Tesis sobre el tema "Overweight"

This research study draws upon co-constructed data to describe and interpret overweight nurses' experiences of their interactions with overweight patients. Within the limited number of research studies that investigate the worldview of overweight nurses, it is suggested that overweight nurses may have more empathy with overweight patients, who often receive prejudicial and discriminatory care. The objectives of the study, using a qualitative hermeneutical methodology, underpinned by Gadamerian philosophy and a relativist ontological stance, were to describe and interpret the experiences and actions of overweight nurses in their interactions with overweight patients. Seven nurses from various nursing disciplines participated in the study and data were gathered through two semi-structured interviews and note-book keeping. Two key themes were derived from the data: firstly, how the nurses developed their understandings of being overweight and secondly, how they acted upon their understandings in the interaction with their overweight patient. The nurses developed their self and Other understandings of being overweight through personal experience. They acted upon their understandings and managed their self in the interaction with their overweight patient by managing their guilt, dissonance and personal prejudices. They managed their sensitive conversations with their overweight patient by developing embodied empathy. This study has generated new knowledge by proposing that the overweight nurses within this study combine: Other understanding; Self understanding; Acknowledging-thenmanaging prejudice; and Being-with: holistic interacting within their interactions with their overweight patients, which is defined as the new and original concept of embodied empathy-in-action.

Obesity and Periodontitis are two common chronic inflammatory diseases. Based upon the hypothesis that obesity associated systemic inflammation may affect susceptibility to chronic infectious diseases like periodontitis, the aim of this PhD programme was to investigate the association between overweight/obesity and periodontitis. Five studies were conducted: 1) a systematic review to summarise the current evidence on the association including a quantitative meta-analysis of odds ratios (ORs) for having periodontitis in overweight or obese individuals 2) a secondary analysis of individual patient data (n=333) ascertaining the association between overweight/obesity and the extent/severity and treatment response (2 months) of individuals with severe periodontitis 3) a case control analysis of 286 age-matched individuals to assess the odds of periodontitis diagnosis based on overweight or obese status, 4) a prospective cohort study (n=115) investigating the relationship between obesity and periodontal treatment clinical response, 5) a mechanistic study of twenty gingival specimens assessed for differential miRNAs expression between obese and normal weight individuals. Study 1 demonstrated a statistically significant association between overweight and obesity with diagnosis of periodontitis (ORs range= 1.8-2.3). In Study 2, obesity and overweight were statistically significant predictors of clinical periodontal response at 2 months (p<0.05) independently of dental plaque levels. Results from the Study 3 confirmed increased odds of diagnosis of periodontitis in overweight (OR=2.56) and obesity (OR=3.11) after adjusting for known confounders. Study 4 demonstrated that measures of body composition were predictors of poorer non-surgical periodontal treatment response (p<0.05). Study 5 confirmed statistically significant different miRNA signature profiles of gingival tissues between normal weight and obese individuals. In conclusion, this PhD programme provides evidence of a robust association between overweight/obesity and periodontitis prevalence, extent and severity, and treatment response. The results of this thesis support the classification of obesity as a risk indicator for periodontitis.

Overweight and stress interact in complex ways. Excess weight promotes chronic low-grade inflammatory states that can mobilise the hypothalamic-pituitary-adrenal (HPA) axis. HPA axis activation resulting from frequent stress situations can modify energy uptake and expenditure. Separately, both conditions have been linked to changes in brain integrity and executive performance. The organism adapts to situations of caloric surplus through boosting immune, neuroendocrine and cardiometabolic systems to restore energy homeostasis. The allostatic load model establishes that the cumulative effects of adapting to challenging scenarios may result in adverse health situations in the future. There is sufficient evidence to consider that a state of overweight is inherently linked to a higher chronic physiological stress, or allostatic load. Our hypothesis was that, independently of the effects of visceral adiposity, the aggregated effects of the biological alterations related to overweight would be enough detrimental to brain structure and executive functioning. Lean-to-obese volunteers aged 21 to 40 years were recruited from primary health care centres belonging to the Consorci Sanitari de Terrassa. Subjects underwent a medical and neuropsychological examination, as well as a magnetic resonance imaging acquisition at the Hospital Clínic de Barcelona. The allostatic load index consisted of the sum of several biomarkers representing physiological stress. Overweight subjects had a greater allostatic load than healthy weight participants. The allostatic load escalation was negatively correlated with the morphology of cortical areas and tracts known to be ascribed to circuits involved in cognitive control, reward-processing and the integration of visceral-sensory signalling. Finally, the intensification in this index correlated with worse cognitive flexibility.
El sobrepès i l'estrès interactuen de formes complexes. L'excés de pes promou estats inflamatoris crònics de baix grau que poden mobilitzar l'eix hipotalàmic-pituitari-adrenal (HPA). L'activació de l'eix HPA resultant de situacions d'estrès freqüents pot modificar la captació i la despesa d'energia. Les dues condicions s'han vinculat per separat a canvis en la integritat cerebral i l'acompliment executiu. L'organisme s'adapta a situacions de superàvit calòric a través de impulsar sistemes immunes, neuroendocrins i cardiometabòlics per restaurar l'homeòstasi energètica. El model de càrrega alostàtica estableix que els efectes acumulatius de l'adaptació a escenaris desafiadors poden resultar en situacions adverses per a la salut en el futur. Hi ha evidència suficient per a considerar que un estat de sobrepès està inherentment vinculat a un major estrès fisiològic crònic, o càrrega alostàtica. La nostra hipòtesi va ser que, independentment dels efectes de l'adipositat visceral, els efectes agregats de les alteracions biològiques relacionades amb l'excés de pes resultarien suficientment perjudicials per a la estructura cerebral i el funcionament executiu. Es van reclutar voluntaris amb normopès i sobrepès amb edats compreses entre els 21 i els 40 anys de centres d'atenció primària de salut pertanyents al Consorci Sanitari de Terrassa. Els subjectes es van sotmetre a un examen mèdic i neuropsicològic, així com a l'adquisició d'imatges per ressonància magnètica a l'Hospital Clínic de Barcelona. L'índex de càrrega alostàtica va consistir en la suma de diversos biomarcadors representant estrès fisiològic. Els subjectes amb sobrepès van presentar major càrrega alostàtica que els participants de pes saludable. L'escalada de càrrega alostàtica es va correlacionar negativament amb la morfologia d'àrees corticals i tractes coneguts per estar adscrits a circuits implicats en el control cognitiu, el processament de recompenses i la integració de la senyalització visceral-sensorial. Finalment, la intensificació en l'esmentat índex va correlacionar amb una pitjor flexibilitat cognitiva.
El sobrepeso y el estrés interactúan de formas complejas. El exceso de peso promueve estados inflamatorios crónicos de bajo grado que pueden movilizar el eje hipotalámico- pituitario-adrenal (HPA). La activación del eje HPA resultante de situaciones de estrés frecuentes puede modificar la captación y el gasto de energía. Ambas condiciones se han vinculado por separado a cambios en la integridad cerebral y el desempeño ejecutivo. El organismo se adapta a situaciones de superávit calórico a través de varias modificaciones fisiológicas. Esto incluye impulsar sistemas inmunes, neuroendocrinos y cardiometabólicos para restaurar la homeostasis energética. El modelo de carga alostática establece que los efectos acumulativos de la adaptación a escenarios desafiantes pueden resultar en situaciones adversas para la salud en el futuro. Existe evidencia suficiente para considerar que un estado de sobrepeso está inherentemente vinculado a un mayor estrés fisiológico crónico, o carga alostática. Nuestra hipótesis fue que, independientemente de los efectos de la adiposidad visceral, los efectos agregados de las alteraciones biológicas relacionadas con el sobrepeso resultarían suficientemente perjudiciales para la estructura cerebral y el funcionamiento ejecutivo. Se reclutaron voluntarios con normopeso y sobrepeso con edades comprendidas entre los 21 y los 40 años de centros de atención primaria de salud pertenecientes al Consorci Sanitari de Terrassa. Los sujetos se sometieron a un examen médico y neuropsicológico, así como a la adquisición de imágenes por resonancia magnética en el Hospital Clínic de Barcelona. El índice de carga alostática consistió en la suma de varios biomarcadores que representan estrés fisiológico. Los sujetos con sobrepeso presentaron mayor carga alostática que los participantes de peso saludable. La escalada de carga alostática se correlacionó negativamente con la morfología de áreas corticales y tractos conocidos por estar adscritos a circuitos implicados en el control cognitivo, el procesamiento de recompensas y la integración de la señalización visceral-sensorial. Finalmente, la intensificación en dicho índice correlacionó con una peor flexibilidad cognitiva.

