Predicting obesity in young adulthood from childhood and parental obesity

BACKGROUND: Childhood obesity increases the risk of obesity in adulthood, but how parental obesity affects the chances of a child's becoming an obese adult is unknown. We investigated the risk of obesity in young adulthood associated with both obesity in childhood and obesity in one or both parents. METHODS: Height and weight measurements were abstracted from the records of 854 subjects born at a health maintenance organization in Washington State between 1965 and 1971. Their parents' medical records were also reviewed. Childhood obesity was defined as a body-mass index at or above the 85th percentile for age and sex, and obesity in adulthood as a mean body-mass index at or above 27.8 for men and 27.3 for women. RESULTS: In young adulthood (defined as 21 to 29 years of age), 135 subjects (16 percent) were obese. Among those who were obese during childhood, the chance of obesity in adulthood ranged from 8 percent for 1- or 2-year-olds without obese parents to 79 percent for 10-to-14-year-olds with at least one obese parent. After adjustment for parental obesity, the odds ratios for obesity in adulthood associated with childhood obesity ranged from 1.3 (95 percent confidence interval, 0.6 to 3.0) for obesity at 1 or 2 years of age to 17.5 (7.7 to 39.5) for obesity at 15 to 17 years of age. After adjustment for the child's obesity status, the odds ratios for obesity in adulthood associated with having one obese parent ranged from 2.2 (95 percent confidence interval, 1.1 to 4.3) at 15 to 17 years of age to 3.2 (1.8 to 5.7) at 1 or 2 years of age. CONCLUSIONS: Obese children under three years of age without obese parents are at low risk for obesity in adulthood, but among older children, obesity is an increasingly important predictor of adult obesity, regardless of whether the parents are obese. Parental obesity more than doubles the risk of adult obesity among both obese and nonobese children under 10 years of age.     

Ethnic variation in the prevalence of obesity in North American children and youth

The estimated prevalence of obesity in North American children and youth (6 to 17 years) in the 1960s through the 1980s is reported. Use of the triceps skinfold and BMI independently and in combination as indicators of obesity provides different estimates of prevalence due to ethnicity. With the triceps skinfold as the indicator, there is an increase in the prevalence of obesity and a reduction in variation between Black and White children and youth from the 1960s to 1980; however, with the BMI as the indicator, there is no change in the prevalence of obesity and negligible ethnic difference in these national data sets. On the other hand, the prevalence of obesity has increased over time in Mexican American and American Indian children and youth. Data for American children and youth of Asiatic ancestry are limited.     

Prevalence of overweight and associated factors among Oklahomans

BACKGROUND: Obesity among adults in the, United States has been increasing for the last three decades. Overweight is associated with numerous health risks such as diabetes, atherosclerosis, hypertension, sedentary lifestyle, etc. It also throws a very heavy economic burden on society, estimated at $39.3 billion in 1986. OBJECTIVE: To estimate the prevalence of obesity and its associated factors so that efforts to achieve the Healthy Oklahomans 2000 objectives may be brought into sharper focus. STUDY DESIGN: The study design is cross-sectional. METHODS: The study is based on the data from the Behavioral Risk Factor Surveillance System (a three-stage cluster sample survey) for the years 1991 through 1994. Statistical analysis was done with SUDAAN software for complex survey. RESULTS: More than 25% of Oklahomans are overweight. To reach the Year 2000 objectives, a reduction of 10% in overweight will have to be achieved in about three and one-half years. Prevalence of moderate obesity among women is higher than among men. Prevalence of severe obesity is higher among the black community than among other communities. However, prevalence of moderate obesity is the same among blacks and whites. Severe obesity is significantly higher among those with less than a high school education than among those with college education. The prevalence of moderate obesity among non-smokers is significantly higher than among smokers. Among the severely obese, hypertension is more than twice as prevalent as normal blood pressure. Among the moderately obese, high blood pressure is more than one and one-half times more prevalent than normal blood pressure. Obesity increases with age in a predictive manner; it drops after the age of 54. Moderate obesity is significantly higher among women who have had a hysterectomy than those who have not had a hysterectomy. Prevalence of severe obesity as well as moderate obesity is very much higher among diabetics than among non-diabetics. A large proportion of severely obese people are physically inactive. We did not find an association between consumption of fruits and vegetables as a part of normal diet and prevalence of obesity. CONCLUSION: Strenuous and focused efforts need to be made among the vulnerable groups, in view of the short time left until year 2000, to reduce the prevalence of obesity to the level laid down in the Year 2000 objectives.     

