial and environmental conditions. A significant correlation was found between the children's obesity expressed by a normalized body mass index BMI z-score, unrelated to age and sex, and mother's level of education and father's obesity (Chi(2) test, p<0.05). A positive correlation was demonstrated between the normalized relative body mass index (BMI z-score) and children's anthropometrical parameters--thickness of skin and adipose folds on the arm, below the shoulder blade (scapula), on the abdomen and their sum, arm circumference, waste-hip ratio and body fat content and the children's parents body mass index (father's BMI, mother's BMI). In boys with simple obesity the tendency to central obesity was observed since early childhood. In the examined group of children no distortions of metabolism of carbohydrates were observed (correct fasting levels of glucose), while in children with obesity the irregularities of metabolism of fats were noted. The implemented dietary treatment (low energy diet with elements of low glycemic index) had a significant impact on improvement of lipid metabolism in all children in whom the irregularities of metabolism of fats were noted. Modification of the diet of children aged 3-6 by implementing dietary recommendations, including the increased frequency of meals and the choice of products with low glycemic index, did not have a significant impact on the decrease of the body mass index in 95% of examined children. A considerable number of children aged 3-6 (n=12) continued to eat only three meals a day and their model of nutrition, including the selection of products, was not significantly modified. The introduced low energy diet with elements of low glycemic index in children of school age (7-15 years) with simple obesity positively influenced the decrease of analyzed features and parameters (p<0.0001). During dietary treatment statistically significant decrease of the children's body mass was observed as well as a decrease of the thickness of skin and adipose folds on the arm, below the shoulder blade (scapula), on the abdomen and a decrease of arm circumference and body fat content. The change of the energy content of a daily food ration, the amount of consumed carbohydrates and products from the group of sugar and sweets, cereal foodstuffs and fat and products from the group of other fats was positively correlated with body mass loss expressed as the difference between z-score BMI before and after the dietary treatment. The modification of the eating habits--increased frequency of meals and reduction or elimination of eating between the meals during the nutrition intervention were not significantly linked to the change of normalized body mass index in the examined children. Only the frequency of eating sweets was related to the change of z-score BMI (p<0.05). The implemented dietary treatment in obese children aged 7-15 yrs significantly influenced the body mass loss. In children (n=38/236) with lipid metabolism abnormalities, the low energy diet with elements of low glycemic index had a favorable impact on the lipid profile. The increased levels of total cholesterol, LDL cholesterol and triglycerides returned to normal. CONCLUSIONS: 1. Simple obesity in children aged 3-15 yrs is connected with familial and environmental factors, including incorrect eating habits. 2. Dietary treatment consisting in the lowering of energetic value of the diet through the reduction of fat consumption and quantity and quality changes with respect to carbohydrates consumption decreased the children's obesity, and was more effective in the older age group (7-15 yrs). Dietary treatment normalizes the lipid profile in children. 3. Significant body mass loss has been observed in children in whose diet the amount of proteins and their share in the total energy value only slightly differs from the level before the dietary treatment. The amount of proteins in the children's diet was within the range of physiological recommendations.

Adolescent↗
PubMedDate not supplied

[Family environment of children with simple obesity].

Fifty obese children aged from 6 to 15 years and 50 non-obese controls paired on the basis of age and sex were evaluated by anthropometric measurements and a parents' questionnaire. Birth weight was comparable in obese and non-obese children. The majority (78%) of the cases in the study group were becoming obese during the age among 2 and 12 years. It was found that obese children were about five times as likely to have an obese parent as controls: 44% of the obese children had obese fathers and 12% had obese mothers. There also a significant difference in the chance of having an obese sibling between the obese and control groups. However, the difference of socioeconomic status between the two groups did not reach level of significance. The results indicated that there are likely to be more obese family members at home for every obese case identified in a weight control clinic. Identification, prevention, and control of childhood obesity in at-risk families are an important pediatric issue. Further research efforts are needed to unravel the multiple factors associated with childhood obesity.

Adolescent↗
PubMed1993

Obesity in free-ranging rhesus macaques.