Background: Childhood overweight has become a growing public health challenge. It has been suggested that inadequate or excessive gestational weight gain (GWG) may result in permanent metabolic and neuronal changes in the developing fetus. Although effects of GWG on birth weight are established, less is known about its effects on the long-term weight status of the child. In 2009, the Institute of Medicine (IOM) and the National Research Council (NRC) published recommendations for trimester-specific and total GWG depending on maternal pre-pregnancy body mass index (BMI). It is unknown, however, how well the trimester-specific IOM/NRC recommendations for GWG identify women at risk of total GWG outside those recommendations. It is also unknown, whether a reverse from excessive GWG in early or mid-pregnancy reduces the risk of childhood overweight. Aims: Contribute to the existing knowledge on the association between GWG and childhood overweight (study 1). Examine whether and to what extent inadequate or excessive total GWG can be predicted in the first, second and third trimester, based on trimester-specific GWG cut-off values (study 2). Investigate whether a reverse from excessive GWG before the third trimester is associated with a risk reduction of childhood overweight (study 3). Methods: A retrospective cohort study was conducted. The sample was recruited prior to the school entry health examinations in 2009 and 2010. Data on maternal weight was derived from medical records and child’s anthropometric data were measured. From 11,730 mother-child pairs available, 6,837 were included in study 1, 7,962 in study 2 and 6,767 in study 3. To investigate the effect of total GWG, overall and stratified by maternal pre-pregnancy BMI, and reverse from excessive GWG in early or mid-pregnancy, multivariate logistic regression analyses were conducted including a large number of potential confounders. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. The prognostic values of lower and upper trimester-specific GWG cut-off values were examined by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive diagnostic likelihood ratio (DLR+). Results: 1) Overall, the risk of childhood overweight increased by 4% per additional kg GWG (OR: 1.04, 95% CI: 1.02, 1.05). Excessive total GWG was associated with a 57 % higher risk of childhood overweight (OR: 1.57, 95% CI: 1.30, 1.91). Stratified by maternal pre-pregnancy BMI, significant associations between excessive GWG and childhood overweight found among normal weight mothers (OR: 1.29, 95% CI: 1.01, 1.66) and overweight mothers (OR: 1.64, 95% CI: 1.06, 2.63). 2) Prediction of total GWG within the IOM/NRC recommendations increased with gestational age and was related to the maternal BMI category and outcome. In trimester two, inadequate total GWG could be predicted with a sensitivity of 49% and 60.2% and a PPV of 72.1% and 68.3% in underweight and normal-weight mothers, respectively. Excessive GWG could be predicted with a sensitivity of 72.7% and 70.4% and a PPV of 94.3% and 93.3% in overweight and obese mothers, respectively. 3) Compared to mothers who always gained below the excessive GWG cut-off values (reference category), children of mothers with excessive GWG in the third and any previous trimester had a 42% higher risk of overweight at school entry (OR: 1.42, 95% CI: 1.17, 1.72). There was a 39% higher risk if mothers gained excessively in the third trimester only (OR: 1.39, 95% CI: 1.06, 1.82). No higher risk was observed for mothers who reversed from excessive GWG before the third trimester compared to reference category. Conclusions: Excessive total GWG appears to be a risk factor for childhood overweight. It can be well predicted from the second trimester on, in particular in overweight and obese women. Reverse from excessive GWG before the third trimester may reduce the risk of childhood overweight. More research is required to further establish the strength of association between GWG and childhood overweight. It appears possible to identify women at risk of gaining outside the recommendations as early as the second trimester. Those women should be allocated to appropriate weight modifying measures. The long-term benefit of GWG modifying measures on childhood overweight, especially a reverse from excessive GWG in the first or second trimester, should be investigated in randomised controlled studies.
Hintergrund: Kindliches Übergewicht stellt eine wachsende Herausforderung an das Gesundheitssystem dar. Es wird angenommen, dass eine inadäquate oder exzessive mütterliche gestationale Gewichtszunahme (GGZ) zu dauerhaften metabolischen und neuronalen Veränderungen im heranwachsenden Fötus führen kann. Zusammenhänge zwischen der GGZ und dem Geburtsgewicht des Kindes wurden umfassend belegt. Weniger erforscht ist der Einfluss der GGZ auf die langfristige Gewichtsentwicklung des Kindes. Im Jahre 2009 veröffentlichten das Institute of Medicine (IOM) und das National Research Council (NRC) Grenzwerte für die trimester-spezifische und totale GGZ in Abhängigkeit des mütterlichen Body Mass Index (BMI). Bisher unbekannt ist, in wie weit sich diese trimester-spezifischen Grenzwerte dazu eigenen, um eine Abweichung von den Grenzwerten am Ende der Schwangerschaft vorherzusagen und somit gefährdete Mütter frühzeitig zu identifizieren. Zudem ist ungeklärt, ob eine Umkehr von der exzessiven GGZ vor dem dritten Trimester mit einer Risikoreduktion für kindliches Übergewicht einhergeht. Ziele: Beitrag zur existierenden Literatur über den Zusammenhang zwischen GGZ und kindlichem Übergewicht (Studie 1). Analyse, ob und in welchem Ausmaß inadäquate oder exzessive GGZ am Ende der Schwangerschaft durch trimester-spezifische IOM/NRC GGZ Grenzwerte vorhergesagt werden kann (Studie 2). Analyse, ob eine Umkehr von exzessiver GGZ in der frühen oder mittleren Schwangerschaft das Risiko von späteren kindlichen Übergewichts reduziert (Studie 3). Methoden: In einer retrospektiven Kohortenstudie wurden Daten von 11.730 Mutter-Kind Paaren erhoben. Die Stichprobenrekrutierung erfolgte im Rahmen der Schuleingangsuntersuchungen in den Jahren 2009 und 2010. Angaben zum mütterlichen Gewicht wurden dem Mutterpass entnommen und die anthropometrischen Daten des Kindes gemessen. Von 11.730 verfügbaren Mutter-Kind Paaren, wurden 6.837 in Studie 1, 7.962 in Studie 2 und 6.767 in Studie 3 eingeschlossen. Multivariate logistische Regressionsanalysen wurden herangezogen, um den Effekt von totaler GGZ während der Schwangerschaft, über alle Mütter hinweg und stratifiziert nach präkonzeptionellen BMI, und der Umkehr von exzessiver GGZ vor dem dritten Trimester zu analysieren. Odds Ratios (OR) und 95% Konfidenzintervalle (CI) wurden berechnet und eine große Anzahl an potenziellen Störvariablen eingeschlossen. Die Vorhersagekraft der trimester-spezifischen Grenzwerte wurde mittels der Berechnung von Sensitivität, Spezifität, positiver prädiktiver Wert (PPV), negativer prädiktiver Wert (NPV) und der positive diagnostische Likelihood Ratio (DLR+) analysiert. Ergebnisse: 1) Insgesamt war jedes zusätzliche kg GGZ mit einer 4%igen Risikoerhöhung für kindliches Übergewicht assoziiert (OR: 1.04, 95% CI: 1.02, 1.05). Eine exzessive totale GGZ war mit einer 57%igen Risikosteigerung verbunden (OR: 1.57, 95% CI: 1.30, 1.91). Die stratifizierte Analyse ergab signifikante Effekte für exzessive totale GGZ innerhalb der normalgewichtigen (OR: 1.29, 95% CI: 1.01, 1.66) und übergewichtigen Mütter (OR: 1.64, 95% CI: 1.06, 2.63). 2) Die Vorhersage der totalen GGZ innerhalb der IOM/NRC Empfehlungen verbesserte sich mit fortschreitendem Gestationsalter und war abhängig von der mütterlichen BMI Kategorie und der Zielgröße. Bei den untergewichtigen bzw. normalgewichtigen Müttern konnte mit den trimester-spezifischen GGZ Grenzwerten des zweiten Trimesters eine inadäquate totale GGZ mit einer Sensitivität von 49% bzw. 60.2% und einem PPV von 72.1% bzw. 68.3% vorhergesagt werden. Bei den übergewichtigen und adipösen Müttern konnte mit den trimester-spezifschen GGZ Grenzwerten des zweiten Trimesters eine totale exzessive GGZ mit einer Sensitivität von 72.7% bzw. 70.4% und einem PPV von 94.3% bzw. 93.3% vorhergesagt werden. 3) Im Vergleich zu Müttern die während der gesamten Schwangerschaft unterhalb des Grenzwertes für exzessives GGZ lagen (Referenzkategorie), war eine exzessive Gewichtszunahme im dritten und mindestens einem vorhergehenden Trimester mit einer 42%igen Risikoerhöhung assoziiert (OR: 1.42, 95% CI: 1.17, 1.72). Nahmen die Mütter nur im letzten Trimester exzessiv zu, lag die Risikoerhöhung bei 39% (OR: 1.39, 95% CI: 1.06, 1.82). Kein erhöhtes Risiko für kindliches Übergewicht zeigte sich bei den Müttern die ausschließlich in den ersten zwei Trimestern exzessiv zugenommen hatten. Diskussion: Exzessive GGZ scheint ein Risikofaktor für kindliches Übergewicht zu sein. Insbesondere bei übergewichtigen und adipösen Müttern kann eine exzessive GGZ außerhalb der IOM/NRC Empfehlungen ab dem zweiten Trimester vorhergesagt werden. Die Umkehr einer exzessiven GGZ vor dem dritten Trimester scheint das Risiko für kindliches Übergewicht zu reduzieren. Weitere Forschung über Stärke des Zusammenhangs zwischen GGZ und kindlichem Übergewicht ist notwendig. Es scheint möglich, Frauen deren totale GGZ potenziell außerhalb der Empfehlungen liegt ab dem zweiten Trimester zu identifizieren. Diese Frauen sollten wirkungsvollen gewichtsmodifizierenden Maßnahmen zugeführt werden. Die langfristige positive Auswirkung dieser Maßnahmen, insbesondere eine Umkehr von exzessiver GGZ vor dem dritten Trimester, auf die Prävention von kindlichem Übergewicht, sollte in randomisiert-kontrollierten Studien untersucht werden.

