Abstract: It has been suggested that a significant proportion of overweight and obese individuals underestimate their weight status and think of themselves as being a healthier weight status than they are. The present study examines the prevalence of weight status misperceptions in a recent sample of UK adults, and tests whether the use of self-reported BMI biases estimation of weight status misperceptions. Data came from UK adults who took part in the 2013 Health Survey for England. We examined the proportion of overweight vs. normal weight (categorised using self-reported vs. measured BMI) males and females who perceived their weight as being ‘about right’, as well as how common this perception was among individuals whose waist circumference (WC) placed them at increased risk of ill health. A large proportion of overweight (according to measured BMI) women (31 %) and men (55 %) perceived their weight as being ‘about right’ and over half of participants with a WC that placed them at increased risk of future ill health believed their weight was ‘about right’. The use of self-reported (vs. measured) BMI resulted in underestimation of the proportion of overweight individuals who identified their weight as ‘about right’ and overestimation of the number of normal weight individuals believing their weight was ‘too heavy’. A large proportion of UK adults who are overweight misperceive their weight status. The use of self-reported BMI data is likely to produce biased estimates of weight status misperceptions. The use of objectively measured BMI is preferable as it will provide more accurate estimates of weight misperception.

Abstract: Weight change in first year university students, often referred to as ‘Freshman 15’, has been shown to be a common problem in North America. Studies have reported weight gain to be between 1 kg and 4 kg over the academic year and a recent meta-analysis found a mean gain of 1.34 kg and that 61 % of students gained weight. A limited number of studies have investigated weight change in England and large scale studies are needed to understand better weight change trends and to conduct subgroup analyses. This is important in the context of rising obesity prevalence, especially as behaviours and unhealthy weight in early adulthood often remains over the lifetime. We recruited students across 23 universities in England to complete a web-based survey at three time points in 2014–2015: beginning of academic year, December, end of academic year. Students were asked to self-report height and weight. We calculated weight change of each student between time points and conducted t-tests and pared analysis of variance to investigate the effect of time, sex and initial BMI. We also investigated weight change amongst weight gainers and in weight losers separately. We followed 215 students over three time points and found a mean weight change of 0.98 kg (95%CI 0.49–1.47) over a mean length of 34 weeks of follow-up. The weight change rate was not significantly different over different terms. Over 51 % of the sample gained more than 0.5 kg by the end of the academic year, with a mean gain of 3.46 kg. Female weight gainers had a significantly lower baseline weight than non-weight gaining females. Twenty-five percent of the sample lost more than 0.5 kg with a mean of −3.21 kg. Within weight losers, males lost significantly more weight than females. Our findings reinforce that the first year of university is a crucial time in the life of students during which the majority tend to gain weight. However, we also found that 25 % lost weight, indicating that 75 % of students undergo a meaningful weight change in their first year. Universities must recognise their role in promoting healthy weight maintenance.

Abstract: Errors in reported height and weight raise concerns about body mass index (BMI) and obesity estimates obtained from self or proxy reports. Researchers have corrected BMI using linear statistical models, primarily with adult samples. We compared the accuracy of BMI correction in children for models that included child or parent reports versus both reports, and models that separately predicted height and weight compared to a single model for BMI. Height and weight from child reports, parent reports, and objective measurements for 475 children participating in the Military Teenagers’ Environment, Exercise and Nutrition Study were analyzed. Two approaches were evaluated: (1) separate linear correction models for height and weight versus (2) a single linear correction model for BMI. Each approach considered models for height, weight, or BMI with child reports, parent reports, or both reports, respectively, as predictors, stratified by gender. Prediction accuracy was computed using leave-one-out validation. Models were compared using root mean squared error for BMI, and sensitivity and specificity for overweight and obesity indicators. Models that included both reports provided the best fit relative to a model using either set of reports, with adjusted R2 of height, weight, and BMI models ranging from 67.1 to 87.6 % in males, and 69.2 to 88.3 % in females. Estimates of BMI from separate models for height and weight had the least prediction error, relative to those derived from a single model for BMI or from uncorrected (child or parent) reports. Cross-validated Root Mean Squared Error (RMSEs) preferred a model that included only parent reports among males and females, compared to models with only child reports or both reports. When assessing sensitivity (true positive) for obesity and overweight/obesity, the results varied by gender and outcomes. Specificity (true negative) was similarly high for all models. Objective measurements are more accurate than self- or proxy-reports of BMI. In situations where objective measurement is infeasible, an approach that combines collecting a validation sub-sample including multiple reports of children’s height and weight, with estimation of BMI correction models maybe a cost-effective and practical solution. Correction models generate BMI estimates that are closer to objective measurements than reports.

Abstract: Short sleep has been linked to obesity. However, sleep is a multidimensional behavior that cannot be characterized solely by sleep duration. There is limited study that comprehensively examined different sleep characteristics in relation to obesity. We examined various aspects of sleep in relation to adiposity in 2005–2006 NHANES participants who were 18 or older and free of cardiovascular disease, cancer, emphysema, chronic bronchitis and depression (N = 3995). Sleep characteristics were self-reported, and included duration, overall quality, onset latency, fragmentation, daytime sleepiness, snoring, and sleep disorders. Body measurements included weight, height, waist circumference, and dual-energy X-ray absorptiometry measured fat mass. Snoring was associated with higher BMI (adjusted difference in kg/m2 comparing snoring for 5+ nights/week with no snoring (95 % confidence interval), 1.85 (0.88, 2.83)), larger waist circumference (cm, 4.52 (2.29, 6.75)), higher percentage of body fat (%, 1.61 (0.84, 2.38)), and higher android/gynoid ratio (0.03 (0.01, 0.06)). The associations were independent of sleep duration and sleep quality, and cannot be explained by the existence of sleep disorders such as sleep apnea. Poor sleep quality (two or more problematic sleep conditions) and short sleep duration (<6 h) were also associated with higher measures of body size and fat composition, although the effects were attenuated after snoring was adjusted. In a nationally representative sample of healthy US adults, snoring, short sleep, and poor sleep quality were associated with higher adiposity.

