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PubMed1982

Twenty-four-hour energy expenditure and resting metabolic rate in obese, moderately obese, and control subjects.

Twenty-four-hour energy expenditure (24-EE), resting metabolic rate (RMR) and body composition were determined in 30 subjects from three groups; control (103 +/- 2% ideal body weight, n = 10), moderately obese (129 +/- 1% ideal body weight, n = 6), and obese (170 +/- 5% ideal body weight, n = 14) individuals. Twenty-four EE was measured in a comfortable airtight respiration chamber. When expressed as absolute values, both RMR and 24-EE were significantly increased in obese subjects when compared to normal weight subjects. The RMR was 7592 +/- 351 kJ/day in the obese, 6652 +/- 242 kJ/day in the moderately obese, and 6118 +/- 405 kJ/day in the controls. Mean 24-EE values were 10043 +/- 363, 9599 +/- 277, and 8439 +/- 432 kJ/day in the obese, moderately obese, and controls, respectively. The larger energy expenditure in the obese over 24 h was mainly due to a greater VO2 during the daylight hours. However, 92% of the larger 24-EE in the obese, compared to the control group, was accounted for by the higher RMR and only 8% by other factors such as the increased cost of moving the extra weight of the obese. The higher RMR and 24-EE in the obese was best related to the increased fat free mass.

Adult↗
PubMed1998

Familial predisposition for obesity may modify the predictive value of serum leptin concentrations for long-term weight change in obese women.

Leptin is believed to play a role in regulating food intake and body weight. The aim of this study was to examine the influence of parental history of obesity on the association between baseline serum leptin concentrations and subsequent 4-y weight changes. Changes in food intake were also considered in the analysis. Middle-aged, obese women with no obese parent (n = 25) or at least one obese parent (n = 24) were included in the analysis. At baseline, women with no parental history of obesity and women with a parental history of obesity did not differ in body mass index (in kg/m2: 41.2 and 40.2, respectively) or median leptin concentrations (40.8 and 38.8 microg/L, respectively). Four-year weight changes varied widely in both groups combined (from -30 to 24 kg). Stratified regression analysis, adjusted for age, weight, and height, revealed that high leptin concentrations predicted less weight gain (or more weight loss) in women with no obese parent (beta = -21.2, P = 0.0006) but played no significant role in predicting weight gain in women with at least one obese parent (beta = -3.8, P = 0.41). Adding changes in energy and fat intakes to the model reduced the association between leptin and weight change to nonsignificance in the women with no obese parent, indicating that the effect of leptin could be explained largely by dietary changes. In conclusion, serum leptin concentrations predict long-term weight change in obese women with no history of parental obesity, an association largely mediated by changes in food intake.

Adult↗
PubMed2003

Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women.

BACKGROUND: Obese women require higher gonadotrophin doses for ovarian stimulation and to trigger ovulation. The bioavailability of a drug is affected by its route of administration. Herein, the bioavailability of hCG was compared after intramuscular (i.m.) or subcutaneous (s.c.) injection in obese and non-obese women. METHODS: Twenty four Chinese women, 12 with a body mass index (BMI) >/==" BORDER="0">28 kg/m(2) and 12 with a BMI of 20-25 kg/m(2) were recruited as the obese and non-obese groups respectively. A single hCG injection was given intramuscularly on one occasion, and subcutaneously on a second occasion, separated by 4 weeks. Blood samples were taken at intervals for the pharmacokinetic study of hCG. RESULTS: Examination of the hCG plasma concentration-time curve showed the area under the curve (AUC) and maximum concentration (C(max)) of hCG to be significantly higher after i.m. injection than after s.c. injection in both the obese and non-obese groups. However, the AUC and C(max) values in obese women were significantly lower than in non-obese women, irrespective of whether i.m. or s.c. dosing was employed. CONCLUSIONS: Intramuscular dosing of hCG provided better bioavailability than s.c. dosing, but bioavailability was significantly less in obese women than in non-obese women.