Association between duration of obesity and risk of non-insulin-dependent diabetes mellitus. The Sotetsu Study

The authors investigated the association between duration of obesity (ordinary obesity as body mass index (BMI) (kg/m2) > or = 25.0 and extreme obesity as BMI > or = 27.8) and the risk of diabetes mellitus. Male employees of a railway company, aged 30 years or older, observed for 10 years or more, free from serious disease conditions, with initial BMI <25.0, aged 30 years or more at the time diabetes was diagnosed, and with complete data, were examined by univariate and multivariate analyses (n = 1,598). Age-adjusted odds ratios for diabetes were significantly increased among males who were obese for 10-19.9 years and >20 years (odds ratios = 2.10 and 2.84 for ordinary obesity and 6.14 and 4.15 for extreme obesity, respectively). Additional adjustment for current obesity, physical activity, smoking, drinking, family history, and observation period did not change the findings remarkably. In conclusion, > or = 10 years duration of ordinary obesity or > or = 1 year of extreme obesity was an important predictor for diabetes independent of age, current obesity, physical activity, smoking, drinking, family history, and observation period.     

Prader-Willi and other syndromes associated with obesity and mental retardation

Constitutional obesity and mental retardation cooccur in several multiple congenital anomaly syndromes, including Prader-Willi syndrome, Bardet-Biedl syndrome, Cohen syndrome, Albright hereditary osteodystrophy, and Borjeson-Forssman-Lehmann syndrome as well as some rarer disorders. Although hypothalamic-pituitary axis abnormalities are thought to be a possible causative mechanism in some of these disorders, current knowledge is insufficient to explain the pathophysiologic mechanism of obesity in most multiple congenital anomaly/mental retardation syndromes. The chromosomal location of many of these syndromes is known, and studies are ongoing to identify the causative genes. Further delineation of the functions of the underlying genes will likely be instructive regarding mechanisms of appetite, satiety, and obesity in the general population. This review details current knowledge of the clinical and molecular genetic findings of multiple congenital anomaly/mental retardation syndromes associated with intrinsic obesity in an effort to delineate causative mechanisms and genetic abnormalities contributing to obesity.     

Prevalence and risk factors of obesity in adults

INTRODUCTION: A population-based cross-sectional study was conducted in Pelotas, Southern Brazil, with the objective of determining the prevalence of obesity and identify associated, variables as this condition increased markedly in the country between 1974 and 1989. MATERIAL AND METHODS: One thousand and thirty-five adults between 20 and 69 years of age were studied. Obesity was defined as a Body Mass Index--BMI--equal to or over 30 Kg/square meter). The multivariate analyses took into account the hierarchical model of the variables associated with obesity for both men and women. RESULTS: The prevalence for the overall population was of 21% (CI 18-23). It was higher among women--25% (CI 22-29) than for men--15% (CI 12-18). Socioeconomic status was positively associated with obesity among men, whereas the opposite situation was reported for women, with those belonging to the poorest social strata presenting increased BMI. Reported obesity in their parents was associated with increased BMI in the subjects, and this association remained statistically significant even after compensating for the effect of possible confounding variables. Self-reported diabetes and arterial hypertension doubled the risk of obesity, whereas non-smoking was associated with obesity only among women. Variables which were not associated with obesity after adjusting for confounders were alcohol consumption, marital status and parity. Women having more daily meals were less prone to obesity, even after controlling for confounders, and this association was not quite significant for men (p = 0.07). CONCLUSIONS: The prevalence of obesity was higher among women, and important differences in risk factors were noticed when the population was considered by sex.     

The problem of obesity in children from the mountains and the city

The problem of obesity has been investigated on 547 children from the mountains and the city by a questionary and by measuring skinfolds and body weight. The ratio of obesity is very high specially in children of the city and in parents of both groups. Obesity of parents, small sportif activity and nearly daily watching television was found to favour obesity of the children. Factors against obesity are the hard work of children in the mountains and large sportif activity. The mean values of body weight and skinfolds partially differ very much from the median values and cannot be used as norm.     

