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PubMed2002

Secular trends in overweight and obesity among Finnish adolescents in 1977-1999.

OBJECTIVE: To study the trends in overweight and obesity among Finnish adolescents in 1977-1999. DESIGN: Mailed surveys every other year. SUBJECTS: Nationally representative samples of 12, 14, 16 and 18-y-olds (n = 64,147, response rate 78.9%). METHODS: Overweight and obesity were measured by body mass index (BMI) and relative weight (RW) based on self-reported height and weight. BMI > or = the 85th percentile cut-off point for BMI in each age- and sex-specific group in the entire data set was considered as overweight, and BMI > or = 95th percentile cut-off point as obesity. RW > or = 110% and > or = 120%, calculated as the individual's weight divided by the mean weight in each age- and sex-specific height percentile group in the entire data set, were considered as overweight and obesity, respectively. The trends in overweight and obesity are described by the change in the 85th and 95th percentile cut-off points of BMI over time. The prevalence of overweight and obesity is also reported using BMI reference values recommended for international comparisons. Because of the similarity of the BMI and the RW criteria in classifying adolescents as overweight and obese, only results based on BMI are presented. RESULTS: Overweight and obesity increased linearly in all sex and age groups from 1977 to 1999. Depending on the age group, the average increase in the 85th percentile cut-off point of the BMI per 10 y was 0.6-1.1 kg/m2 in boys and 0.3-0.7 kg/m2 in girls. The 95th percentile cut-off point of the BMI for boys and girls increased by 1.1-1.6 kg/m2 and by 0.6-1.0 kg/m2 per 10 y, respectively. In boys, the increase in overweight and obesity was largest in the two youngest age groups. In girls, the increase in overweight was largest in the oldest age group, and that of obesity both in the 14 and 18-y-olds. Overweight and obesity increased more in boys than in girls in all age groups except in the 18-y-olds among whom the increase was similar in both sexes. Examination of the entire BMI distribution showed that there was little or no change over time at the lower (5th, 15th) and middle (50th) percentiles, but increasing differences at the upper end of the distribution, the increases in the 95th percentile being even more marked than those in the 85th percentile curves. According to international reference values, the age-standardized prevalence of overweight increased in boys from 7.2 to 16.7%, and in girls from 4.0 to 9.8%, between 1977 and 1999. The prevalence of obesity in boys was 1.1% in 1977 and 2.7% in 1999, and in girls 0.4 and 1.4%, respectively. CONCLUSION: Overweight and obesity increased remarkably among Finnish adolescents from 1977 to 1999. The changes concentrated at the upper end of the BMI distribution, suggesting that factors behind this development have influenced only a part of the adolescent population.

Adolescent↗
PubMed2003

Effect of lifestyle changes on whole-body protein turnover in obese adolescents.

OBJECTIVE: To investigate the effect of lifestyle changes on whole-body protein turnover (WBPT) in obese adolescents. DESIGN/METHODS: Randomized and controlled nonpharmacological intervention study of WBPT in obese adolescents using stable isotope dilution techniques. SUBJECTS AND MEASUREMENTS: We studied a total of 21 adolescents (11 boys and 10 girls, matched for their pubertal status) of which 15 were obese (age=15.8+/-0.4 y old and BMI=38.6+/-3.3 kg/m(2)) and six were lean controls (age=16.0+/-0.4 y old and BMI=21.3+/-1.2 kg/m(2)). The obese subjects were subjected to a randomized controlled lifestyle intervention program that involved moderate physical activity and diet changes for 3 months. A group of lean age-matched subjects was also studied at baseline to compare the WBPT in obese and lean adolescents. The studies were performed during a primed, continuous infusion of L-[1-(13)C]leucine. Leucine appearance rate (Leu Ra) was used as an index of whole protein breakdown and the nonoxidative portion of leucine disposal (NOLD) as an index of whole-body protein synthesis. RESULTS: The obese groups showed significantly higher body mass index (BMI), fat mass (FM), percent body fat (%BF), fat-free mass (FFM), resting energy expenditure (REE) and WBPT compared to the lean controls. The intervention program resulted in a redistribution of the parameters of body composition without apparent changes in BMI or body weight. There was a significant decrease in WBPT in the obese intervention group, but not in the obese control group. Insulin levels also decreased significantly in the obese group after intervention but not in the obese control group, whereas the glucose concentrations remained normal in all groups at baseline and also after intervention/or control. CONCLUSIONS: Results from the current study suggest: (i). abonormalities of protein metabolism occur early in the clinical course of obesity and (ii). these abnormalities are modifiable by moderate lifestyle changes in obese adolescents. The mechanism for these changes in WBPT in obese adolescents as well as their impact on specific cardiovascular risk factors and turnover of specific proteins will require further investigation.