Adult↗
PubMed1990

Differences in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consecutive cases.

Two hundred and sixty-three women with ultrasound-diagnosed polycystic ovary syndrome were studied of whom 91 (35%) were obese (BMI greater than 25 kg/m2). Obese women with PCOS had a greater prevalence of hirsutism (73% compared with 56%) and menstrual disorders than non-obese subjects. Total testosterone and androstenedione concentrations in serum were similar in the two subgroups but SHBG concentrations were significantly lower, and free testosterone levels higher, in obese compared with lean subjects. In addition, concentrations of androsterone glucuronide, a marker of peripheral 5 alpha-reductase activity, were higher in obese than in non-obese women with PCOS. There were no significant correlations of either SHBG or free testosterone with androsterone glucuronide suggesting that obesity has independent effects on transport and on metabolism of androgen. There were no significant differences between the subgroups in either baseline gonadotrophin concentrations or the pulsatile pattern of LH and FSH secretion studied over an 8-h period. There was, however, an inverse correlation of FSH with BMI, but only in the obese subgroup. In conclusion, the increased frequency of hirsutism in obese compared with lean women with PCOS is associated with increased bio-availability of androgens to peripheral tissues and enhanced activity of 5 alpha-reductase in obese subjects. The mechanism underlying the higher prevalence of anovulation in obese women remains unexplained.

Androgens↗
PubMed2006

Comparison of pre- and postoperative pulmonary function in obese and non-obese female patients undergoing coronary artery bypass graft surgery.

OBJECTIVE AND BACKGROUND: Various studies have suggested that body size and in-hospital mortality are related. However, only a few analysed the effects of obesity on pulmonary complications following coronary artery bypass graft surgery (CABG). The purpose of the present study was to assess early changes in lung volumes, respiratory complications and arterial blood gas tension following CABG in obese women. METHODS: Pulmonary function tests (PFTs), treadmill exercise capacity tests (TM), arterial blood gases and pulmonary complications were studied in 124 obese (mean age 57.2+/-5.8 years) and 108 non-obese (mean age 58.6+/-5.9 years) female patients undergoing elective CABG. PFT, TM tests, arterial blood gas analyses and CXR were performed in the preoperative and postoperative periods and pulmonary complications were recorded. Breathing and coughing exercises, early ambulation and pulmonary clearing techniques were used by physical therapists to prevent pulmonary complications after CABG surgery. RESULTS: Postoperative PFT and TM tests deteriorated significantly in both groups (P<0.0001). The deterioration in the obese group was highly significant. The postoperative deterioration of blood gas measurements in obese patients was also statistically significant compared to non-obese patients. Early pulmonary complications developed in 21 (16.94%) of the obese patients and in 10 (9.25%) of non-obese patients. Duration of mechanical ventilation, intensive care unit and hospital stays were longer compared to the non-obese patients (P=0.008, P<0.0001, P=0.0386, respectively). CONCLUSION: Obesity has a detrimental effect on pulmonary function, exercise capacity, blood gas measurements and complications rates in postoperative period following CABG surgery.

Blood Gas Analysis↗
PubMed2001

Obesity-associated disorders before and after weight reduction by vertical banded gastroplasty in morbidly vs super obese individuals.