There is significant research evidence to demonstrate that physical activity can produce weight loss, weight maintenance and positive health effects in the overweight and obese. However, it can be difficult to get this population sufficiently active to achieve these benefits. This thesis reports on a series of studies that explore physical activity used alone and in conjunction with other weight management strategies. The primary aim was to gain a greater understanding about how weight loss and continued long term weight maintenance could be achieved. The first study was a systematic review on the dose of physical activity associated with weight loss and weight maintenance, it investigated if the current treatment dose was appropriate. The findings correlated with the recently published new CDC guidelines. In the second study, semi-structured interviews were employed to explore the attitudes and experiences of overweight and obese individuals towards weight loss and health. It was reported by participants that they prefer autonomy and personalisation to tailor weight loss and health strategies to their own lifestyles. It was also found that their knowledge base was confused and outdated. In the final study, a sample of overweight and obese adults took part in participatory action research with the aim to design and assess their own weight management programme. A multi-strategy weight management programme emerged that could be tailored to individual lifestyle. Tips and ideas were also devised to aid weight maintenance. This thesis found that the overweight and obese appeared to favour a multi-strategy weight management intervention that could be incorporated, personalised and tailored to their everyday lives. Physical activity (that was enjoyable, lifestyle or accomplished through accumulated bouts), dietary changes, education/improved knowledge base, support and weight monitoring all appeared to be important factors to aid weight management.