Adolescent↗
PubMed2004

New insights into the field of children and adolescents' obesity: the European perspective.

EDITOR'S NOTE: The problem of childhood obesity is accelerating throughout the world. The following is a position paper from The European Childhood Obesity Group (ECOG) that outlines the nature of the problem of childhood obesity along with treatment and prevention methods available today. The paucity of literature on prevention and treatment of obesity in children as documented in this paper points out the need for much additional research on obesity in children. OBJECTIVES: The awareness of childhood obesity as a major health problem and an uncontrolled worldwide epidemic has to be increased in the society. DESIGN: In order to improve the quality of the health care and to minimize the cost it is important to investigate and standardize pediatric obesity prevention and treatment and to adapt to social and cultural aspects. RESULTS: Obesity is the result of excess body fat. The different norms and definitions in Europe and the US is described and clarified. However, the available methods for the direct measurement of body fat are not easily used in daily practice. For this reason, obesity is often assessed by means of indirect estimates of body fat, that is, anthropometrics. There are essentially six relevant levels, which could be involved in prevention of child and adolescent obesity: family (child, parents, siblings, etc), schools, health professionals, government, industry and media. Evidence-based health promotion programs has to be given a high priority. Government should encourage media increase information about healthy nutrition and to avoid the marketing of unhealthy foods including sweet drinks, for example, in TV. Many different approaches of treatments of obesity have been investigated, including diet, exercise, behavioral therapy, surgery, and medication. None have been found to be effective enough as sole tools in children. This has led to focus on multidisciplinary programs especially involving families. Behavioral cognitive therapy is effective in treating childhood obesity as is family therapy. Surgery and drug treatment cannot be recommended without additional research. Clinicians should consider the various factors that can influence body composition. CONCLUSION: It is important to know and to follow nutritional factors, energy intake and composition of the diet, nutrition and hormonal status, food preferences and behavior, and the influence of non-nutritional factors. We recommend that obesity should be the major priority both in the health care system, on the scientific level and for future political actions.

Adolescent↗
PubMed2005

Association study between chromosome 10q26.11 and obesity among Swedish men.

OBJECTIVE: Proximal chromosome 10q26 was recently linked to waist/hip ratio in European and African-American families. The objective was to investigate whether genomic variation in chromosome 10q26.11 reflects variation in obesity-related clinical parameters in a Swedish population. DESIGN: Genetic association study of single-nucleotide polymorphisms (SNPs) in chromosome 10q26.11 and obesity-related clinical parameters was performed. Obesity was defined as body mass index (BMI) > or = 30 kg/m2. SUBJECTS: Swedish Caucasians comprising 276 obese and 480 nonobese men, 313 obese and 494 nonobese women, 177 obese and 163 nonobese patients with type 2 diabetes mellitus (T2DM), and 106 obese and 201 nonobese subjects with impaired glucose tolerance (IGT) patients. MEASUREMENTS: Genotypes of 11 SNPs at chromosome 10q26.11, and various obesity-related clinical parameters. RESULTS: Homozygosity of a common haplotype constructed by three SNPs, rs2185937, rs1797 and hCV1402327, covering an interval of 2.7 kb, was suggested to confer an increased risk for obesity of 1.5 among men (P = 0.043). The C allele frequency and homozygous genotype frequency of the rs1797 tended to be higher among obese compared to among nonobese men (P = 0.017 and 0.020, respectively). The distribution of BMI and diastolic blood pressure was higher among those with the C/C genotype (P = 0.022 and 0.0061, respectively). The obese and the nonobese groups were homogeneous over BMI subgroups with regard to rs1797 risk genotype distribution. There was no tendency for association between rs1797 and obesity among neither women nor T2DM nor IGT patients. CONCLUSION: We show support for association between proximal chromosome 10q26.11 and obesity among Swedish men but not women through the analysis of a haplotype encompassing 2.7 kb.