BACKGROUND: The amount of excess weight which must be lost in order to cure or to improve disorders associated with obesity remains unknown. This study was designed to compare super obese and morbidly obese patients in terms of weight reduction following VBG and to investigate the effects of postoperative weight changes to preexisting co-morbidities. METHODS: 125 patients underwent VBG. Group A consisted of 80 morbidly obese patients (64%) and group B consisted of 45 super obese patients (36%). Preoperative examination was planned to identify and determine the severity of any disorders associated with obesity, that the patients may have had. Following VBG, all patients were followed-up at regular time periods, for at least 2 and up to 4 years. The progress of preexisting co-morbidities was evaluated and carefully recorded. RESULTS: Among the 80 patients of Group A, there were 240 total co-morbidities (3 per patient), and in group B there were 196 co-morbidities (4.35 per patient) preoperatively. Dyspnea during fatigue and arthritis were found at statistically higher incidence in the super obese category. At the end of the second postoperative year, greater weight loss in terms of number kilograms was seen in patients in group B, but these patients did not reach a BMI lower than 35, while patients in group A had mean BMI below 30. In group A, 66% of the co-morbidities completely resolved, 19% significantly diminished and 15% remain unchanged. In group B, the respective percentages were 53%, 27.5% and 19.5%. However, after weight reduction by VBG a significant number of co-morbidities remain in the super obese patients (92 or 2.044 per/patient), and this is believed to be due to the greater remaining excess weight. CONCLUSION: Reduction of body weight by VBG is associated with resolution or improvement of a significant number of the obesity-associated disorders. However, super obese patients remain obese after surgery, and this results in two-fold higher remaining morbidity.

Adult↗
PubMed2006

Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery.

BACKGROUND: Obesity is considered a highly prevalent risk factor for venous thromboembolism (VTE) in hospitalized patients. However, recommendations for VTE prophylaxis in obese patients are not clear. METHODS: To evaluate obesity as a risk factor for VTE in medical and bariatric patients and the efficacy of VTE prophylaxis, we performed a systematic review in MEDLINE, Cochrane Database of Systematic Reviews and LILACS from 1976 to 2006. Evidence was evaluated independently by 2 authors and presented descriptively. RESULTS: Of the 124 studies found, 87 were excluded based on predefined criteria. There is no consensus among studies, but prospective cohorts show that obesity is associated with a higher risk of VTE in medical patients. There is evidence that the risk of VTE exceeds that attributable to the surgical procedure alone in bariatric surgery. Only 6 studies evaluated prophylactic methods (unfractionated heparin, low molecular weight heparin and sequential compression devices) in obese patients. Although these studies have some methodological flaws, they suggest efficacy of VTE prophylaxis in medical and surgical obese patients. CONCLUSIONS: Obesity is a risk factor for VTE in obese medical patients and patients undergoing bariatric surgery. Obesity appears to play an adjuvant role for the development of VTE in hospitalized patients with other risk factors. The small number of prospective trials in this population prevents a definite conclusion about the most effective and safe VTE prophylactic method for obese patients. Thus, randomized clinical trials to compare VTE prophylactic methods in obese patients are still highly warranted.

Bariatric Surgery↗
PubMedDate not supplied

Prevalence of obesity in adolescents and the impact of sexual maturation stage on body mass index in obese adolescents.

OBJECTIVE: Puberty is a high-risk period for the development of obesity. The aim of this study was to determine the prevalence of obesity in adolescents admitted to an outpatient adolescent clinic and investigate the relationships between the increase of body mass index and sexual maturation stages in obese adolescents. MATERIAL AND METHODS: We recruited 6,462 adolescents, aged 9-16 years, admitted to the outpatient clinic of our Adolescent Unit, between May 1999 and September 2000. BMI was calculated as weight per height with weight in kilograms and height in meters. Adolescents with a BMI > or = 95th percentile for age and sex were defined as obese, with BMI's > or = 90th percentile but < 95th percentile were defined as overweight and considered at risk for obesity. Obese adolescents, with endocrine problems identified to cause obesity, were excluded from this study. Pearson correlation coefficients were used to assess the relationships between BMI and age. The differences between the sexual maturation stages were evaluated with Mann-whitney U Test. RESULTS: Out of 6,462 cases screened, 151 obese adolescents were found. Prevalence of obesity for the total sample surveyed was estimated at 2.3%. BMI values were significantly correlated with age in both sexes. In girls, only the increase of BMI values from stage I to stage II was found to be statistically significant. In boys, BMI values did not differ significantly between the sexual maturation stages but the number of obese cases were high in stages I and II. DISCUSSION AND CONCLUSION: The pubertal growth spurt (timing determined by sexual maturation stage) effects the amount of fat accumulation and the distribution of fat in different ways in boys and girls. So, not only the age and sex but also the sexual maturation stage has to be taken into account while evaluating the BMI values for investigating the risk of obesity in puberty.