Abstract: As a result of both genetic and environmental factors, the body composition and topography of African populations are presumed to be different from western populations. Accordingly, globally accepted anthropometric markers may perform differently in African populations. In the era of rapid emergence of cardio-vascular diseases in sub-Saharan Africa, evidence about the performance of these markers in African settings is essential. The aim of this study was to investigate the inter-relationships among the four main anthropometric indices in measuring overweight and obesity in an urban poor African setting. Data from a cardiovascular disease risk factor assessment study in urban slums of Nairobi were analyzed. In the major study, data were collected from 5190 study participants. We considered four anthropometric markers of overweight and obesity: Body Mass Index, Waist Circumference, Waist to Hip Ratio, and Waist to Height Ratio. Pairwise correlations and kappa statistics were used to assess the relationship and agreement among these markers, respectively. Discordances between the indices were also analyzed. The weighted prevalence of above normal body composition was 21.6 % by body mass index, 28.9 % by waist circumference, 45.5 % by waist to hip ratio, and 38.9 % by waist to height ratio. The overall inter-index correlation was +0.44. Waist to hip ratio generally had lower correlation with the other anthropometric indices. High level of discordance exists between body mass index and waist to hip ratio. Combining the four indices shows that 791 (16.1 %) respondents had above normal body composition in all four indices. Waist circumference better predicted hypertension and hyperglycemia while waist to height ratio better predicted hypercholesterolemia. There exists a moderate level of correlation and a remarkable level of discordance among the four anthropometric indices with regard to the ascertainment of abnormal body composition in an urban slum setting in Africa. Waist circumference is a better predictor of cardio-metabolic risk.

Abstract: To date research examining the benefits of menu labelling in the UK is sparse. The aim of the present study was to examine the impact of menu labelling in a UK obese population. Using a repeated measures design, 61 patients at a tier 3 weight management service completed four questionnaires to assess their food choice (control) and behaviour change when presented with 3 menu labelling formats (calorie content; nutrient content; and energy expenditure). All three forms of labelling increased participants weight control concerns compared to the control condition. There was a significant difference in content of food ordered in the three menu labelling formats compared to the control condition. The calorie condition had the largest percentage decrease in calories selected followed by energy expenditure and nutrient content. However, no difference was observed between the three conditions in the desire for menu labelling in restaurants to be introduced in the UK. The findings suggest that menu labelling should be enforced in the UK as it is both beneficial to promoting healthy eating and in demand. This study is the first to examine menu labelling in a UK obese population using energy expenditure equivalents to provide nutritional information.

Abstract: In Switzerland, as in other developed countries, the prevalence of overweight and obesity has increased substantially since the early 1990s. Most of the analyses so far have been based on sporadic surveys or self-reported data and did not offer potential for small-area analyses. The goal of this study was to investigate spatial variation and determinants of obesity among young Swiss men using recent conscription data. A complete, anonymized dataset of conscription records for the 2010–2012 period were provided by Swiss Armed Forces. We used a series of Bayesian hierarchical logistic regression models to investigate the spatial pattern of obesity across 3,187 postcodes, varying them by type of random effects (spatially unstructured and structured), level of adjustment by individual (age and professional status) and area-based [urbanicity and index of socio-economic position (SEP)] characteristics. The analysed dataset consisted of 100,919 conscripts, out of which 5,892 (5.8 %) were obese. Crude obesity prevalence increased with age among conscripts of lower individual and area-based SEP and varied greatly over postcodes. Best model’s estimates of adjusted odds ratios of obesity on postcode level ranged from 0.61 to 1.93 and showed a strong spatial pattern of obesity risk across the country. Odds ratios above 1 concentrated in central and north Switzerland. Smaller pockets of elevated obesity risk also emerged around cities of Geneva, Fribourg and Lausanne. Lower estimates were observed in North-East and East as well as south of the Alps. Importantly, small regional outliers were observed and patterning did not follow administrative boundaries. Similarly as with crude obesity prevalence, the best fitting model confirmed increasing risk of obesity with age and among conscripts of lower professional status. The risk decreased with higher area-based SEP and, to a lesser degree – in rural areas. In Switzerland, there is a substantial spatial variation in obesity risk among young Swiss men. Small-area estimates of obesity risk derived from conscripts records contribute to its understanding and could be used to design further studies and interventions.