Spontaneous obesity in free-ranging rhesus macaques (Macaca mulatta) was assessed in terms of body size, body fat distribution, endocrinological/metabolic indices, and social and familial factors. Eleven animals (six females, five males), or 7% of the adult population surveyed, were defined as obese on the basis of morphometric indices of adiposity > 2 s.d. above the mean for adults in this colony. The age of the obese animals ranged from 9-16 years; obese males were older than females (average 14 vs. 12 years), but this difference was not significant. Mean body weights for obese males and females were 14.1 +/- 0.5 and 13.5 +/- 0.7 kg, respectively. There were no gender differences in either the incidence of obesity or measures of body fat. Serum concentrations of cholesterol and testosterone were not significantly different between obese and nonobese monkeys. Serum triglyceride levels were somewhat higher in obese animals, but this difference was not significant. Glucose clearance was within normal limits in both obese and age- and sex-matched non-obese monkeys (> 2% per min). Although increased adiposity was significantly correlated with fasting insulin and the insulin response to glucose loading, differences between obese and non-obese animals in these values did not achieve significance. The incidence of obesity ranged from 0-20% among the eleven matrilines studied, and several primary familial relationships were observed within the obese sample. Most obese females were from a high ranking matriline whereas only one of the obese males was high ranking at the time of the survey.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1997

[Health risks and economic costs associated with obesity requiring a comprehensive weight reduction program].

An increasing prevalence of obesity all over the world reflects a lack of effective measures in both prevention and treatment of obesity. Obesity as a disease has been underestimated by the lay-public as well as health care providers. However, obesity represents a substantial health problem associated with a decreased quality of life. Obesity is linked to numerous chronic diseases (cardiovascular diseases, diabetes, hyperlipidemia, gout, osteoarthritis, gall-stones, and bowel, breast and genitourinary cancers) that lead to premature disability and mortality. Health risks increase with a body mass index (BMI) over 25 in individuals 19-35 years of age and with a BMI over 27 in those 35 years of age and older. Health risks also increase with an excess accumulation of visceral fat manifested as an increase in waist circumference (> 100 cm) or in waist to hip ratio (> 0.85 for females and > 1.00 for males). According to studies carried out in different countries current economic costs of obesity represent 5-8% of all direct health costs. In contrast, effective treatment of obesity results in a substantial decrease in expenditures associated with pharmacotherapy of hypertension, diabetes, hyperlipidemia and osteoarthritis. Both scientists and clinicians involved in obesity research and treatment recommend to introduce the long-term weight management programs focussing more on the overall health of the participants than the weight loss per se. Therefore, it will be necessary to establish new realistic goals in the obesity management that reflect reasonable weights and recently experienced beneficial health effects of modest (5-10%) weight loss. Comprehensive obesity treatment consisting of low fat diet, exercise, behavioral modification, drug therapy and surgical procedures requires differentiated weight management programs modified according to the degree and type of obesity as well as to current health complications present. The Czech Society for the Study of Obesity defined a comprehensive weight reduction program carried out in weight reduction clubs, out-patient obesity clinics and in specialized departments attached to the university hospitals. In order to provide an integrated knowledge from many different disciplines connected with obesity three week postgraduate course has been organized for physicians involved in obesity management. Even the most spread weight reduction clubs in our country (STOB) are supervised by the trained counselors. The main goal of different weight management programs is to find out optimal approaches leading to long-term beneficial outcome and ameliorating the variety of disorders associated with obesity.

Health Care Costs↗
PubMed1967

Studies on lipogenesis in vivo: Fatty acid and cholesterol synthesis in hyperglycaemic-obese mice.

