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Though the benefits of healthy lifestyle choices are well-established among the general population, less is known about how developing and adhering to healthy lifestyle habits benefits obese versus normal weight or overweight individuals. The purpose of this study was to determine the association between healthy lifestyle habits (eating 5 or more fruits and vegetables daily, exercising regularly, consuming alcohol in moderation, and not smoking) and mortality in a large, population-based sample stratified by body mass index (BMI). We examined the association between healthy lifestyle habits and mortality in a sample of 11,761 men and women from the National Health and Nutrition Examination Survey III; subjects were ages 21 and older and fell at various points along the BMI scale, from normal weight to obese. Subjects were enrolled between October 1988 and October 1994 and were followed for an average of 170 months. After multivariable adjustment for age, sex, race, education, and marital status, the hazard ratios (95% CIs) for all-cause mortality for individuals who adhered to 0, 1, 2, or 3 healthy habits were 3.27 (2.36-4.54), 2.59 (2.06-3.25), 1.74 (1.51-2.02), and 1.29 (1.09-1.53), respectively, relative to individuals who adhered to all 4 healthy habits. When stratified into normal weight, overweight, and obese groups, all groups benefited from the adoption of healthy habits, with the greatest benefit seen within the obese group. Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.
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... BMI is not useful in cardiovascular risk prediction when actual measurements of health, such as blood pressure, lipids, or history of diabetes are available [46]. Moreover, if people participate in healthy lifestyle habits, such as eating fruits and vegetables, exercising, consuming alcohol in moderation, and not smoking, BMI no longer is associated with increased mortality [47], demonstrating that BMI is simply one way of measuring a body and not an actual health indicator. Investigations in nonpregnant patients have found that adjustment for actual markers of metabolic dysfunction, such as CRP and fasting insulin, obviates the role of BMI in mortality prediction [48]. ...
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Purpose of Review Our goal is to describe the prevalence and harms of weight stigma and bias in obstetric care in order to challenge the current weight-centric model of care. Recent Findings Weight stigma and bias are commonly experienced by pregnant people when seeking medical care. Weight stigma has the potential to cause adverse pregnancy outcomes through allostatic load, avoidance of care to avoid stigma, and inequities in provision of care to people of higher weight. The BMI was not established as a measure of health and is not a strong predictor of adverse pregnancy outcomes, despite existing associations. Although there are many associations between higher BMI and adverse pregnancy outcomes, those associations have not accounted for the possible concurrent harms of weight stigma and weight cycling. Both weight loss recommendations and routine weighing in pregnancy care are not supported by evidence and warrant reconsideration. Summary We encourage people to take simple steps to decrease weight bias in their care of pregnant people and to reconsider the associations between BMI and adverse pregnancy outcomes.
... Some dietitians have moved towards NWFAs in light of studies showing that weight-loss interventions do not consistently yield sustainable, long-term weight changes or improved health [8,9]. They also recognize that NWFAs are associated with reduced morbidity regardless of weight loss or body mass index [10][11][12][13]. Finally, some consider NWFAs to be more client centred because they are believed to redress weight stigma [3,14]. ...
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Non-weight-focused approaches (NWFAs) may be used by some clinicians when working with higher-weight clients. In contrast to weight-focused approaches (WFAs), NWFAs de-emphasize or negate weight loss and emphasize overall diet quality and physical activity. The extent to which WFAs, NWFAs, or a combination of both WFAs and NWFAs are used by dietitians is unknown in Canada and globally. This study surveyed Canadian Registered Dietitians (RDs) who counsel higher-weight clients to assess which practice approaches are most commonly used, how they view the importance of weight, and how they define “obesity” for the study population. Five practice approaches were initially defined and used to inform the survey: solely weight-focused; moderately weight-focused; those who fluctuate between weight-focused/weight-inclusive approaches (e.g., used both approaches); weight inclusive and; weight liberated. Participants (n = 383; 94.8% women; 82.2% white) were recruited using social media and professional listservs. Overall, 45.4% of participants used NWFAs, 40.5% fluctuated between weight-focused/moderately weight-focused, and 14.1% used weight-focused approaches (solely weight focused and moderately weight focused). Many participants (63%) agreed that weight loss was not important for higher-weight clients. However, 81% of participants received no formal preparation in NWFAs during their education or training. More research is needed to understand NWFAs and to inform dietetic education in support of efforts to eliminate weight stigma and provide inclusive access to care.