Obesity and insulin resistance are serious health concerns in children and adolescents (young people). Interventions to increase the potential for fat oxidation and improve insulin sensitivity could have widespread clinical relevance. Although exercise is often advocated for health, the factors implicated in the relationship between exercise, fat oxidation and insulin resistance are not well understood in young people. This thesis has investigated the effect of manipulations in exercise and breakfast on metabolism in young people, focusing on fat oxidation and postprandial blood glucose control. The first experimental study, Chapter 4, compared two different exercise protocols for estimating the intensity corresponding to maximal fat oxidation (Fatmax) in non-overweight prepubertal children. A 3 min incremental protocol was recommended to provide an estimation of Fatmax using a wide range of intensities in this population. Using this protocol, Chapter 5 demonstrated that Fatmax was higher for treadmill compared with cycling exercise in pre- to early pubertal children. Furthermore, treadmill exercise resulted in higher rates of fat oxidation over a range of absolute and relative intensities and fat oxidation remained high over a wider range of intensities. Therefore, treadmill exercise (walking or slow running) is clearly preferential for promoting fat oxidation in this population. Subsequently, Chapter 6 examined the effect of mixed breakfast meals containing high (HGI) and low (LGI) glycaemic index carbohydrates on blood glucose, plasma insulin and fat oxidation in overweight and non-overweight girls. Breakfast GI did not affect fat oxidation during the postprandial rest period or subsequent exercise. However, the main finding of this study related to blood glucose; the higher blood glucose response following the HGI compared with LGI breakfast was more pronounced in the overweight girls. This suggested a reduced ability to cope with the metabolic demands of HGI breakfast consumption in overweight girls and highlighted that strategies to reduce insulin resistance in this population are required. Consequently, Chapter 7 investigated the effect of treadmill exercise at Fatmax performed 16 h prior to HGI breakfast consumption on blood glucose, plasma insulin and fat oxidation in overweight and non-overweight girls. Fatmax exercise reduced the postprandial insulin response in the non-overweight, but not the overweight, girls while blood glucose was unchanged in both groups. More encouragingly, fat oxidation was increased after exercise in both the overweight and non-overweight girls. Collectively, the four experimental studies within this thesis have demonstrated that treadmill exercise at Fatmax is an effective means of elevating fat oxidation both during and up to 16 h after exercise. When considering postprandial glucose and insulin responses to HGI breakfast consumption, LGI breakfasts should be recommended for overweight girls, whilst acute treadmill exercise at Fatmax can reduce postprandial insulin concentrations in non-overweight girls. Walking or slow running (Fatmax treadmill exercise) and LGI breakfast consumption may be best advocated in combination for promoting fat oxidation and improving postprandial blood glucose control in young people. These two simple lifestyle-related strategies may provide an effective, safe and attractive means for preventing and treating obesity, insulin resistance and related disorders. Key words: exercise, metabolism, substrate oxidation, fat oxidation, glucose, insulin, glycaemic index, overweight, children, adolescents.

Recent research has shown an association between low dietary calcium intake and obesity in adults as well as overweight in young children; however, this relationship has not been investigated in adolescents. The purpose of this study was to examine the relationship between inadequate calcium intake and overweight in adolescents. The hypothesis of this study was that there is a negative correlation between dietary calcium intake and overweight in adolescents. The study population consisted of middle school and high school students (n = 102) in a local school district. The gender and ethnic distributions of the sample were as follows: 74% female, 26% male, 63% Caucasian, 16% African-American, 12% Hispanic, and 8% other. Dietary calcium and energy intakes were assessed using a previously validated calcium-focused food frequency questionnaire (FFQ) for youths. Calcium intake was also assessed using a single question on daily milk consumption. The FFQ was administered by trained interviewers to groups of three to five students. Body fat was assessed using body mass index for age (BMI-for-age) and sum of triceps and subscapular skinfolds (STS). The mean reported calcium intake was 1,972 ± 912 mg/day, and mean reported energy intake was 3,421 ± 1,710 kcals/day. Reported calcium intake from the FFQ was inflated since approximately 75% reported drinking less than three glasses of milk a day. According to BMI-for-age, 29% were classified as at risk of overweight or overweight. Using STS, 39% were classified as overweight. Chi-square analysis using either method of dietary calcium intake and either method of overweight assessment did not show dependence between categories of calcium intake and level of weight or body fat. This study failed to show a relationship between dietary calcium intake and risk of overweight or overweight in adolescents.

High-intensity interval training (HIIT) consists of short intervals of exercise at high intensity intermitted by intervals of lower intensity and is associated with improvement of body composition and metabolic health in adults. Studies in overweight adolescents are scarce. We conducted a randomized controlled trial in overweight adolescents to compare acceptance and attendance of HIIT with or without weekly motivational encouragement through text messages and access to a study website. HIIT was offered for six months (including summer vacation) twice a week (60 min/session). Participation rates were continuously assessed and acceptance was measured. Clinical parameters were assessed at baseline and after six months. Twenty-eight adolescents participated in this study (age 15.5 +/- 1.4; 54% female). The standard deviation score for body mass index over all participants was 2.33 at baseline and decreased by 0.026 (95% CI - 0.048 to 0.10) units, p = 0.49. Waist to height ratio was 0.596 at baseline and decreased by 0.013 (95% CI 0.0025 to 0.024), p = 0.023. Participation within the first two months ranged from 65% to 75%, but fell to 15% within the last three months. Attendance in the intervention group was 14% (95% CI - 8 to 37), p = 0.18, higher than the control group. Overall program content was rated as \"good\" by participants, although high drop-out rates were observed. Summer months constitute a serious problem regarding attendance. The use of media support has to be assessed further in appropriately powered trials.