Adolescent↗
PubMed2006

Content comparison of health status measures for obesity based on the international classification of functioning, disability and health.

OBJECTIVE: To compare the content covered by twelve obesity-specific health status measures using the International Classification of Functioning, Disability and Health (ICF). DESIGN: Obesity-specific health status measures were identified and then linked to the ICF separately by two trained health professionals according to standardized guidelines. The degree of agreement between health professionals was calculated by means of the kappa (kappa) statistic. Bootstrapped confidence intervals (CI) were calculated. The obesity-specific health-status measures were compared on the component and category level of the ICF. MEASUREMENTS: welve condition-specific health-status measures were identified and included in this study, namely the obesity-related problem scale, the obesity eating problems scale, the obesity-related coping and obesity-related distress questionnaire, the impact of weight on quality of life questionnaire (short version), the health-related quality of life questionnaire, the obesity adjustment survey (short form), the short specific quality of life scale, the obesity-related well-being questionnaire, the bariatric analysis and reporting outcome system, the bariatric quality of life index, the obesity and weight loss quality of life questionnaire and the weight-related symptom measure. RESULTS: In the 280 items of the eight measures, a total of 413 concepts were identified and linked to the 87 different ICF categories. The measures varied strongly in the number of concepts contained and the number of ICF categories used to map these concepts. Items on body functions varied form 12% in the obesity-related problem scale to 95% in the weight-related symptom measure. The estimated kappa coefficients ranged between 0.79 (CI: 0.72, 0.86) at the component ICFs level and 0.97 (CI: 0.93, 1.0) at the third ICF's level. CONCLUSION: The ICF proved highly useful for the content comparison of obesity-specific health-status measures. The results may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies in obesity.

Adaptation, Psychological↗
PubMed1998

Pulsatile secretion of ACTH and cortisol in premenopausal women: effect of obesity and body fat distribution.

OBJECTIVE: There is emerging evidence that women with visceral obesity may have hyper-responsiveness of the hypothalamic-pituitary-adrenal axis. There are no studies on basal daily secretory pattern of ACTH and cortisol in subjects with different obesity phenotypes. DESIGN AND PATIENTS: In this study we examined daytime pulsatile secretion of ACTH and cortisol in two groups of premenopausal obese women with visceral (V-BFD) (BMI 37.1 +/- 1.7) and subcutaneous (S-BFD) (BMI 38.8 +/- 1.5) body fat distribution (measured by CT scan) and in a group of normal weight healthy controls (BMI 21.1 +/- 0.5). After an overnight fast, blood samples were taken at 15-minute intervals for 12 h (49 samples, from 0800 h until 2000 h). All women avoided breakfast but had a normal lunch and dinner, both containing similar food, energy and nutrient composition. ACTH and cortisol responses to mixed meals at noon and in the evening were also investigated. RESULTS: Mean values of ACTH and cortisol did not differ between the groups. However, ACTH pulse frequency was significantly higher in V-BFD (P < 0.06) and S-BFD (P < 0.02) obese women than in controls, without any significant differences between the two obese subgroups. Mean ACTH pulse amplitude was lower in the V-BFD than in S-BFD obese (P < 0.02) and control (P < 0.05) groups. Cortisol episodic characteristics did not differ between V-BFD and S-BFD obese and controls. All differences in ACTH pulsatile parameters between obese and controls and between the two obese subgroups were evident only in the morning, with no further significant differences during the early and late afternoon. There were no significant differences in cortisol parameters during the three periods of the day between the various groups, apart from late afternoon cortisol pulse frequencies, which were significantly lower in V-BFD than in controls. After lunch, ACTH and cortisol levels significantly increased in all groups, but the cortisol increase tended to be more rapid in V-BFD than in the other two groups. After dinner, ACTH significantly increased in V-BFD and controls but not in the S-BFD group, whereas cortisol rose significantly in all groups, but significantly less in S-BFD than in V-BFD and controls. CortisolAUC (but not ACTHAUC) after lunch was significantly higher than after dinner in all groups. ACTH response after each meal was similar in all groups, but cortisolAUC after dinner was significantly lower in S-BFD than in V-BFD women. CONCLUSION: This study demonstrates that in premenopausal women, obesity, particularly the visceral phenotype, is associated with several abnormalities of ACTH pulsatile secretion, particularly in the morning. On the contrary, no major differences were present in either blood concentrations, diurnal rhythm or secretory pattern of cortisol between obese and controls. The responses to meals seem to indicate a much more rapid cortisol response after lunch in women with visceral obesity and a reduced activation of the hypothalamic-pituitary-adrenal axis after dinner in women with subcutaneous obesity.