... Several lines of evidence suggest that individuals with an elevated BMI might still be at lower ASCVD risk if they are metabolically healthy (insulin sensitive, normal blood pressure and lipid levels) and/or if they have healthy lifestyle habits (are physically active, do not smoke and eat a healthy diet). 4,5 However recent prospective studies have shown that individuals with an elevated BMI might be at higher ASCVD risk, even if they are metabolically healthy 6 or if they have healthy lifestyle habits 7 . This has led many investigators to conclude that regardless of their metabolic health and lifestyle habits, individuals with an elevated body weight should lose weight to reduce ASCVD risk, even in the absence of conclusive trial evidence showing that intentional weight loss is linked with a lower risk of cardiovascular outcomes and despite the fact that the BMI is not included in ASCVD risk prediction algorithms such as the Pooled Cohort Equations. ...
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Background: The impact of an elevated body mass index (BMI) on atherosclerotic cardiovascular diseases (ASCVD) risk in individuals who are "metabolically healthy" is debated. Our objective was to investigate the respective contributions of BMI as well as lifestyle and cardiometabolic risk factors combined to ASCVD incidence in 319,866 UK Biobank participants. . Methods: We developed a cardiovascular health score (CVHS) based on four lifestyle and six cardiometabolic parameters. The impact of the CVHS on incident ASCVD (15,699 events) alone and in BMI and waist-to-hip ratio categories was assessed using Cox proportional hazards in women and men separately. Results: In participants with a high CVHS (8-10), those with a BMI ≥35.0 kg/m2 had a nonsignificant higher ASCVD risk (HR=1.20 [95% CI, 0.84-1.70], p=0.32) compared to those with a BMI of 18.5-24.9 kg/m2. In participants with a BMI 18.5-24.9 kg/m2, those with a lower CVHS (0-2) had a higher ASCVD risk (HR=4.06 [95% CI, 3.23-5.10], p<0.001) compared to those with a higher CVHS (8-10). When we used the waist-to-hip ratio instead of the BMI, a dose-response relationship between the WHR and ASCVD risk was obtained in healthier participants. Results were similar in women compared to men. Conclusions: In participants of the UK Biobank, the relationship between the BMI and ASCVD incidence in healthy individuals was inconsistent whereas cardiovascular risk factors strongly predicted ASCVD incidence in all BMI categories. Weight inclusive interventions targeting lifestyle-related and metabolic risk factors are likely to prevent cardiovascular outcomes, regardless of their impact on body weight. Keywords: Body mass index, abdominal adiposity, obesity, cardiovascular disease, lifestyle, metabolic health, ideal cardiovascular health and genetics
... A unique characteristic of this study was the association of healthy habits and their protective factors on exercise behaviors. Previous research has shown that healthy habits (i.e., vegetable consumption, adequate exercise levels, etc.) were shown to have significant health benefits regardless of an individual's BMI [55,56]. Although small, the sample contained a wide range of ages and BMIs, and gender and race had adequate distribution across outcome categories. ...
