Barbara J. Scott

Overweight in Children and Adolescents Pathophysiology, Consequences, Prevention, and Treatment

The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.

A Classification System to Evaluate Weight Maintainers, Gainers, and Losers

OBJECTIVES To study natural weight changes and to develop a weight classification system that can identify weight maintainers, gainers, and losers. DESIGN/OUTCOME: A prospective, observational study in which weight changes over five annual measurements were evaluated. In the weight classification system used, changes greater than 5 lb defined weight maintenance, gain, or loss. SUBJECTS/SETTINGS Subjects were healthy, normal-weight and over weight, men and women (mean age = 44.1 +/- 14.1 years) in the Relationships of Energy, Nutrition, and Obesity to Cardiovascular Disease Risk Study. Prospective data for 385 of the original 508 subjects for whom actual weights were available for each of the 5 years (1985 to 1990) were used to classify and characterize subjects by weight-change categories. STATISTICAL ANALYSES Cross-tabulations (with chi 2 tests) and hterarchical log-linear analyses (with partial chi 2 tests) to examine the relationships of categorical variables; analyses of variance (with F tests) for continuous measures. RESULTS Over the 4-year interval, 46% of subjects were classified as maintainers, 34% as gainers, and 20% as losers. Over shorter 1-year epochs, more subjects were maintainers (62%) and fewer subjects were gainers (22%) or losers (16%). Maintainers had fewer and smaller magnitudes of weight fluctuations and showed fewer deleterious changes in health risk factors than gainers. APPLICATIONS Weight changes of greater than +/-5 lb can classify a person as a weight maintainer, or loser. Although annual weight changes were used in this study, a weight change of more than 5 lb between any two points in time may suggest nonmaintenance of weight or weight instability that needs further evaluation.

Dietary fat consumption in a cohort of American adults, 1985-1991: covariates, secular trends, and compliance with guidelines.

Purpose. To examine compliance with the guideline for dietary fat (i.e., 30% of total daily calories) and covariates of fat intake in a cohort of adults using both 24-hour recall and food frequency questionnaire (FFQ). Design. Prospective, observational cohort study over 5 years. Setting. Community-based sample in Reno, Nevada. Subjects. Equal numbers of male and female, lean and overweight adults (n = 508), recruited from 1985 to 1986, of whom 348 completed all relevant surveys. Measures. Subjects underwent repeated anthropometric measures and completed extensive surveys on diet, weight cycling, lifestyle, and physical activity. Results. Mean fat intake by 24-hour recall declined from 36.9% to 33.6% of calories between years 1 and 5 (p < .001), while calorie intake increased (p = .2). As measured by FFQ at year 2, mean fat intake was 39.1 % of calories, and only 11.8% of subjects were in compliance with the guideline for dietary fat intake. Fat intake by FFQ at year 2 was statistically higher than by 24-hour recall in year 1 for lean women (p = .02) and lean men (p = .02), but not for the overweight of either gender, and was significantly higher than the year 5 24-hour recall for all categories of gender and weight (p < .001). Calorie intake, gender, and body mass index were significant in regression models that explained less than 10% of total variability in fat intake (r2 = .08; p < .01). Conclusions. Compliance with the nationally recommended level of dietary fat intake was poor in this cohort, especially as measured by FFQ. Variability in fat intake was largely unexplained by host characteristics, including education. Further study is required to corroborate secular trends in population fat intake, elucidate the determinants of such intake, and identify cost-effective strategies for reducing the consumption of dietary fat.

Dieting and Disordered Eating Correlates of Weight Fluctuation in Normal And Obese Adults

Abstract Weight dissatisfaction, dieting, and weight change, assessed by questionnaires, were studied in 471 subjects stratified by gender, age (20–60+years) and weight (normal/obese), participating in the RENO Diet Heart Study. Female and obese subjects had more weight dissatisfaction, dieting, and binges and were more overweight in adolescence. Females and

Teaching Nutrition Assessment to First Year Medical Students in a Practice Setting