1. Lipogenesis has been studied in intact genetically obese mice by measuring the incorporation of a single oral dose of 250mg. of [U-(14)C]glucose into fatty acid and cholesterol in the liver and extrahepatic tissues. Studies were also carried out with [U-(14)C]glucose added to the diet and fed for 24hr. With either method of isotope administration, the conversion of [U-(14)C]glucose into fatty acid was greatly elevated in the livers of the obese mice. In contrast, conversion of the single dose of [(14)C]glucose into fatty acid in extrahepatic tissues of obese mice was only half that occurring in the non-obese litter mates. When [(14)C]glucose was given in the diet for 24hr. the total accumulation of labelled fatty acid in extrahepatic tissues of obese mice was slightly less than in the non-obese. Uptake of labelled glucose and conversion into fatty acid in adipose tissue of the obese mice decreased with age. 2. Conversion of the single dose of [(14)C]glucose into liver cholesterol was comparable in obese and non-obese mice fed on a purified low-fat diet. However, obese mice given this diet for 12 weeks accumulated 1.54% of cholesterol in the liver compared with 0.29% in the non-obese litter mates. This accumulation apparently resulted from a decrease in removal of cholesterol from the liver, rather than an increased synthesis. 3. Conversion of the single dose of [(14)C]glucose into extrahepatic fatty acid was decreased by 18hr. starvation proportionally as much in obese as in non-obese mice. The decrease in liver fatty acid synthesis caused by starvation also was considerable in obese mice, although somewhat less marked than in the non-obese. 4. The metabolic derangements in the liver could be more fundamental to the development of the obesity than the changes seen in extrahepatic tissues.

Journal Article↗
PubMed2006

Mortality and cardiac and vascular outcomes in extremely obese women.

CONTEXT: Obesity, typically measured as body mass index of 30 or higher, has 3 subclasses: obesity 1 (30-34.9); obesity 2 (35-39.9); and extreme obesity (> or =40). Extreme obesity is increasing particularly rapidly in the United States, yet its health risks are not well characterized. OBJECTIVE: To determine how cardiovascular and mortality risks differ across clinical weight categories in women, with a focus on extreme obesity. DESIGN, SETTING, AND PARTICIPANTS: We examined incident mortality and cardiovascular outcomes by weight status in 90,185 women recruited from 40 US centers for the Women's Health Initiative Observational Study and followed up for an average of 7.0 years (October 1, 1993 to August 31, 2004). MAIN OUTCOME MEASURES: Incidence of mortality, coronary heart disease, diabetes, and hypertension. RESULTS: Extreme obesity prevalence differed with race/ethnicity, from 1% among Asian and Pacific Islanders to 10% among black women. All-cause mortality rates per 10,000 person-years were 68.39 (95% confidence interval [CI], 65.26-71.68) for normal body mass index, 71.16 (95% CI, 67.68-74.82) for overweight, 84.47 (95% CI, 78.90-90.42) for obesity 1, 102.85 (95% CI, 92.90-113.86) for obesity 2, and 116.85 (95% CI, 103.36-132.11) for extreme obesity. Analyses adjusted for age, smoking, educational achievement, US region, and physical activity levels showed that weight-related risk for all-cause mortality, coronary heart disease mortality, and coronary heart disease incidence did not differ by race/ethnicity. Adjusted analyses among white and black participants showed positive trends in all-cause mortality and coronary heart disease incidence with increasing weight category. Much of the obesity-related mortality and coronary heart disease risk was mediated by diabetes, hypertension, and hyperlipidemia. In white women, weight-related all-cause mortality risk was modified by age, with obesity conferring less risk among older women. CONCLUSIONS: Considering obesity as a body mass index of 30 or higher may lead to misinterpretation of individual and population risks. Escalating extreme obesity may exacerbate health effects and costs of the obesity epidemic.

Aged↗
PubMed2000

National patterns of physician activities related to obesity management.