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Introduction: The COVID-19 pandemic has affected our nation's health further than the infection it causes. Physical activity levels and dietary intake have suffered while individuals grapple with the changes in behavior to reduce viral transmission. With unique nuances regarding the access to physical activity and nutrition during the pandemic, the constructs of Health Belief Model (HBM) may present themselves differently in nutrition and exercise behaviors compared to precautions implemented to reduce viral transmission studied in previous research. The purpose of this study was to investigate the extent of exercise and nutritional behavior change during the COVID-19 pandemic and explain the reason for and extent of this change using HBM constructs (perceived susceptibility, severity, benefit of action, and barriers to action). Methods: This study used a cross-sectional design to collect 206 surveys. This survey collected information on self-reported exercise and nutrition changes during the pandemic and self-reported levels of the HBM constructs. Results: Findings showed individuals with medium or high exercise behavior change had greater odds of increased HBM score than individuals with little to no exercise behavior change (OR = 1.117, 95% CI: 1.020-1.223, SE: 0.0464, p = 0.0175). There was no association between nutritional behavior change and HBM score (OR = 1.011, 95% CI: 0.895-1.142, p = 08646). Conclusion: Individuals who reported a more drastic change in either exercise had greater odds of increased feelings of perceived susceptibility and severity related to COVID-19 and decreased perceived benefits and increased barriers to exercise. This relationship was not found regarding nutrition behavior change. These results encourage public health practitioners to understand how an individual's perceived feelings about a threat may affect exercise and nutritional behaviors.
... There were no differences in hazard ratios between BMI categories for those who reported all four positive habits. 55 Furthermore, in a systematic review and metaanalysis exploring the link between BMI and all-cause mortality, researchers analyzed hazard ratios of all-cause mortality relative to normal weight based on BMI (which was assigned a hazard ratio of 1.00). They found that people who are underweight are at higher risk of death (1.25-2.97) ...
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Current healthcare is weight‐centric, equating weight and health. This approach to healthcare has negative consequences on patient well‐being. The aim of this article is to make a case for a paradigm shift in how clinicians view and address body weight. In this review, we (1) address common flawed assumptions in the weight‐centric approach to healthcare, (2) review the weight science literature and provide evidence for the negative consequences of promoting dieting and weight loss, and (3) provide practice recommendations for weight‐inclusive care.
... 14-17 A longitudinal study following more than 11 000 participants suggests that an individual's lifespan increases with the adoption of each primary health behavior (eating 5 or more fruits and vegetables daily, exercising regularly, consuming alcohol in moderation, and not smoking). 18 Research has shown that including LM training in the medical school curriculum results in a greater likelihood of physicians engaging in personal healthpromoting behaviors and counseling patients regarding such behaviors. 19,20 Additionally, patients are more willing to engage in a healthful lifestyle when their physicians model these behaviors. ...
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Purpose: High-value care is becoming increasingly important as the United States shifts toward a more sustainable health care system. Lifestyle medicine (LM) may be the highest-value model of care. Surprisingly, however, it is taught in a minority of medical schools. In this article, we describe a pilot project of introducing a brief LM course taught within the Mayo Clinic Alix School of Medicine in Arizona. The main purpose of the course was to introduce the students to LM as a specialty practice and to provide students with foundational knowledge of the pillars of LM. Results: Students reported improved personal health habits and increased confidence in LM competencies.
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Introduction Intuitive eating interventions aim to improve individual health and promote sustainable changes to one's relationship with food. However, there is no evidence-based consensus on the impact of intuitive eating interventions on diet quality. This systematic review aimed to investigate intuitive eating interventions and their impact on diet quality. Method PubMed, Embase, CINAHL, PsycInfo, and Cochrane databases were systematically searched to October 2021 for studies reporting interventions that encompassed the principles of intuitive eating and measured diet quality. Other health outcomes were used for secondary analysis. Findings were synthesized narratively. Results Seventeen papers reporting 14 intervention studies (n = 3,960) were included in the review. All studies found a positive or neutral effect on diet quality following an intuitive eating intervention. A favorable change in eating behavior following these interventions was also observed. Discussion Intuitive eating promotes an attunement to the body, which aids in improving diet quality because of increased awareness of physiological cues. The reduction of emotional and binge eating may also increase diet quality. Implications for Research and Practice Findings from the current review suggest that intuitive eating interventions are most effective face-to-face, in a group setting, and sustained for at least 3 months.