Introduction: Overweight and obesity are associated with onset and progression of atrial fibrillation (AF). Catheter ablation is considered a safe and curative therapy in advanced stages of AF.In this retrospective study wewanted toinvestigate the impact of overweight and obesity on AF-recurrence after ablation,in patients with symptomatic AF undergoing successful elective catheter ablation.Methods:The study population included 90 patients with symptomatic AF who received elective catheter ablation at University Hospital Örebro between 2015-2016. Patients were categorized into 3 study groups: Lean (<25.0 kg/m2), Overweight (25.0-29.9 kg/m2) and Obese (≥30 kg/m2). Recurrence was defined as clinical symptoms and electrocardiogram (ECG)recording consistent with AF within 3 -12 months after ablation.Fisher’s exact test was used to compare AF-recurrence between BMI groups. Results:Out of 90 patients included, 3 were excluded due to missing data. BMI-categories consisted of 17 (19.6%) lean, 47 (54.0%) overweight and 23 (26,4%) obesepatients. Recurrence rates in the different groups were 5.9% in the lean group, 29.8%in the overweight group and 17.4% in the obese group.Compared to lean patients, AF-recurrence was statistically significantly higher in the overweight population (p=0.04), but not in the obese population (p=0.3). BMI was not an independent predictor of AF-recurrence after ablation in the univariate (p=0.52) and multivariate logistic regression analysis (p=0.18).Conclusion:Compared to lean patients,recurrence of AF after catheter ablation was statistically significantly higher in overweight patients, but not in obese patients. BMI seemed not to be an independent predictor of AF-recurrence.

Next to age, obesity is one of the main predictors of the development of osteoarthritis. The link between obesity and osteoarthritis is a multi-unit. Definitely it was considered that excess weight leads to wear and tear seam. In fact, excessive load leads to cartilage degradation and subchondral bone shows that weight plays an important role in the initiation and development of osteoarthritis. However, the weight is correlated with obesity, osteoarthritis no weight-bearing joints.

Background and Aims. Obesity is a major risk factor for type 2 diabetes, cardiovascular diseases, cancer, pulmonary diseases, osteoporosis. Our study aimed to evaluate the caloric intake, vitamins and minerals from food before a nutritional intervention to overweight and obese patients. Material and methods. We evaluated the content of food before running a nutritional intervention program of 124 overweight and obese patients . We assessed the kilocalories, vitamins and minerals from intake food using a 7-day weighed food self-records; measured resting metabolic rate after eight hours fasting with an indirect calorimeter and parameters like weight, body mass index, body fat, percent of body fat, abdominal circumference and arterial tension.

Attention deficit/hyperactivity disorder (ADHD) is a childhood disorder that often persists into adulthood. Among adults, ADHD is highly comorbid with addictive behaviors (e.g., substance abuse and dependence), and depressive disorders. Recently, an association between ADHD and obesity has been reported in the literature; emotional and binge eating may be “addictive behaviors” that contribute to weight gain in this population. The purpose of this study was to test competing models of the hypothesized link between ADHD symptomology and overweight. Specifically, in Model 1, symptoms of depression are expected to mediate the relationship between symptoms of impulsivity and inattention and emotional and binge eating which, in turn, leads to weight gain (i.e., increased BMI). In Model 2, however, the impulsive symptoms have direct relationships with emotional and binge eating in addition to being mediated by depressive symptoms. Structural equation modeling (SEM) was employed to test how the models fit the data of 790 college men. Both models fit the data well, with Model 2 being preferred because of its greater connection to theory. All paths were significant indicating that increased impulsive and inattentive symptoms predicted increased symptoms of depression that, in turn, predicted increased emotional/binge eating, which has a direct and positive relationship with increased BMI. Moreover, impulsive symptoms were also directly related to emotional/binge eating, suggesting different paths to overweight across ADHD subtypes. The findings of the current study elucidate the links between ADHD symptoms and overweight (i.e., increased BMI).

The purpose of this project was to explore parent perceptions about their children's weight and the perceived barriers to implementing healthy eating habits and patterns of physical activity for their children.

Health seeking behaviour is important in older people with hypertension and overweight, in terms of managing health factors that are related to their health and illness. However, health seeking behaviour of Thai older people is not well documented. This qualitative study aimed to describe health seeking behaviour of overweight hypertensive older people. Seven older women and three men participated in this study through purposive sampling. Qualitative data were gathered via in-depth interviews and were analyzed using content analysis. The results of this study illustrated that older people started to seek health care after understanding the need to seek health care due to the severity of their symptoms. The older people began illness management by using their knowledge to take care of themselves. If management was ineffective, they would seek health care from professional health care providers and traditional healers. Additionally, family members play important roles in the health seeking behaviour of older people. In particular, Thai older people with hypertension and overweight demonstrate various health seeking behaviours that are useful to health care providers in providing appropriate care to these older people, aiming to promote better health of the older people.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2007.
Title from electronic title page (viewed Dec. 18, 2007). " ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Health Policy and Administration." Discipline: Health Policy and Administration; Department/School: Public Health.

Individuals with overweight and obesity frequently underestimate their weight status and underestimation is more pronounced in areas with high rates of obesity. After a literature review in Chapter 1, Chapter 2 examines whether male overweight and obesity is visually underestimated and whether exposure to heavier bodies results in greater underestimation. In Study 1, 1000 participants estimated the weight status of men with normal weight, overweight and obesity in an online survey. The weight status of men with overweight and obesity was frequently underestimated. In Study 2, 90 participants reported how the size of their male peers compared to an overweight male and estimated the weight status of 10 men with overweight and obesity in a paper based survey. Those with heavier peers were more likely to underestimate overweight and obesity. Finally in Study 3, 230 participants completed a between-subjects, online study in which they were exposed to men with normal weight or obese BMI's or control images before estimating the weight status of a male with overweight. Exposure to slimmer bodies reduced underestimation of overweight. Chapter 3 examines whether male and female overweight and obesity is visually underestimated and whether visual body size norms explain why exposure to heavier bodies increases underestimation of overweight. In Study 1, 91 participants estimated the weight status of men and women with normal weight, overweight or obesity in an online survey. Male and female overweight and obesity was frequently underestimated. In Study 2, 79 participants reported visual body size norms and estimated the weight status of men and women with overweight in an online survey. Those who perceived larger bodies as being normal were more likely to underestimate overweight. Finally in Study 3, 290 participants completed an online, between-subjects study in which they were exposed to men or women with healthy weight or obesity, reported visual body size norms and estimated the weight status of a man or woman with overweight. Those exposed to obesity reported larger body size norms and were more likely to underestimate overweight. Some research suggests underestimation of overweight could be a barrier to weight loss whilst other studies find that identifying as overweight is associated with weight gain over time. As such, Chapter 4 examines whether the psychosocial experience of feeling overweight affects eating behaviour. In Study 1, 120 women participated in a between-subjects study, they wore an obese body suit or control clothing in public or private settings before tasting and rating snack foods. Women who wore the body suit ate more than women who wore the control clothing, regardless of setting. In Study 2, 150 men and women wore an obese body suit or control clothing before tasting snack foods. Women who wore the obese body suit ate more than women who wore the control clothing. There was no effect of clothing on male consumption. We examined possible mediators of this effect but did not find supporting evidence. This thesis suggests that overweight is frequently visually underestimated due to increases in obesity increasing the range of bodies which are perceived as being normal. Furthermore, identifying as overweight may lead to increased snack food consumption, but it is not clear why this occurs. Future research should identify the mechanism explaining why feeling overweight can lead to increased consumption, as this would inform the inclusion of additional support in weight loss interventions.

