Behavioral treatment of childhood obesity: Theoretical and practical implications.

The impressive 10-yr success of behavioral treatment of childhood obesity stands in marked contrast to the disappointing long-term results obtained with obese adults. It may be easier to teach children healthy eating and activity habits. Parents also regulate access to food, thereby reducing the importance of self-control. Whether treatment of childhood obesity affects the later development of an eating disorder is a question that calls for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abdominal obesity and its metabolic complications: implications for the risk of ischaemic heart disease

Although the health hazards of obesity are well established, obese individuals are not all at equal risk of developing a disease, which reflects the heterogeneity of this condition. The regional distribution of body fat is now recognized as a very important component of the obesity-related health hazards. Epidemiological studies have shown that abdominal obesity, that is, a preponderance of fat in the abdominal area, is a better predictor of both cardiovascular disease and type 2 diabetes than obesity per se. It is now generally accepted that the fat located within the abdominal cavity, the visceral fat, is the best correlate of most of the highly atherogenic metabolic complications seen in individuals with abdominal obesity. These include, among others, insulin resistance and hyperinsulinaemia, hypertriglyceridaemia, reduced plasma high-density lipoprotein (HDL) cholesterol concentrations and an increased number of small, dense low-density lipoprotein (LDL) particles. This review summarizes the evidence that these metabolic complications may account to a large extent for the increased risk of cardiovascular disease associated with abdominal/visceral obesity. Abdominal obesity may be the most prevalent denominator of highly atherogenic dyslipidaemic and hyperinsulinaemic/insulin-resistant states in affluent, sedentary societies. Targeting individuals with this high-risk trait in primary prevention is therefore crucial if we are truly to have an impact on the incidence of cardiovascular disease.     

Effects of exercise training on abdominal obesity and related metabolic complications

Excessive deposition of visceral adipose tissue is known to predispose to cardiovascular diseases. Considerable epidemiological and experimental evidence suggests that many physiological factors are involved in the aetiology of premature atherosclerosis associated with visceral obesity. Insulin resistance is frequently associated with abdominal obesity, and probably plays an important role in the pathophysiology of hypertriglyceridaemia, low levels of plasma high-density lipoprotein (HDL)-cholesterol, hypertension and reduced fibrinolytic activity. Exercise training may counteract the aberrant metabolic profile associated with abdominal obesity both directly and as a consequence of body fat loss. Exercise may increase insulin sensitivity, favourably alter the plasma lipoprotein profile and improve fibrinolytic activity. Changes in the activity of insulin-sensitive glucose transporters and of skeletal muscle lipoprotein lipase are some of the possible explanations for the increased insulin sensitivity and improved blood lipid profile associated with regular exercise. This review presents physical training as a relevant nonpharmacological tool in the treatment of abdominal obesity and associated metabolic disorders. The impact of regular exercise on the different aspects of the insulin resistance syndrome is discussed. The roles of gender, age and the state of insulin resistance on the metabolic effect of physical training are also considered.     

Effects of diet and diet-plus-exercise programs on resting metabolic rate: a meta-analysis

Studies examining the effects of diet (D) and diet-plus-exercise (DE) programs on resting metabolic rate (RMR) report equivocal results. The purpose of this study was to use meta-analysis to determine if exercise prevents the decrease in RMR observed with dieting. Results from the 22 studies included in this analysis revealed that the majority of studies used female subjects ages 31-45 years, who were fed a relatively low-fat, high-carbohydrate diet of less than 5,023 kJ.day-1. The predominant prescribed exercise was aerobic in nature, 31-60 min in duration, performed 4-5 days per week, and of moderate intensity (51-70% of VO2max). Contrary to what is reported in narrative reviews, RMR decreased significantly with both D and DE programs, and the drop with D was significantly greater than that with DE. In conclusion, the addition of exercise to dietary restriction appears to prevent some of the decrease in RMR observed in premenopausal women.     