Abstract: Obesity has long been highlighted for its association with increased incidence of cardiovascular disease (CVD). Nonetheless, the best adiposity indices to evaluate the CVD risk factors remain contentious and few studies have been performed in Asian populations. In the present study, we compared the association strength of percent body fat (PBF) to indirect anthropometric measures of general adiposity (body mass index (BMI) and body adiposity index (BAI)) and central adiposity (waist circumference (WC), and waist-to-hip ratio (WHR)) for the prediction of CVD risk factors in healthy men and women living in Singapore. A total of 125 individuals (63 men and 62 women) took part in this study. PBF was measured by using three different techniques, including bioelectrical impedance analysis (BIA), BOD POD, and dual-energy X-ray absorptiometry (DEXA). Anthropometric measurements (WC, hip circumference (HC), height, and weight), fasting blood glucose (FBG), fasting serum insulin (FSI), and lipid profiles were determined according to standard protocols. Correlations of anthropometric measurements and PBF with CVD risk factors were compared. Irrespective of the measuring techniques, PBF showed strong positive correlations with FSI, HOMA-IR, TC/HDL, TG/HDL, and LDL/HDL in both genders. While PBF was highly correlated with FBG, SBP, and DBP in females, no significant relationships were observed in males. Amongst the five anthropometric measures of adiposity, BAI was the best predictor for CVD risk factors in female participants (r = 0.593 for HOMA-IR, r = 0.542 for TG/HDL, r = 0.474 for SBP, and r = 0.448 for DBP). For males, the combination of WC (r = 0.629 for HOMA-IR, and r = 0.446 for TG/HDL) and WHR (r = 0.352 for SBP, and r = 0.366 for DBP) had the best correlation with CVD risk factors. Measurement of PBF does not outperform the simple anthropometric measurements of obesity, i.e. BAI, WC, and WHR, in the prediction of CVD risk factors in healthy Asian adults. While measures of central adiposity (WC and WHR) tend to show stronger associations with CVD risk factors in males, measures of general adiposity (BAI) seems to be the best predictor in females. The gender differences in the association between adiposity indices and CVD risk factors may relate to different body fat distribution in males and females living in Singapore. These results may find further clinical utility to identify patients with CVD risk factors in a more efficient way.

Abstract: Weight management education is one of the key strategies to assist patients to manage their weight. Educational resources provide an important adjunct in the chain of communication between practitioners and patients. However, one in five Australian adults has low health literacy. The purpose of this study was to assess the readability and analyse the content of weight management resources. This study is based on the analysis of 23 resources found in the waiting rooms of ten Sydney-based general practices and downloaded from two clinical software packages used at these practices. The reading grade level of these resources was calculated using the Flesch Reading Ease, Flesch-Kincaid Grade Level, Fry Readability Graph, and the Simplified Measure of Gobbledygook. Resources’ content was analysed for the presence of dietary, physical activity, and behaviour change elements, as recommended by the Clinical practice guidelines for the management of overweight and obesity in adults, adolescents, and children in Australia. The resources’ average reading grade level was for a 10th grader (9.5 ± 1.8). These findings highlight that the average reading grade level was two grades higher than the recommended reading grade level for health education resources of 8th grade level or below. Seventy percent of resources contained dietary and behaviour change elements. Physical activity was included in half of the resources. Two messages were identified to be inconsistent with the guidelines and three messages had no scientific basis. A body of evidence now exists that supports the need to develop evidence-based education resources for weight management that place low demand on literacy, without compromising content accuracy. The findings from this study suggest that there is significant room for improvement in the educational resources provided in general practices.

Abstract: Ankle-brachial index (ABI) and indices of obesity are both use to indicate cardiovascular risk However, association between body composition indices and ABI, a measure of peripheral arterial disease, is inconsistent in various study reports In this study, we investigated the relationship between ABI and general and central indices of obesity in Ghanaians without history of cardiovascular diseases In a case–control design, ABI was measured in a total of 623 subjects and categorised into PAD (ABI ≤ 09, n = 261) and non-PAD (ABI > 09, n = 362) groups Anthropometric indices, BMI, waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) were also measured PAD subjects had higher mean BMI (298 ± 87 vs 265 ± 76 kg/m2, p = 0043) and waist circumference (95 ± 15 vs 92 ± 24 cm, p = 0034) than non-PAD subjects In multivariable logistic regression models, having BMI ≥ 30 kg/m2 increased the odds of both unilateral [OR (95 % CI): 2 (114–351), p < 001] and overall PAD [2 (122–327), p < 001] In indigenous Ghanaians in our study, PAD participants had higher BMI and waist circumference than non-PAD participants Also, halving BMI ≥ 30 kg/m2 was associated with twofold increase in the odds of PAD

Abstract: The metabolic syndrome is a worldwide health issue, with non-alcoholic fatty liver disease (liver steatosis) being one of its features, particularly closely related to insulin resistance. This study aims to investigate whether quantification of hepatic steatosis by abdominal ultrasonography, using hepatorenal index, is a feasible tool for the prediction of insulin resistance, and thus the metabolic syndrome. Patients were recruited from the Centre of Obesity at the University Hospital of North Norway, and among participants from the Sixth Tromso Study. Homeostasis Model Assessment of Insulin Resistance (HOMA1-IR) was measured, body mass index (BMI, kg/m2) calculated, and hepatorenal index (HRI), i.e. the ratio of liver to kidney optical densities, was measured by transabdominal ultrasonography. Receiver operating characteristic (ROC) analyses were performed, detecting insulin resistance at HOMA1-IR cut-off values >2.3 and >2.5. Ninety participants were included in the study, of which 46 (51 %) had BMI ≥30 and 27 (30 %) had BMI ≥35. Overall, HRI at level 1.17 had sensitivity 0.90 and specificity 0.70 for predicting insulin resistance (HOMA1-IR >2.3) in all participants. For participants with BMI ≥30, HRI at level 1.17 had sensitivity 0.94 and specificity 0.70, and for BMI ≥35, HRI at level 1.17 had sensitivity 0.93 and specificity 0.75 for predicting HOMA1-IR >2.3. Setting the HRI limit at 1.42 gave low sensitivities and high specificities in all BMI groups. In the analysis predicting HOMA1-IR >2.5, sensitivity values were almost the same as in the analysis predicting HOMA1-IR >2.3, but specificity values were lower in this analysis. Detection and quantification of hepatic steatosis by ultrasound and the hepatorenal index is a feasible screening tool for identifying patients with low risk of having insulin resistance (IR, HRI <1.17), patients at risk of having IR (HRI 1.17-1.41) and patients with likely IR (HRI ≥1.42), especially in obese individuals.