Adolescent↗
PubMed2001

Circulating IGF binding protein-1 is inversely associated with leptin in non-obese men and obese postmenopausal women.

OBJECTIVE: Hyperleptinaemia and hyperinsulinaemia interrelate to insulin-like growth factor binding protein 1 (IGFBP-1), and disturbances in the growth hormone-IGF-I axis are linked to obesity and cardiovascular diseases. However, whether the association between leptin and the GH-IGF-I axis is altered with increasing obesity is not known. We therefore examined the relationship between leptin, IGF-I, IGFBP-1, insulin and proinsulin in men and women with or without obesity in a population study. DESIGN AND SUBJECTS: Healthy subjects (n=158; 85 men and 73 pre- and postmenopausal women) from the Northern Sweden MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) population were studied with a cross-sectional design. METHODS: Anthropometric measurements (body mass index (BMI) and waist circumference) and oral glucose tolerance tests were performed. Radioimmunoassays were used for the analyses of leptin, IGF-I and IGFBP-1, and ELISAs for specific insulin and proinsulin. RESULTS: Leptin inversely correlated to IGFBP-1 in non-obese men (P<0.05) and obese postmenopausal women (P<0.05). In contrast, leptin did not correlate to IGF-I. IGFBP-1 was also significantly associated with proinsulin in non-obese men (P<0.01) and non-obese premenopausal women (P<0.05). The association between leptin and IGFBP-1 was lost after adjustment for insulin. In multivariate analyses taking measures of adiposity into account, low proinsulin, and IGF-I in combination with old age, but not leptin, predicted high IGFBP-1 levels. CONCLUSIONS: Leptin was inversely associated with IGFBP-1 in non-obese men and obese postmenopausal women, and proinsulin was inversely associated with IGFBP-1 in non-obese men and premenopausal women. However, these associations were lost with increasing central obesity in men and premenopausal women and after control for insulin. Therefore, this study suggests (i) that leptin is of minor importance for regulation of IGFBP-1 levels and (ii) that the insulin resistance syndrome is characterised by an altered relationship between leptin, IGFBP-1 and insulin.

Adipose Tissue↗
PubMed2002

Parental obesity, lifestyle factors and obesity in preschool children: results of the Toyama Birth Cohort study.

The aim of this study was to clarify the impact of parental obesity and lifestyle factors on obesity in preschool children. The subjects consisted of 8941 children aged 3 years, born in 1989. Anthropometric measurements and questionnaire surveys were conducted between 1992 and 1994. Subjects of body mass index (BMI; (weight (kg))/(height (m))2) more than the age- and sex-specific centiles linked to adult overweight were defined as obese subjects. Parental obesity was defined as BMI of 25 kg/m2 or more. Logistic regression analysis was performed to clarify the strengths of parental and lifestyle factors on childhood obesity, adjusted for possible confounding factors. Odds ratios (ORs) of paternal and maternal obesity for childhood obesity were 1.70(1.43-2.02) and 2.56(2.07-3.17), respectively. There was a dose-response relationship between short sleeping hours and obesity. Compared to subjects taking 11 hours sleep or more, the adjusted OR was 1.20(0.97-1.49) for those taking 10 to 11 hours sleep, 1.34(1.05-1.72) for those taking 9 to 10 hours sleep, and 1.57(0.90-2.75) for those taking less than 9 hours sleep. Eating and exercising habits were not significantly associated with obesity. These results indicate that parental obesity and short sleeping hours are possible risk factors for obesity in preschool children.

Adult↗
PubMed2003

Overweight and obesity in Australia: the 1999-2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab).