Transcriptional regulation of metabolic processes: implications for cardiac metabolism

Developmental delay is frequently used to identify children with delay in meeting developmental milestones in one or more streams of development. There is no consensus on the specific definition. Developmental delay is best viewed generically as a chief complaint rather than a diagnosis. A child suspected to have delays should always be assessed in each of the major streams of development: expressive and receptive language, including social communication; visual problem solving (nonverbal cognition); motor development; neurobehavioral development; and social-emotional development. A model developed by the National Center for Medical Rehabilitation Research is used to compare existing classifications of developmental delays. This model defines the five domains in the disability process: pathophysiology, impairment, functional limitation, disability, and societal limitation. An etiology domain is added. This model is used to illustrate how existing classification systems of cerebral palsy, mental retardation, autism, and language delay draw on information from one or more domains. The model illustrates some of the conflicts between different systems. For example, most classification systems for cerebral palsy emphasize only impairment (spasticity, dyskinesias, and topography). The current definition and classification system for mental retardation focuses on functional limitations (IQ), disability, and societal limitations, ignoring pathophysiology and details of impairment. Given the complexity of neurodevelopmental disabilities, it is unlikely that a single classification system will fit all needs.     

Behavioral treatment of childhood obesity.

[Correction Notice: An erratum for this article was reported in Vol 103(3) of Psychological Bulletin (see record 2008-10688-001). Tables 1 and 2 contain several errors. The correct data is provided in the erratum. These errors do not influence any of the main points or conclusions in this article.] Obesity is a common problem in children and is associated with an increased risk of adult obesity. Twenty-four studies on the behavioral treatment of childhood obesity are reviewed. Studies involving comparisons of behavioral treatment with no treatment or placebos have shown the superiority of behavioral treatment. In addition, the effects of a number of treatment factors on outcome are suggested. These factors include parental involvement, the arrangement of treatment contingencies, and exercise. Several directions for future research are presented, including selecting which children to treat, individualizing treatment, prevention, community programs, and the side effects of weight control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Five-year follow-up of family-based behavioral treatments for childhood obesity.

This article presents the 5-year outcome of family-based behavioral treatment of obesity for 6- to 12-year-old children in 162 families across 4 treatment outcome studies. Results suggest that treatments that use (a) conjoint targeting and reinforcement of child and parent behavior or (b) reciprocal targeting and reinforcement of children and parents are associated with the best child outcomes. Predictors of child success include self-monitoring, changing eating behavior, praise, and change in parent percent overweight. Parental outcome is predicted by self-monitoring weight, baseline parent percent overweight, and participation in fewer subsequent weight control programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ten-year outcomes of behavioral family-based treatment for childhood obesity.

Reports 10-yr treatment outcomes for obese children in 4 randomized treatment studies. At 10 yrs, 34% decreased percentage overweight by 20% or more, and 30% were not obese. Significant effects were observed when parents and children were targeted and reinforced for weight loss in comparison with nontargeted controls and for children given lifestyle or aerobic exercise in comparison with a calisthenics control. 34% of the variance in change in percentage overweight was predicted from sex, baseline percentage overweight, self-monitoring weight, meals eaten at home, and family and friends' support for eating and exercise. Results show long-term changes in children depend on the treatment, and evidence converges on the importance of the family and other sources of support for eating and activity change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategies and potential molecular targets for obesity treatment

Obesity is an increasingly prevalent and important health problem. Although treatment is available, the long-term maintenance of medically significant weight loss (5 to 10 percent of initial body weight) is rare. Since 1995 there has been an explosion of research focused on the regulation of energy balance and fat mass. Characterization of obesity-associated gene products has revealed new biochemical pathways and molecular targets for pharmacological intervention that will likely lead to new treatments. Ideally, these treatments will be viewed as adjuncts to behavioral and lifestyle changes aimed at maintenance of weight loss and improved health.     