Abstract: Obesity is a risk factor for inadequate receipt of recommended preventive care services. The objective of this study was to assess the relationship between increasing body mass index and receipt of influenza and pneumococcal vaccinations. A systematic review of the PubMed, Embase, and Web of Science databases was conducted from January 1966 to May 2015 for cohort and cross-sectional studies that assessed the relationship between body mass index and the receipt of vaccinations for influenza and pneumococcus. Separate meta-analyses by obesity classification were performed using a random effects model. Six cross-sectional and three cohort studies were included. Average vaccine uptake was 50.4 % for influenza vaccination and 34.6 % for pneumococcal vaccination. Compared to normal weight patients, combined odds ratio (95 % confidence interval) for influenza vaccination was 1.11 (95 % CI 0.97–1.25) for obese (≥30 kg/m2) patients. When the outcome was reported by obesity class, combined odds ratios of influenza vaccination were 1.13 (95 % CI 1.02–1.24) for Class I (30–34.9 kg/m2) obesity, 1.21 (95 % CI 1.05–1.37) for Class II obesity (35–39.9 kg/m2), and 1.19 (95 % CI 0.95–1.42) for Class III obesity (≥40 kg/m2) patients. Compared to normal weight patients, combined odds ratio of pneumococcal vaccination were 1.20 (95 % CI 1.13–1.27) for obese patients. When the outcome was reported by obesity class, combined odds ratios were 1.08 (95 % CI 1.04–1.13) for Class I obesity patients, 1.13 (95 % CI 1.10–1.16) for Class II obesity patients, and 1.26 (95 % CI 1.15–1.38) for Class III obesity patients for pneumococcal vaccination. Combined findings from the current literature suggest that adults with obesity are more likely than non-obese peers to receive vaccination for influenza and pneumococcus. However, suboptimal vaccination coverage was observed across all body sizes, so future interventions should focus on improving vaccination rates for all adults.

Abstract: Obesity-related comorbidities are thought to result from the reprogramming of the epigenome in numerous tissues and cell types, and in particular, mature adipocytes within visceral and subcutaneous adipose tissue, VAT and SAT. The cell-type specific chromatin remodeling of mature adipocytes within VAT and SAT is poorly understood, in part, because of the difficulties of isolating and manipulating large fragile mature adipocyte cells from adipose tissues. We constructed MA-INTACT (Mature Adipocyte-Isolation of Nuclei TAgged in specific Cell Types) mice using the adiponectin (ADIPOQ) promoter (ADNp) to tag the surface of mature adipocyte nuclei with a reporter protein. The SUN1mRFP1Flag reporter is comprised of a fragment of the nuclear transmembrane protein SUN1, the fluorescent protein mRFP1, and three copies of the Flag epitope tag. Mature adipocyte nuclei were rapidly and efficiently immuno-captured from VAT and SAT (MVA and MSA nuclei, respectively), of MA-INTACT mice. MVA and MSA nuclei contained 1,000 to 10,000-fold higher levels of adipocyte-specific transcripts, ADIPOQ, PPARg2, EDNRB, and LEP, relative to uncaptured nuclei, while the latter expressed higher levels of leukocyte and endothelial cell markers IKZF1, RETN, SERPINF1, SERPINE1, ILF3, and TNFA. MVA and MSA nuclei differentially expressed several factors linked to adipogenesis or obesity-related health risks including CEBPA, KLF2, RETN, SERPINE1, and TNFA. The various nuclear populations dramatically differentially expressed transcripts encoding chromatin remodeler proteins regulating DNA cytosine methylation and hydroxymethylation (TETs, DNMTs, TDG, GADD45s) and nucleosomal histone modification (ARID1A, KAT2B, KDM4A, PRMT1, PRMT5, PAXIP1). Remarkably, MSA and MVA nuclei expressed 200 to 1000-fold higher levels of thermogenic marker transcripts PRDM16 and UCP1. The MA-INTACT mouse enables a simple way to perform cell-type specific analysis of highly purified mature adipocyte nuclei from VAT and SAT and increases the statistical significance of data collected on adipocytes. Isolated VAT and SAT adipocyte nuclei expressed distinct patterns of transcripts encoding chromatin remodeling factors and proteins relevant to diabetes, cardiovascular disease, and thermogenesis. The MA-INTACT mouse is an useful model to test the impact of caloric intake, dietary nutrients, exercise, and pharmaceuticals on the epigenome-induced health risks of obesity.