OBJECTIVE: To measure the prevalence of obesity in Australian adults and to examine the associations of obesity with socioeconomic and lifestyle factors. DESIGN: AusDiab, a cross-sectional study conducted between May 1999 and December 2000, involved participants from 42 randomly selected districts throughout Australia. PARTICIPANTS: Of 20,347 eligible people aged > or = 25 years who completed a household interview, 11,247 attended the physical examination at local survey sites (response rate, 55%). MAIN OUTCOME MEASURES: Overweight and obesity defined by body mass index (BMI; kg/m(2)) and waist circumference (cm); sociodemographic factors (including smoking, physical activity and television viewing time). RESULTS: The prevalence of overweight and obesity (BMI > or = 25.0 kg/m(2); waist circumference > 80.0 cm [women] or > or = 94.0 cm [men]) in both sexes was almost 60%, defined by either BMI or waist circumference. The prevalence of obesity was 2.5 times higher than in 1980. Using waist circumference, the prevalence of obesity was higher in women than men (34.1% v 26.8%; P < 0.01). Lower educational status, higher television viewing time and lower physical activity time were each strongly associated with obesity, with television viewing time showing a stronger relationship than physical activity time. CONCLUSIONS: The prevalence of obesity in Australia has more than doubled in the past 20 years. Strong positive associations between obesity and each of television viewing time and lower physical activity time confirm the influence of sedentary lifestyles on obesity, and underline the potential benefits of reducing sedentary behaviour, as well as increasing physical activity, to curb the obesity epidemic.

Adult↗
PubMedDate not supplied

[The personality of obese persons in psychological tests with special consideration on latent obesity].

The results of psychological tests of the obese are inconsistent and no characteristic personality structure of the obese can be deduced from them. Investigations in childhood obesity failed to establish a general psychogenetic model of obesity. Yet overweight and ideal weight-subjects differ in spontaneous eating behaviour. Appetite and satiety of obese subjects are controlled by external stimuli to a far greater extent than in nonobese. From a behavioural scientific viewpoint it is proposed that learning experiences during childhood socialisation generate the disposition for obesity which can manifest itself later, after interaction with a special environment. At this stage, however, individual reactions to starting overweight are insolved; this process is strongly influenced by individual personality structures: an inadequate conflict management favours obesity; by cognitive control normal weight can be preserved in spite of the acquired disposition for obesity. Taking these "latently obese" as an example the role of personality structure and wrong eating habits is discussed and related to possible therapeutic strategies. A model of the psychogenetic basis of obesity is proposed. In this model eating-related learning experience is attributed a primary role and individual personality structure a secondary role in the psychogenesis of obesity.

Age Factors↗
PubMed2006

[Study on the level changes of obesity-associated factors and puberty-associated hormones and their relationship between obese and normal 13 years old children].

OBJECTIVE: To investigate the level changes of obesity-associated factors and puberty-associated hormones and their relationship between obese and normal Children. METHODS: The concentrations of orexins, leptin, insulin, testosterone (T), estradiol (E), luteotrophic hormone (LH), as well as follicle stimulating hormone (FSH) in blood were measured respectively in 78 cases of 13 years old obesity children and 84 normal children as a control group by the means of RIA methods. The bone ages were evaluated with "bone age standard of hundred percent scale". RESULTS: The leptin and insulin concentrations were significantly higher in obesity children as compared with the control group (P < 0.01). The concentrations of plasma orexinA were significantly lower in obesity children as compared with the control group (P < 0.01). The concentrations of T were significantly lower in obesity boys as compared with the control group (P < 0.01). The concentrations of E2 and LH were significantly higher in obesity girls as compared with the control group (P < 0.01). The bone age of the obese children was significantly older than that of the control group. Along with the bone age of children became older, the concentration of leptin and LH in blood were significantly increased. There was a positive correlation between LH and FSH in two groups of either boys and girls and so did between leptin and insulin, C-peptide, E2 (P < 0.01). In the group of normal boys, the positive correlations between LH, FSH and E2 were shown (r = 0.373, 0.314, P <0.05), and a negative correlations between leptin and T were shown as( r = -0.423, P < 0.01), a positive correlation between leptin and FSH was also shown as (r = 0.308, P < 0.05). In the control group of girls, there were positive correlations between leptin, LH and E2 (r = 0.585, 0.647, P < 0.01). Any correlations between LH, FSH T and E2 were not shown in the two obese groups of boys and girls. CONCLUSION: The leptin, orexinA, insulin, T, E2, and LH concentrations had been changed significantly in blood among those obesity children, and so as their interactions. The high level of leptin in obesity children may change the concentrations of T, E2 and LH and affect the development of puberty.