Obesity is common in adolescence and associated with medical complications. As maladaptive emotional processing is assumed to influence obesity, this research investigated emotional openness (EO), a general model of emotional processing, in normal-weight versus overweight adolescents, with consideration of gender differences, in order to determine whether a particular EO profile is characteristic of overweight adolescents. This research also explored the psychometric characteristics of the Dimensions of Openness to Emotions Questionnaire (DOE-20), a comprehensive multifactorial instrument that assesses emotional processing. The DOE-20 and the Positive and Negative Affect Schedule (PANAS) short form were completed by 160 adolescents (mean age: 14.36 ± 0.61 years), 39 of which were overweight. A multivariate analysis of variance showed no difference with respect to overweight status, but better ability to recognize and regulate emotions in boys than girls. The original five-factor structure of the DOE-20 was confirmed by confirmatory factor analysis; however, internal consistency was modest. As this research did not replicate the EO profile previously found in obese adults, we discuss the adequacy of the DOE-20 to evaluate EO in adolescents as well as the ability of the construct of EO to assess emotional processing in obesity. Further research should examine the links between EO, problematic eating behaviors, and obesity.

The prevalence of obesity has reached dramatic proportions over recent years, and obesity among older adults is becoming an increasingly important concern in developed countries with ageing populations. Weight loss is recommended for all obese individuals, regardless of age, yet while there has been a vast amount of research into factors surrounding weight loss across younger and middle-aged populations, the evidence base on weight loss in older adults is lacking. This thesis uses data from a cross-sectional survey of UK adults, and two large epidemiological studies of ageing, the English Longitudinal Study of Ageing and the Health and Retirement Study in the US, to address this gap in the literature. Study 1 highlights the high prevalence of desire to weigh less and attempts at weight loss among older adults, and Study 2 reveals that a surprisingly high proportion of those who are overweight or obese are achieving clinically meaningful (≥5%) weight loss. Studies 3 and 4 show that despite reductions in cardio-metabolic risk, weight loss in overweight/obese older adults is associated with increased risk of depressed mood, and this association grows stronger with each decade of age. However, Study 5 finds some evidence to suggest that rates of depressed mood might only be increased during the process of weight loss, and that if weight loss is maintained there might be benefits for mood relative to baseline. This research contributes to the understanding of weight loss in older adults – particularly that which occurs in the general population, outside of the trial context – and emphasises the need for health professionals to take into consideration patients’ psychological wellbeing when recommending or responding to weight loss at older ages. Limitations of this work and directions for future research are discussed.

Obesity is common in adolescence and associated with medical complications. As maladaptive emotional processing is assumed to influence obesity, this research investigated emotional openness (EO), a general model of emotional processing, in normal-weight versus overweight adolescents, with consideration of gender differences, in order to determine whether a particular EO profile is characteristic of overweight adolescents. This research also explored the psychometric characteristics of the Dimensions of Openness to Emotions Questionnaire (DOE-20), a comprehensive multifactorial instrument that assesses emotional processing. The DOE-20 and the Positive and Negative Affect Schedule (PANAS) short form were completed by 160 adolescents (mean age: 14.36 ± 0.61 years), 39 of which were overweight. A multivariate analysis of variance showed no difference with respect to overweight status, but better ability to recognize and regulate emotions in boys than girls. The original five-factor structure of the DOE-20 was confirmed by confirmatory factor analysis; however, internal consistency was modest. As this research did not replicate the EO profile previously found in obese adults, we discuss the adequacy of the DOE-20 to evaluate EO in adolescents as well as the ability of the construct of EO to assess emotional processing in obesity. Further research should examine the links between EO, problematic eating behaviors, and obesity.

The primary objective of this exploratory study is to understand how ties and influence patterns among actors’ interactions (in this particular case the term actors refer to student/children, father, mother, best friend, and teacher) within an intervention setting affect the students’ dietary habits, physical activities habits and sedentary behaviour. This exploratory study will attempt to identify interesting patterns related to children’s behaviour. As eating habits in children may be affected by various factors, including school intervention, ties and other influence agents, it is extremely difficult to identify the “cause effect relationship” in their eating habits. Therefore, this work is a comprehensive description of our attempt to identify possible factors associated with the improvement of children’s behaviours. The exploratory study hopes that this work forms the basis for future studies where it is possible to better control samples and use improved measurement tools for ties and influence levels. As a result, it will be possible to identify with better precision which factors really influence children’s behaviour. Therefore, not only do the theories and findings presented in this exploratory study entail very different pathways of effect and diverse methodologies for measurement, they also help us to understand the need for innovative ways to design and measure interventions.

OBJETIVO Investigar associação entre participação no programa de assistência alimentar e sobrepeso/obesidade, segundo nível de pobreza. MÉTODOS Estudo transversal com dados sobre 46.217 mulheres não gestantes e não lactantes, de Lima, Peru, obtidos de pesquisas, com representatividade nacional, nos anos de 2003, 2004, 2006 e 2008-2010. A variável dependente foi o sobrepeso/obesidade e a independente foi a participação no programa de assistência alimentar. Utilizou-se regressão de Poisson; os modelos foram estratificados por nível socioeconômico familiar para todo o país, por área de residência (Lima versus o resto do país; urbano versus residência rural) e anos de estudo (2003-2006 versus 2008-2010). Os modelos foram ajustados por idade, nível acadêmico, urbanização e ano de estudo. RESULTADOS Participar do programa de assistência alimentar associou-se com risco aumentado de sobrepeso/obesidade para as mulheres que viviam em domicílios sem indicadores de pobreza (PR = 1,29; IC95% 1,06;1,57). Quando estratificados por área de residência, foram observadas associações similares para as mulheres que vivem em Lima e em áreas urbanas; não foram encontradas associações entre a participação no programa de assistência alimentar e sobrepeso/obesidade entre as mulheres que vivem fora de Lima ou em áreas rurais, independentemente de sua condição de pobreza. CONCLUSÕES Participar do programa de assistência alimentar associou-se com sobrepeso/obesidade para mulheres não pobres. Estudos adicionais serão necessários em países que enfrentam ambas as faces da má nutrição.
pia.chaparro@chess.su.se
OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.
Revisión por pares

Research suggests declines in physical activity may occur after age 12. The purpose of this study was to determine the relationships between adolescent physical activity, BMI, and nutrition. Adolescents, ages 12-17 (N = 223), wore pedometers for 11 consecutive days and completed a nutrition survey, the Youth Adolescent Questionnaire. Activity levels did not differ among the ages of 12-17 year old adolescents, and boys were more active than girls. There was a low, but significant relationship between BMI and physical activity levels for both boys and girls. Energy intake was not related to BMI or physical activity levels in boys or girls.