Adrenocorticotropic Hormone↗
PubMed2000

Unfavorable lipid profiles in mild obesity with excess body fat percentage.

BACKGROUND: The aim of the present study was to investigate the usefulness of subclassifications of overweight children using the body fat percentage (Fat%) to predict the serum lipid profile. METHODS: School children (431, 236 boys and 195 girls) aged 9-12 years were divided into three obesity groups (non-, mild and advanced obesity) and were further divided into two subgroups according to the Fat% measured by bioelectrical impedance analysis. The mean fasting serum lipid levels were also evaluated. RESULTS: In the non-obesity and the advanced obesity groups, the Fat%-based subclassification demonstrated no essential differences in lipid profiles or in the prevalence of hyperlipidemia between the two subgroups. However, in the mild obesity group, the levels of low-density lipoprotein cholesterol and triglyceride and the atherogenic index were significantly higher and the high-density lipoprotein cholesterol level was significantly lower in the adipositic subgroup (Fat% > or = age/sex-specific cut-off value) than in the non-adipositic subgroup. Multiple comparison of lipid levels among all six categories of children indicated that the adipositic subgroup of mild obesity had no advantage over the advanced obesity group with respect to the atherogenic potential and that the non-adipositic subgroup of mild obesity showed no additional risks compared to the non-obesity group. Moreover, the prevalence of hyperlipidemia in the adipositic subgroup of mild obesity (50.0%) was significantly different from that in its non-adipositic counterpart (13.3%) and was equivalent to that in the advanced obesity group. CONCLUSIONS: These results suggest that Fat% evaluation is useful to divide mildly obese children into two distinct subtypes based on serum lipid profiles and that the excess Fat% in mildly obese school children is a predictor of atherogenesis.

Adipose Tissue↗
PubMed2001

Clinical aspects of obesity in childhood and adolescence.

The level of fatness of a child at which morbidity acutely and/or later in life increases is determined on an acturial basis. Direct measurements of body fat content, e.g. hydrodensitometry, bioimpedance, or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is generally accepted now to be used to define obesity in children and adolescents clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to substantially increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (for example, MC4R). Environmental/exogenous factors largely contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc.) and genetic syndromes (Prader-Labhard-Willi syndrome, Bardet Biedl syndrome, etc.) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia, back pain and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behaviour modification and nutrition education. The role of regular exercise and exercise programmes is emphasized. Surgical procedures and drugs used in adult obesity are still not generally recommended in children and adolescents with obesity. As obesity is the most common chronic disorder in industrialized societies, its impact on individual lives as well as on health economics has to be recognized more widely. This review is aimed towards defining the clinical problem of childhood obesity on the basis of current knowledge and towards outlining future research areas in the field of energy homoesostasis and food intake in relation to child health. Finally, one should aim to increase public awareness of the ever increasing health burden and economic dimension of the childhood obesity epidemic that is present around the globe.