Abstract: Maternal obesity is accompanied by maternal and fetal complications during and after pregnancy The risks seem to increase with degree of obesity Leptin has been suggested to play a role in the development of obesity related complications Whether maternal leptin levels differ between obese and morbidly obese women, during and after pregnancy, have to our knowledge not been previously described Neither has the association between maternal leptin levels and gestational weight gain in obese women The aim was to evaluate if maternal plasma leptin levels were associated with different degrees of maternal obesity and gestational weight gain Prospective cohort study including women categorized as obesity class I-III (n = 343) and divided into three gestational weight gain groups (n = 304) Maternal plasma leptin was measured at gestational week 15, 29 and 10 weeks postpartum Maternal Body Mass Index (BMI) was calculated from early pregnancy weight Gestational weight gain was calculated using maternal weight in delivery week minus early pregnancy weight The mean value and confidence interval of plasma-leptin were analysed with a two-way ANOVA model Interaction effect between BMI and gestational weight gain group was tested with a two-way ANOVA model The mean maternal leptin concentrations were significantly higher in women with obesity class III compared to women in obesity class I, at all times when plasma leptin were measured The mean leptin concentrations were also significantly higher in women with obesity class II compared to women in obesity class I, except in gestational week 29 There was no difference in mean levels of plasma leptin between the gestational weight gain groups No significant interaction between BMI and gestational weight gain group was found Plasma leptin levels during and after pregnancy were associated with obesity class but not with degree of gestational weight gain These results are in concordance with epidemiological findings where the risk of obstetric complications increases with increased maternal obesity class The effect on obstetric outcome by degree of gestational weight gain is less pronounced than the adverse effects associated with maternal obesity

Abstract: Community Health Centers (CHCs) are important settings for obesity prevention and control. However, few studies have explored the barriers that CHC clinicians perceive their patients face in maintaining a healthy weight. Semi-structured in-depth interviews were conducted with thirty physicians, physician assistants, and nurse practitioners recruited from four Community Health Centers (CHCs), located in a rural, southwestern region of the state of Georgia, US. Interviews were digitally recorded, transcribed verbatim, and thematically analyzed. Clinicians perceived that their patients face numerous individual, interpersonal, and community-level barriers to weight loss. Perceived individual-level barriers included interrelated aspects of poverty and limited motivation to lose weight. Perceived interpersonal barriers included social and cultural norms, such as positive associations with larger body sizes, negative associations with smaller body sizes, lack of awareness of obesity as a problem, and beliefs regarding hereditary or generational body types. Perceived community-level barriers included limited healthy food options and aspects of the local food culture in the Southern US. Clinicians perceived that their patients face barriers to weight loss at multiple levels of the social ecology, including individual, social, and environmental factors. Results may partly explain limited provision of weight counseling in CHCs and suggest opportunities for intervention.

Abstract: Reports on alterations in somatic neural functions due to non-diabetic obesity, a major risk factor for diabetes, are few and still a matter of debate. Nevertheless, to our knowledge, reports lack any comments on the type of somatic nerve fibers affected in non-diabetic obesity. Therefore, this study aimed to find out the alteration in somatic neural functions in non-diabetic obese persons if any. The study was conducted on 30 adult non-diabetic obese persons (mean age 32.07 ± 7.25 years) with BMI > 30 Kg/m2 (mean BMI 30.02 ± 2.89 Kg/m2) and 29 age- and sex-matched normal weight controls (mean age 30.48 ± 8.01 years) with BMI: 18–24Kg/m2 (mean BMI 21.87 ± 2.40 Kg/m2). Nerve conduction study (NCS) variables of median, tibial and sural nerves were assessed in each subject using standard protocol. The data were compared by Mann Whitney ‘U’ test. In comparison to normal weight persons, obese had lower compound muscle action potential (CMAP) amplitudes of right median [9.09(7.62–10.20) Vs 10.75(8.71–12.2) mV, p = 0.025] and bilateral tibial nerves [Right: 8.5(7.04–11.18) Vs 12.1(10.55–15) mV, p < 0.001 and left 9.08(6.58–11.65) Vs 13.05(10.2–15.6) mV, p = 0.002]. Furthermore, obese persons had prolonged CMAP durations of right and left median [10.5(9.62–12) Vs 10(8.4–10.3) ms, p = 0.02 and 10.85(10–11.88) Vs 10(9–10.57) ms, p = 0.019] and right tibial [10(9–11) 8.5(7.92–10) ms, p = 0.032] nerves. Sensory NCS (sural nerve) also showed diminished sensory nerve action potential (SNAP) amplitude [16(12.08–18.21) vs 22.8(18.3–31.08) μV, p < 0.001] and prolonged duration. However, onset latencies and conduction velocities for all nerves were comparable between the groups. This study documents subclinical peripheral nerve damage in non-diabetic obese with abnormal NCS parameters; shorter amplitudes and prolonged CMAP and SNAP durations. The reduced amplitudes of mixed and sensory nerves might be due to decreased axonal number stimulation or actual decrease in number of axonal fibers, or defect at NMJ in non-diabetic obese. Prolonged durations but normal onset latencies and conduction velocities strongly suggest involvement of slow conducting fibers.

Abstract: Childhood overweight and obesity is a growing health challenge in Japan and might be associated with childhood poverty. We aimed to investigate the association between low economic status and body mass index (BMI) and to reveal the mediators of this association among junior high school students in Japan. Junior high school students (N = 2968) from two cities in Shizuoka, Japan, were surveyed. Questionnaires assessed subjective economic status, weight, and height. Economic status was categorized into low and non-low, and BMI z-scores were calculated using the WHO Growth Reference. Multivariate regression analyses were conducted to determine the association between economic status and BMI z-scores, adjusted for covariates and stratified by gender. Among girls, low economic status was significantly positively associated with BMI z-scores in the crude model (coefficient: 0.35; p = 0.001). In a model adjusted for breakfast skipping, the coefficient of economic status decreased by 28.57 % but remained significant (coefficient: 0.25; p = 0.017). In the final model adjusted for other possible covariates, low economic status remained significantly positively associated with BMI z-score (coefficient: 0.22; p = 0.044). The same association was not found for boys. Low economic status was positively associated with higher BMI among girls in junior high school in Japan, but this was not true for boys. Childhood poverty might be associated with overweight and obesity among adolescent girls in Japan. Health policies at junior high schools to discourage breakfast skipping might be effective for countering the association between childhood poverty and overweight in adolescent girls.