Obesity: Psychological causes, correlations, and speculations.

Reviews the literature for consistencies and disagreements about psychological factors associated with obesity, particularly the issue of external cue sensitivity. Methodological problems associated with these studies are discussed, as well as alternative explanations for the findings. Research on the association between other personality variables and obesity is also presented. The problems inherent in defining and measuring the obese state and in viewing obesity as if it were a unitary syndrome are considered. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obesity and hypertension

An increasing number of clinical trials have demonstrated that obese patients are more likely than lean individuals to be hypertensive. Moreover, both obesity and arterial hypertension have been identified as independent risk factors for cardiovascular disease. Pathophysiologically, obesity appears to have a major influence on the hemodynamic changes associated with hypertension. The available evidence suggests that at any given level of arterial pressure, obese hypertensive patients have a higher cardiac output and lower total peripheral resistance than do lean patients. Recent reports have indicated that obesity exerts a disparate effect on target organs in hypertension. Whereas at rest obesity seems to mitigate cardiovascular changes in the systemic vascular bed caused by hypertension, no such mitigation was observed in the renovasculature; left ventricular hypertrophy as a major cardiovascular risk factor was even exacerbated by the presence of obesity. The different hemodynamic patterns in obese hypertensive patients have recently been shown clinically relevant for treating hypertensive patients.     

Less invasive techniques for mitral valve surgery

This paper reviews the published cost-of-illness studies on obesity. The medical literature has demonstrated that obesity is an independent risk factor for a number of medical conditions, including diabetes mellitus, hypertension, coronary heart disease, elevated cholesterol levels, depression, musculoskeletal disorders, gallbladder disease, and several cancers. Since these conditions can be costly to treat, obesity clearly has a substantial economic impact. Epidemiologic estimates of the aggregate economic costs associated with specific obesity-related diseases in the United States indicate that the annual burden to society totals in the billions of dollars, representing 5.5% to 7.8% of total health-care expenditures. Although estimates of the costs attributable to obesity differ across studies, the one common finding is that these costs are substantial from a health-policy perspective. The objective of this paper is to identify and review the obesity cost-of-illness literature, address study limitations, and identify key areas for future economic research. This review indicates that the economic burden of obesity has been estimated using a prevalence-based cost-of-illness framework. Areas for future research include estimating the economic burden of obesity using an incidence-based cost-of-illness framework and modeling the association between health-care expenditure and level of obesity using individual-level data, such as medical and pharmacy claims data.     

Obesity as a risk factor for certain types of cancer

In conclusion, obesity has been associated with increased risk for a number of different types of cancer. The evidence has been most consistent for endometrial cancer, breast cancer in postmenopausal women, and renal cell cancer. More variable results have been reported for colorectal, prostate and pancreatic cancer. Possible mechanisms by which obesity may influence cancer risk include alteration in hormonal patterns, including sex hormones and insulin, and factors such as the distribution of body fat and changes in adiposity at different ages. The increasing prevalence of obesity in many parts of the world emphasizes the importance of learning more about the relationship between obesity and cancer and the mechanisms involved in their interaction.     

Assessing obesity: classification and epidemiology

Obesity is generally defined as a body mass index (BMI) of 30 kg/m2 and higher. Overweight is defined as a BMI between 25 and 30 kg/m2. The prevalence varies considerably between countries, and between regions within countries. It is estimated that more than half of adults aged 35-65 living in Europe are either overweight or obese. Overweight is more common among men than among women but obesity is more common among women. The prevalence of obesity in Europe is probably in the order of 10-20% in men and 15-25% in adult women. In most European countries who have reliable data on time-trends the prevalence of obesity seems to be increasing. In most European countries, obesity is usually inversely associated with socio-economic status, particularly among women. New classifications of overweight may be based on cut-off points for simple anthropometric measures which reflects both total adiposity as well as abdominal fatness.     

