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Causes of Obesity
Abstract
The prevalence of obesity has been rising steadily over the last several decades and is currently at unprecedented levels: more than 68% of US adults are considered overweight, and 35% are obese (Flegal et al., JAMA 303:235-241, 2010). This increase has occurred across every age, sex, race, and smoking status, and data indicate that segments of individuals in the highest weight categories (i.e., BMI > 40 kg/m(2)) have increased proportionately more than those in lower BMI categories (BMI < 35 kg/m(2)). The dramatic rise in obesity has also occurred in many other countries, and the causes of this increase are not fully understood (Hill and Melanson, Med Sci Sports Exerc 31:S515-S521, 1999).
... Obesity is usually due to an imbalance between energy consumption and energy expenditure, but it can also be caused by genetic, environmental, psychological and economic factors [14]. The genetic etiology of obesity is a deeply researched topic, and the genetic analysis of obese patients has shown that rare polymorphisms should also be considered for understanding molecular etiology [15][16][17][18][19]. Due to genetic heterogeneity, it can be difficult to identify genetic defects in patients with obesity. ...
Obesity is a chronic disease in which abnormal deposition of fat threatens health, leading to diabetes, cardiovascular diseases, cancer, and other chronic illnesses. According to the WHO, 19.8% of the adult population in Italy is obese, and the prevalence is higher among men. It is important to know the predisposition of an individual to become obese and to respond to bariatric surgery, the most up-to-date treatment for severe obesity. To this purpose, we developed an NGS gene panel, comprising 72 diagnostic genes and 244 candidate genes, and we sequenced 247 adult obese Italian patients. Eleven deleterious variants in 9 diagnostic genes and 17 deleterious variants in 11 candidate genes were identified. Interestingly, mutations were found in several genes correlated to the Bardet–Biedl syndrome. Then, 25 patients were clinically followed to evaluate their response to bariatric surgery. After a 12-month follow-up, the patients that carried deleterious variants in diagnostic or candidate genes had a reduced weight loss, as compared to the other patients. The NGS-based panel, including diagnostic and candidate genes used in this study, could play a role in evaluating, diagnosing, and managing obese individuals, and may help in predicting the outcome of bariatric surgery.
Salicornia herbacea is a halophyte indigenous to marine coastal areas and salt fields and has been used as a traditional remedy for diarrhea, abdominal pain, constipation, and indigestion. Its component isorhamnetin-3-O-glucoside (IR3G) may have antioxidant, anti-inflammatory, and anti-adipogenic properties. In the present study, we aimed to investigate the anti-obesity effect of S. herbacea extract and IR3G on mouse 3T3-L1 adipocytes and db/db obesity mice. S. herbacea extract and IR3G inhibited lipase in a concentration-dependent manner. Oil Red O staining disclosed that S. herbacea extract and IR3G significantly suppressed lipid accumulation and adipogenesis and also inhibited the expression of the C/EBPα in the 3T3-L1 adipocytes. In experiments using db/db mice, administering of S. herbacea extract limited body weight gain and significantly reduced feed efficiency and adipose tissue weight. Moreover, analyzing blood triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein, it was confirmed that LDL was significantly decreased and total cholesterol slightly reduced by S. herbacea extract. However, there was no significant change by S. herbacea extract in the changes in blood levels of leptin and adiponectin. Taken together, these results suggest that S. herbacea extract and IR3G inhibit adipogenesis by suppressing the pro-adipogenic transcription factors in 3T3-L1 preadipocytes and prevent obesity by regulating the blood lipid profile as well as the weight of adipose tissue.
People’s lifestyles and, especially, their eating habits affect their health and the functioning of the organs in their bodies, including the kidneys. One’s diet influences the cells’ responses to stressful conditions such as acute kidney injury (AKI). This study aims to determine the preconditioning effects of four different diets: energy restriction (ER) diet, time restriction (TR) eating, intermittent fasting (IF), and high-fat diet (HF) on histopathological indices of the kidney as well as the molecules involved in apoptosis during AKI. Adult male rats underwent ER, TR, IF, and HF diets for eight weeks. Then, AKI was induced, and renal function indices, histopathological indices, and molecules involved in apoptosis were measured. In animals with AKI, urinary albumin excretion, serum urea, creatinine and, Bax/Bcl-2 ratio increased in the kidney, while renal eGFR decreased. ER and TR diets improved renal parameters and prevented an increase in the Bax/Bcl-2 ratio. The IF diet improved renal parameters but had no effect on the Bax/Bcl-2 ratio. On the other hand, the HF diet worsened renal function and increased the Bax/Bcl-2 ratio. Histopathological examination also showed improved kidney conditions in the ER and TR groups and more damage in the HF group. This study demonstrated that ER and TR diets have renoprotective effects on AKI and possibly cause the resistance of kidney cells to damage by reducing the Bax/Bcl-2 ratio and improving apoptotic conditions.
Obesity is a social problem that needs to be carefully considered regarding its causes and consequences. This study examines the impact of human development, unemployment, and globalization on obesity in BRICS (Brazil, Russia, India, China, and South Africa) countries from 1991 to 2016. For this aim, the study uses Fourier causality and cointegration tests, which consider smooth structural breaks. The cointegration test results show that obesity and explanatory variables do not move together in the long run for all countries. According to the causality result of this study, there is a unidirectional causal relationship from obesity to unemployment in China. On the other hand, there is unidirectional causality from obesity to human development and globalization in India. Overall, India can lessen the negative effects of obesity on its population and improve its standing in the global economy if it promotes healthy lifestyles and controls the food and beverage industry. On the other hand, obesity may cause people to become unemployed, so it is recommended that policymakers fight obesity to control unemployment in China.
Obesity is characterized by the excessive accumulation of mature adipocytes that store surplus energy in the form of lipids. In this study, we investigated the inhibitory effects of loganin on adipogenesis in mouse preadipocyte 3T3-L1 cells and primary cultured adipose-derived stem cells (ADSCs) in vitro and in mice with ovariectomy (OVX)- and high-fat diet (HFD)-induced obesity in vivo. For an in vitro study, loganin was co-incubated during adipogenesis in both 3T3-L1 cells and ADSCs, lipid droplets were evaluated by oil red O staining, and adipogenesis-related factors were assessed by qRT-PCR. For in vivo studies, mouse models of OVX- and HFD-induced obesity were orally administered with loganin, body weight was measured, and hepatic steatosis and development of excessive fat were evaluated by histological analysis. Loganin treatment reduced adipocyte differentiation by accumulating lipid droplets through the downregulation of adipogenesis-related factors, including peroxisome proliferator-activated receptor γ (Pparg), CCAAT/enhancer-binding protein α (Cebpa), perilipin 2 (Plin2), fatty acid synthase (Fasn), and sterol regulatory element binding transcription protein 1 (Srebp1). Loganin administration prevented weight gain in mouse models of obesity induced by OVX and HFD. Further, loganin inhibited metabolic abnormalities, such as hepatic steatosis and adipocyte enlargement, and increased the serum levels of leptin and insulin in both OVX- and HFD-induced obesity models. These results suggest that loganin is a potential candidate for preventing and treating obesity.
In 2016, obese patients represented 13% of the worldwide adult population, and by 2030, they are projected to make up 34%. Obesity is an incommunicable disease, but it can induce many health problems. The groups consisted of a control, a 65% high-fat group, and a 250 mg/kg P. erosus group. Several biomarkers, such as body weight gain, the presence of TC/LDL/HDL in the serum, the weight of fat tissue, and liver weight/morphology, were investigated to define the anti-obesity mechanisms of P. erosus, and the adipogenesis pathway was studied. P. erosus suppressed body weight gain, decreased TC and LDL, prevented fat tissue weight gain, and prevented liver weight gain by blocking lipid droplet accumulation. P. erosus effectively decreased the up-regulated levels of leptin, significantly controlled both C/EBPα and PPARγ levels, and prevented increased FAS expression levels. We concluded that P. erosus effectively controlled obesity by regulating leptin-C/EBPα-PPARγ and FAS and might be a promising AOM.
Obesity, a rising concern in the Eastern world, encompasses several co-morbidities, namely non-alcoholic fatty liver disease (NAFLD). Potential natural-based interventions to decrease the burden of obesity complications are being investigated. Many of the edible parts of plants are not sold for consumption and end up as massive waste, losing nutritional potential. In fact, a sizeable amount of waste is generated within the different steps of the food supply chain, representing a massive loss of both plant material and natural resources. A good example is Brassica by-products (BBPs). The objective of this work was to investigate the effect of three different extracts from broccoli (Brassica oleracea var italica) by-products in an in vitro model of free fatty acid (FFA)-induced lipotoxicity using human hepatoma HepG2 cells. Broccoli leaf, stalk, and inflorescence extracts induced a dose-dependent decrease in the cell viability of HepG2 cells. However, the maximal non-lethal concentrations of leaves, stalks, and inflorescences (10 μg/mL) did not compromise mitochondrial function or neutral lipid accumulation in HepG2 cells. The extracts significantly decreased FFA-induced lipid accumulation in HepG2 cells either in a co-incubation or pre-incubation strategy. The broccoli extracts’ capacity to prevent the FFA-induced decrease in catalase activity in HepG2 may explain the observed effects.
Obesity is a growing health concern in today’s society. Current estimates indicate that obesity occurs in both adults and young people. Recent research also found that the Hispanic population in the U.S. is 1.9 times more likely to be overweight as compared to their non-Hispanic population. Obesity is a multifactorial disease that has a variety of causes. All current treatment options incorporate dietary changes aimed at establishing a negative energy balance. According to current scientific research, multiple factors are involved with the development of obesity, including genetic, biochemical, psychological, environmental, behavioral, and socio-demographic factors. The people who suffer from obesity are far more likely to suffer serious health problems, such as stroke, diabetes, lung disease, bone and joint disease, cancer, heart disease, neurological disorders, and poor mental health. Studies indicate that multiple cellular changes are implicated in the progression of obesity, mitochondrial dysfunction, deregulated microRNAs, inflammatory changes, hormonal deregulation, and others. This article highlights the role that oxidative stress plays in obesity and current obesity-prevention techniques with an emphasis on the impact of catechins to prevent and treat obesity.
Objective:
Various personality traits have longitudinal relations with body mass index (BMI), a measure of body weight and a risk factor for numerous health concerns. We tested these associations' compatibility with causality in either direction.
Method:
Using three waves of the Wisconsin Longitudinal Study (N = 12,235, Mage = 53.33 at baseline), we tested how accurately the Five-Factor Model personality domains and their items could collectively predict BMI and change in it with elastic net models. With multilevel models, we tested (a) bidirectional and (b) within-person associations between BMI and personality traits.
Results:
The five domains were able to predict concurrent (r = .08), but not future BMI. Twenty-nine personality items predicted concurrent and future BMI at r = .21 and r = .16 to .25, respectively. Neither the domains nor items could collectively predict change in BMI. Similarly, no individual trait predicted change in BMI, but BMI predicted changes in Conscientiousness, Agreeableness, and several items (|b*| = .03 to .08). BMI had within-person correlations with these same traits; time-invariant third factors like genetics or childhood environments therefore could not (fully) account for their relations.
Conclusions:
Body weight may contribute to adults' personality development, but the reverse appears less likely.