The effect of increased weight on peak pressures: implications for obesity and diabetic foot pathology

The purpose of this study was to determine if increased weight contributes to increased mean peak plantar foot pressures when foot function, deformity, and structure are controlled. Ten male and nine female volunteers without sensory neuropathy or other systemic disease were evaluated in the study. Using a repeated measures design, peak plantar foot pressures were compared using the Novel Pedar in-shoe pressure measurement system under three conditions. Baseline measurements were made while volunteers wore the standard test footwear, a thin-soled rubber oxford sneaker. The second and third test conditions involved pressure measurements with an additional 9.1 kg (20 lb) and 18.2 kg (40 lb), respectively, of weight evenly distributed in pockets on the front and back of a workout vest. There was a significant increase in mean peak plantar foot pressures under the metatarsal heads, heel, and midfoot for each incremental increase of weight (baseline vs. 9.1 kg, p < .05; 9.1 kg vs. 18.2 kg, p < .05). The authors conclude that increases in weight increased plantar foot pressures for the first metatarsal, lesser metatarsal, midfoot, and heel regions in both men and women.     

Epidemic obesity in the United States: are fast foods and television viewing contributing?

Chlorpromazine and prochlorperazine have previously been shown to enhance the susceptibility of Burkholderia cepacia to aminoglycosides. To screen other non-antibiotic drugs containing similar amine (-N-CH3) groups, we examined a range of such agents that are in current clinical use for the treatment of non-infectious diseases, in combination with antibiotics that are ineffective against B. cepacia. At a concentration of 0.2 mM, theobromine, theophylline, trifluoperazine, fluophenazine and coumarin-152 significantly reduced (by four-fold) the MICs of gentamicin and ceftazidime. Theobromine and theophylline also reduced the MICs of amikacin and azithromycin.     

Caucasian versus African-American differences in orosomucoid: potential implications for therapy

We conducted a prospective, nonrandomized study in healthy volunteers to determine if racial differences exist in orosomucoid (ORM) and its variants, and to examine quinidine and lidocaine binding to the protein. Total ORM serum concentrations were measured by Laurell-Rocket immunoelectrophoresis. Allele types were determined by isoelectric focusing and immunoblotting. Total and unbound quinidine and lidocaine concentrations were measured with standard fluorescence polarization immunoassays after ultrafiltration. The frequency of the common ORM alleles was similar between 38 Caucasians and 67 African-Americans. Mean total ORM concentration was significantly lower in Caucasians (57.3 +/- 25.4 vs 73.2 +/- 33.9 mg/dl, p=0.01). However, more Caucasians took oral contraceptives, which may have decreased ORM concentrations. Quinidine unbound fraction (UF) was related to ORM phenotype. The highest UF was found with ORM 1-S (p=0.009). There were no significant relationships between ORM phenotype and lidocaine UF. Overall, African-Americans had higher ORM concentrations than Caucasians. Quinidine binding showed significant relationships to specific ORM variants.     

Pace and continuity of television programs: Effects on children's attention and comprehension.

16 15-min children's TV programs varying in continuity (high vs low), pace (high vs low), and animation (cartoon vs live production) were made from broadcast material and shown to 80 children from kindergarten and 1st grade and 80 children from 3rd–4th grade. Ss viewed 2 of the programs and were then tested for recall. The recall task required sequential seriation of still photos taken from the program. Older Ss attended longer and reconstructed sequences better than younger Ss. High-continuity (story) programs led to greater attention and better recall than low-continuity (magazine) programs. Low-paced shows were recalled better than high-paced shows. Older Ss recalled best when shown either low pace or story format or both. Young Ss showed additive increments in recall due to low pace and high continuity. Regression analyses indicated higher correlations between attention and recall for animated stories than for other types of programs, an effect attributed to their relatively high stereotypy in the medium. Results are interpreted as indicating evidence for development of active, schematic processing of TV by children and for strategic attending by older children, based on perceived processing demands. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of family-based treatment of childhood obesity.