Abstract LEARNING OUTCOME: To describe a method for integrating nutrition assessment and demonstrating its relevance in the primary care medical curriculum. In order provide medical students with earlier exposure to patients and generalist medicine an Introduction to Patient Care course was recently added to the curriculum. First and second year students learn basic interviewing and examination skills through didactic sessions and once a week participation with a generalist MD preceptor in their practice office. As part of this course, the students were given a nutrition assignment to be completed with a patient in the preceptors office. The timing was optimal in that a medical nutrition course was being taught concurrently. The objective for the assignment was to involve students and preceptors in nutrition assessment and counseling using practical tools and techniques. Each student discussed the assignment with their preceptor, selected a patient willing to fill out a questionnaire and food frequency and discuss nutrition recommendations, and submitted a write up of pertinent background information along with copies of the completed questionnaires and recommendations provided to their patient. All 51 students completed the assignment selecting patients ranging in age from 3 months to 79 years. The majority (78%) were regular office patients being seen for on-going care of an existing illness, well check ups, or treatment of a new illness or injury, and the remainder were co-workers or friends. One fourth of the patients selected had no diagnosis listed, but common diagnoses among others included diabetes, overweight, thyroid conditions and hypertension. Forty one of the students included the patients height and weight in their write up, but only 14 evaluated weight status. Most of the students (63%) chose to actively interview the patients using the questionnaires instead of having the patients fill them out themselves. Thoroughness of the write ups varied: 90% included some social history, 47% family history of disease, 71% medications, 59% exercise habits, and 59% included pertinent lab values. Eleven of the students used a nutrition analysis program available in the library to further evaluate their findings, and nine cited specific references. On average, each student provided their client with 5 recommendations, the majority of which were judged by the nutrition faculty member to be appropriate and practical. The overall quality of the completed assignments indicates that early involvement of medical students may enhance their interest in nutrition and secondarily reach community preceptors with information about new nutrition applications.

A Comparison of Results From Two Bioimpedance Analyzers: HIV Infected V.S. Non-infected Adults

Abstract LEARNING OUTCOME: To determine whether there would be greater variability in body composition (BC) results obtained from two different bioimpedance analyzers (BIA) used at the same time and under the same conditions with HIV infected (HIV+) v.s. non-infected (HIV-) adults. The accurate determination of BC in HIV+ individuals is a critical adjunct to the provision of timely and appropriate nutrition intervention. Yet its measurement may be complicated by the somewhat unexpected BC changes that are experienced by individuals with this disease. Subjects (Ss) included 24 relatively healthy HIV+ adults (5♂,♀19; Xage=42.7; XBMI= 24.9) and 29 healthy HIV- volunteers (22♂,7♀ Xage=40.5; XBMI=26.5 ). All Ss met four hour pre-test conditions (fasting, no vigorous exercise, no alcohol, no caffeine) and were measured either on the floor or on an exam table without any parts of the body touching each other. Height and weight were measured on all Ss, and age and activity level were determined from interview. Sites were cleaned with alcohol, electrodes were placed on hand and foot as specified by manufacturers instructions, and BC was measured consecutively using two BIAs (BodyStat 1500 [BS] and Maltron [M]). The difference in % body fat (%BF) as measured by the two analyzers was calculated for each subject (DIF = % BF-M minus % BF-BS). Data were analyzed using SPSS for Windows. Percent body fat results were: 1) BS-HIV+: 23.4%; 2) BS-HIV-: 30.3%; 3) M-HIV+: 23.8%; and 4) M-HIV-: 31.2%). Mean DIF was slightly less for the HIV+ group (0.4±4.9 v.s. 1.0±4.7; ns) and slightly greater for men (2.1 vs. -0.7; p 30 were more likely to be HIV- and have positive differences (value from Maltron > Body Stat). From these data it appears that the variability in measures between the two BIA methods is within acceptable limits in an HIV+ group indicating that the simple BIA technology may be adequate to monitor this important parameter of body composition in relatively healthy clients.

Relationship of Body Mass Index to Energy Density and Diet Composition in a Free-Living Population

Energy density (amount of energy contained in a given amount of food) may have value in the assessment and treatment of obesity. In this study, consistent differences in energy density with increasing body mass index were not observed. Gender differences were attributed primarily to relative water content of the diet.