Exposure to stress early in life has been associated with adult-onset co-morbidities such as chronic pain, metabolic dysregulation, obesity, and inactivity. We have established an early life stress model using neonatal maternal separation (NMS) in mice, which displays evidence of increased body weight and adiposity, widespread mechanical allodynia, and hypothalamic-pituitary-adrenal axis dysregulation in male mice. Early life stress and consumption of a western style diet contribute to the development of obesity, however, relatively few pre-clinical studies have been performed in female rodents, which are known to be protected against diet induced obesity and metabolic dysfunction. In this study we gave naïve and NMS female mice access to a high-fat/high-sucrose (HFS) diet beginning at 4 weeks of age. Robust increases in body weight and fat were observed in HFS-fed NMS mice during the first 10 weeks on the diet, driven partly by increased food intake. Female NMS mice on a HFS diet showed widespread mechanical hypersensitivity compared to either naïve mice on a HFS diet or NMS mice on a control diet. HFS diet-fed NMS mice also had impaired glucose tolerance and fasting hyperinsulinemia. Strikingly, female NMS mice on a HFS diet showed evidence of hepatic steatosis with increased triglyceride levels and altered glucocorticoid receptor levels and phosphorylation state. They also exhibited increased energy expenditure as observed via indirect calorimetry and expression of pro-inflammatory markers in perigonadal adipose. Altogether, our data suggest that early life stress exposure increased the susceptibility of female mice to develop diet-induced metabolic dysfunction and pain-like behaviors.
Objective:
Launching priority actions demand a comprehensive appraisal of the size effect that risk factors have on the burden of overweight and obesity. This study aimed to estimate the incidence of overweight and obesity among children and adolescents, with special emphasis on the role of specific risk factors.
Materials and methods:
Secondary analysis of data from the younger cohort of the Young Lives Study in Peru (2002-2017). The outcomes were: overweight and obesity, defined by the World Health Organization standards; whereas the exposures included caesarean birth, physical activity levels, sodas and sugar-sweetened beverages consumption, snacks consumption, and maternal body mass index (BMI). We used multilevel Poisson regression models, considering the repetitive nature of data, to estimate incidence rate ratios (IRRs) and population attributable fractions (PAFs).
Results:
A total of 2052 children, mean age 1 (SD 0.4) year, and 50% girls, were enrolled at baseline. After 14 (SD 0.5) years of follow-up, the incidence of overweight and obesity were 7.9 (95% CI 7.6-8.2) and 2.2 (95% CI 2.0-2.4) per 100 person-year, respectively. Maternal BMI (IRRs 3.51; PAF 31.8%), low physical activity (IRR 1.64; PAF 27.4%), caesarean birth (IRR 1.63; PAF 11.4%), almost daily snack consumption (IRR 1.60; PAF 32.1%), and almost daily consumption of sweetened beverages (IRR 1.47; PAF 26.0%) increased the risk of developing obesity.
Conclusions:
This study provides evidence on the risk of overweight and obesity attributable to diet habits, physical activity and the obesogenic niche among children and adolescents in Peru, which may guide the implementation of evidence-based interventions.
Background:
This study explored the effects of a virtual reality exercise program on overweight middle-aged women.
Methods:
This randomized controlled trial included women 40-65 years of age with a body mass index (BMI) of 23 kg/m2 or more living in Daejeon City. The virtual reality environment was set up by attaching an IoT sensor to an indoor bicycle and linking it with a smartphone, enabling exercise in an immersive virtual reality through a head-mounted display.
Results:
In the virtual reality exercise group, the BMI was significantly decreased after the 8-week intervention compared with the baseline value (F = 59.491, p < 0.001). The depression scores were significantly different among the three groups, with the intervention effect being more significant in the virtual reality exercise group than in the indoor bicycle exercise and control groups (F = 3.462, p < 0.001). Furthermore, the levels of exercise fun (F = 12.373, p < 0.001) and exercise immersion (F = 14.629, p < 0.001) were significantly higher in the virtual reality exercise group than in the indoor bicycle exercise and control groups.
Conclusions:
The virtual reality exercise program positively affected the BMI and the levels of depression, exercise fun, and exercise immersion in overweight middle-aged women. It is an effective home exercise program for obesity management in this population.
This study investigated the effectiveness of Native American (NA) targeted obesity prevention messages. The researchers manipulated obesity attributions (internal vs. external) and message sources (NAs vs. non-NAs) in a 2 × 2 mixed experimental design to examine the way these message attributes influence NAs' emotional, attitudinal, cognitive, and behavioral responses. One-hundred and eighteen Cheyenne and Arapaho (C&A) tribal citizens read two paper-based obesity prevention PSAs and then answered questions that assessed their message responses. The key findings demonstrated that the match between participants' ethnicity and the message source's ethnicity had a significant effect, as it reduced anger and promoted positive message attitudes and favorable source evaluations. Implications, limitations, and suggestions for future research and NA targeted health campaigns are discussed.
Nearly 50% of adults will suffer from obesity in the U.S. by 2030. High obesity rates can lead to high economic and healthcare burdens in addition to elevated mortality rates and reduced health span in patients. Emerging data demonstrate that obesity is a multifactorial complex disease with various etiologies including aging, a lifestyle of chronic high-fat diets (HFD), genetic predispositions, and circadian disruption. Time-restricted feeding/eating (TRF; TRE in humans) is an intervention demonstrated by studies to show promise as an effective alternative therapy for ameliorating the effects of obesity and metabolic disease. New studies have recently suggested that TRF/TRE modulates the skeletal muscle which plays a crucial role in metabolism historically observed to be impaired under obesity. Here we discuss recent findings regarding potential mechanisms underlying TRF’s modulation of skeletal muscle function, metabolism, and structure which may shed light on future research related to TRF as a solution to obesity.
Chemical analysis by analytical instrumentation has played a major role in disease diagnosis, which is a necessary step for disease treatment. While the treatment process often targets specific organs or compounds, the diagnostic step can occur through various means, including physical or chemical examination. Chemically, the genome may be evaluated to give information about potential genetic outcomes, the transcriptome to provide information about expression actively occurring, the proteome to offer insight on functions causing metabolite expression, or the metabolome to provide a picture of both past and ongoing physiological function in the body. Mass spectrometry (MS) has been elevated among other analytical instrumentation because it can be used to evaluate all four biological machineries of the body. In addition, MS provides enhanced sensitivity, selectivity, versatility, and speed for rapid turnaround time, qualities that are important for instance in clinical procedures involving the diagnosis of a pediatric patient in intensive care or a cancer patient undergoing surgery. In this review, we provide a summary of the use of MS to evaluate biomarkers for newborn screening and cancer diagnosis. As many reviews have recently appeared focusing on MS methods and instrumentation for metabolite analysis, we sought to describe the biological basis for many metabolomic and additional omics biomarkers used in newborn screening and how tandem MS methods have recently been applied, in comparison to traditional methods. Similar comparison is done for cancer screening, with emphasis on emerging MS approaches that allow biological fluids, tissues, and breath to be analyzed for the presence of diagnostic metabolites yielding insight for treatment options based on the understanding of prior and current physiological functions of the body.
The lateral orbitofrontal cortex (lOFC) receives sensory information about food and integrates these signals with expected outcomes to guide future actions, and thus may play a key role in a distributed network of neural circuits that regulate feeding behavior. Here, we reveal a new role for the lOFC in the cognitive control of behavior in obesity. Food-seeking behavior is biased in obesity such that in male obese mice, behaviors are less flexible to changes in the perceived value of the outcome. Obesity is associated with reduced lOFC inhibitory drive and chemogenetic reduction in GABAergic neurotransmission in the lOFC induces obesity-like impairments in goal-directed behavior. Conversely, pharmacological or optogenetic restoration of inhibitory neurotransmission in the lOFC of obese mice reinstates flexible behavior. Our results indicate that obesity-induced disinhibition of the lOFC leads to a failure to update changes in the value of food with satiety, which in turn may influence how individuals make decisions in an obesogenic environment.
The prevalence of obesity has reached pandemic proportions worldwide and certainly in the United States. Obesity is a well-established independent risk factor for development of many cardiovascular diseases (CVD), including heart failure, coronary heart disease, atrial fibrillation, and hypertension. Therefore, it is logical to expect obesity would have a strong correlation with CVD mortality. However, a substantial body of literature demonstrates a paradox with improved prognosis of overweight and obese patients with established CVD compared to lean patients with the identical CVD. Surprisingly, similar data has also shown that cardiovascular fitness, rather than weight loss alone, influences the relationship between obesity and mortality in those with established CVD. The impact of fitness, exercise, physical activity (PA), and weight loss and their relationship to the obesity paradox are all reviewed here.
Introducción:
Se ha demostrado que el alto consumo de fructosa magnifica la lesión por isquemia cerebral en foco isquémico y región de penumbra. Sin embargo, la isquemia también produce cambios en áreas exofocales como la amígdala, una estructura importante en el procesamiento emocional. Por lo tanto, el objetivo de la investigación fue caracterizar los cambios histológicos de las dendritas de la amígdala provocados por alto consumo de fructosa en un modelo experimental de isquemia cerebral.
Método:
Se utilizaron ratas Wistar alimentadas con alimento estándar; al grupo control se les suministró agua y al grupo fructosa (HDF) se les suministró add libitum 20% de fructosa en agua durante 11 semanas. Algunas ratas fueron sometidas a una isquemia cerebral. Por lo tanto, se tuvieron cuatro grupos experimentales: Sham control, Sham HDF, Isquemia control, Isquemia HDF. Se realizaron cortes coronales de los cerebros -de 50 um- y se realizó inmunohistoquímica de la proteína asociada a microtúbulos 2 (MAP2). Se capturaron imágenes que fueron procesadas en el software Image J.
Resultados:
Se encontró pérdida de inmunorreactividad de dendritas en grupos isquémicos, y además inmunoreactividad de MAP2 tipo acúmulos en los grupos HDF.
Conclusión:
De acuerdo con lo anterior tanto la isquemia como el alto consumo de fructosa generan alteraciones dendríticas en la amígdala.
With better quality of life, obesity is becoming a worldwide disease due to over-eating and sedentary lifestyle. Therefore, daily monitoring of the glucose and body fat percentage (%) is vital to keep track of one’s health. Currently, separated devices are required to monitor each parameter at home and some are still invasive to measure the glucose level. In this study, a portable band-shaped bioimpedance system is proposed to measure both parameters. The system is battery run with two main modules: the current source and the voltage recording, with minimal design to fit into a band of 150 mm x 40 mm in dimension. The impedance is measured at the frequency of 1 kHz at 30 kHz sampling frequency and in 1000 signal cycles to flatten noises. The final average impedance is calculated and evaluated in correlation with the body fat and the fasting glucose. The system was tested on 21 volunteers and 4 locations were picked for the impedance measurement: the arm under the triceps, the side of the belly, the back on one side and the thigh under the bicep femoris. The results show promising results with the arm being the best location for predicting the body fat (correlation coefficient: 0.89, 95% CI: 0.73-0.95), while the thigh impedance best correlated with the fasting glucose (correlation coefficient: 0.92, 95% CI: 0.81-0.97). These preliminary results indicate the feasibility and capacity of the proposed system as a home-based, portable and convenient system in monitoring the body fat and glucose. The system’s performance will be verified and replicated in a future larger study.