Obesity: entrance port to multimorbidity

Obesity is an essential risk factor for hypertension, coronary heart disease and stroke as well as for metabolic disturbances, especially for type 2 diabetes, hyper- and dyslipidemia, and it is responsible for the metabolic syndrome with insulin resistance and hyperinsulinemia. Disturbances in the lung function are also induced by obesity, as a higher risk for arthrosis on the lower extremities. Some oncological diseases like breast-, endometrial-, and prostatic cancer are associated with obesity. It is evident, that the fat distribution plays an important role in the development of obesity associated diseases: the accumulation of visceral fat has a higher risk as the peripheral fat, probably due to the different metabolism.     

Obesity in primary care patients in Kelantan, Malaysia: prevalence, and patients' knowledge and attitudes

This study measured the body mass index (BMI), and assessed attitudes and knowledge about obesity, of 197 male and 217 female patients aged 20-59 years attending the primary care clinic of the university hospital in Kelantan, Malaysia. There was no significant difference between the mean BMI of males (23.7) and females (24.2). In the overweight group (BMI 25-29.9) were 60 men (30%) and 66 women (30%). In the obese group (BMI 30 and above) were 12 men (6%) and 22 women (10%). Both diabetes mellitus and hypertension were associated with significantly higher BMI's. Knowledge about obesity was lacking. Sixty-three (15%) failed to recognize that obesity is bad for health. When asked the causes of obesity, 88 (21%) failed to mention either diet or lack of exercise. "Being happy" was suggested as a cause by 32 (8%). When asked if certain foods would cause obesity if eaten in excess, 45 (11%) said "No" for fatty foods, and 164 (40%) said "No" for sweet foods. Concerning appearance, 30 (15%) men regarded an obese man as normal or even handsome, while 49 (23%) women regarded an obese woman as normal or beautiful. Obesity is common among our adult patients, and is associated with some of their common health problems. However, a substantial minority do not regard obesity as unhealthy, do not relate it to diet or lack of exercise, do not recognize important groups of fattening foods, and do not regard obesity as unattractive.     

Effects of obesity and weight loss on cardiac function and valvular performance

OBJECTIVE: To study the consequences of long-standing obesity on myocardial function and valvular performance and to determine the effects of weight loss on these cardiovascular features. RESEARCH METHODS AND PROCEDURES: We included 41 patients with obesity referred for weight-reducing gastroplasty, 31 patients with obesity who received dietary recommendations, and 43 lean subjects. Body weight and blood pressure were measured, and cardiac function and valvular performance were estimated echocardiographically. Left ventricular ejection fraction was used to assess systolic heart function, and the ratio of transmitral early to atrial (E/A) peak flow velocity was used as an estimate of diastolic filling. All three study groups were investigated at baseline, and the two groups with obesity were re-examined at 1-year follow-up. RESULTS: Patients with obesity had higher blood pressure, greater cardiac output, lower ejection fraction, and reduced E/A ratio, compared with lean subjects (p<0.01). Surgical treatment of obesity led to significant decreases in body weight, whereas body weight remained unchanged in the group treated with dietary recommendations (p<0.001). In the weight loss group, blood pressure and cardiac output decreased and the E/A ratio increased (p<0.001). Left ventricular ejection fraction tended to increase in the weight loss group and decrease in the obese control group (p<0.01). No significant valvular disease was observed in any of the subjects with obesity at baseline or after weight loss. DISCUSSION: We conclude that weight reduction in subjects with obesity is associated with improvements in left ventricular diastolic filling and has favorable effects on left ventricular ejection fraction. Neither obesity nor weight loss seem to promote valvular heart disease.     

Physician attitudes toward managing obesity: differences among six specialty groups

BACKGROUND: The Healthy People 2000 report recommended that physicians more actively address obesity, but little is known about current attitudes and practices of physicians, particularly across specialty areas relevant to obesity as a medical risk factor. METHODS: A mail survey of 1,222 physicians from six specialties (family practice, internal medicine, gynecology, endocrinology, cardiology, and orthopedics) investigated beliefs, attitudes, and practices regarding obesity in relation to medical risk, management, and interest in training and other resources. RESULTS: Specialty groups shared high concern for the health risks of moderate and morbid obesity, but distinct attitudes and patterns of practice emerged. For example, family practitioners, internists, and endocrinologists reported treating obesity themselves in about 50% of obese patients, which correlated with reported use of more active treatment approaches (r = 0.62, P < 0.0001). Other groups reported intervening with 5 to 29% of patients, but expressed greater interest in making referrals. Physicians reporting "any specialty training related to ... obesity" ranged from 4.5% of family practitioners to 36.4% of endocrinologists. CONCLUSIONS: Physicians express high concern with management of obesity but variable interest in assuming this role themselves. Mild obesity may be particularly undertreated. Research is critically needed to assess effective physician roles in weight management and to support the development of physician guidelines.     