Adolescent↗
PubMed1990

[Correlation between changes in obesity from adolescence to young adulthood and family obesity--the results of cross sectional and longitudinal studies].

We conducted a survey of 356 married couples and their 552 children living in Hisayama in Fukuoka prefecture in order to investigate the correlation between changes in obesity from adolescence to young adulthood. 1. A positive correlation between couples in weight and height could be found, but its coefficient was weak (r = 0.12, 0.10). There was no correlation between couples in BMI. 2. The correlation between parents and their children in height, weight and BMI was significantly positive (r = 0.18, 0.45), having a coefficient greater than that of the correlation between married couples. 3. The correlation coefficient between mother and child was greater than that of the correlation coefficient between father and child. 4. The BMI of a child with either parent obese was significantly greater than that of a child with neither parent obese. Obesity appeared more frequently in children whose BMI of parent was higher. 5. A positive correlation between the BMI of young adults and that of adolescents could be found, and the average BMI of the obesity group was higher than that of the non-obesity group even in the adolescent subjects. 6. Even after considering BMI during adolescence, the familial factor had a significant relationship to the BMI of young adulthood. These results suggest that obesity in adolescence will influence obesity in young adulthood, and that the appearance of obesity strongly correlates with the familial obesity factor. In conclusion, it is very important to take preventative measures, in cooperation with the family, early in a child's adolescent years in order to avoid obesity in adulthood.

Adolescent↗
PubMed1990

Alterations in adipocyte adenylate cyclase activity in morbidly obese and formerly morbidly obese humans.

Studies examining animal models of genetic obesity have identified defects in adipocyte hormone-stimulated lipolysis that involve the adenylate cyclase transmembrane signaling system, specifically those components that decrease adenylate cyclase activity. To determine whether obese people demonstrate alterations in adenylate cyclase activity that could contribute to the maintenance of obesity by inhibiting lipolysis, we examined human adipocytes from patients who were lean, obese, or formerly obese. Fat samples were obtained from the lower abdomen of 14 women who were morbidly obese (obese group), from 10 women who were formerly morbidly obese and had lost weight after gastric stapling (postobese group), and from 10 similarly aged women of normal weight (controls). Adipocyte adenylate cyclase activity was determined under ligand-free (no stimulatory or inhibitory influences present), hormone-stimulated (isoproterenol, 10(-6) mmol/L), and maximal (cells stimulated with 10 mumol/L forskolin) conditions by measuring cyclic adenosine monophosphate (cAMP) levels by radioimmunoassay. The activity of adenylate cyclase was significantly different (p less than 0.01) in the three groups. Adipocytes from obese women had lower levels of cyclase activity under both ligand-free (5% vs 16% of maximal) and hormone-stimulated conditions (76% vs 100% of maximal) than adipocytes from normal women. Postobese women had levels of hormone-stimulated cAMP identical to those of normal women but still had abnormal ligand-free levels (under 5%). These results suggest the presence of an alteration in adipocyte adenylate cyclase regulation in morbidly obese women that is not entirely corrected when weight is lost after food intake is reduced by gastric stapling. This alteration in ligand-free cAMP activity may contribute to the development and maintenance of obesity.

Adenylyl Cyclases↗
PubMed1981

[Obesity in children. I. The prevalence of obesity in the Netherlands].