Glioblastoma multiforme (GBM) is a malignant primary tumor type of the central nervous system (CNS). This type of brain tumor is rare and is responsible for 12–15% of all brain tumors. The typical survival rate of GBM is only 12 to 14 months. GBM has a poor and unsatisfactory prognosis despite advances in research and therapeutic interventions via neurosurgery, radiation, and chemotherapy. The molecular heterogeneity, aggressive nature, and occurrence of drug-resistant cancer stem cells in GB restricts the therapeutic efficacy. Interestingly, the CNS tumors in children are the second most usual and persistent type of solid tumor. Since numerous research studies has shown the association between obesity and cancer, childhood obesity is one of the potential reasons behind the development of CNS tumors, including GBM. Obesity in children has almost reached epidemic rates in both developed and developing countries, harming children’s physical and mental health. Obese children are more likely to face obesity as adults and develop non-communicable diseases such as diabetes and cardiovascular disease as compared to adults with normal weight. However, the actual origin and cause of obesity are difficult to be pointed out, as it is assumed to be a disorder with numerous causes such as environmental factors, lifestyle, and cultural background. In this narrative review article, we discuss the various molecular and genetic drivers of obesity that can be targeted as potential contributing factors to fight the development of GBM in children.
Modern technological lifestyles promote allergic diseases, especially food allergies. The underlying molecular mechanisms remain to be uncovered. Protein acetylation is one of the most important post-translational modifications, and it is involved in regulating multiple body metabolic processes. This study aimed to clarify the effects of a high-fat diet (HFD) on allergy risk and the underlying mechanisms. Four-week-old male C57BL/6J mice were randomly divided into two groups and fed a normal fat diet (NFD) or HFD for 24 weeks. Then, serum lipids were measured, and skeletal muscle was collected for acetylome analysis. Compared with the findings in the NFD group, HFD-fed mice were obese and hyperlipidemic. Acetylome analysis also revealed 32 differentially expressed proteins between the HFD and NFD groups. Among these, eight acetylated proteins were upregulated in the HFD group. In addition, 13 and 11 proteins were acetylated only in the HFD group and NFD group, respectively. These proteins were mainly involved in regulating energy metabolism and mitochondrial function. This study provides information regarding the underlying molecular mechanisms by which HFD promotes allergy.
Obesity has a profound influence on the progression of many diseases. It induces multi-factorial effects such as dyslipidemia, insulin resistance, diabetes, arterial hypertension, and increased incidences of cancers. Multiple mechanisms link obesity with cancer initiation and progression; however, the least studied is the role of macrophages. Nutritional overload causes adipose tissue expansion in obesity and alters the balance between pro- and anti-inflammatory macrophages, which becomes a primary cause of inflammation. The chronic low-grade inflammation driven by macrophages is also an important characteristic of cancer. Adipose tissue secretes various adipokines, namely adiponectin, leptin, IL-6, TNF-α, etc., which influence macrophage behavior and tumor progression. Furthermore, other metabolic effects of obesity, such as hyperlipidemia, hyperglycemia, and hypercholesterolemia, can also regulate macrophage functionality towards tumor cells. This review summarizes events and mechanisms by which obesity influences macrophage-tumor cell interactions. The role of macrophages in anti-cancer therapies under obese conditions, as well as the effect of macrophages on T cells to regulate tumor progression, are also highlighted.
Introduction
Metabolic syndrome and its components are major health concerns around the world. Among various factors, overweight/obesity, its consequent inflammation, and hypertension are of special importance. Plums are anti-oxidant-rich fruits which have long been investigated for their health benefits. In this systematic review and meta-analysis, we investigated the possible impact of plum supplementation on obesity, inflammation, and blood pressure.
Methods
All of the major databases (PubMed, Scopus, Cochrane, and Web of Science, Google Scholar and EMBASE) were searched to obtain the articles eligible for the review. Relevant data was extracted for the final analysis. Weighted mean difference (WMD) was obtained using fixed and random effect models. The main outcomes included systolic and diastolic blood pressure, body weight, body mass index (BMI), body fat percentage, waist circumference (WC) and blood C-reactive protein (CRP) levels. The effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI).
Results
Crude search provided 3121 articles, among which 11 were eligible to be included. After crude and subgroup analysis, we were unable to detect any significant impact of plum supplementation on body weight (weight mean difference (WMD) of 0.04 kg; 95% CI: -1.55, 1.63, p=0.959), BMI (WMD 0.39 kg/m²; 95% CI: -0.11, 0.90, p= 0.125), body fat percentage (WMD= 0.59 %; 95% CI: -0.41, 1.59, p =0.249), waist circumference (WMD= 0.60 cm; 95% CI: -1.83, 3.04, p= 0.627), systolic blood pressure (WMD -1.24 mmHg; 95% CI: -3.08, 0.59, p= 0.185), diastolic blood pressure (WMD -4.32 mmHg (95% CI: -9.29, 0.65, p = 0.089), or inflammation indicated by C-reactive protein (CRP) levels (WMD= 0.23 mg/l; 95% CI: -0.27, 0.73, p= 0.371).
Conclusion
Our results show that plum supplementation has no positive effect on factors of metabolic syndrome. We recommend that further research in the form of clinical trials be conducted to make a clear conclusion as of the effectiveness of plum supplementation on parameters of metabolic syndrome.
Objectives
The aim of this study is to compare acute effects of consuming extra virgin coconut oil (EVCO) as a source of medium chain fatty acids and extra virgin olive oil (EVOO) as a source of long chain fatty acids in normal weight and obese subjects.
Design
Randomised, crossover design.
Participants
Metabolically healthy twenty male subjects (10 normal weight; 10 obese) aged 19–40 years.
Intervention
Subjects consumed breakfast meals containing skimmed milk, fat-free white cheese, bread and EVCO (25 g) or EVOO (25 g).
Outcome measures
Visual analog scale evaluations, resting metabolic rate measurements and selected blood parameters analysis (glucose, triglyceride, insulin and plasma peptide YY) were performed before and after the test breakfast meals. In addition, energy intakes were evaluated by ad libitum lunch meal at 180 min.
Results
Visual analogue scale values of hunger and desire to eat decreased significantly after EVCO consumption than EVOO consumption in normal weight subjects at 180 min. There was an increase trend in plasma PYY at 30 and 180 min after EVCO breakfast compared to EVOO breakfast. Ad libitum energy intakes after EVCO and EVOO consumption in normal weight subjects were 924 ± 302; 845 ± 158 kcal (p = 0.272), respectively whereas in obese subjects were 859 ± 238; 994 ± 265 kcal (p = 0.069) respectively.
Conclusion
The results of this study shows that consumption of EVCO compared to EVOO may have suppressive effect on hunger and desire to eat, may affect postprandial PYY levels differently and have no effect on postprandial energy expenditure.
Trial registration
Clinical Trials NCT04738929 .
Introduction: Many factors contribute to obesity, which is an important health problem in the world and in our country. The present study was conducted to investigate the effect of nutritional knowledge level on obesity among university students. Methods: The study was conducted with 252 university students. Anthropometric measurements (body weight, height, waist, hip circumference) were made and body mass index (BMI) and waist / hip ratio (WHR) were calculated. Bioelectrical impedance method was used for body fat analysis. The nutritional knowledge levels of the students were evaluated using the Adult Nutrition Knowledge Level Scale (YETBID). Results: Women had higher body fat ratio (p<0.001). It was observed that 39.7% of male students and 14.3% of female students were obese (p<0.001). There was no significant difference between genders regarding waist circumference measurement and WHR (p>0.001). Smoking and alcohol consumption was higher among males (p<0.05). Basic nutrition and food preference knowledge levels of females were higher than males (p<0.05). There was no significant relationship between male and female students' BMI, waist circumference measurements, body fat ratios, WHR, their nutritional knowledge level and food preferences (p>0.05). Conclusions: Although nutritional knowledge level of female students were better, their nutritional knowledge sub-scales, BMI, WHR, waist circumference and body fat ratios did not significantly differ from male students. More research is needed to reveal the effect of nutritional knowledge in preventing obesity.
The effects of the hypocaloric diet under hospitalization on blood biochemical parameters (lipid, glycaemic, thyroid and liver profiles) were not reported in literature. This study aims to evaluate the efficacy and safety of a hypocaloric diet under hospitalisation in obese patients. A total of 151 obese subjects (49 males and 102 females, aged 69.38 ± 14.1 years, BMI 41.78 ± 7.1) were enrolled in this study. Participants were treated with an hypocaloric diet for a maximum period of 3 months. Outcomes were assessed at the beginning and at the end of the recovery period. The average duration of the hospitalisation was 47.5 days ± 1.3. The effect of the diet on all the outcomes was evaluated using the Analysis of Covariance (ANCOVA) and the predictors of weight loss were identified using linear regression. The diet induced a reduction in the anthropometric (BMI decrease of −2.713 points) and DXA body measurements in addition to serum lipids, glucose, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and C-reactive protein (CRP) levels without affecting the muscle mass, liver and thyroid profiles. During the intervention, there was a positive shift in body composition favouring fat free mass (FFM). Lower insulin but higher serum calcium and potassium levels were predictors of weight loss.
Improved human material living standards have resulted in a continuous increase in the rate of obesity caused by excessive sugar intake. Consequently, the number of diabetic patients has skyrocketed, not only resulting in a global health problem but also causing huge medical pressure on the government. Limiting sugar intake is a serious problem in many countries worldwide. To this end, the market for sugar substitute products, such as artificial sweeteners and natural sugar substitutes (NSS), has begun to rapidly grow. In contrast to controversial artificial sweeteners, NSS, which are linked to health concepts, have received particular attention. This review focuses on the extraction technology and biomedical function of NSS, with a view of generating insights to improve extraction for its large-scale application. Further, we highlight research progress in the use of NSS as food for special medical purpose (FSMP) for patients.
There are fundamental sex differences in the regulation of energy homeostasis. Better understanding of the underlying mechanisms of energy balance that account for this asymmetry will assist in developing sex-specific therapies for sexually dimorphic diseases such as obesity. Multiple organs, including the hypothalamus and adipose tissue, play vital roles in the regulation of energy homeostasis, which are regulated differently in males and females. Various neuronal populations, particularly within the hypothalamus, such as arcuate nucleus (ARC), can sense nutrient content of the body by the help of peripheral hormones such leptin, derived from adipocytes, to regulate energy homeostasis. This review summarizes how adipose tissue crosstalk with homeostatic network control systems in the brain, which includes energy regulatory regions and the hypothalamic–pituitary axis, contribute to energy regulation in a sex-specific manner. Moreover, development of obesity is contingent upon diet and environmental factors. Substances from diet and environmental contaminants can exert insidious effects on energy metabolism, acting peripherally through the aryl hydrocarbon receptor (AhR). Developmental AhR activation can impart permanent alterations of neuronal development that can manifest a number of sex-specific physiological changes, which sometimes become evident only in adulthood. AhR is currently being investigated as a potential target for treating obesity. The consensus is that impaired function of the receptor protects from obesity in mice. AhR also modulates sex steroid receptors, and hence, one of the objectives of this review is to explain why investigating sex differences while examining this receptor is crucial. Overall, this review summarizes sex differences in the regulation of energy homeostasis imparted by the adipose–hypothalamic axis and examines how this axis can be affected by xenobiotics that signal through AhR.
The global prevalence of obesity is alarmingly high and is impacting both developed and underdeveloped countries, beyond the borders of ethnicity, sex, and age. On the other hand, the global interest in dieting has increased, and people are obsessed with certain fad diets, assuming them as a magic bullet for their long-term problems. A fad diet is a popular dietary pattern known to be a quick fix for obesity. These diets are quite appealing due to the proposed claims, but the lack of scientific evidence is a big question mark. Such diets are often marketed with specific claims that defy the basic principles of biochemistry and nutritional adequacy. These diets may have protective effects against obesity and certain chronic diseases like cardiovascular diseases, metabolic syndrome, and certain cancers. Limited evidence exists to support the proposed claims; rather certain studies suggest the negative health consequences of long-term adherence to such dietary patterns. Many fad diets have emerged in the previous few decades. This review article will explore the current evidence related to the health impacts of some most popular diets: Atkins diet, ketogenic diet, Paleolithic diet, Mediterranean diet, vegetarian diet, intermittent fasting and detox diet.