CONTEXT: National physician practices related to the clinical recognition and management of obesity are unknown. OBJECTIVES: To estimate national patterns of office-based, obesity-related practices and to determine the independent predictors of these practices. DESIGN: Serial cross-sectional surveys of physician office visits. SETTING: Ambulatory medical care in the United States. PATIENTS: We analyzed 55,858 adult physician office visits sampled in the 1995-1996 National Ambulatory Medical Care Surveys. Data from the Third National Health and Nutrition Examination Surveys, 1988-1994 were used to assess and, then, adjust for the underreporting of obesity. MAIN OUTCOME MEASURES: Reporting of obesity at office visits and physician counseling for weight loss, exercise, and diet among patients identified as obese. RESULTS: Physicians reported obesity in only 8.6% of 1995-1996 National Ambulatory Medical Care Surveys visits. The 22.7% prevalence rate of the Third National Health and Nutrition Examination Surveys, 1988-1994 suggests that physicians reported obesity in only 38% of their obese patients. Among visits by patients identified as obese, physicians frequently provided counseling for weight loss (35.5%), exercise (32.8%), and diet (41.5%). Adjusted for population prevalence; however, each service was provided to no more than one quarter of all obese patients. While patients with obesity-related comorbidities were treated more aggressively, in these patients, weight loss counseling occurred at only 52% of the visits. CONCLUSIONS: Specific interventions to address obesity are infrequent in visits to US physicians. Obesity is underreported and interventions are only moderately likely among patients identified as obese, even for those with serious obesity-related comorbidities.

Adult↗
PubMed2006

Prevalence of overweight and obesity in the United States, 1999-2004.

CONTEXT: The prevalence of overweight in children and adolescents and obesity in adults in the United States has increased over several decades. OBJECTIVE: To provide current estimates of the prevalence and trends of overweight in children and adolescents and obesity in adults. DESIGN, SETTING, AND PARTICIPANTS: Analysis of height and weight measurements from 3958 children and adolescents aged 2 to 19 years and 4431 adults aged 20 years or older obtained in 2003-2004 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Data from the NHANES obtained in 1999-2000 and in 2001-2002 were compared with data from 2003-2004. MAIN OUTCOME MEASURES: Estimates of the prevalence of overweight in children and adolescents and obesity in adults. Overweight among children and adolescents was defined as at or above the 95th percentile of the sex-specific body mass index (BMI) for age growth charts. Obesity among adults was defined as a BMI of 30 or higher; extreme obesity was defined as a BMI of 40 or higher. RESULTS: In 2003-2004, 17.1% of US children and adolescents were overweight and 32.2% of adults were obese. Tests for trend were significant for male and female children and adolescents, indicating an increase in the prevalence of overweight in female children and adolescents from 13.8% in 1999-2000 to 16.0% in 2003-2004 and an increase in the prevalence of overweight in male children and adolescents from 14.0% to 18.2%. Among men, the prevalence of obesity increased significantly between 1999-2000 (27.5%) and 2003-2004 (31.1%). Among women, no significant increase in obesity was observed between 1999-2000 (33.4%) and 2003-2004 (33.2%). The prevalence of extreme obesity (body mass index > or =40) in 2003-2004 was 2.8% in men and 6.9% in women. In 2003-2004, significant differences in obesity prevalence remained by race/ethnicity and by age. Approximately 30% of non-Hispanic white adults were obese as were 45.0% of non-Hispanic black adults and 36.8% of Mexican Americans. Among adults aged 20 to 39 years, 28.5% were obese while 36.8% of adults aged 40 to 59 years and 31.0% of those aged 60 years or older were obese in 2003-2004. CONCLUSIONS: The prevalence of overweight among children and adolescents and obesity among men increased significantly during the 6-year period from 1999 to 2004; among women, no overall increases in the prevalence of obesity were observed. These estimates were based on a 6-year period and suggest that the increases in body weight are continuing in men and in children and adolescents while they may be leveling off in women.

Adolescent↗
PubMed2003

Binge eating in obese children and adolescents.