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Introduction: Occupational therapists are key members of the multidisciplinary team and regularly work with people of higher weight across age groups and practice settings. There is limited existing research regarding the occupational therapy role with this client group. The aim of this study was to explore occupational therapy practice and barriers to service provision for Australian occupational therapists working with clients of higher weight. Methods: A cross-sectional study design using a self-administered online survey was distributed to members of the national occupational therapy professional association. The survey was designed to identify common assessments and interventions used with clients of higher weight and explore occupational therapists' perspectives on their knowledge and confidence and the barriers to service delivery. Descriptive statistics were used to summarise rating scales, and open-ended responses were analysed using thematic analysis. Results: Eighty Australian occupational therapists working in a range of settings and with varied experience levels participated in the study. Participants described the most common areas of occupational therapy assessment and intervention when working with clients of higher weight to be self-care, equipment prescription, home modifications and pressure care. Respondents were least confident in interventions related to psychosocial, leisure and employment interventions. Barriers to service delivery included accessibility and cost of equipment, lack of training and weight stigma. Conclusion: Occupational therapy practice promotes and enables participation in everyday occupations with people of higher weight. This study highlights not only the occupational therapy skills and unique approach to the person, their environment and occupations but also the challenges faced by occupational therapists when working with people of higher weight. Occupational therapists could consider utilising the weight-inclusive paradigm to broaden their contribution from self-care to other important aspects of participation and well-being.
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A systematic review and meta-analysis was conducted to evaluate evidence-based strategies for increasing the delivery of smoking cessation treatments in primary care clinics. The review included studies published before January 1, 2009. The pooled odds-ratio (OR) was calculated for intervention group versus control group for practitioner performance for "5As" (Ask, Advise, Assess, Assist and Arrange) delivery and smoking abstinence. Multi-component interventions were defined as interventions which combined two or more intervention strategies. Thirty-seven trials met eligibility criteria. Evidence from multiple large-scale trials was found to support the efficacy of multi-component interventions in increasing "5As" delivery. The pooled OR for multi-component interventions compared to control was 1.79 [95% CI 1.6-2.1] for "ask", 1.6 [95% CI 1.4-1.8] for "advice", 9.3 [95% CI 6.8-12.8] for "assist" (quit date) and 3.5 [95% CI 2.8-4.2] for "assist" (prescribe medications). Evidence was also found to support the value of practice-level interventions in increasing 5As delivery. Adjunct counseling [OR 1.7; 95% CI 1.5-2.0] and multi-component interventions [OR 2.2; 95% CI 1.7-2.8] were found to significantly increase smoking abstinence. Multi-component interventions improve smoking outcomes in primary care settings. Future trials should attempt to isolate which components of multi-component interventions are required to optimize cost-effectiveness.
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Background: Exercise is widely promoted as a method of weight management, while the other health benefits are often ignored. The purpose of this study was to examine whether exercise-induced improvements in health are influenced by changes in body weight. Methods: Fifty-eight sedentary overweight/obese men and women (BMI 31.8 (SD 4.5) kg/m2) participated in a 12-week supervised aerobic exercise intervention (70% heart rate max, five times a week, 500 kcal per session). Body composition, anthropometric parameters, aerobic capacity, blood pressure and acute psychological response to exercise were measured at weeks 0 and 12. Results: The mean reduction in body weight was −3.3 (3.63) kg (p<0.01). However, 26 of the 58 participants failed to attain the predicted weight loss estimated from individuals’ exercise-induced energy expenditure. Their mean weight loss was only −0.9 (1.8) kg (p<0.01). Despite attaining a lower-than-predicted weight reduction, these individuals experienced significant increases in aerobic capacity (6.3 (6.0) ml/kg/min; p<0.01), and a decreased systolic (−6.00 (11.5) mm Hg; p<0.05) and diastolic blood pressure (−3.9 (5.8) mm Hg; p<0.01), waist circumference (−3.7 (2.7) cm; p<0.01) and resting heart rate (−4.8 (8.9) bpm, p<0.001). In addition, these individuals experienced an acute exercise-induced increase in positive mood. Conclusions: These data demonstrate that significant and meaningful health benefits can be achieved even in the presence of lower-than-expected exercise-induced weight loss. A less successful reduction in body weight does not undermine the beneficial effects of aerobic exercise. From a public health perspective, exercise should be encouraged and the emphasis on weight loss reduced.