To combat the immense toll on global public health induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), new vaccines were developed. While these vaccines have protected the populations who received them from severe SARS-CoV-2 infection, the effectiveness and durability of these vaccines in individuals with obesity are not fully understood. Our uncertainty of the ability of these novel vaccines to induce protective immunity in humans with obesity stems from historical data that revealed obesity-associated immune defects to influenza vaccines. This review analyzes the efficacy of SARS-CoV-2 vaccines in humans with obesity. According to the vaccine safety and efficacy information for the Pfizer, Moderna, and Johnson & Johnson formulations, these vaccines showed a similar efficacy in both individuals with and without obesity. However, clinical trials that assess BMI and central obesity showed that induced antibody titers are lower in individuals with obesity when compared to healthy weight subjects, highlighting a potential early waning of vaccine-induced antibodies linked to obesity rates. Thus, the desired protective effects of SARS-CoV-2 vaccination were potentially diminished in humans with obesity when compared to the healthy weight population, but further studies outlining functional implications of the link between obesity and lower antibody titers need to be conducted to understand the full impact of this immune phenomenon. Further, additional research must be completed to truly understand the immune responses mounted against SARS-CoV-2 in patients with obesity, and whether these responses differ from those elicited by previously studied influenza viruses.
The macroeconomic effect of the obesity epidemic on environmental degradation was examined for panel data from thirty-one European countries from 1991 to 2016. The quantile via moments model (QVM) was used to realize our empirical investigation. The empirical results indicate that the obesity epidemic, electricity consumption, and urbanisation encourage environmental degradation by increasing CO2 emissions, while economic growth decreases them. Moreover, we identify that the obesity epidemic raises the environmental degradation problem in three ways. First, the obesity epidemic is caused by the increased consumption of processed foods from multinational food corporations. The increase in food production will positively impact energy consumption from non-renewable energy sources. Second, obesity reduces physical and outdoor activities, increasing the intensive use of home appliances and motorized transportation and screen-viewing leisure activities, consequently increasing energy consumption from non-renewable energy sources. A third possible way can be related indirectly to economic growth, globalization, and urbanisation. This empirical investigation will contribute to the literature and for policymakers and governments. Therefore, this investigation will encourage the development of initiatives to mitigate the obesity problem in European countries and accelerate the energy transition process. Finally, this investigation will open a new topic in the literature regarding the correlation between the obesity epidemic and environmental degradation
Background:
Previous studies have shown that the C allele of melanocortin 4 receptor (MC4R) rs17782313 and Alternative Healthy Eating Index (AHEI) are separately associated with obesity. However, no study has assessed the aim of this study which is to investigate the interaction between MC4R rs17782313 variants and AHEI and their association with central and general obesity indices.
Methods:
A total of 291 women with BMI ≥25 and aged 18-48 years enrolled in this cross-sectional study. All participants were assessed for body composition, anthropometric measures, dietary intake, and blood parameters. After obtaining data of dietary intake from the 147-item food frequency questionnaire (FFQ) the AHEI was calculated. MC4R rs17782313 SNPs were assessed using the restriction fragment length polymorphism (PCR-RFLP) method.
Results:
After adjustment for age, energy intake, physical activity, marital and economic status, the interaction between MC4R rs17782313 and AHEI was associated with hip circumference (HC) (β=-0.41, 95%CI: -0.77 to -0.05, P=0.02), body mass index (BMI) (β=-0.15, 95%CI: -0.29 to -0.02, P=0.02), fat mass (kg) (β=-0.28, 95%CI: -0.56 to -0.01, P=0.03), Visceral fat area (VFA) (β=-5.68, 95%CI: -9.55 to -1.80, P=0.004). The other measures that seem to be suggestively related to this interaction (0.05< P <0.07) are waist circumference (WC), waist-to-height ratio (WHtR), trunk fat (TF) (%), TF (kg), fat mass (%), and fat mass index (FMI).
Conclusion:
Interaction between MC4R rs17782313 and AHEI can be related to some central and general obesity indices in overweight/obese women. This article is protected by copyright. All rights reserved.
A wide and interacting range of individual, environmental and socioeconomic factors contribute to obesity. As a consequence, weight management strategies almost always comprise a mixture of several parallel approaches, each with its challenges and unique goals. Broadly, weight management strategies comprise of two main strands. The non-pharmacotherapy approach includes various lifestyle modifications in terms of dietary therapy, exercise and behavioral modifications, including the prevention of possible relapses. Pharmacotherapy, on the other hand, involves several anti-obesity medications, employed as single or combination therapy. Generally, the goals of weight management should be realistic and individualized to patient’s experiences, abilties, and risks in order to maximize the likelihood of success. This chapter tackles these weight management strategies in turn, explaining each as well as highlighting their distinctive features and challenges, effectiveness and safety, requisites, and where appropriate, indications and contraindications.
Keywords: Obesity, weight management, dietary therapy, behavioral therapy, physical activity, exercise, anti-obesity medications, pharmacotherapy
Citation: Elhag W & El Ansari W. (2022) Medical Weight Management: A
Multidisciplinary Approach. In: Weight Management - Challenges and Opportunities, Hassan M. Heshmati (Ed.). Intech Open. ISBN 978-1-80355-187-6
Objective:
To investigate the influence of body mass index (BMI) on perioperative outcomes, postoperative Patient-Reported Outcome Measures (PROMs), and minimal clinically important difference (MCID) achievement among Workers' Compensation (WC) claimants undergoing minimally invasive lumbar decompression (MIS-LD).
Methods:
WC patients diagnosed with herniated nucleus pulposus (HNP) undergoing single-level MIS-LD were identified. Patients were divided into three groups: Non-Obese (<30 kg/m2), Obese I (≥30 and <35 kg/m2), and Obese II/III (≥35 kg/m2).1 PROMs were collected preoperatively and at 6-weeks/12-weeks/6-months/1-year/2-years postoperatively. The predictive influence of BMI grouping on mean PROM scores was computed using simple linear regression. To compare PROMs between groups, post-hoc pairwise comparisons of adjusted means were utilized. MCID achievement was compared between groups with chi-squared analysis.
Results:
81 patients were in the non-obese cohort, and 43 and 45 in the Obese I and Obese II/III cohorts, respectively. VAS leg, ODI, and SF-12 PCS were worse in the Obese I cohort at 12-weeks, and SF-12 PCS was lower in the Obese I vs. Obese II/III subgroup analysis (p≤0.045, all). MCID achievement rates for ODI were higher for the Non-Obese group at 12-weeks and for overall (p≤0.049, both). MCID attainment for VAS back was higher among the Non-Obese cohort at 6-weeks (p=0.022).
Conclusion:
Patients with higher levels of obesity were more likely to experience longer LOS and delayed discharge following MIS-LD. Increasing BMI was generally not a significant predictor of postoperative pain, disability, or physical health PROMs at most timepoints. MCID achievement rates for disability relief were significantly higher for non-obese patients.
Objective
Obesity is a highly prevalent, non-communicable, disease associated with numerous comorbid complications, such as cardiovascular disease. Following a healthy diet is known to help reduce the risk of both obesity and cardiovascular disease. This study was conducted to evaluate the association of recommended food score (RFS) and none recommended food score (NRFS) with cardiovascular risk factors in overweight and obese women.
Methods
This cross-sectional study was performed on 379 overweight and obese (BMI ≥25 kg/m²) women aged 18-48 years. Anthropometric measurements and body composition analysis were assessed in all participants. Dietary intake was assessed by a valid and reliable food frequency questionnaire (FFQ) containing 147 items, and RFS and NRFS was calculated. Biochemical assessments including TC, HDL, LDL, TG, FBS, insulin, HOMA-IR, and hs-CRP were quantified by ELISA.
Results
The mean age and BMI of participants were 36.73 ± 9.21 (y) and 31.17 ± 4.22 (kg/m²), respectively. Binary logistic regression showed that participants in the highest tertile of the RFS compared to the lowest tertile had 57% lower odds for hypertriglyceridemia [OR = 0.43, 95%CI = 0.20-0.92, P = 0.03]. Subjects with high adherence to the NRFS had lower HDL [OR = 2.11, 95%CI = 1.08-4.12, P = 0.02] and higher odds for hypertriglyceridemia [OR = 2.95, 95%CI = 1.47-5.94, P = 0.002] compared to low adherence.
Conclusions
There was an inverse significant association between adherence to RFS and odds of hypertriglyceridemia. There was a significant association between NRFS and hypertriglyceridemia, in addition to an inverse association between NRFS and HDL. We recommend that people increase their consumption of fruits, vegetables, whole grains, lean meats or meat alternates, and low-fat dairy and avoid red meat, processed meat, chips, high-fat dairy, solid oil, refined grains, and variety of sweetened foods to prevent cardiovascular disease.
Purpose
Obesity is a growing, global health problem and previous cross-sectional studies have demonstrated an association between obesity and chronic rhinosinusitis (CRS). There is, however, a lack of prospective studies regarding the impact of obesity on developing (new-onset) CRS.
Methods
Questionnaire-based data (n = 5769) relating to new-onset CRS and Body Mass Index (BMI) were collected in 2013 and 2018 from the Telemark population study in Telemark, Norway. Odds ratios for the risk of new-onset CRS in 2018 in relation to BMI in 2013 were calculated, adjusted for smoking habits, asthma, gender and age.
Results
When comparing the group with normal weight (18.5 ≤ BMI < 25) with the obese group (BMI ≥ 30), the odds of new-onset CRS was 53% higher [OR 1.53 (1.11, 2.10)] in the obese group.
Conclusion
CRS is a multifactorial disease with different phenotypes and it is important to consider obesity when assessing patients with CRS in a clinical setting.
The increasing prevalence of obesity and overweight is a significant public concern throughout the world. Obesity is a complex disorder involving an excessive amount of body fat. It is not just a cosmetic concern. It is a medical challenge that increases the risk of other diseases and health circumstances, such as diabetes, heart disease, high blood pressure and certain cancers. Environmental and genetic factors are involved in obesity as a significant metabolic disorder along with diabetes. Gut microbiota (GM) has a high potential for energy harvesting from the diet. In the current review, we aim to consider the role of GM, gut dysbiosis and significant therapies to treat obesity. Dietary modifications, probiotics, prebiotics, synbiotics compounds, using faecal microbiota transplant, and other microbial-based therapies are the strategies to intervene in obesity reducing improvement. Each of these factors serves through various mechanisms including a variety of receptors and compounds to control body weight. Trial and animal investigations have indicated that GM can affect both sides of the energy-balancing equation; first, as an influencing factor for energy utilisation from the diet and also as an influencing factor that regulates the host genes and energy storage and expenditure. All the investigated articles declare the clear and inevitable role of GM in obesity. Overall, obesity and obesity-relevant metabolic disorders are characterised by specific modifications in the human microbiota’s composition and functions. The emerging therapeutic methods display positive and promising effects; however, further research must be done to update and complete existing knowledge.