OBJECTIVE: The first goal of the current study was to examine the extent to which a population of obese children and adolescents have developed binge eating problems. The second goal was to generate variables that would distinguish obese binge eaters from obese non-binge eaters. METHOD: A group of 126 children and adolescents seeking residential care because of their obesity was selected. A self-report version of the Eating Disorder Examination was administered. RESULTS: Binge eating episodes were reported by 36.5% of the obese youngsters. Six percent reported two or more episodes of binge eating a week. Obese binge eaters differed significantly from obese non-binge eaters in self-esteem and in a broad range of eating-related characteristics. Compared with obese non-binge eaters, the obese binge eaters were slightly younger. Obese binge eaters did not differ from obese non-binge eaters in degree of overweight or depression. DISCUSSION: Results suggest that binge eating is a prevalent problem among obese children and adolescents seeking help for their obesity. The marked difference between obese children with and without binge eating suggests the need for special treatment to focus on the problems of obese binge eaters.

Adolescent↗
PubMed2004

Hypopnea in pediatric patients with obesity hypertension.

Obesity is associated with the development of hypertension but it is still not clear why hypertension is not observed in all obese patients. Obesity is a risk factor for the development of obstructive sleep apnea syndrome (OSAS) in children. OSAS has been linked to the development of hypertension in adults and children. The purpose of this study was to test the hypothesis that OSAS is one of the reasons that some obese children are hypertensive and some are not. The overnight polysomnography records of 90 patients (aged 4.2-18.8 years) were reviewed. BMI(score) [body mass index (BMI)/95th percentile BMI for age, sex, and race] was used to express the degree of obesity. The severity of systolic hypertension and diastolic hypertension were expressed as SBP(score) (systolic BP/the 95th percentile systolic BP for age, sex, and height) and DBP(score) (diastolic BP/the 95th percentile diastolic BP for age, sex, and height), respectively. OSAS was defined as more than one episodes of apnea per hour (AI) or an O(2) saturation associated with obstructive apnea of less than 90%. There were 56 obese patients; 42 were hypertensive and 40 patients were diagnosed with OSAS. The incidence of hypertension (68% vs. 30%) and obesity (75% vs. 52%) was higher in OSAS patients than those without OSAS. Compared with the non-obese patients, obese patients had a higher incidence of hypertension or OSAS, a higher BMI(score), SBP(score), DBP(score), AI, hypopnea index (HI), and apnea-hypopnea index (AHI). In obese patients, both SBP(score) and DBP(score) correlated positively with BMI(score), arousal index, and HI. DBP(score) also correlated positively with AHI. Multiple regression analysis showed that HI and BMI(score) were significant independent predictors of SBP(score) or DBP(score). Obese and hypertensive patients had a higher HI, AHI, and incidence of OSAS (64% vs. 29%) than the obese and normotensive patients. In conclusion, HI had a significant correlation with the degree of hypertension in obese patients, which could not be attributed to the degree of obesity. These findings are consistent with the hypothesis that OSAS is one of the reasons why some obese children are hypertensive and some are not.

Adolescent↗
PubMed1990

Resting energy expenditure in women: impact of obesity and body-fat distribution.

Postabsorptive resting metabolic rate (RMR) and diet-induced thermogenesis (DIT) were repeatedly assessed with an indirect calorimetric ventilated hood system in a group of 32 healthy premenopausal obese women, body fat percentage 46.4 +/- 0.9 (mean +/- SEM), age 38.5 +/- 0.9 years. RMR and DIT were also measured in a group of 10 healthy premenopausal non-obese women, body fat percentage 31.3 +/- 1.7, age 37.7 +/- 2.4 years. The obese women were subdivided according to the waist-to-hips girth ratio (WHR) into three groups with a different type of body fat distribution: A gluteal-femoral obese group (n = 10), WHR less than 0.79; an intermediate obese group (n = 10), 0.79 less than WHR less than 0.85; and an abdominal obese group (n = 12), WHR greater than 0.85. No significant differences were observed among the obese groups in age, body weight, body fat mass, and fat-free body mass. Body fat distribution was not associated with differences in DIT, pre- and postprandial respiratory quotients and substrate oxidation rates, but the abdominal obese women had significantly higher RMRs adjusted for age, fat mass, and fat-free body mass (6,075 +/- 200 kJ/d) in comparison with the gluteal-femoral obese women (5,502 +/- 205 kJ/d) and in comparison with obese women with an intermediate body fat distribution (5,517 +/- 193 kJ/d), but not in comparison with a non-obese control group, 6,790 +/- 261 kJ/d. It is concluded that within the total group of obese women, the non-abdominal obese can be characterized by relatively reduced resting metabolic rates in comparison with either the abdominal obese or with non-obese women.