This study was a 5-year follow-up of obese children who participated in a family-based behavioral weight-control program targeting and reinforcing children and parents for weight loss (Epstein, Wing, Koeske, Andrasik, & Ossip, 1981). Children in the parent-plus-child group showed significantly greater weight reductions after 5 years (–22.7% overweight) than did children in a child-alone target group or in a no-target control group (4.3% and 8.2% overweight, respectively). One third of children in the parent-plus-child group were within 20% of normal weight in comparison with 5% of the children in the no-target control group. Height percentile decreased from the 72nd to the 60th percentile; these changes were negatively related to weight change. These children remained taller than the average child after weight loss, and children of short and medium-height parents were still relatively taller than their parents after 5 years. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of healthy aging on the regional cerebral metabolic rate of glucose assessed with statistical parametric mapping

The aging process is thought to result in changes in synaptic activity reflecting both functional and structural cell derangement. However, previous PET reports on age-related changes in resting brain glucose utilization (CMRglc) have been discrepant, presumably because of methodological as well as subject screening differences. In contrast to other studies, which used a region of interest approach, the objective of the present work was to determine, by means of the SPM software, the changes in regional CMRglc as a function of age in 24 optimally healthy, unmedicated volunteers of ages from 20 to 67 years. Global CMRglc showed a significant decline with age (approximately 6% per decade, P < 0.05), which concerned all the voxels studied save for most of the occipital cortex and part of the cerebellum. The most significant effects (P < 0.001) concerned the association neocortex in perisylvian temporoparietal and anterior temporal areas, the insula, the inferior and posterior-lateral frontal regions, the anterior cingulate cortex, the head of caudate nucleus, and the anterior thalamus, in a bilateral and essentially symmetrical fashion. The high posterior parietal cortex was not sampled in this study. This distribution of changes in CMRglc with age may differ from that seen in Alzheimer' disease, where the earliest metabolic reduction has been shown to affect the posterior cingulate cortex.     

Problem solving in the treatment of childhood obesity.

This study randomized obese children from 67 families to groups that received a 6-month family-based behavioral weight-control program plus parent and child problem solving, child problem solving, or standard treatment with no additional problem solving. The standard group showed larger body mass index (BMI) decreases than the parent?+?child group through 2 years, with significant differences in the percentage of children who showed large BMI changes. Significant statistical and clinical improvements were observed over time in child behavior problems and parental distress. Parent problem solving increased in the parent?+?child condition relative to the other conditions, whereas child problem solving increased equally in all conditions. The bulk of evidence suggests that problem solving did not add to treatment effectiveness beyond the standard family-based treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Astrocytoma cell interaction with elastin substrates: implications for astrocytoma invasive potential

Elastin has been identified within the meninges and the microvasculature of the normal human brain. However, the role that elastin plays in either facilitating astrocytoma cell attachment to these structures or modulating astrocytoma invasion has not been previously characterized. We have recently shown that astrocytoma cell lines and specimens produce tropoelastin, and express the 67 kDa elastin binding protein (EBP). In the present report, we have established that astrocytoma cells attach to elastin as a substrate in vitro. The U87 MG astrocytoma cell line demonstrated the greatest degree of adhesion. In addition, all astrocytoma cell lines examined were capable of penetrating and migrating through an intact elastin membrane, and of degrading tritiated-elastin, a process that could be prevented by the pre-incubation of astrocytoma cells with EDTA, but not with alpha1-antitrypsin. Astrocytoma cells were also capable of penetrating 1 mm sections of human brain tissue maintained as organotypic cultures. Interestingly, the invasive potential of cultured astrocytoma cells plated on organotypic cultures of human brain was significantly increased after exposure to elastin degradation products (kappa-elastin), which interact with astrocytoma cell surface EBP. Our data show that astrocytoma cells express a functional 67 kDa EBP, enabling them to potentially recognize and attach to elastin as a substrate. These data also suggest that this elastin receptor may be involved in processes which regulate regional astrocytoma invasion.