Introduction: The role of genetic factors in obesity has long been recognized, but their involved specific genes remained unidentified. The relationship between p53 gene single nucleotide polymorphisms and the risk of obesity has been investigated in recent years. Therefore, this study aimed to investigate the association of p53 Arg72Pro C>G (rs1042522) polymorphism with the risk of obesity in our study.
Methods: This study included 52 patients with obesity (26 were females and 26 were males) and 52 normal-weight healthy controls. Genomic DNA isolation was performed from the blood samples of all participants. p53 Arg72Pro C>G (rs1042522) polymorphism was detected by real-time quantitative polymerase chain reaction from genomic DNA samples.
Results: No significant associations were identified between Arg72Pro (rs1042522) p53 polymorphism and obesity risk. Glucose levels are significantly different between the obese and control groups with the CC and CG genotypes, but without difference in the GG homozygous genotype.
Conclusion: Our study is one of the first to investigate the relationship between p53 codon 72 polymorphisms and obesity risk but revealed no correlation between them. The relatively small number of participants may limit our study. Further research is needed in a large cohort to associate the p53 gene Arg72Pro C>G (rs1042522) variant with obesity risk.
Obesity is a major health problem that is caused by body fat accumulation and that can lead to metabolic diseases. Owing to several side effects of the currently used antiobesity drugs, natural plants have risen as safe and potential candidates to alleviate obesity. We have previously reported the antiobesity effect of Hydrangea serrata (Thunb.) Ser. leaves extract (WHS) and its underlying mechanisms. As an extension of our preclinical studies, this study aimed to investigate the effect of WHS on body weight and body fat reduction in overweight or obese humans. A total of 93 healthy overweight or obese males and females, aged 19–65 years, with body mass indexes (BMIs) ≥ 25 and <32 kg/m2, were recruited and received either an oral administration of 600 mg of WHS, or placebo tablets for 12 weeks. Daily supplementation with WHS decreased body weights, body fat masses, and BMIs compared with the placebo-treated group. The hip circumferences, visceral fat areas, abdominal fat areas, and visceral-to-subcutaneous ratios decreased after WHS supplementation. No significant side effects were observed during or after the 12 weeks of WHS intake. In conclusion, WHS, which has beneficial effects on body weight and body fat reduction, could be a promising antiobesity supplement that does not produce any side effects.
Galacto-oligosaccharides (GOS) are commonly used as prebiotic with a variety of known metabolic benefits; however, whether GOS plays a protective role in obesity remains unknown. Here, we demonstrate that GOS prevented obesity in a rat model of obesity induced by a high-fat diet. Our results showed that GOS effectively slowed weight gain in diet-induced obese rats without affecting energy intake. GOS significantly suppressed the hypertrophy and hyperplasia of white adipose tissue and markedly reduced the ratio of the fat/body. Consistently, GOS significantly improved serum total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels, indicating the weight loss activity of GOS. Interestingly, GOS also significantly increased the expression levels of browning proteins, including uncoupling protein 1, peroxisome proliferator-activated receptor-γ, peroxisome proliferator-activated receptor-γ coactivator 1α, and PR domain 16, in both white and brown adipose tissue. Furthermore, we found that GOS markedly increased the expression levels of liver X receptor α, peroxisome proliferation-activated receptor-α, low-density lipoprotein receptor, and cholesterol 7α-hydroxylase proteins in the liver of obese rats. Taken together, we concluded that GOS inhibits obesity by accelerating the browning of white fat cells and the thermogenesis of brown fat cells and that GOS improves host lipid homeostasis by promoting cholesterol catabolism.
Background:
Obesity is a prevalent disease in modern society. Despite the various interventions available in conventional medicine, their success rates are not satisfactory because of the complex mechanisms involved in obesity. Cupping therapy is a traditional Chinese medicinal intervention, and it has become widely used in various clinical settings for the treatment of obesity. This systematic review and meta-analysis will investigate the effects of cupping on obesity.
Methods:
Three Korean databases (KoreaMed, Oriental Medicine Advanced Searching Integrated System, and ScienceON), 1 Japanese database (Citation Information by the National Institute of Informatics), 1 Chinese database (Chinese National Knowledge Infrastructure), MEDLINE/PubMed, EMBASE, and The Cochrane Central Register of Controlled Trials will be searched for studies published until March 2021. The primary outcome is body weight. The secondary outcomes will be body mass index, waist-hip ratio, waist circumference, hip circumference, body fat mass, body fat percentage, and adverse events.
Results:
This systematic review and meta-analysis will evaluate the effects of cupping therapy for obesity.
Conclusion:
The results of this systematic review and meta-analysis will then be discussed in a related journal for clinicians working with obese patients to apply the interventions in this article.
Trial registration number:
DOI 10.17605/OSF.IO/P8JVM (https://osf.io/p8jvm).
The past few decades have shown a worrisome increase in the prevalence of obesity and its related illnesses. This increasing burden has a noteworthy impact on overall worldwide mortality and morbidity, with significant economic implications as well. The same trend is apparent regarding pediatric obesity. This is a particularly concerning aspect when considering the well-established link between cardiovascular disease and obesity, and the fact that childhood obesity frequently leads to adult obesity. Moreover, most obese adults have a history of excess weight starting in childhood. In addition, given the cumulative character of both time and severity of exposure to obesity as a risk factor for associated diseases, the repercussions of obesity prevalence and related morbidity could be exponential in time. The purpose of this review is to outline key aspects regarding the current knowledge on childhood and adolescent obesity as a cardiometabolic risk factor, as well as the most common etiological pathways involved in the development of weight excess and associated cardiovascular and metabolic diseases.
A large amount of waste is generated within the different steps of the food supply chain, representing a significant loss of natural resources, plant material, and economic value for producers and consumers. During harvesting and processing, many parts of edible plants are not sold for consumption and end up as massive waste, adding environmental hazards to the list of concerns regarding food wastage. An example is Brassica oleracea var. Italica (broccoli) by-products, which represent 75% of the plant mass-generated. A growing concern in the Western world is obesity, which results from incorrect lifestyles and comprises an extensive array of co-morbidities. Several studies have linked these co-morbidities to increased oxidative stress, thus, naturally occurring and readily available antioxidant compounds are an attractive way to mitigate metabolic diseases. The idea of by-products selected for their biomedical value is not novel. However, there is innovation underlying the use of Brassica by-products in the context of obesity. For this reason, Brassica by-products are prime candidates suggested to be used in the treatment of obesity due to its bioactive compounds, such as sulforaphane, with antioxidant activity. Here, we review the economic and health potential of Brassica bioactive compounds in the context of obesity.
Objective:
To review the scientific literature on the influence of verified nutrition, food and diet interventions on occupational health.
Method:
This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Diet, Food, and Nutrition" and "Occupational Health" and applying the filters "Clinical Trial", "Humans" and "Adult: 19+ years"; the search was conducted on 29 May 2021.
Results:
A total of 401 references were retrieved from the bibliographic databases, with an additional 16 identified through a secondary search; among the studies retrieved, 34 clinical trials were selected after applying the inclusion and exclusion criteria. The interventions were grouped into seven categories: (1) dietary interventions associated with exercise or educational programs; (2) individual environmental interventions or other educational actions; (3) educational interventions oriented toward lifestyle, dietetics, physical activity and stress management; (4) economic incentives; (5) multicomponent interventions (combination of mindfulness, e-coaching and the addition of fruits and vegetables); or dietary interventions (facilitating greater food supply in cafeterias); or interventions focused on physical exercise.
Conclusions:
Given that most people spend a large part of their time in the workplace and, therefore, eat at least one of their daily meals there, well-planned interventions-preferably including several strategies-have been demonstrated, in general, as useful for combating overweight and obesity. From the meta-regression study, it was observed that the interventions give better results in people who presented high Body Mass Index (BMI) values (obesity). In contrast, intervention 2 (interventions related to workplace environment) would not give the expected results (it would increase the BMI).
Objective
Cognitive interventions may be effective in weight loss. The purpose of this study was to assess if cognitive reappraisal (CR; reframing the meaning of a stimulus in order to change the resulting emotional response), can reduce food attentional bias (FAB) using the Visual Dot Probe (VDP) paradigm.
Method
126 participants (age 27 ± 5.8) were randomly assigned either to a CR or to a control (CN) group. After assessing baseline VDP levels for FAB, participants either wrote sentences that discourage eating fattening food or neutral sentences. Next, all participants performed the VDP post intervention. Participants also self-reported on disordered eating behaviors and their height and weight were charted. We hypothesized that CR would reduce FAB and that disordered eating would moderate the association between group and FAB.
Results
FAB decreased post intervention, specifically in the CR group. The bulimia sub-scale showed an interaction between bulimic eating, time and group. Among those who were high on the bulimia scale, the CR group showed lower FAB post-intervention compared to the CN group.
Discussion
This study suggests that CR may decrease the attentional bias toward high-calorie food compared to other strategies in the general population and among people with high bulimia measures, in particular.
Plain English summary
Obesity has a negative impact on many aspects of life and much research is dedicated to trying to better understand behaviors concerning obesity. People are prone to focus their attention on things that are of importance to them, such as food. When people focus their attention on food, we call this Food Attention Bias (FAB). Cognitive reappraisal (CR) interventions involve the person's conscious cognitive change of the meaning of the situation aiming to consequently change the emotional response to it, such as saying to yourself “I shouldn’t eat this because I don’t want to get fat”. CR has been found to be helpful in lowering FAB using brain imagining techniques but has not yet been studied in cognitive processes. Our study used a Visual dot probe paradigm (VDP) to assess the efficacy of CR on lowering FAB. Two groups, one using CR and a control group were assessed twice on FAB, using the VDP paradigm. Compared to the normal condition, the CR intervention helped reduce FAB. This reduction was especially significant for people with a higher tendency for bulimic behavior. The VDP paradigm, utilizing CR. can be expanded to help build an intervention aimed at reducing FAB over time. This, in turn might bring to weight reduction. People with bulimic tendencies might especially benefit from CR interventions when dealing with weight loss.
Intestinal microbiota has been shown to be a potential determining factor in the development of obesity. The objective of this systematic review is to collect and learn, based on the latest available evidence, the effect of the use of probiotics and synbiotics in randomized clinical trials on weight loss in people with overweight and obesity. A search for articles was carried out in PubMed, Web of science and Scopus until September 2021, using search strategies that included the terms "obesity", "overweight", "probiotic", "synbiotic", "Lactobacillus", "Bifidobacterium" and "weight loss". Of the 185 articles found, only 25 complied with the selection criteria and were analyzed in the review, of which 23 observed positive effects on weight loss. The intake of probiotics or synbi-otics could lead to significant weight reductions, either maintaining habitual lifestyle habits or in combination with energy restriction and/or increased physical activity for an average of 12 weeks. Specific strains belonging to the genus Lactobacillus and Bifidobacterium were the most used and those that showed the best results in reducing body weight. Both probiotics and synbiotics have the potential to help in weight loss in overweight and obese populations.