Adolescent↗
PubMed1985

Maternal obesity as a risk factor in gestational diabetes.

Maternal obesity has been associated with both gestational diabetes mellitus (GDM) and neonatal macrosomia. Most studies of obesity in pregnancy have demonstrated an increased risk for GDM. However, the contribution of obesity as an added risk in GDM has not been examined. The purpose of this study was to examine the contribution of obesity as a risk factor to perinatal morbidity in gestationally diabetic women by comparing the maternal and neonatal outcome in obese and nonobese gestationally diabetic women. From 1979 to 1983, the maternal, intrapartum, and neonatal characteristics of all prepartum gravid patients with GDM were examined. Of the 158 patients with documented GDM, 62 (39%) were obese (weight greater than 90 kg). There was no difference in maternal age (obese 29.3 +/- 5.4 years, nonobese 28.7 +/- 6.5 years) parity, or prepartum risk score between the obese and nonobese patients. The incidence of prematurity, pre-eclampsia, fetal distress, and primary cesarean sections were not different between the groups. There were no differences in Apgar scores, gestational age, or perinatal morbidity. However, the obese patients delivered heavier neonates expressed as mean birthweight (obese 3667 +/- 682 gms, nonobese 3331 +/- 750 gms. P less than .01), the number of macrosomic (greater than 4 kg) neonates (obese 37%, nonobese 14%, P less than .001) and K-score, (obese 0.8 +/- 1, nonobese 0.4 +/- 9, P less than .05). These data indicate that obese patients with GDM have an increased risk of neonatal macrosomia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Safety of transesophageal echocardiography in patients who are obese.

Patients with obesity tend to have a higher incidence of hypertension, coronary artery disease, and sleep apnea, conditions that could potentially predispose to complications during transesophageal echocardiography (TEE). In addition, patients who are obese are more likely to have oxygen desaturation during upper gastrointestinal endoscopy. However, the safety of TEE in a large cohort of patients with obesity has not been reported. Thus, the safety of TEE in 341 patients who were obese (body mass index >/= 27.5 kg/m(2), mean 41.0 +/- 10.3) and in 323 control patients who were not obese was compared. Minor complications (ie, complications of a transient duration and requiring no or only simple intervention) occurred with equal frequency in the control and obese groups (16.5% vs 16.7%, P = not significant). Transient oxygen desaturation did not differ between the control versus obese group (2.5% vs 3.8%, P = not significant), but was more common (6.7%) in a subgroup (n = 150) of patients who were morbidly obese as compared with control patients (P <.05). Transient hypotension was observed in 3.5% of the obese group compared with 7.4% in the control group (P <.05). However, transient hypertension was noted in 10.6% of the patients who were obese compared with 6.5% in the control group (P =.072). A major complication occurred in 2 patients with obesity, one who required vasopressor medication for persistent hypotension and another needing pharmacologic rate control of atrial fibrillation. One patient in the control group had provoked supraventricular tachycardia and angina. No deaths occurred in either group. Subjective tolerance for the procedure was similar (P = not significant) in both groups with 84% of patients with obesity having good to excellent tolerance compared with 88% in that of the control group. Thus, TEE can be safely performed in patients who are obese.

Adult↗
PubMed2005

Factors associated with obesity in an adult Mediterranean population: influence on plasma lipid profile.

