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ABSTRACT: BACKGROUND: Obesity is a stigmatizing condition associated with adverse psychosocial consequences. The relative importance of weight stigma in reducing health utility or the value a person places on their current health state is unknown. METHODS: We conducted a telephone survey of patients with obesity. All were seeking weight loss surgery at two bariatric centers (70 % response rate). We assessed patients' health utility (preference-based quality life measure) via a series of standard gamble scenarios assessing patients' willingness to risk death to lose various amounts of weight or achieve perfect health (range 0 to 1; 0 = death and 1 = most valued health/weight state). Multivariable models assessed associations among quality of life domains from the Short-form 36 (SF-36) and Impact of Weight on Quality of Life-lite (IWQOL-lite) and patients' health utility. RESULTS: Our study sample (n = 574) had a mean body mass index of 46.5 kg/m(2) and a mean health utility of 0.87, reflecting the group's average willingness to accept a 13 % risk of death to achieve their most desired health/weight state; utilities were highly variable, however, with 10 % reporting a utility of 1.00 and 27 % reporting a utility lower than 0.90. Among the IWQOL-lite subscales, Public Distress and Work Life were the only two subscales significantly associated with patients' utility after adjustment for sociodemographic factors. Among the SF-36 subscales, Role Physical, Physical Functioning, and Role Emotional were significantly associated with patients' utility. When the leading subscales on both IWQOL-lite and SF-36 were considered together, Role Physical, Public Distress, and to a lesser degree Role Emotional remained independently associated with patients' health utility. CONCLUSION: Patients seeking weight loss surgery report health utilities similar to those reported for people living with diabetes or with laryngeal cancer; however, utility values varied widely with more than a quarter of patients willing to accept more than a 10 % risk of death to achieve their most valued health/weight state. Interference with role functioning due to physical limitations and obesity-related social stigma were strong determinants of reduced health utility.
Journal of General Internal Medicine 09/2012; · 2.83 Impact Factor
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ABSTRACT: Little is known about weight control strategies associated with successful weight loss among obese U.S. adults in the general population.
To identify strategies associated with losing at least 5% and 10% of body weight.
Multivariable analysis of data from obese adult (BMI ≥30) participants in the 2001-2006 NHANES to identify strategies associated with losing ≥5% and ≥10% of body weight (conducted in 2009-2011).
Of 4021 obese adults, 2523 (63%) reported trying to lose weight in the previous year. Among those attempting weight loss, 1026 (40%) lost ≥5% and 510 (20%) lost ≥10% weight. After adjustment for potential confounders, strategies associated with losing ≥5% weight included eating less fat (OR=1.41, 95% CI=1.14, 1.75); exercising more (OR=1.29, 95% CI=1.05, 1.60); and using prescription weight loss medications (OR=1.77, 95% CI=1.00, 3.13). Eating less fat (OR=1.37, 95% CI=1.04, 1.79); exercising more (OR=1.36, 95% CI=1.12, 1.65); and using prescription weight loss medications (OR=2.05, 95% CI=1.09, 3.86) were also associated with losing ≥10% weight, as was joining commercial weight loss programs (OR=1.72, 95% CI=1.00, 2.96). Adults eating diet products were less likely to achieve 10% weight loss (OR=0.48, 95% CI=0.31, 0.72). Liquid diets, nonprescription diet pills, and popular diets had no association with successful weight loss.
A substantial proportion of obese U.S. adults who attempted to lose weight reported weight loss, at least in the short term. Obese adults were more likely to report achieving meaningful weight loss if they ate less fat, exercised more, used prescription weight loss medications, or participated in commercial weight loss programs.
American journal of preventive medicine 05/2012; 42(5):481-5. · 4.24 Impact Factor
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ABSTRACT: The adverse effect of obesity on health outcomes may be lower in older and African American adults than in the general U.S. population.
To examine and compare the relationship between obesity and all-cause mortality and functional decline among older U.S. adults.
Longitudinal cohort study.
Secondary analysis of data from the 1994 to 2000 Medicare Current Beneficiary Surveys, linked to Medicare enrollment files through 22 April 2008.
20,975 community-dwelling participants in the 1994 to 2000 Medicare Current Beneficiary Surveys who were aged 65 years or older.
All-cause mortality through 22 April 2008; new or worsening disability in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in 2 years.
37% of the study sample were overweight (body mass index [BMI] of 25 to <30 kg/m(2)), 18% were obese (BMI ≥30 kg/m(2)), 48% died during the 14-year follow-up, and 27% had ADL and 43% had IADL disability at baseline. Among those without severe disability at baseline, 17% developed new or worsening ADL disability and 26% developed new or worsening IADL disability within 2 years. After adjustment, adults with a BMI of 35 kg/m(2) or greater were the only group above the normal BMI range who had a higher risk for mortality (hazard ratio, 1.49 [95% CI, 1.20 to 1.85] in men and 1.21 [CI, 1.06 to 1.39] in women, compared with the reference group [BMI of 22.0 to 24.9 kg/m(2)]; P for BMI-sex interaction = 0.003). In contrast, both overweight and obesity were associated with new or progressive ADL and IADL disability in a dose-dependent manner, particularly for white men and women. Significant interactions were detected between BMI and sex but not between BMI and race for any outcome, although risk estimates for ADL disability seemed attenuated in African American relative to white respondents.
This was an observational study, baseline data were self-reported, and the study had limited power to detect differences between white and African American respondents.
Among older U.S. adults, obesity was not associated with mortality, except for those with at least moderately severe obesity. However, lower levels of obesity were associated with new or worsening disability within 2 years. Efforts to prevent disability in older adults should target those who are overweight or obese.