High-intensity interval training (HIIT) and linseed oil (LO) supplementation are effective strategies to reduce obesity-induced oxidative stress. Our aim was to determine whether the HIIT + LO combination prevents obesity-induced oxidative stress in high fat diet (HFD)-fed rats. HFD-fed 8-week-old, male, Wistar rats were subdivided in four groups: HFD, LO (2% of sunflower oil replaced with 2% of LO in the HFD), HIIT (4 days/week for 12 weeks), and HIIT + LO. Wistar rats fed a low-fat diet (LFD) were used as controls. Epididymal and subcutaneous adipose tissue, gastrocnemius muscle, liver, and plasma samples were collected to measure oxidative stress markers (AOPP, oxLDL), antioxidant (SOD, CAT, and GPx activities) and pro-oxidant (NOx and XO) enzyme activities. Compared with the LFD, the HFD altered the pro/antioxidant status in different tissues (increase of AOPP, oxLDL, SOD and catalase activities in plasma, and SOD activity increase in liver and decrease in adipose tissues) but not in gastrocnemius. LO upregulated CAT activity and decreased NOx in liver. HIIT alleviated HFD negative effects in liver by reducing SOD and NOx activities. Moreover, the HIIT + LO combination potentiated SOD activity upregulation in subcutaneous tissue. HIIT and LO supplementation have independent beneficial effects on the pro/antioxidant balance. Their association promotes SOD activity in subcutaneous adipose tissue.
Physical inactivity contributes to weight gain in adults, but whether this relationship is true for children of different ethnic groups is not well established.
To assess participation in vigorous activity and television watching habits and their relationship to body weight and fatness in US children.
Nationally representative cross-sectional survey with an in-person interview and medical examination. SETTING and
Between 1988 and 1994, 4063 children aged 8 through 16 years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups.
Episodes of weekly vigorous activity and daily hours of television watched, and their relationship to body mass index and body fatness.
Eighty percent of US children reported performing 3 or more bouts of vigorous activity each week. This rate was lower in non-Hispanic black and Mexican American girls (69% and 73%, respectively). Twenty percent of US children participated in 2 or fewer bouts of vigorous activity perweek, and the rate was higher in girls (26%) than in boys (17%). Overall, 26% of US children watched 4 or more hours of television per day and 67% watched at least 2 hours per day. Non-Hispanic black children had the highest rates of watching 4 or more hours of television per day (42%). Boys and girls who watch 4 or more hours of television each day had greater body fat (P<.001) and had a greater body mass index (P<.001) than those who watched less than 2 hours per day.
Many US children watch a great deal of television and are inadequately vigorously active. Vigorous activity levels are lowest among girls, non-Hispanic blacks, and Mexican Americans. Intervention strategies to promote lifelong physical activity among US children are needed to stem the adverse health consequences of inactivity.
For thirty-five years, U.S. agriculture has operated under a "cheap food" policy that spurred production of a few commodity crops, not fruit or vegetables, and thus of the calories from them. A key driver of childhood obesity is the consumption of excess calories, many from inexpensive, nutrient-poor snacks, sweets, and sweetened beverages made with fats and sugars derived from these policy-supported crops. Limiting or eliminating farm subsidies to commodity farmers is wrongly perceived as a quick fix to a complex agricultural system, evolved over decades, that promotes obesity. Yet this paper does set forth a series of policy recommendations that could help, including managing commodity crop oversupply and supporting farmers who produce more fruit and vegetables to build a healthier, more balanced agricultural policy.
The prevalence of obesity increased in the United States between 1976-1980 and 1988-1994 and again between 1988-1994 and 1999-2000.
To examine trends in obesity from 1999 through 2008 and the current prevalence of obesity and overweight for 2007-2008.
Analysis of height and weight measurements from 5555 adult men and women aged 20 years or older obtained in 2007-2008 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 2007-2008 were compared with results obtained from 1999 through 2006.
Estimates of the prevalence of overweight and obesity in adults. Overweight was defined as a body mass index (BMI) of 25.0 to 29.9. Obesity was defined as a BMI of 30.0 or higher.
In 2007-2008, the age-adjusted prevalence of obesity was 33.8% (95% confidence interval [CI], 31.6%-36.0%) overall, 32.2% (95% CI, 29.5%-35.0%) among men, and 35.5% (95% CI, 33.2%-37.7%) among women. The corresponding prevalence estimates for overweight and obesity combined (BMI > or = 25) were 68.0% (95% CI, 66.3%-69.8%), 72.3% (95% CI, 70.4%-74.1%), and 64.1% (95% CI, 61.3%-66.9%). Obesity prevalence varied by age group and by racial and ethnic group for both men and women. Over the 10-year period, obesity showed no significant trend among women (adjusted odds ratio [AOR] for 2007-2008 vs 1999-2000, 1.12 [95% CI, 0.89-1.32]). For men, there was a significant linear trend (AOR for 2007-2008 vs 1999-2000, 1.32 [95% CI, 1.12-1.58]); however, the 3 most recent data points did not differ significantly from each other.
In 2007-2008, the prevalence of obesity was 32.2% among adult men and 35.5% among adult women. The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men.
The obesity epidemic is a global issue and shows no signs of abating, while the cause of this epidemic remains unclear. Marketing practices of energy-dense foods and institutionally-driven declines in physical activity are the alleged perpetrators for the epidemic, despite a lack of solid evidence to demonstrate their causal role. While both may contribute to obesity, we call attention to their unquestioned dominance in program funding and public efforts to reduce obesity, and propose several alternative putative contributors that would benefit from equal consideration and attention. Evidence for microorganisms, epigenetics, increasing maternal age, greater fecundity among people with higher adiposity, assortative mating, sleep debt, endocrine disruptors, pharmaceutical iatrogenesis, reduction in variability of ambient temperatures, and intrauterine and intergenerational effects as contributing factors to the obesity epidemic are reviewed herein. While the evidence is strong for some contributors such as pharmaceutical-induced weight gain, it is still emerging for other reviewed factors. Considering the role of such putative etiological factors of obesity may lead to comprehensive, cause specific, and effective strategies for prevention and treatment of this global epidemic.
The association of sociodemographic and family composition data with obesity was studied in 1213 black and 1166 white girls, ages 9 and 10, enrolled in the National Heart, Lung, and Blood Institute's Growth and Health Study. Obesity was defined as body mass index at or greater than age- and sex-specific 85th percentile as outlined in the Second National Health and Nutrition Examination Survey. The prevalence of obesity was higher for pubertal girls than for prepubertal girls and for girls with older mothers/female guardians. As odds ratio of 1.14 was observed for each 5-year increase in maternal age. Obesity was less common for girls with more siblings; the odds for obesity decreased by 14% for each additional sibling in the household. In blacks, the prevalence of obesity was not related to parental employment or to parental education. In whites, the odds of obesity were higher for girls with no employed parent/guardian in the household and for girls with parents or guardians with lower levels of educational attainment. Examining the associations between sociodemographic factors and risk of childhood obesity provides important clues for understanding racial differences in obesity, a major risk factor for coronary heart disease.
To assess the acclimation of pigs to heat stress, the effects of high (33 degrees C) or thermoneutral (23 degrees C) constant temperatures on feeding behaviour and components of energy balance were studied in group-housed young pigs. Three groups of five pigs were used at each temperature. After 1 week of adaptation, voluntary feed intake (VFI) and heat production (HP) were recorded for thirteen consecutive days. Animals were fed ad libitum. Fasting HP was measured on the last day. Average initial body weights (BW) were 21.4 and 20.9 kg at 23 and 33 degrees C respectively. Feeding behaviour was measured individually and rate of feed intake and characteristics of feeding behaviour were calculated. The O(2) consumption, CO(2) production and physical activity of the group were used to calculate total HP (HP(tot)) and its components, i.e. fasting HP (HP(fas)), HP due to physical activity (HP(act)) and thermic effect of feed (TEF). The BW gain and VFI were reduced by 37 and 30 % respectively at 33 degrees C. The decrease in VFI corresponded to reduced consumption time (-34 %) and size of the meals (-32 %). Feeding behaviour was mostly diurnal (66 % of the VFI), and the rate of feed intake (28 g/min) was not affected by temperature. Daily HP(tot), HP(fas) and TEF, expressed per kg metabolic weight (BW(0.60)), were significantly decreased at 33 degrees C by 22, 18 and 35 % respectively, whereas HP(act) was not affected; TEF expressed per g feed was not affected (2 kJ/g). The decrease in HP(tot) at 33 degrees C was caused by a reduction in TEF and HP(fas) (kJ/d per/kg BW(0.60)), which are both related to reduction in VFI.
To determine the extent of the spousal resemblance for adiposity and leanness in the Canadian population.
Cross-sectional population survey.
The sample comprised parents and offspring from 1341 families (n=4023) of the Canada Fitness Survey. Indicators of adiposity included the body mass index (BMI) and the sum of five skinfolds (SF5). Both offspring and parents were ranked by their BMI and SF5 percentile position in the population using the entire Canada Fitness Survey database (n=15 818).
Pearson correlations indicated significant spousal resemblance for both BMI (r=0.14; P<0.0001) and SF5 (r=0.13; P<0.0001). However, the magnitude of the spousal correlations varied by the adiposity status of the offspring, with spousal correlations tending to be stronger in parents of lean or obese children and lower among parents of 'average' children. Bivariate histograms indicated that among lean (<or=5th percentile) and obese offspring (>or=95th percentile), the parental pairs tended to cluster among the lower and higher percentiles of adiposity, respectively.
There are spousal similarities in adiposity, particularly among parents of lean or obese offspring in the Canadian population. The degree to which these similarities are due to a loading of spouses with genes predisposing to obesity or a shared household environment cannot be determined from the present study. However, these results are compatible with the notion that genes and mutations predisposing to obesity are more prevalent among obese parents while those for pronounced leanness are more prevalent among lean parents.
Recently, the U.S. Surgeon General described two aspects of national health that require our immediate attention: As a nation, we are becoming increasingly more sedentary and more overweight. Furthermore, he and some of the most prominent health agencies have suggested that one of the primary strategies to overcome what is viewed as a national epidemic is the promotion of quality physical education in our schools. This paper describes in brief the facts associated with this concern, what is meant by quality physical education, and the role of the school nurse in helping to promote physical education in the schools.
Physical activity declines during adolescence, but the underlying reasons remain unknown.
We prospectively followed 1213 black girls and 1166 white girls enrolled in the National Heart, Lung, and Blood Institute Growth and Health Study from the ages of 9 or 10 to the ages of 18 or 19 years. We used a validated questionnaire to measure leisure-time physical activity on the basis of metabolic equivalents (MET) for reported activities and their frequency in MET-times per week; a higher score indicated greater activity.
The respective median activity scores for black girls and white girls were 27.3 and 30.8 MET-times per week at base line and declined to 0 and 11.0 by year 10 of the study (a 100 percent decline for black girls and a 64 percent decline for white girls, P<0.001). By the age of 16 or 17 years, 56 percent of the black girls and 31 percent of the white girls reported no habitual leisure-time activity. Lower levels of parental education were associated with greater decline in activity for white girls at both younger ages (P<0.001) and older ages (P=0.005); for black girls, this association was seen only at the older ages (P=0.04). Pregnancy was associated with decline in activity among black girls (P<0.001) but not among white girls, whereas cigarette smoking was associated with decline in activity among white girls (P<0.001). A higher body-mass index was associated with greater decline in activity among girls of both races (P< or =0.05).
Substantial declines in physical activity occur during adolescence in girls and are greater in black girls than in white girls. Some determinants of this decline, such as higher body-mass index, pregnancy, and smoking, may be modifiable.
The prevalence of overweight and obesity has increased markedly in the last 2 decades in the United States.
To update the US prevalence estimates of overweight in children and obesity in adults, using the most recent national data of height and weight measurements.
As part of the National Health and Nutrition Examination Survey (NHANES), a complex multistage probability sample of the US noninstitutionalized civilian population, both height and weight measurements were obtained from 4115 adults and 4018 children in 1999-2000 and from 4390 adults and 4258 children in 2001-2002.