Abstract: Recent evidence suggests that a substantial subgroup of the population who have a high-risk waist circumference (WC) do not have an obese body mass index (BMI). This study aimed to explore whether including those with a non-obese BMI but high risk WC as ‘obese’ improves prediction of adiposity-related metabolic outcomes.

Abstract: The King’s Obesity Staging Criteria (KOSC) comprises of a four-graded set of health related domains. We aimed to examine whether, according to KOSC, patients undergoing bariatric surgery differed from those opting for conservative treatment. We graded 2142 consecutive patients with morbid obesity attending our centre from 2005-10 into the following KOSC domains: airway/apnoea, body mass index (BMI), cardiovascular risk (CV-risk), diabetes mellitus, economic complications, functional limitations, gonadal dysfunction, and perceived health status/body image. Both patients and physicians agreed upon treatment choice through a shared decision making process. A total of 1329 (62%) patients opted for lifestyle intervention and 813 (37%) for bariatric surgery as their first treatment choice. The patients treated with bariatric surgery were younger (42 vs. 44 years, p < 0.001), had a higher BMI (45.4 vs. 43.8 kg/m2, p < 0.001) and had a lower ten year estimated CV-risk (9.4 vs. 10.7%, p = 0.004) than the lifestyle intervention group. Compared with having BMI < 40 kg/m2, BMI ≥ 40 kg/m2 was associated with 85% increased odds of bariatric surgery (OR 1.85 [95% CI 1.48, 2.30]). Conversely, patients with ≥20% ten year CV-risk, had lower odds of bariatric surgery than patients with <20% CV-risk (0.68 [0.53, 0.87]). BMI was the strongest KOSC-domain associated with subsequent bariatric surgery after a shared decision making process. Prospective studies are required to assess whether the use of KOSC can help guide patients and clinicians to identify the most appropriate choice of treatment for morbid obesity.

Abstract: Weight loss improves cardiovascular risk factors and “quality of life”. Most therapeutic approaches fail to induce a sustained weight loss and most individuals undergo weight regain. In this paper the comprehensive design of the “MAINTAIN” study, all assessments as well as the one year lifestyle intervention will be outlined in detail. One-center randomized controlled trial with seven assessment time points conducted 2009-2015. For the randomization eight groups were distinguished in a list to allocate intervention or control group: Females and males either pre-pubertal or pubertal and with a BMI-SDS under or over 2.5. Setting: Weight loss at a residential weight reduction programme Berlin/Brandenburg and intervention at a paediatric outpatient clinic; Participants: 137 children and adolescents (10 to 17 years). Intervention: Participants were randomized after an initial weight loss at a residential weight reduction programme and allocated to intervention (n=65) and control (n=72) conditions. The intervention group received an one-year group multi-professional lifestyle intervention with monthly meetings at the paediatric outpatient obesity clinic. The control group had a free living phase for one year and both groups 48 months follow up. Main outcome measures: Participants who are engaged in monthly intervention meetings will benefit in terms of a sustained weight maintenance. The primary aim is to describe the dynamic of hormonal and metabolic mechanisms counter-balancing sustained weight loss during puberty and adolescence. The secondary aim is to investigate the effect of an intensive family based lifestyle intervention during the weight maintenance period on the endogenous counter-regulation as well as on health related quality of life. The third aim is to establish predictors for successful weight maintenance and risk factors for weight regain in obese children and adolescents. Weight maintenance after induced weight loss is one of the most important therapeutic challenges as long as most patients fail to maintain their weight loss. MAINTAIN is the first paediatric RCT addressing in parallel to a RCT in obese adults the course of weight regain after induced weight loss and is embedded in an experimental research consortium in order to also address several molecular mechanisms of weight regain. ClinicalTrials NCT00850629 , first registration 17 February 2009, verified January 2012, Paediatric part of the interventional study. Ethic proposal approved at 08.04.2009

Abstract: Many common risk factors for cardiovascular disease (CVD) originate in childhood and adolescence. There is a lack of literature examining variability within study populations, as well as a shortage of simultaneous analyses of CVD risk factors operating in tandem. We used data from Project HeartBeat!-a multi-cohort longitudinal growth study of children and adolescents in the US - for assessing multiple profiles for lipids, blood pressure, and anthropometric measures. Principal component functional curve analysis methods were used to summarize trajectories of multiple measurements. Subsequently less favorable health (high risk) and more favorable (low risk) groups from both female and male cohorts were identified and compared to US national norms. Compared to national norms, the high risk groups have increased waist circumference, body mass index, and percent body fat as well as higher low-density lipoprotein cholesterol and triglyceride levels, and lower high-density lipoprotein cholesterol. The risk profiles also exhibit patterns of convergence and divergence across the high and low risk groups as a function of age. These observations may have clinical and public health implications in identifying groups of children at high risk of CVD for earlier interventions.