Leptin and the regulation of body weight

Leptin has received considerable attention as a newly recognized metabolic hormone and for its potential for therapeutic use in the treatment of human obesity. Furthermore, defects in the leptin signal pathway that result in obesity in animal models have raised the possibility of a similar etiology for obesity in humans. This review will summarize the current findings on leptin in both humans and rodents. These findings will be discussed with respect to our view of the physiology and potential for pathophysiology in leptin-mediated regulation of body weight and composition.     

Exposure to elevated levels of dietary fat attenuates psychostimulant reward and mesolimbic dopamine turnover in the rat.

Recent studies indicate that decreased central dopamine is associated with diet-induced obesity in humans and in animal models. In the current study, the authors assessed the hypothesis that diet-induced obesity reduces mesolimbic dopamine function. Specifically, the authors compared dopamine turnover in this region between rats fed a high-fat diet and those consuming a standard low-fat diet. The authors also assessed behavioral consequences of diet-induced obesity by testing the response of these animals in a conditioned place paradigm using amphetamine as a reinforcer and in an operant conditioning paradigm using sucrose reinforcement. Results demonstrate that animals consuming a high-fat diet, independent of the development of obesity, exhibit decreased dopamine turnover in the mesolimbic system, reduced preference for an amphetamine cue, and attenuated operant responding for sucrose. The authors also observed that diet-induced obesity with a high-fat diet attenuated mesolimbic dopamine turnover in the nucleus accumbens. These data are consistent with recent hypotheses that the hormonal signals derived from adipose tissue regulate the activity of central nervous system structures involved in reward and motivation, which may have implications for the treatment of obesity and/or addiction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The economic cost of obesity: the French situation

OBJECTIVE: To estimate the economic burden of obesity in France. DESIGN: A prevalence-based approach identifying the costs incurred during a given year (1992) by obese subjects. MEASUREMENTS: Direct costs (personal health care, hospital care, physician services, drugs) and indirect costs (lost output as a result of cessation or reduction of productivity caused by morbidity and mortality); economic benefits due to the reduced incidence of hip fractures. RESULTS: The direct costs of obesity (BMI > or = 27) were 11.89 billion French Francs (FF), which corresponded to about 2% of the expenses of the French care system. Hypertension represented 33% of the total amount and cancer 2.5% of the direct cost of obesity. Indirect costs represented FF 0.6 billion. These are conservative estimates as far as all obesity-related diseases and all health care and indirect costs were not included due to missing information. CONCLUSION: These results were remarkably similar to previous reports on the economic costs of obesity in other western countries (USA, Sweden, Netherlands, Australia) which concluded that the cost of obesity amounted to around 2% to 5% of the total cost of health care in industrialized societies.     

Treatment of mild, moderate, and severe obesity in children.

This paper examines treatment alternatives for children and adolescents as a function of degree of obesity. Treatment for mild obesity (20-40% overweight) should be preventive, emphasizing long-term changes in eating and activity patterns with the goal of weight maintenance and relative weight reduction. Short-term behaviour modification programmes, which include parental support, are effective in achieving these goals. Outpatient clinics or schools where social support is available are appropriate treatment settings. More comprehensive behavioural programmes are needed for treating moderate obesity (41-100% overweight). Such programmes include extended treatment periods, depositrefund contracts, direct parental involvement, and increased emphasis on lifestyle exercise. Outpatient clinics and schools remain optimal treatment settings, but more research is needed on camp settings. Radical treatments such as surgery, drugs, and very low calorie diets cannot be recommended for moderate childhood obesity. Severe obesity (> 100% overweight) requires consideration of radical interventions, and evidence to date supports the experimental use of very low calorie diets (protein-sparing modified fasts) together with behaviour modification. Such dietary treatment must be conducted in hospitals under strict medical supervision. Neither drugs nor surgery can be recommended for severe obesity in children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)