National Institute of Diabetes and Digestive and Kidney Diseases.
Annals of internal medicine 05/2011; 154(10):645-55. · 16.73 Impact Factor
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ABSTRACT: Limited data exist about patient preferences and self-efficacy for different diets. We explored the preferences and self-efficacy of primary care patients for reducing fat, reducing carbohydrates, or reducing calories. We conducted a self-administered survey study of 71 primary care patients (response rate of 52%). Of patients, 59%, 53%, and 60% had high self-efficacy for reducing fat, reducing carbohydrates, and reducing calories from their diet, respectively. Preferences were comparable, with 76% highly willing to reduce fat, 76% highly willing to reduce carbohydrates, and 72% of patients highly willing to reduce calories/portions. Female sex and higher BMI were associated with high self-efficacy for all three dietary changes. A significantly higher proportion of nonwhites than whites had high self-efficacy for reducing fat and reducing carbohydrates (P < 0.05). Obese patients in our study have similarly high willingness and self-efficacy and comparable preferences for adopting changes consistent with three popular diets.
Obesity 09/2009; 18(2):430-2. · 4.28 Impact Factor
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Anita L DeStefano,
Jeanne Latourelle,
Mark F Lew,
Oksana Suchowersky,
Christine Klein,
Lawrence I Golbe,
Margery H Mark,
John H Growdon,
G Fredrick Wooten,
Ray Watts, [......],
Jomana Al-Hinti,
Anette T Moller,
Karen Ostergaard,
Scott J Sherman,
Richard Roxburgh,
Barry Snow,
John T Slevin,
Franca Cambi,
James F Gusella,
Richard H Myers
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ABSTRACT: Genetic variants in embryonic lethal, abnormal vision, Drosophila-like 4 (ELAVL4) have been reported to be associated with onset age of Parkinson disease (PD) or risk for PD affection in Caucasian populations. In the current study we genotyped three single nucleotide polymorphisms in ELAVL4 in a Caucasian study sample consisting of 712 PD patients and 312 unrelated controls from the GenePD study. The minor allele of rs967582 was associated with increased risk of PD (odds ratio = 1.46, nominal P value = 0.011) in the GenePD population. The minor allele of rs967582 was also the risk allele for PD affection or earlier onset age in the previously studied populations. This replication of association with rs967582 in a third cohort further implicates ELAVL4 as a PD susceptibility gene.
Human Genetics 09/2008; 124(1):95-9. · 5.07 Impact Factor
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ABSTRACT: Obesity is associated with higher cervical cancer mortality, but its relationship with sexual behavioral risk factors that predispose women to human papilloma virus (HPV) and cervical cancer is unclear. We used data from 3,329 women participants, aged 20-59 years, of the 1999-2004 National Health and Nutrition Examination Survey, to analyze the relationship between BMI and age at first intercourse, number of sexual partners, condom use during sexual activity, history of sexually transmitted disease (STD), herpes simplex virus 2 (HSV-2) seropositivity, and HPV prevalence. BMI was not associated with the prevalence of HPV. Mildly obese women (BMI 30.0-34.9 kg/m(2)) were least likely to report a STD history (9% vs. 13% in normal weight) and >or=2 sexual partners in the previous year (8% vs. 13%) while overweight women (BMI 25.0-29.9 kg/m(2)) were least likely to report >or=10 lifetime partners; among those with multiple partners, BMI was not associated with sexual activity without condoms in the past month. After adjustment for age, race/ethnicity, and education, women with higher BMI were less likely to report sexual behavioral risk factors than normal-weight women; however, odds ratios were only significant for mildly obese women for reporting a STD history (0.74, 95% confidence interval 0.55-0.99) and having >or=2 sexual partners in the last year (0.57, 0.39-0.85). Higher BMI was not associated with HSV-2 seropositivity after adjustment. HPV and sexual behavioral risk factors for HPV and cervical cancer are not more prevalent in obese than normal-weight women and unlikely to account for higher-observed cervical cancer mortality in obese women.
Obesity 09/2008; 16(11):2552-5. · 4.28 Impact Factor
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Christopher F McNicoll,
Jeanne C Latourelle,
Marcy E MacDonald,
Mark F Lew,
Oksana Suchowersky,
Christine Klein,
Lawrence I Golbe,
Margery H Mark,
John H Growdon,
G Frederick Wooten, [......],
Jomana Al-Hinti,
Anette T Moller,
Karen Ostergaard,
Scott J Sherman,
Richard Roxburgh,
Barry Snow,
John T Slevin,
Franca Cambi,
James F Gusella,
Richard H Myers
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ABSTRACT: The ATP/ADP ratio reflects mitochondrial function and has been reported to be influenced by the size of the Huntington disease gene (HD) repeat. Impaired mitochondrial function has long been implicated in the pathogenesis of Parkinson's disease (PD), and therefore, we evaluated the relationship of the HD CAG repeat size to PD onset age in a large sample of familial PD cases. PD affected siblings (n = 495), with known onset ages from 248 families, were genotyped for the HD CAG repeat. Genotyping failed in 11 cases leaving 484 for analysis, including 35 LRRK2 carriers. All cases had HD CAG repeats (range, 15-34) below the clinical range for HD, although 5.2% of the sample (n = 25) had repeats in the intermediate range (the intermediate range lower limit = 27; upper limit = 35 repeats), suggesting that the prevalence of intermediate allele carriers in the general population is significant. No relation between the HD CAG repeat size and the age at onset for PD was found in this sample of familial PD.
Movement Disorders 08/2008; 23(11):1596-601. · 4.51 Impact Factor