Abstract: Backgrounds The development of effective strategies for the management of overweight in adolescence is a well recognized need. The current study investigates the effectiveness of an e-therapeutic platform (Next.Step) which aims to promote weight management skills and the adoption of health-promoting behaviours among overweight adolescents.

Abstract: Obesity is a significant public health problem and innovative treatments are needed. The purpose of this pilot study was to assess the preliminary efficacy and safety of a combined treatment of low-level laser therapy (LLLT) and lorcaserin on weight loss, health quality of life (QOL) measures, and cardiovascular risk factors. Forty-five overweight and obese adult participants with a body mass index (BMI) >26.9 and <40 were randomized to receive LLLT, lorcaserin, or a combination of the two therapies. All study participants received treatment for 3 months and were followed for 3 months post-treatment. Participants were recruited from June 2014 through September 2014. The majority of the 44 participants accrued to this study were female (84 %) with an average age of 43.9 years (range 22 to 64 years). Most participants (93 % LLLT alone, 87 % LLLT + lorcaserin) completed at least 80 % of the LLLT treatments. From baseline to end of treatment, significant reductions in waist circumference were noted for each treatment group (-2.3 ± 4.1 cm, -6.0 ± 7.3 cm, and -4.0 ± 5.5 cm for LLLT, lorcaserin and combination respectively); however, the reduction in body weight was only significant in those receiving lorcaserin and combination treatment (-0.4 ± 1.5 kg, -1.3 ± 1.2 kg and -1.3 ± 1.3 kg). No significant differences were noted between the groups. Self-reported satisfaction was higher in the lorcaserin versus the LLLT group. This small pilot demonstrates that when combined with behavioral intervention, Lorcaserin and LLLT may be effective components of a comprehensive approach to the treatment of overweight and obesity in the clinical setting. Further studies with larger sample size and longer duration of treatment and follow-up are needed to further address efficacy. Trial registration: NCT02129608 . Registered June 15, 2014.

Abstract: Obesity disproportionately affects children from low-income families and those from racial and ethnic minorities. The relationship between snacking and weight status remains unclear, although snacking is known to be an important eating episode for energy and nutrient intake particularly in young children. The purpose of this pilot study was to examine the snack intake of minority preschool children enrolled in the Head Start Program in four centers in Detroit, Michigan, and investigate differences by child weight status. This secondary data analysis used snack time food observation and anthropometric data from a convenience sample of 55 African American children (44 % girls, mean age = 3.8 years). Snack intake data was obtained over a mean of 5 days through direct observation of children by dietetic interns, and later converted into food group servings according to the United States Department of Agriculture (USDA) meal patterns and averaged for each child. Height and weight measurements were systematically collected and BMI-for-age percentiles were used to classify children into weight categories. One sample, paired samples and independent samples t-tests were performed to test for differences within and between means. Based on BMI-for-age percentiles, 72.7 % of the sample was under/healthy weight and 27.3 % was overweight/obese. Average (mean ± SD) intake of milk (0.76 ± 0.34) and overall fruits/vegetables (0.77 ± 0.34) was significantly lower than one USDA serving, while average intake of grains and breads (2.04 ± 0.89), meat/meat alternates (2.20 ± 1.89) and other foods (1.43 ± 1.08) was significantly higher than one USDA serving (p ≤ 0.05). Children ate more when offered canned versus fresh fruits (0.93 ± 0.57 vs. 0.65 ± 0.37, p = 0.007). Except for a significantly higher milk intake in the overweight/obese group compared to the under/healthy weight group (0.86 ± 0.48 vs. 0.72 ± 0.27, p = 0.021], no relationship was found between snack food intake and weight category. Only in the overweight/obese group was the intake of milk and fresh fruits not significantly different than one USDA serving. Findings suggest that regardless of weight status low-income minority preschool children are consuming larger serving sizes when offered less healthy versus healthier snack foods. Continued efforts should be made to provide healthful snack foods at preschool settings to prevent obesity and promote healthier food habits.

Abstract: Background Peroxisome proliferator-activated receptor gamma 2 (PPAR-γ2) is a transcription factor with a key role in adipocyte differentiation, lipid storage and glucose homeostasis. The Ala allele of the common Pro12Ala polymorphism in the isoform PPAR-γ2 is at the center of many controversies because in some populations, it has been observed to be associated with T2DM or obesity but, not in others. The aim of this study was to investigate the association of Pro12Ala polymorphism in the PPAR-γ2 gene with susceptibility to obesity or T2DM in a Cameroonian population.

Abstract: To examine associations of Body mass Index (BMI) and mental distress in late midlife in a large Danish community sample and to investigate the effect of socio-demographic factors. The study sample comprised 3613 Danish men and 1673 women aged 49–63 years from the Copenhagen Ageing and Midlife Biobank (CAMB) with complete information on measured BMI, severity of mental symptoms assessed by the Symptom Check-List’ (SCL-90), and socio-demographic factors including sex, age, occupational social class, and educational duration. Linear and logistic regression were used to evaluate associations between BMI category and SCL-90. Unadjusted SCL-90 subscale scores differed significantly across BMI categories (p < 0.001) among both men and women with more mental distress in the underweight, obese and severely obese BMI categories except for the anxiety scale which was not associated with BMI category in women. In the adjusted analyses, all symptom scales remained significantly associated with BMI among men after adjusting for socio-demographic factors while only associations with somatization and depression scales remained significant for women.. When SCL-90 case status was applied as an outcome, significant unadjusted associations with BMI category were observed for somatization (p < 0.001), depression (p = 0.026) and the General Severity Index (p = 0.002) among men and somatization (p = 0.002) among women. Furthermore, somatization case-status was significantly predicted by BMI category (p < 0.001) in men after adjusting for socio-demographic factors. Results indicate more mental distress among underweight, obese and severely obese men and women after adjusting for socio-demographic factors. Furthermore, obese men have higher risk of reporting clinically relevant symptoms of somatization independently of socio-demographic factors.