A review is presented of the prevalence of obesity among apparently healthy 8 year old schoolchildren, based on the findings of the National Nutrition Council's cross-sectional surveys, periodically performed in the Netherlands with 3 year intervals in the period 1960-1977. When clinical obesity is defined as more than 25 pct fat mass of total body-weight in young children, 3 to 4 pct obesity occurs in smaller towns or villages in the peripheral areas of the country and 4 to 7 pct in big cities. When 20 pct fat mass is the criterium for the lower limit of obesity, the prevalence for thick including obese children varies from 10 to 13 pct in small towns versus 14 to 20 pct in big cities. The prevalence of obesity thus defined tends to be lower from 1968 onwards. From various other surveys in the Netherlands similar reports are published, mentioning 2 pct of clinical obesity among 6 to 7 year olds up to 4 and 7 pct among 10 year olds and 8-10 pct among school attending adolescents of 15 and 16 years old. There are no reliable data on the prevalence of obesity among infants and toddlers in this country. A second part of this interview on obesity among children will relate to the possible effects of childhood obesity for obesity in later life.

Adult↗
PubMed1993

Morbid obesity: a comparison between a general population and obesity surgery patients.

Characteristics of morbidity obese adults in the general population and morbidly obese adults presenting for obesity surgery were compared. Black morbidly obese women in the general population were less obese than black women obesity surgery patients, showed less emotional distress, and had fewer abnormal eating behaviours; age and socio-economic status were similar. A greater proportion of morbidly obese surgery patients were white women than would be expected either on the basis of the prevalence of morbid obesity in the general population or on census data. It was hypothesized that black women and white men avoid obesity surgery until they are physically debilitated by their overweight, while white women elect for obesity surgery when the emotional distress associated with obesity becomes debilitating.

Adult↗
PubMed2000

Improving health professionals' management and the organisation of care for overweight and obese people.

BACKGROUND: Obesity is increasing throughout the industrialised world. If left unchecked it will have major implications for both population health and costs to health services. Health professionals have a key role to play in tackling the obesity problem, but little is known about how they may be encouraged to work more effectively with overweight and obese people. OBJECTIVES: The main objective was to determine whether health professionals' management or the organisation of care for overweight and obese people could be improved. SEARCH STRATEGY: We searched the specialised registers of the Cochrane Effective Practice and Organisation of Care Group (May 1997), the Cochrane Depression, Anxiety and Neurosis Group (August 1997), the Cochrane Diabetes Group (August 1997), the Cochrane Controlled Trials Register (September 1997), MEDLINE to January 1998, EMBASE to December 1997, Cinahl (1982 to November 1997), PsycLit (1974 to December 1997), Sigle (1980 to November 1997), Sociofile (1974 to October 1997), Dissertation Abstracts (1861 to January 1998), Conference Papers Index (1973 to January 1998), Resource Database in Continuing Medical Education. We also hand searched seven key journals and contacted experts in the field. SELECTION CRITERIA: Randomised trials, controlled before-and-after studies and interrupted time series analyses of providers' management of obesity or the organisation of care to improve provider practice or patient outcomes. We addressed three a priori comparisons and a fourth post hoc comparison. 1. Interventions aimed at improving health professionals' management or the delivery of health care for overweight/obese patients are more effective than usual care. 2. Interventions aimed at redressing negative attitudes and related practices towards overweight/obese patients are more effective than usual care. 3. Organisational interventions designed to change the structure of services for overweight/obese people are more effective than educational or behavioural interventions for health professionals. 4. Comparisons of different organisational interventions. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Twelve studies were included involving more than 393 providers and 3392 patients. Four studies were identified for comparison 1. Three were professional-oriented interventions (the use of reminders and training) and the fourth was a study of professional and organisational interventions of shared care. No studies were identified for comparisons 2 or 3. Eight studies were identified for post hoc comparison 4. These compared either the deliverer of weight loss interventions or the setting of interventions. The included studies were heterogeneous and of generally poor quality. REVIEWER'S CONCLUSIONS: At present, decisions about improving provision of services must be based on the evidence of patient interventions and good clinical judgement. Further research is needed to identify cost effective strategies for improving the management of obesity.

Body Weight↗