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There is a general perception that almost no one succeeds in long-term maintenance of weight loss. However, research has shown that approximately 20% of overweight individuals are successful at long-term weight loss when defined as losing at least 10% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss. National Weight Control Registry members have lost an average of 33 kg and maintained the loss for more than 5 y. To maintain their weight loss, members report engaging in high levels of physical activity ( approximately 1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends. Moreover, weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2-5 y, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. National Weight Control Registry members provide evidence that long-term weight loss maintenance is possible and help identify the specific approaches associated with long-term success.
Article
Context The increase in sedentary lifestyle may contribute to the rise in obesity nationally. Although guidelines suggest that physicians counsel all patients about exercise, physicians counsel only a minority of their patients. Whether patient factors influence physician counseling is not well established.Objectives To examine and to identify factors associated with exercise counseling by US physicians.Design and Setting National population-based supplemental (Year 2000) survey to the 1995 National Health Interview Survey.Participants Of the 17,317 respondents to the Year 2000 supplemental survey, 9711 adults had seen a physician in the previous year, and 9299 responded when asked about physician counseling on exercise.Main Outcome Measure Physician counseling to begin or to continue to exercise.Results Of 9299 respondents, 34% reported being counseled about exercise at their last visit. After adjustment for other sociodemographic and clinical factors, women were slightly more likely to be counseled, with an adjusted odds ratio (AOR) of 1.15 (95% confidence interval [CI], 1.02-1.29). Physicians counseled older patients (>30 years) more often than younger patients; those aged 40 to 49 years were counseled most often (AOR, 1.71 [95% CI, 1.34-2.20]). Patients with incomes above $50,000, those with higher levels of physical activity, college graduates, and patients who were overweight to obese (body mass index: 25 to ≥30 kg/m2) were more likely to be counseled, as were patients with cardiac disease (AOR, 1.81 [95% CI, 1.52-2.14]) and diabetes (AOR, 1.87 [95% CI, 1.46-2.38]). Counseling did not vary by physician specialty or patient race.Conclusion The rate of physician counseling about exercise is low nationally. Physicians appear to counsel as secondary prevention and are less likely to counsel patients at risk for obesity. The failure to counsel younger, disease-free adults and those from lower socioeconomic groups may represent important missed opportunities for primary prevention.
Article
About 97 million adults in the United States are overweight or obese. Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality. The aim of this guideline is to provide useful advice on how to achieve weight reduction and maintenance of a lower body weight. It is also important to note that prevention of further weight gain can be a goal for some patients. Obesity is a chronic disease, and both the patient and the practitioner need to understand that successful treatment requires a life-long effort. Assessment of Weight and Body Fat Two measures important for assessing overweight and total body fat content are; determining body mass index (BMI) and measuring waist circumference. 1. Body Mass Index: The BMI, which describes relative weight for height, is significantly correlated with total body fat content. The BMI should be used to assess overweight and obesity and to monitor changes in body weight. Measurements of body weight alone can be used to determine efficacy of weight loss therapy. BMI is calculated as weight (kg)/height squared (m 2). To estimate BMI using pounds and inches, use: [weight (pounds)/height (inches) 2 ] x 703. Weight classifications by BMI, selected for use in this report, are shown in the table below. • Pregnant women who, on the basis of their pre-pregnant weight, would be classified as obese may encounter certain obstetrical risks. However, the inappropriateness of weight reduction during pregnancy is well recognized (Thomas, 1995). Hence, this guideline specifically excludes pregnant women. Source (adapted from): Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity. WHO, Geneva, June 1997.