OBJECTIVE: The aim of the study was to identify factors associated with obesity, and their influence on plasma lipid profile in an adult Mediterranean population. DESIGN: The data were obtained from a cross-sectional epidemiological survey. SETTING: The study population resided in Andalusia, a western Mediterranean region in southern Spain. SUBJECTS: The survey was carried out with a random sample of 3421 subjects (1747 men, 1674 women) between 25 and 60 years of age. Blood samples were obtained for biochemical assays in a random subsample of 340 subjects (167 men, 173 women). INTERVENTIONS: Food consumption was assessed by 48-h recall. Height, weight, triceps, biceps, subscapular and suprailiac skinfolds, mid-upper arm, waist (WC) and hip circumferences, glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were measured. Information about lifestyles was obtained with a questionnaire. RESULTS: Of the adult population we studied, 18.9% were obese (body mass index [BMI] > or = 30 kg/m2). A larger proportion of men than women were overweight, but the opposite was found for obesity. Mean plasma lipid values were not modified significantly by obesity or lifestyle factors, and were within the normal range. Sex, age, physical exercise and lower educational level were associated directly with the risk of obesity, and smoking was associated inversely with the risk of obesity. In obese smokers WC and waist-hip ratio were larger, and levels of HDL-cholesterol were lower (p < 0.05) than in obese nonsmokers. Glucemia was higher in obese persons who consumed alcohol (p < 0.05) than in obese persons who did not consume alcohol. The risk of hypercholesterolemia and high levels of LDL-cholesterol was associated only with age, and the risk of low levels of HDL-cholesterol was associated only with high WC. CONCLUSION: Our results provide an estimate of the prevalence of obesity in the adult population in southern Spain, and of the associated factors. Sex, age, leisure-time physical exercise and educational level appear to influence obesity. Only age and WC but not BMI were associated with a risk of dyslipidemia. No dietary associations were observed between energy or macronutrient intake and plasma lipid concentrations in overweight or obese persons.

Adult↗
PubMed2006

Cross-national comparison of environmental and policy correlates of obesity in Europe.

BACKGROUND: Despite the growing agreement that modern environments fuel increased food consumption and decreased physical activity, few studies have addressed environmental and policy correlates of obesity. This study describes obesity patterns across Europe and identifies macroenvironmental factors associated with obesity prevalence at a national level. METHODS: Data on obesity prevalence and indicators of the physical, economic, and policy environment were assembled from international databases for 24 European countries. Coefficient estimates between overall, male, and female obesity prevalence and each independent variable were calculated using linear regression. RESULTS: The obesity prevalence varied widely across countries and between genders with higher values in Central and Eastern European countries and lower values in France, Italy, and some Scandinavian countries. Statistically significant inverse associations were observed between overall and female obesity prevalence and variables from the following domains: economic (real domestic product), food (available fat), urbanization (urban population), transport (passenger cars, price of gasoline, motorways), and policy (governance indicators). There was also a negative association between overall obesity and available fruits/vegetables, and between female obesity and single-member households. Male obesity was inversely associated with available fruits/vegetables and density of motorways. The magnitude of the coefficient estimates suggests stronger associations for female obesity than for male obesity in all cases. CONCLUSIONS: This exploratory study suggests a need to conduct additional research examining the role of obesogenic environments in European countries, with a special focus on policy-related variables, and to further study gender-specific differences in obesity and its correlates.

Cross-Cultural Comparison↗
PubMed2006

Overweight and obesity at school entry as predictor of overweight in adolescence in an Arctic child population.

BACKGROUND: The aim of this study was to analyse the changes in the prevalence of overweight, obesity, and in mean body mass index (BMI) among school children, and to analyse the predictive value of overweight and obesity at school entry to overweight and obesity in adolescence in an Arctic child population. METHODS: Retrospective cohort study. A database was created on the basis of files from health examinations. Data on children aged 5-7 years and 13-17 years and the subsample of children followed from school entry to adolescence was analysed. RESULTS: During the years 1972-2002 the prevalence of overweight and obesity increased significantly, and mean BMI rose by 5.6% at school entry and by 4.7% in adolescence. Sensitivity and specificity: Of the children being obese in adolescence, 56.3% were already obese at school entry; for the overweight children, 50.6% were also overweight or obese at school entry. Of the children with normal weight in adolescence, 91.9% were also normal weight at school entry. The positive predictive value of being overweight or obese combined at school entry was 59.5%, i.e. more than every second retained their overweight or obesity in adolescence. Only 10% of the obese school entry children had gained normal weight in adolescence. The negative predictive value for normal weight children at school entry was 91.3%. CONCLUSION: The study showed that during 30 years from 1972, overweight and obesity among school children in Greenland have increased dramatically. Overweight and obesity at school entry were shown to be a good predictor of overweight or obesity in adolescence.