Thesis (M.S.)--West Virginia University, 2009.
Title from document title page. Document formatted into pages; contains vii, 64 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 38-40).

Thesis (Honors)--Ohio State University, 2007.
Title from first page of PDF file. Document formatted into pages: contains 26 p.; also includes graphics. Includes bibliographical references (p. 25-26). Available online via Ohio State University's Knowledge Bank.

Study One aimed to provide a current understanding of pupils’ attitudes towards people who are overweight and the prevalence and significance of weight-based unkindness in school. Methods: The study followed a mixed method, sequential qualitative and quantitative research design. Part One of the study used exploratory focus groups to ascertain that weight-based unkindness was a valid concern for children and young people, when compared against unkindness of other content. The focus group also ensured that the vignettes used in the survey (Part Two) were ecologically valid. Part Two included an existing measure of weight-stigma (attitude scale) and three sets of vignette-based questions to measure pupils’ perceptions of the frequency and severity of different incidents of unkindness. Part Two, was administered to 214 participants via a computerised survey. Results: The majority of pupils (61%) judged the overweight characters to be the least accepted. Participants also perceived significantly greater hurt, anger, embarrassment and humour to follow episodes of weight-based unkindness. Study Two aimed to better understand why, how and what is ‘different’ about pupils’ understanding of weight-based unkindness when compared to other types of unkindness. Methods: This study adopted an explorative approach to hear the lived experiences of six teachers and 29 children in two South West Primary Schools. Data was collected via semi-structured interviews, administered through focus groups (pupils) and paired interviews (teachers). Data was analysed using latent thematic analysis (Braun & Clarke, 2006). Results: The study found that pupils used the language of personal choice to attribute personal responsibility to overweight CYP, whilst teachers attributed this blame to their parents. Teachers espoused acceptance for the overweight whilst their behaviours implicitly reinforced the ‘thin-ideal’. Key findings are discussed from a theoretical perspective and their implication for supporting attitude change is highlighted.

Despite warnings about the implications of excess weight for health, U.K. Government statistics show that the number of men who are becoming overweight/obese is continuing to increase. Evidence also points to overweight males experiencing social disapproval reflected in negative character attributions and discrimination, as well as increasing body dissatisfaction.

Abstract Gestational diabetes mellitus (GDM) is defined as disturbed glucose metabolism first recognized during pregnancy. Untreated GDM increases the risk of obstetric and neonatal complications, such as fetal overgrowth (macrosomia). The first-line treatment of GDM includes diet therapy and the self-monitoring of blood glucose concentrations and, if needed, pharmacotherapy, which is most commonly accomplished with insulin. Oral anti-diabetic agents such as metformin have recently been under investigation. GDM increases the risk of developing overt diabetes, metabolic syndrome and cardiovascular diseases. The aim of the present study was to investigate the effect of metformin vs. insulin therapy on pregnancy and neonatal outcome as well as on later growth and development of the infant and to investigate the independent and concomitant effects of GDM and maternal overweight/obesity on pregnancy outcome and maternal long-term risks. In a randomized study of 100 women, metformin therapy was not associated with an increased risk of pregnancy or neonatal complications when compared with insulin treatment. However, 32% of the women treated with metformin needed additional insulin in the achievement of normoglycaemia. The need of additional insulin was associated with maternal obesity, an earlier need of pharmacotherapy and fasting hyperglycaemia in OGTT. Infants exposed to metformin were taller and heavier at the age of 18 months compared with infants exposed to insulin. There was no difference in the motor, social or linguistic development between these children when assessed at the age of 18 months. In an epidemiological study of 24,565 pregnancies, normal-weight women with GDM did not have an increased risk of macrosomia or Caesarean delivery when compared with normal-weight women without GDM. GDM was an independent risk factor of neonatal morbidity, especially hypoglycaemia. Maternal overweight and obesity were independent risk factors of macrosomia and obesity was also an independent risk factor of Caesarean delivery and neonatal morbidity. In a follow-up study (n = 116), women with a history of insulin-treated GDM had an increased risk of metabolic syndrome when compared with women without GDM 19 years after index pregnancy. However, maternal pre-pregnancy overweight as such was a stronger risk factor as regards the development of metabolic syndrome than previous GDM
Tiivistelmä Raskausdiabetes on ensimmäisen kerran raskauden aikana ilmaantuva glukoosiaineenvaihdunnan häiriö. Hoitamattomana raskausdiabetes lisää raskaana olevan ja vastasyntyneen komplikaatioriskiä, erityisesti sikiön liiallista kasvua (makrosomiaa). Raskausdiabetestä hoidetaan ruokavaliolla, veren glukoosipitoisuuksien omaseurannalla sekä tarvittaessa lääkehoidolla, joka on useimmiten insuliinihoitoa. Muita diabeteslääkkeitä, kuten metformiinia, on tutkittu viime vuosina paljon. Raskausdiabetes lisää myöhemmällä iällä riskiä sairastua diabetekseen, metaboliseen oireyhtymään sekä sydän- ja verisuonisairauksiin. Tämän tutkimuksen tarkoituksena oli selvittää metformiinihoidon tehoa ja turvallisuutta verrattuna insuliiniin raskausdiabeteksen hoidossa. Lisäksi selvitettiin raskausdiabeteksen ja ylipainon itsenäistä vaikutusta raskauskomplikaatioiden esiintyvyyteen sekä naisen myöhempään sairastuvuuteen. Satunnaistetussa tutkimuksessa (n = 100) metformiini ei lisännyt vastasyntyneen makrosomian eikä vastasyntyneen tai raskauskomplikaatioiden riskiä verrattuna insuliiniin. Metformiinilla hoidetuista naisista 32% tarvitsi lisäksi insuliinia normaalin glukoositasapainon saavuttamiseksi. Lisäinsuliinin tarvetta ennustivat äidin lihavuus, varhainen lääkehoidon tarve sekä kohollaan olevat glukoosin paastoarvot sokerirasituksessa. Metformiinille altistuneet lapset olivat sekä pidempiä että painavampia 18 kuukauden iässä kuin insuliinille altistuneet lapset, mutta heidän motorisessa, sosiaalisessa tai kielellisessä kehityksessään ei ollut eroja. Epidemiologisessa tutkimuksessa (n = 24,565) normaalipainoisen naisen raskausdiabetes ei lisännyt keisarileikkauksen tai sikiön makrosomian riskiä verrattuna normaalipainoisiin naisiin, joiden sokeriaineenvaihdunta oli normaali. Raskausdiabetes lisäsi itsenäisesti vastasyntyneen sairastavuuden ja hypoglykemian riskiä. Äidin ylipaino ja lihavuus lisäsivät itsenäisesti makrosomian riskiä ja lihavuus myös keisarileikkauksen ja vastasyntyneen sairastuvuuden riskiä. Seurantatutkimuksessa (n = 116) insuliinihoidettujen raskausdiabeetikoiden riski sairastua 19 vuotta raskauden jälkeen myöhempään metaboliseen oireyhtymään oli lisääntynyt verrattuna terveisiin verrokkeihin. Raskautta edeltävä ylipaino oli vahvempi riskitekijä metabolisen oireyhtymän kehittymiselle kuin aiempi raskausdiabetes