Prevalence of overweight (body mass index [BMI] > or =95th percentile of the sex-specific BMI-for-age growth chart) among children and prevalence of overweight (BMI, 25.0-29.9), obesity (BMI > or =30.0), and extreme obesity (BMI > or =40.0) among adults by sex, age, and racial/ethnic group.
Between 1999-2000 and 2001-2002, there were no significant changes among adults in the prevalence of overweight or obesity (64.5% vs 65.7%), obesity (30.5% vs 30.6%), or extreme obesity (4.7% vs 5.1%), or among children aged 6 through 19 years in the prevalence of at risk for overweight or overweight (29.9% vs 31.5%) or overweight (15.0% vs 16.5%). Overall, among adults aged at least 20 years in 1999-2002, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese. Among children aged 6 through 19 years in 1999-2002, 31.0% were at risk for overweight or overweight and 16.0% were overweight. The NHANES results indicate continuing disparities by sex and between racial/ethnic groups in the prevalence of overweight and obesity.
There is no indication that the prevalence of obesity among adults and overweight among children is decreasing. The high levels of overweight among children and obesity among adults remain a major public health concern.
Total sleep deprivation in rodents and in humans has been associated with hyperphagia. Over the past 40 years, self-reported sleep duration in the United States has decreased by almost 2 hours.
To determine whether partial sleep curtailment, an increasingly prevalent behavior, alters appetite regulation.
Randomized, 2-period, 2-condition crossover clinical study.
Clinical Research Center, University of Chicago, Chicago, Illinois.
12 healthy men (mean age [+/-SD], 22 +/- 2 years; mean body mass index [+/-SD], 23.6 +/- 2.0 kg/m2).
Daytime profiles of plasma leptin and ghrelin levels and subjective ratings of hunger and appetite.
2 days of sleep restriction and 2 days of sleep extension under controlled conditions of caloric intake and physical activity.
Sleep restriction was associated with average reductions in the anorexigenic hormone leptin (decrease, 18%; P = 0.04), elevations in the orexigenic factor ghrelin (increase, 28%; P < 0.04), and increased hunger (increase, 24%; P < 0.01) and appetite (increase, 23%; P = 0.01), especially for calorie-dense foods with high carbohydrate content (increase, 33% to 45%; P = 0.02).
The study included only 12 young men and did not measure energy expenditure.
Short sleep duration in young, healthy men is associated with decreased leptin levels, increased ghrelin levels, and increased hunger and appetite.
Human adenovirus-36 (Ad-36) increases adiposity and paradoxically lowers serum cholesterol and triglycerides in chickens, mice, and non-human primates. The role of Ad-36 in human obesity is unknown.
To determine the prevalence of Ad-36 antibodies in obese and nonobese humans. To evaluate the association of Ad-36 antibodies with body mass index (BMI) and serum lipids.
Cohort study. Volunteers from obesity treatment programs, communities, and a research study.
Obese and nonobese volunteers at the University of Wisconsin, Madison, WI, and the Bowen Center, Naples, Florida. Obese and thin volunteer research subjects and 89 twin pairs at Columbia University, New York.
Study 1: 502 subjects; serum neutralization assay for antibodies to Ad-2, Ad-31, Ad-36, and Ad-37; serum cholesterol and triglycerides assays. Study 2: BMI and %body fat in 28 twin pairs discordant for Ad-36 antibodies.
Presence of antibodies to adenoviruses, BMI, serum cholesterol and triglycerides levels.
Significant (P < 0.001) association of obesity and positive Ad-36 antibody status, independent of age, sex, and collection site. Ad-36 antibodies in 30% of obese, 11% of nonobese. Lower serum cholesterol and triglycerides (P < 0.003) in Ad-36 antibody-positive vs -negative subjects. Twin pairs: antibody-positive twins had higher BMIs (24.5+/-5.2 vs 23.1+/-4.5 kg/m2, P < 0.03) and %body fat (29.6+/-9.5% vs 27.5+/-9.9%, P < 0.04). No association of Ad-2, Ad-31, or Ad-37 antibodies with BMI or serum lipids.
Ad-36 is associated with increased body weight and lower serum lipids in humans. Prospective studies are indicated to determine if Ad-36 plays a role in the etiology of human obesity.
To investigate plausible contributors to the obesity epidemic beyond the two most commonly suggested factors, reduced physical activity and food marketing practices.
A narrative review of data and published materials that provide evidence of the role of additional putative factors in contributing to the increasing prevalence of obesity.
Information was drawn from ecological and epidemiological studies of humans, animal studies and studies addressing physiological mechanisms, when available.
For at least 10 putative additional explanations for the increased prevalence of obesity over the recent decades, we found supportive (although not conclusive) evidence that in many cases is as compelling as the evidence for more commonly discussed putative explanations.
Undue attention has been devoted to reduced physical activity and food marketing practices as postulated causes for increases in the prevalence of obesity, leading to neglect of other plausible mechanisms and well-intentioned, but potentially ill-founded proposals for reducing obesity rates.
Human adenovirus 36 (Ad-36) increases adiposity and reduces serum lipids in chicken, mouse, and non-human primate models, and it is linked to obesity in sero-epidemiological studies in humans. Involvement of the central nervous system (CNS) or adipose tissue in the mechanism of Ad-36-induced adiposity is unknown. The effects of Ad-36 on adiposity and on the neuroendocrine system were investigated in a rat model.
Five-week-old male Wistar rats were inoculated intraperitoneally with Ad-36 or medium.
Despite similar food intakes, infected rats attained significantly greater body weight and fat pad weight by 30 weeks post-inoculation. Epididymal-inguinal, retroperitoneal, and visceral fat pad weights of the infected group were greater by 60%, 46%, and 86%, respectively (p < 0.00001). The fasting serum insulin level and homeostasis model assessment index indicated greater insulin sensitivity in the infected group. Visceral adipose tissue expression of glycerol 3-phosphate dehydrogenase, peroxisome proliferator-activated receptor gamma, and CCAAT/enhancer-binding protein alpha and beta was markedly increased in the infected animals compared with controls. Ad-36 decreased norepinephrine levels significantly in the paraventricular nucleus in infected vs. control rats (mean +/- standard error, 8.9 +/- 1.1 vs. 12.8 +/- 1.2 pg/microg protein; p < 0.05). Ad-36 markedly decreased serum corticosterone in infected vs. control rats (mean +/- standard error, 97 +/- 41.0 vs. 221 +/- 111 ng/mL; p < 0.005).
The results suggest that the pro-adipogenic effect of Ad-36 may involve peripheral as well as central effects. The male Wistar rat is a good model for the elucidation of metabolic and molecular mechanisms of Ad-36-induced adiposity.
Although we are just beginning to understand how environmental factors such as portion size affect eating behavior, the available data suggest that large portions of energy-dense foods are contributing to the obesity epidemic. Several possible strategies for adjusting portions to bring intake back in line with energy requirements are discussed. The continuing rise in the rates of obesity calls for urgent action.
The prevalence of obesity has increased substantially over the past 30 years. We performed a quantitative analysis of the nature and extent of the person-to-person spread of obesity as a possible factor contributing to the obesity epidemic.
We evaluated a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. The body-mass index was available for all subjects. We used longitudinal statistical models to examine whether weight gain in one person was associated with weight gain in his or her friends, siblings, spouse, and neighbors.
Discernible clusters of obese persons (body-mass index [the weight in kilograms divided by the square of the height in meters], > or =30) were present in the network at all time points, and the clusters extended to three degrees of separation. These clusters did not appear to be solely attributable to the selective formation of social ties among obese persons. A person's chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval. Among pairs of adult siblings, if one sibling became obese, the chance that the other would become obese increased by 40% (95% CI, 21 to 60). If one spouse became obese, the likelihood that the other spouse would become obese increased by 37% (95% CI, 7 to 73). These effects were not seen among neighbors in the immediate geographic location. Persons of the same sex had relatively greater influence on each other than those of the opposite sex. The spread of smoking cessation did not account for the spread of obesity in the network.
Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. These findings have implications for clinical and public health interventions.
Leptin levels were stable across the daytime period under both sleep conditions, which was consistent with the fact that calories were exclusively delivered in the form of a constant glucose infusion. Average total sleep time was 9 hours and 8 minutes when the men spent 10 hours in bed and 3 hours and 53 minutes when the men spent 4 hours in bed (P < 0.01). When spending 4 hours in bed, the participants had mean leptin levels that were 18% lower (2.1 ng/mL vs. 2.6 ng/mL; P = 0.04) (Figure 1, part A) and mean ghrelin levels that were 28% higher (3.3 ng/mL vs. 2.6 ng/mL; P = 0.04) (Figure 1, part B) than when the participants spent 10 hours in bed. The ratio of the concentrations of orexigenic ghrelin to anorexigenic leptin increased by 71% (CI, 7% to 135%) with 4 hours in bed compared with 10 hours in bed. Sleep restriction relative to sleep extension was associated with a 24% increase in hunger ratings on the 10-cm visual analogue scale (P < 0.01) and a 23% increase in appetite ratings for all food categories combined (P = 0.01) (Figure 1, parts C and D, and Table 1). The increase in appetite tended to be greatest for calorie-dense foods with high carbohydrate content (sweets, salty foods, and starchy foods: increase, 33% to 45%; P = 0.06) (Table 1). The increase in appetite for fruits and vegetables was less consistent and of lesser magnitude (increase, 17% to 21%) (Table 1). Appetite for protein-rich nutrients (meat, poultry, fish, eggs, and dairy foods) was not significantly affected by sleep duration (Table 1). When we considered the changes in ghrelin and leptin in an integrated fashion by calculating the ghrelin-to-leptin ratio, the increase in hunger was proportional to the increase in ghrelin-to-leptin ratio (r = 0.87) (Figure 2). Almost 70% of the variance in increased hunger could be accounted for by the increase in the ghrelin-to-leptin ratio.
The simultaneous increases in obesity in almost all countries seem to be driven mainly by changes in the global food system, which is producing more processed, affordable, and effectively marketed food than ever before. This passive overconsumption of energy leading to obesity is a predictable outcome of market economies predicated on consumption-based growth. The global food system drivers interact with local environmental factors to create a wide variation in obesity prevalence between populations. Within populations, the interactions between environmental and individual factors, including genetic makeup, explain variability in body size between individuals. However, even with this individual variation, the epidemic has predictable patterns in subpopulations. In low-income countries, obesity mostly affects middle-aged adults (especially women) from wealthy, urban environments; whereas in high-income countries it affects both sexes and all ages, but is disproportionately greater in disadvantaged groups. Unlike other major causes of preventable death and disability, such as tobacco use, injuries, and infectious diseases, there are no exemplar populations in which the obesity epidemic has been reversed by public health measures. This absence increases the urgency for evidence-creating policy action, with a priority on reduction of the supply-side drivers.
The major drivers of the obesity epidemic are much debated and have considerable policy importance for the population-wide prevention of obesity.
The objective was to determine the relative contributions of increased energy intake and reduced physical activity to the US obesity epidemic.
We predicted the changes in weight from the changes in estimated energy intakes in US children and adults between the 1970s and 2000s. The increased US food energy supply (adjusted for wastage and assumed to be proportional to energy intake) was apportioned to children and adults and inserted into equations that relate energy intake to body weight derived from doubly labeled water studies. The weight increases predicted from the equations were compared with weight increases measured in representative US surveys over the same period.