Adolescent↗
PubMed2001

Infectobesity: obesity of infectious origin.

In the U.S., the prevalence of obesity increased by 30% from 1980 to 1990, and this increase appears to be continuing. Although obesity has multiple etiologies, an overlooked possibility is obesity of an infectious origin. Six pathogens are reported to cause obesity in animals. Canine distemper virus was the first virus reported to cause obesity in mice, followed by Rous-associated virus-7, an avian retrovirus, which has been shown to cause stunting, obesity and hyperlipidemia in chickens. Next, the obesity-promoting effect of Borna disease virus was demonstrated in rats. Scrapie agents were reported to induce obesity in mice and hamsters. The final two reports were of SMAM-1, an avian adenovirus, and Ad-36, a human adenovirus that caused obesity in animals. Additionally, an association with human obesity is the unique feature of SMAM-1 and Ad-36. Although the exact mechanism of pathogen-induced obesity is unclear, infection attributable to certain organisms should be included in the long list of potential etiological factors for obesity. In addition, the involvement of some pathogens in etiology of obesity suggests the possibility of a similar role for additional pathogens.

Animals↗
PubMed2005

The impact of obesity on health-related quality-of-life in the general adult US population.

BACKGROUND: The US Preventive Services Task Force recently recommended screening all adult patients for obesity due in part to the strong association between obesity and numerous chronic diseases. However, how obesity affects health-related quality-of-life (HRQL), particularly for persons without any chronic diseases, is less clear. METHODS: The relationship between obesity and HRQL was examined using data from the 2000 Medical Expenditure Panel Survey. Respondents > or =18 years were classified as underweight, normal weight, overweight, class I obesity, and class II obesity based on their BMI. HRQL was measured by the 12-item Short Form physical and mental summary scores (PCS-12 and MCS-12, respectively) and EuroQol EQ-5D index and visual analogue scale (EQ VAS). The impact of obesity on HRQL was examined through multivariate regression, adjusting for sociodemographics and disease status. RESULTS: After adjustment, HRQL decreased with increasing level of obesity. Compared to normal weight respondents, persons with severe obesity had significantly lower scores with scores on the PCS-12, MCS-12, EQ-5D index, and EQ VAS being 4.0, 1.1, 0.073, and 4.8 points lower, respectively. Such decrements of HRQL for severe obesity were similar to the decrements seen for diabetes or hypertension. Persons with moderate obesity or who were overweight also had significantly lower HRQL scores, particularly on the PCS-12 and EQ-5D index. Underweight persons also had lower MCS-12 and EQ VAS scores. CONCLUSIONS: Persons with obesity had significantly lower HRQL than those who were normal weight and such lower scores were seen even for persons without chronic diseases known to be linked to obesity.

Adolescent↗
PubMed1998

Differential impact of obesity on glucose metabolism in black and white American adolescents.

BACKGROUND: The authors have previously demonstrated abnormalities in glucose and insulin metabolism in nondiabetic black American (BA) adults versus white American (WA) adults. Whether similar glucoregulatory alterations extend to BA adolescents remain unknown. In addition, obesity, a known risk factor for insulin resistance and hyperinsulinemia, occurs in a greater proportion of BA adults and children when compared to WA. The objective of the present study was to examine the differential effects of obesity on glucose homeostasis in BA and WA adolescents. METHODS: We examined glucose homeostasis in BA and WA adolescents using oral glucose tolerance test (OGTT), intravenous glucose tolerance test (IVGTT), and [6,6-2H2]-glucose infusion. The study consisted of four age-, sex-, and pubertal stage-matched groups: 15 lean BA, 29 lean WA, 7 obese BA, and 9 obese WA. RESULTS: Both obese groups had significantly increased insulin and C-peptide area under the curve (AUC) during OGTT and IVGTT when compared to their same-race lean counterparts. During OGTT, obese BA demonstrated greater insulin and C-peptide when compared to obese WA. During IVGTT, first- and second-phase insulin were significantly greater in obese BA versus obese WA. CONCLUSION: In summary, BA adolescents demonstrated insulin resistance which is markedly exaggerated in the face of obesity when compared to WA adolescents, implying a differential impact for obesity on glucose homeostasis that is unique to the obese BA adolescent group. In conclusion, there is a need for early aggressive weight management in obese BA adolescents.