Background: Increasing physical activity (PA) may help to reduce the risk of obesity related pregnancy complications. However little is known about the amount, type and intensity of PA obese pregnant women engage in, or the most appropriate measurement method. Previous research suggests that obese pregnant women receive limited advice concerning PA from midwives. Objectives: To investigate the amount of PA carried out by this population and how this changes during pregnancy, to compare measurement methods, and to describe the knowledge, attitudes and practice of midwives surrounding PA. Methods: 1. 130 pregnant women, BMI≥25kg/m2, consented to PA measurement at 2 or 3 time points using the Actigraph accelerometer and Recent Physical Activity Questionnaire. 2. Questionnaires were designed and distributed to midwives within 3 NHS Trusts on Tyneside (n=365) with the aim of identifying barriers to discussing and advising PA with obese pregnant women. The design used the Theoretical Domains Framework approach which uses behavioural determinants to investigate implementation difficulties. Results: 1. At 12-16 weeks gestation over half of the participants achieved 30 minutes of moderate or vigorous PA, decreasing by 36 weeks to 24%. Women who were more active at baseline decreased their PA during pregnancy; those who were less active remained so. Self-reported PA also fell but did not correlate with objectively measured PA. 2. Midwives scored highest on knowledge and social-professional role and lowest on skills, capabilities and environment/context/resources domains. Regression analysis indicated that skills and memory/attention/decision domains had a significant influence on discussing PA. Conclusion: Research is needed to find methods to encourage obese women to increase and maintain PA levels before and during pregnancy, and to find the most appropriate PA measurement methods. Midwives feel knowledgeable and believe giving PA advice to be part of their role, but lack skills, capabilities and resources. Strategies to remove such barriers are needed.

Research findings from adult studies suggest that being teased about weight or size when growing up may be a risk factor in the development of later eating and body image problems. However, little research has focused directly on teasing experiences in childhood. The current study aimed to extend previous work and investigate the frequency of overweight-related victimisation and its psychological correlates in preadolescent boys and girls. It was hypothesised that victimised children would have lower self-esteem, more body dissatisfaction, and be more likely to report dieting to lose weight. From the sample of three hundred and eighty-three children (200 boys and 183 girls), aged nine years, it was found that 41% of girls and 36% of boys reported general victimisation. Furthermore, 21 % of girls and 16% of boys reported overweight-related victimisation, which included being teased, bullied, and called names about being fat. Overweight-related victimisation was associated with reduced self-esteem and greater levels of body dissatisfaction, even when controlling for BMI. These children were also more likely to report dieting and restrained eating behaviours than non-overweight victimised participants. Moreover, the overweight-related victimised participants received less attractiveness nominations from their peers than non-overweight victimised participants. Not surprisingly these participants rated fat teasing worse than other forms of teasing and it was more upsetting for them. This study also investigated characteristics associated overweight-related victimisers and found they had lower behavioural conduct esteem and lower global self-worth. In addition, they considered physical appearance more important for self-worth than those who did not victimise others for overweight. To date, this is the first study to describe levels of overweight related victimisation in a community sample of preadolescent boys and girls. Overall, this study highlights the presence of obesity stigmatisation, through teasing, in children and the potential negative consequences of overweight-related victimisation. Further research is required to examine the role of peer victimisation as a risk factor in the emergence of eating and weight concerns.

The purpose of this study was to understand the lived experiences of four overweight/obese Hispanic adolescents as individuals by utilizing Social Cognitive Theory’s (SCT) (Bandura, 1977, 1986, & 1989) reciprocal interaction of the environment, personal factors and behaviors of the participants in order to investigate the health risk behaviors of the participants as they related to overweight and obesity. Additionally, the commonalities and differences across participants were examined. Four female Hispanic adolescents whose BMI measured at the 99th percentiles for age and gender were randomly chosen from students enrolled in a junior high school physical education intervention class. Experiences of each participant were examined utilizing school cumulative records, a demographic questionnaire, participant observation in certain contexts, and a series of interviews, based on questions derived from SCT. Methodological triangulation and grounded theory were utilized in order to examine the research question. The accumulated data were presented in four separate case studies, which examined the life perspectives of each participant. A componential analysis was used to interpret the data. Results of the individual case studies showed that the school, home, and community environments were found to be influential to the health status of the four overweight participants, with the family appearing to be the primary source of influence. This study's conclusions indicate that the schools, homes and communities of the participants did not encourage physical activity or diet control and health risk behaviors in this regard were reinforced and perpetuated by family and friends.

The prevalence of overweight and obese individuals has been a critical issue which has caused a worldwide concerns for the health threats, since it is burdened due to several linked diseases. This business plan proposes the establishment of a for-profit health clinic named NutriMed that provides a quality care and is mainly patient centered. This clinic provide the care to decrease the prevalence of overweight and obesity among the children of the ages 5 to 19 years. The functioning of this clinic is based on Barlow et al approach for prevention and treatment of obesity using the multidisciplinary team effort, which consist of physician, dietitian, exercise expert, nurse and behavioral therapist. The goal of this health clinic is to improve the health in the Los Angles community especially for children. This is done by identifying the priorities and striving for a patient-centered and evidence based approach to care. While this plan acknowledges the challenges in serving indigent populations, the clinic will contract with Medi-Cal and commit to continuous fundraising efforts to remain financially sustainable in order to improve the health of vulnerable Angelino’s children.