Abstract: Misperception of body weight by individuals is a known occurrence. However, it is a potential target for implementing obesity reduction interventions in patients with cardiovascular and metabolic diseases. The aim of this study was to describe the association between self-perception of body weight and objectively measured body mass index (BMI) among cardiac patients in a specialist cardiology institution in Sri Lanka. During the study period, 322 (61 %) males and 204 (39 %) females were recruited from consecutive admissions to the Institute of Cardiology, National Hospital, Colombo, Sri Lanka. An interviewer-administered questionnaire was used to assess demographic characteristics, medical records and body weight perception. Weight, height and waist circumference (WC) were measured and Asian anthropometric cut-off points for BMI and WC were applied. The mean BMI of the study population was 23.61 kg/m2. Body size misperception was seen in a significant proportion of the cohort. 85.2 % of overweight patients reported themselves to be of ‘normal weight’ or even ‘underweight’. Moreover, 36 % of obese patients misperceived body weight as being of ‘normal weight’ while 10.9 % considered themselves to be ‘underweight’. 61.9 % of males and 68.8 % of females with central obesity reported themselves to be ‘underweight’ or ‘normal weight’. Among a subgroup with co-morbid metabolic diseases, significant under-perception of body size was seen. Significant body size misperceptions were noted in this group of cardiac patients. The disparity of perception was seen increasingly with increasing BMI. More than two thirds of overweight and more than half of obese patients believed themselves to have normal or less than normal weight.

Abstract: Worldwide obesity has nearly doubled since 1980 and is a leading risk for global deaths, profoundly affecting morbidity, mortality, health-care costs, and professional and personal quality of life. Treatment of obesity and its consequences include lifestyle intervention, pharmacotherapy, and bariatric surgery. Polyglucosamines have been proposed as an alternative strategy for treating obesity, by reducing the amount of absorbed fat through interaction with dietary fat through various mechanisms. The objective of this study is to investigate the influence of polyglucosamine on the bioavailability of the model compound [9-14C]-oleic acid in female Gottingen minipigs. The study consisted of two treatment groups, each consisting of six adult female Gottingen minipigs with a catheterized vena jugularis to enable frequent blood sampling. One group served as the untreated group (control) and the other group was pre-treated with 2 tablets of 500 mg formoline L112. After 30 min, all animals were dosed orally with [9-14C]-oleic acid. Excreta and blood samples were collected for analysis of radioactivity from 48 h pre-dose up to 144 h post-dosing. At sacrifice, the liver and contents of the gastrointestinal tract were collected for radioanalysis. Upon treatment with polyglucosamine (formoline L112), the Tmax of [14C]-oleic acid in plasma was shifted from 4 to 16 h, and the Cmax decreased significantly from 14.1 μg/g to 3.3 μg/g. In addition, upon treatment with polyglucosamine the internal exposure to [14C]-oleic acid as reflected by the area under the curve during the 0–12 h post-dose time interval (AUC0-12h), is significantly decreased to 32.9 % of the plasma value of [14C]-oleic acid in untreated animals. Even up to 24 h post-dose, the AUC0-24h is significantly decreased to 50.7 % of the plasma value in untreated animals and this significant effect is prolonged up to 60 h post-dose. This study shows that treatment with polyglucosamine (formoline L112) reduces (as judged by Cmax & AUC) and delays (as judged by Tmax) fat absorption from the gastrointestinal tract into the systemic circulation and limits peak exposure to free fatty acids which may contribute to a more beneficial condition in overweight humans.

Abstract: Overweight individuals desire a lower weight than they actually have. Little is known on the extent to which this discrepancy is reduced over time due to adaptation or resignation. The aim of this study is to describe cross-sectional relationships and longitudinal changes in desired body weight and differences between actual and desired body weight according to gender, age and category of body mass index in a large, adult cohort in Tromso, Norway. Cross-sectional analyses of 8960 men and 9992 women aged 25–69 participating in Tromso 4 (during 1994–1995), and longitudinal analyses of 3210 men and 3689 women participating in both Tromso 4 (during 1994–1995) and Tromso 6 (during 2007–2008). Simple descriptive statistics and linear regression was used to describe actual and desired weight, the difference between them, and how gender and age are related to the changes in actual and desired weight over this 13-year period. The difference between actual and desired body weight was largest for the obese and higher among the overweight than the normal weight for both genders. While normal weight men were quite satisfied with their body weight, normal weight women were not. Actual weight increased more than desired weight for all age groups and both genders except the oldest women. The difference between change in actual body weight and change in desired body weight during the 13-year follow-up was significantly larger among men (2.0 kg) than women (1.5 kg) (p < 0.001), and larger among young than older adults (p < 0.001). Adjusting for level of education had no impact on this relationship. Furthermore, the association between age and the difference between change in actual body weight during the 13 years and change in desired body weight in the same period did not differ between men and women and, in gender specific analyses, between subjects with normal weight and those who were overweight or obese at start of follow-up. Older people adapt more to weight gain than younger age groups, with clear gender differences. Further studies of longitudinal changes in desired weight are warranted.