Adolescent↗
PubMed2004

Role of the physician in childhood obesity.

OBJECTIVE: To suggest the role of the practicing physician in examining and treating childhood obesity. How should obesity be determined at clinical examination? Is there an obesity epidemic? What is the likely influence of obesity upon current and future health? What are the causes of obesity, and what does this imply for prevention and treatment? DATA SOURCES: Relevant articles in Medline and personal files. DATA SYNTHESIS: The 80th and 95th percentiles of body mass index and skinfold readings provide the most commonly accepted indices of overweight and obesity in the child. Over the last 20 years, the proportions of overweight and obese children have increased in both indigenous populations and most developed societies. Current methods of assessing physical activity and diet during childhood lack the precision to establish the primary cause of the obesity epidemic, but correlational analysis shows a close relationship between body fat content and a decline in daily energy expenditures. Immediate consequences of childhood obesity include an increased prevalence of atherosclerotic plaques, hypertension, and an adverse lipid profile, with a poor self-image that limits participation in physical activity. Tracking is such that many obese children become obese adults, and in consequence, the long-term risks of cardiovascular and all-cause deaths are increased. The prevention of obesity is easier than its cure. A combination of increased lifestyle activities, less sedentary behavior, and dietary modification seems the most effective approach. This should be supported by the use of behavioral modification techniques and changes in the urban environment that encourage an active lifestyle. CONCLUSIONS: The pediatric physician can contribute to the control of obesity by monitoring body mass index and skinfold thicknesses in all patients. Children above the 50th percentile of body fat need dietary modification and a greater amount of moderate physical activity. Physicians should also advocate quality daily physical education and an environment that encourages adoption of an active lifestyle.

Adolescent↗
PubMed2005

The impact of obesity on the incidence and treatment of gynecologic cancers: a review.

UNLABELLED: Sixty-five percent of the adult population in the United States is overweight and 30% of the population is obese. There is mounting evidence that obesity is a risk factor for gynecologic cancers and may also adversely impact survival. The objectives of this review were to systematically evaluate and discuss the impact of overweight and obesity on endometrial, ovarian, and cervical cancer incidence and to review the data on the impact of obesity on treatment of these same gynecologic cancers. A PUBMED literature search was performed to identify articles in the English language that focused on the impact of obesity on cancer incidence and treatment. References of identified articles were also used to find additional related articles. Obesity profoundly increases the incidence of endometrial cancer, predominantly through the effects of unopposed estrogen. Although the data are less compelling in ovarian and cervical cancer, obesity may modestly increase the incidence of premenopausal ovarian cancer and might potentially increase cervical cancer incidence, perhaps as a result of the impact on glandular cancers or decreased screening compliance. Obese women with cancer have decreased survival; this may be disease-specific, the result of comorbid illnesses, or response to treatment. Obese women have increased surgical complications, may also have increased radiation complications, and there is no current consensus regarding appropriate chemotherapy dosing in the obese patient. Obesity is a serious health problem with significant effects on the incidence and treatment of the gynecologic malignancies. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize the clear evidence that obesity is a risk factor for many cancers, including gynecologic malignancies; describe the role of unopposed estrogen in gynecologic cancers; and explain that obese women overall have a poorer survival rate when afflicted with cancer.

Adenocarcinoma↗