Adipose Tissue↗
PubMed2004

Serum tumor necrosis factor-alpha levels and components of the metabolic syndrome in obese adolescents.

Tumor necrosis factor-alpha (TNF-alpha) seems to be increased in obese subjects, suggesting its role as a proinflammatory cytokine to insulin resistance and metabolic abnormalities in obesity. The aim of this study was to evaluate the relationship between serum TNF-alpha, soluble TNF-alpha receptor 1 (sTNF-R1), TNF-alpha receptor 2 (sTNF-R2), and metabolic syndrome (MS) components and anthropometric indices in obese and non-obese adolescents. A cross-sectional study was performed on obese and non-obese adolescents. We studied 71 adolescents (age, 15 to 16 years old); 39 were obese (obese group; 14 males and 25 females) and 32 were non-obese adolescents (non-obese lean group; 12 males and 20 females). The body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were determined in each subject. The serum TNF-alpha, sTNF-R1, sTNF-R2, fasting plasma glucose (FPG), and lipid profile were also measured. The mean serum TNF-alpha, sTNF-R1, and sTNF-R2 were significantly higher in the obese than the non-obese group (TNF-alpha, 18.15 v 5.88 pg/mL, P < .001; sTNF-R1, 2.01 v 1.40 ng/mL, P < .001; sTNF-R2, 6.06 v 3.70 pg/mL, P < .001). The serum TNF-alpha concentrations were positively correlated with the BMI (TNF-alpha, r = 0.346, P < .05; sTNF-R1, r = 0.624, P < .001; sTNF-R2, r = 0.482, P < .001, respectively) and WC (TNF-alpha, r = 0.525, P < .05; sTNF-R1, r = 0.700, P < .001; sTNF-R2, r = 0.669, P < .001, respectively). The serum TNF-alpha was positively correlated with triglyceride (TG) and DBP, and negatively with high-density lipoprotein-cholesterol (HDLC). The sTNF-R1 and sTNF-R2 were correlated with TG and DBP, and TG, respectively. Obese compared with non-obese adolescents exhibited higher concentrations of TNF-alpha and its soluble receptors, and the higher TNF-alpha concentrations were associated with several components of MS in obese adolescents.

Adolescent↗
PubMed2006

Interleukin-1 (IL-1) receptor antagonist gene polymorphism in normal weight obese syndrome: relationship to body composition and IL-1 alpha and beta plasma levels.

Interleukin-1 receptor antagonist concentration is upregulated in the plasma of patients with obese related disease, and its synthesis is under genetic control. We tested the hypothesis that the polymorphism in the interleukin-1 receptor antagonist gene second intron might be associated with normal weight obese syndrome. The polymorphism of intron 2 in the interleukin-1 receptor antagonist gene, containing a variable numbers of a tandem repeat (VNTR), and interleukin-1alpha and beta plasma levels were evaluated in 110 Caucasian Italian women, divided in three groups: non-obese, normal weight obese and preobese-obese. The allele 1 frequency was not significantly different in the three groups. The alleles 3 and 4 were not observed in any group. The allele 2 frequency in normal weight obese woman (12.5%) and preobese-obese (17.5%) groups were significantly different in comparison with the non-obese group (6.7%). The allele 5 was observed exclusively in non-obese and normal weight obese subjects (13.3 and 7.5%, respectively). In normal weight obese women, plasma concentrations of interleukin-1 alpha and interleukin-1 beta were significantly higher than in non-obese. The allele 2 was observed in normal weight obese as well as a significant association between the increase of interleukin-1 beta plasma amount and the allele 2 carrier. Our findings suggest that the allele 2 might be an important high-risk genetic marker for normal weight obese syndrome and obesity related diseases.

Absorptiometry, Photon↗