For children, the measured weight gain was 4.0 kg, and the predicted weight gain for the increased energy intake was identical at 4.0 kg. For adults, the measured weight gain was 8.6 kg, whereas the predicted weight gain was somewhat higher (10.8 kg).
Increased energy intake appears to be more than sufficient to explain weight gain in the US population. A reversal of the increase in energy intake of approximately 2000 kJ/d (500 kcal/d) for adults and of 1500 kJ/d (350 kcal/d) for children would be needed for a reversal to the mean body weights of the 1970s. Alternatively, large compensatory increases in physical activity (eg, 110-150 min of walking/d), or a combination of both, would achieve the same outcome. Population approaches to reducing obesity should emphasize a reduction in the drivers of increased energy intake.
While global prevalence of obesity continues to increase dramatically, treatment options remain less than optimal. The etiology of obesity is multifactorial, ranging from lifestyle choices such as excess food intake and insufficient physical activity, to use of medications that have weight gain as an undesirable side effect. Economic and political determinants of available foodstuffs and even social networks may also contribute to obesity. Successful management of obesity requires the understanding and acceptance of a new paradigm that identifies obesity as a disease--one defined by waist circumference--that requires treatment. Obesity meets all accepted criteria of a medical disease, including a known etiology, recognized signs and symptoms, and a range of structural and functional changes that culminate in pathologic consequences. Excess adipose tissue acts as an endocrine organ to produce excess free fatty acids, as well as tumor necrosis factor-alpha, interleukin-6, leptin, and plasminogen activator inhibitor-1. These bioactive molecules are associated with hyperinsulinemia, hyperglycemia, insulin resistance, development of diabetes, endothelial damage, and the onset and progression of atherosclerotic lesions. Options for treating obesity include lifestyle modifications (dietary changes, increased physical activity, behavior modification) and, for the morbidly obese, surgery. Lifestyle modification is rarely successful over the long term; therefore, addition of pharmacotherapy should be considered for obese individuals who have difficulty achieving and maintaining weight goals with lifestyle modifications alone. Several weight loss drugs are available for long-term use, with others in various stages of clinical development.
The prezygotic hypothesis considers the possibility that development is subject to environmental influences on the oocyte prior to conception. Such influences may occur in the maternal grandmother's uterus where oogenesis is completed or in the mother before fertilization. According to this hypothesis, the separate eggs from which DZ twins are derived may be sensitive to microenvironmental variations within an ovary. As a first approach, we examined same-sex MZ and DZ twins for maternal age effects on differences between pairs in cognitive and behavioral traits. While no differences between MZ and DZ pairs were found that would indicate a major effect of the prezygotic environment, suggestions are made for further experimental studies of this unexplored question in human development.
The prevalence of obesity has reached epidemic proportions in many countries around the world. However, the genetic and environmental factors contributing to obesity are incompletely understood.
We reviewed studies relating to the regulation of energy balance and how these factors may contribute to the development of obesity.
Although it is widely believed that genetics contribute significantly to the variability in body fatness, the available data do not support a role for defects in resting metabolic rate, substrate metabolism, dietary induced thermogenesis, or the energy cost of physical activity as significant causes of obesity. Furthermore, it is safe to say that the human genotype has not changed substantially over the past two to three decades. Data from several national surveys indicate that over the past few decades, there has been either a slight increase or a very modest decline in total energy and fat intake. This suggests that decreases in physical activity are a major contributing factor. Participation in leisure time physical activity is low but has remained relatively constant. However, an increased reliance on technology has substantially reduced work-related physical activity and the energy expenditure required for daily living.
The most likely environmental factor contributing to the current obesity epidemic is a continued decline in daily energy expenditure that has not been matched by an equivalent reduction in energy intake. Because daily energy expenditure is decreasing, it is difficult for most people to restrict intake to meet energy requirements, and more and more people are becoming obese. Thus, increasing physical activity may be the strategy of choice for public health efforts to prevent obesity.
Application of a new investigative strategy to assess genetic and environmental influences on relative body weight.
Covariance structure analysis of body mass index (BMI) using genetically informative samples.
One-hundred and fourteen monozygotic (MZ) twin pairs (age 5.04-22.93 y), 81 dizygotic (DZ) twin pairs (age 6.05-16.52 y), and 98 virtual twin (VT) pairs, ie same-age unrelated siblings (3.68-54.75 y).
Height, weight, BMI variously obtained by direct measurement and self-report.
In contrast with most previous studies, significant common environmental influence on BMI was observed.
Much past research may have underestimated common environmental effects on BMI because the designs lacked the power or ability to detect them.
Organochlorines are fat-soluble chemical compounds resistant to degradation, so they are stored in the adipose tissue of practically every organism on the planet, including humans. Accumulation of these compounds in the body seems to be related to fat mass, obese individuals having a higher plasma organochlorine concentration than lean subjects. During body weight loss, lipid mobilization and a decrease in fat mass result in increased concentrations of organochlorines in plasma and adipose tissue. Organochlorines may have adverse health effects. For example, they have been associated with altered immune and thyroid functions and with some types of cancer. As these compounds may reach their target organs whilst in the circulation, their increase in plasma during weight loss might be associated with some physiological changes occurring during weight loss. Relationships have indeed been reported among weight loss-induced increase in plasma organochlorine concentration and decreased triiodothyronine (T3) concentration, resting metabolic rate, and skeletal muscle markers for fat oxidation. Although further studies are needed to assess the causality of these relationships, they raise concern about some potential undesirable effects of weight loss. Indeed, the effects of organochlorines on energy balance could complicate body weight loss and even favour weight regain. These notions lend support for weight-loss strategies favouring a moderate weight loss, which would reduce risks for cardiovascular diseases, diabetes and hypertension, without resulting in a substantial release of organochlorines.
Although we are just beginning to understand how environmental factors such as portion size affect eating behavior, the available data suggest that large portions of energy-dense foods are contributing to the obesity epidemic. Several possible strategies for adjusting portions to bring intake back in line with energy requirements are discussed. The continuing rise in the rates of obesity calls for urgent action.
Overweight and obesity have become an urgent public health problem in the United States: approximately 61% of the adult population (97 million adults) are overweight or obese, where overweight is defined as a body mass index (BMI) >/= 25 and obesity is defined as a BMI >/= 30. Overweight and obesity increase the risk for developing many serious chronic diseases such as cardiovascular disease, type 2 diabetes, hypertension, dyslipidemia, and certain cancers. Increased morbidity due to obesity-related disorders begins within the normal weight range. Weight gain in adulthood per se, even in individuals who are normal weight, has deleterious health effects. Medications, particularly those commonly used in psychiatry and neurology, are a significant iatrogenic source of overweight and obesity. The weight gain potential of prescription medications should be considered in order to enhance patient compliance and reduce the risk of metabolic sequelae of weight gain. This article provides an overview of the weight-gain potential of several classes of drugs commonly used in psychiatric practice and considerations for clinicians in prescribing these medications.
Cigarette smoking is the single most important preventable cause of death and illness. Smoking cessation is associated with substantial health benefits. Weight gain is cited as a primary reason for not trying to quit smoking. There is a great variability in the amount of weight gain but younger ages, lower socio-economic status and heavier smoking are predictors of higher weight gain. Weight change after smoking cessation appears to be influenced by underlying genetic factors. Besides, weight gain after smoking cessation is largely because of increased body fat and some studies suggest that it mostly occurs in the subcutaneous region of the body. The mechanism of weight gain includes increased energy intake, decreased resting metabolic rate, decreased physical activity and increased lipoprotein lipase activity. Although there is convincing evidence for the association between smoking cessation and weight gain, the molecular mechanisms underlying this relationship are not well understood. This review summarizes current information of the effects of nicotine on peptides involved in feeding behaviour. Smoking was shown to impair glucose tolerance and insulin sensitivity and cross-sectional studies have demonstrated that smokers are insulin-resistant and hyperinsulinaemic, as compared with non-smokers. Smoking cessation seems to improve insulin sensitivity in spite of the weight gain. Nicotine replacement - in particular nicotine gum - appears to be effective in delaying post-cessation weight gain. In a group of women who failed to quit smoking because of weight gain, a dietary intervention (intermittent very-low-calorie diet) plus nicotine gum showed to both increase success rate in terms of smoking cessation and prevent weight gain. On the other hand, body weight gain at the end of treatment was significantly lower in the patients receiving bupropion or bupropion plus nicotine patch, compared with placebo. Studies with new drugs available for the treatment of obesity - sibutramine and orlistat - are warranted.
Sleep deprivation has been hypothesized to contribute toward obesity by decreasing leptin, increasing ghrelin, and compromising insulin sensitivity. This study examines cross-sectional and longitudinal data from a large United States sample to determine whether sleep duration is associated with obesity and weight gain.
Longitudinal analyses of the 1982-1984, 1987, and 1992 NHANES I Followup Studies and cross-sectional analysis of the 1982-1984 study.
Probability sample of the civilian noninstitutionalized population of the United States.
Sample sizes of 9,588 for the cross-sectional analyses, 8,073 for the 1987, and 6,981 for the 1992 longitudinal analyses.
Measured weight in 1982-1984 and self-reported weights in 1987 and 1992. Subjects between the ages of 32 and 49 years with self-reported sleep durations at baseline less than 7 hours had higher average body mass indexes and were more likely to be obese than subjects with sleep durations of 7 hours. Sleep durations over 7 hours were not consistently associated with either an increased or decreased likelihood of obesity in the cross-sectional and longitudinal results. Each additional hour of sleep at baseline was negatively associated with change in body mass index over the follow-up period, but this association was small and statistically insignificant.
These findings support the hypothesis that sleep duration is associated with obesity in a large longitudinally monitored United States sample. These observations support earlier experimental sleep studies and provide a basis for future studies on weight control interventions that increase the quantity and quality of sleep.
Cigarette smoking is the single most important preventable cause of death and illness. Smoking cessation is associated with substantial health benefits, but weight gain after smoking cessation is perceived to be a barrier against quitting smoking. The aim of the study was to analyse predictors of weight gain after smoking cessation. The sample included 1067 residents, aged 18-70 years, in a health district of Rome who answered to an anonymous postal questionnaire. Among them 482 were former smokers; 398 provided lifetime histories of both body weight and smoking and were considered in the analysis. 52.5% (49.3% M; 60.5% F) reported weight gain after smoking cessation; among these 25.4% reported a weight gain > or =5 kg. The multivariate logistic regression analysis showed a direct association between female gender (OR 1.9, CI 95% 1.1-3.2), age - 45 years (45-65 years: OR 2.5, CI 95% 1.4-4.4; > 64 years OR 2.1, CI 95% 1.0-4.0), number of cigarettes per day >20/day (OR 3.8, CI 95% 1.3-11.5) and weight gain after smoking cessation. The relevance of weight gain following smoking cessation suggests that health benefits associated with smoking cessation may to some extent be negated by the detrimental effects on health of associated weight gain. Smoking cessation programmes should therefore consider incorporating follow-up support to prevent weight gain; regular measurements of body weight together with dietary indications and increase of physical activity are basic factors to implement in the intervention of smoking cessation.
Prevalence and trends in obesity among US adults
- K M Flegal
- M D Carroll
- C L Ogden
- KM Flegal
Flegal KM, Carroll MD, Ogden CL et al. (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303(3):235– 241
Prevalence of overweight and obesity among US children, adolescents, and adults
- A A Hedley
- C L Ogden
- C L Johnson
- AA Hedley
Prevalence of regular physical activity among adults-United States
- Centers for Disease Control and Prevention