Bonnie J. Brehm

Obesity and Presenteeism: The Impact of Body Mass Index on Workplace Productivity

Objective: To examine whether obesity is associated with increased presenteeism (health-related limitations at work). Methods: Randomly selected manufacturing employees (n = 341) were assessed via height and weight measures, demographic survey, wage data, and the Work Limitations Questionnaire. The Work Limitations Questionnaire measures productivity on four dimensions. Analyses of variance and analyses of covariance were computed to identify productivity differences based on body mass index (BMI). Results: Moderately or extremely obese workers (BMI ≥35) experienced the greatest health-related work limitations, specifically regarding time needed to complete tasks and ability to perform physical job demands. These workers experienced a 4.2% health-related loss in productivity, 1.18% more than all other employees, which equates to an additional

One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes

506 annually in lost productivity per worker. Conclusions: The relationship between BMI and presenteeism is characterized by a threshold effect, where extremely or moderately obese workers are significantly less productive than mildly obese workers.

Effect of Marginal Zinc Deficiency on Human Growth and Development

OBJECTIVE—The purpose of this study was to compare the effects of high–monounsaturated fatty acid (MUFA) and high-carbohydrate (CHO) diets on body weight and glycemic control in men and women with type 2 diabetes. RESEARCH DESIGN AND METHODS—Overweight/obese participants with type 2 diabetes (n = 124, age = 56.5 ± 0.8 years, BMI = 35.9 ± 0.3 kg/m2, and A1C = 7.3 ± 0.1%) were randomly assigned to 1 year of a high-MUFA or high-CHO diet. Anthropometric and metabolic parameters were assessed at baseline and after 4, 8, and 12 months of dieting. RESULTS—Baseline characteristics were similar between the treatment groups. The overall retention rate for 1 year was 77% (69% for the high-MUFA group and 84% for the high-CHO group; P = 0.06). Based on food records, both groups had similar energy intake but a significant difference in MUFA intake. Both groups had similar weight loss over 1 year (−4.0 ± 0.8 vs. −3.8 ± 0.6 kg) and comparable improvement in body fat, waist circumference, diastolic blood pressure, HDL cholesterol, A1C, and fasting glucose and insulin. There were no differences in these parameters between the groups. A follow-up assessment of a subset of participants (n = 36) was conducted 18 months after completion of the 52-week diet. These participants maintained their weight loss and A1C during the follow-up period. CONCLUSIONS—In individuals with type 2 diabetes, high-MUFA diets are an alternative to conventional lower-fat, high-CHO diets with comparable beneficial effects on body weight, body composition, cardiovascular risk factors, and glycemic control.

Exercise and Eating Disorders in College-Aged Women: Profiling Excessive Exercisers

Growth and development disorders in humans caused by zinc (Zn) deficiency have been investigated for a long time. Although marginal Zn deficiency is a common nutritional problem around the world, especially in the children of developing countries where diets have less Zn available, it is difficult to identify. This review provides the progression of studies in the effect of Zn deficiency on human growth and development, and also explains the possible mechanisms of how Zn promotes these phenomena. These mechanisms involve the effects of Zn on DNA synthesis, RNA synthesis, and cell division. The concept of zn-finger proteins explains the role of Zn in gene expression and endocrine function. Findings indicate that Zn deficiency can result in delayed growth and development which can be corrected in part by Zn supplementation.

The Dimensions of Obligatory Exercise

This study examined associations among excessive exercise, eating disorders, and selected psychological characteristics in college women ( N = 586). Participants were recruited from university classes and administered the Obligatory Exercise Questionnaire, Eating Disorders Inventory--2, Bulimia Test-Revised, and other psychosocial measures. Results indicated that obligatory exercise is best viewed as multidimensional. These dimensions were used, through cluster analysis, to generate a typology of exercisers. One identified group clearly manifested eating disorder traits and behaviors, as well as signs of psychological disturbance. Another group who exercised with equal intensity but less emotional fixation showed the fewest signs of eating disorders and psychological distress.

Role of Carbohydrate Modification in Weight Management among Obese Children: A Randomized Clinical Trial

Abstract The Obligatory Exercise Questionnaire (OEQ) is one of several instruments used to measure excessive exercise activity, especially as it relates to eating disorders. This measure was subjected to factor analyses to determine its possible multidimensionality. Two hundred fifty high school students (133 females) completed the OEQ and the Eating Disorder Inventory (EDI). Three useful factors emerged from the OEQ: Emotional Element of Exercise; Exercise Frequency and Intensity; and Exercise Preoccupation. Subscales derived from these factors all had higher correlations with the EDI and its subscales than did the total OEQ. These results highlight the complexity of the eating disorder-exercise connection.

Weight loss and metabolic benefits with diets of varying fat and carbohydrate content: separating the wheat from the chaff

OBJECTIVE To compare the effectiveness and safety of carbohydrate (CHO)-modified diets with a standard portion-controlled (PC) diet in obese children. STUDY DESIGN Obese children (n=102) aged 7-12 years were randomly assigned to a 3-month intervention of a low-CHO (LC), reduced glycemic load (RGL), or standard PC diet, along with weekly dietary counseling and biweekly group exercise. Anthropometry, dietary adherence, and clinical measures were evaluated at baseline and 3, 6, and 12 months. Analyses applied intention-to-treat longitudinal mixed models. RESULTS Eighty-five children (83%) completed the 12-month assessment. Daily caloric intake decreased from baseline to all time points for all diet groups (P<.0001), although LC diet adherence was persistently lower (P<.0002). At 3 months, body mass index z score was lower in all diet groups (LC, -0.27 ± 0.04; RGL, -0.20 ± 0.04; PC, -0.21 ± 0.04; P<.0001) and was maintained at 6 months, with similar results for waist circumference and percent body fat. At 12 months, participants in all diet groups had lower body mass index z scores than at baseline (LC, -0.21 ± 0.04; RGL, -0.28 ± 0.04; PC, -0.31 ± 0.04; P<.0001), and lower percent body fat, but no reductions in waist circumference were maintained. All diets demonstrated some improved clinical measures. CONCLUSION Diets with modified CHO intake were as effective as a PC diet for weight management in obese children. However, the lower adherence to the LC diet suggests that this regimen is more difficult for children to follow, particularly in the long term.

Adiponectin changes in relation to the macronutrient composition of a weight-loss diet.

With the rising prevalence of both obesity and diabetes, the contributing role of diet to the prevention and treatment of these conditions has become a major focus of research, clinical practice, and public policy. There has been intense debate over which dietary regimens might be most effective for weight loss, with interest centered on the potential for specific dietary macronutrients to affect body composition, metabolism, and overall health. This Review addresses two regimens with distinct macronutrient prescriptions that have been widely touted as being beneficial for weight loss and/or metabolic profile: diets low in carbohydrate and diets high in monounsaturated fat. Although data from recent randomized, controlled trials suggest these popular diets may be useful for weight control, cardiovascular health, and glycemic control, longer studies of the efficacy and safety of varying macronutrient content are needed to strengthen the evidence base for nutritional recommendations. Until more support for specific macronutrient combinations is available, practitioners can recommend an array of diets with moderate amounts of macronutrients, tailored to individual needs and preferences.

Changing the Work Environment to Promote Wellness A Focus Group Study

Adiponectin is an adipose‐derived protein with beneficial metabolic effects. Low adiponectin is associated with obesity and related diseases. Significant weight loss increases adiponectin, reducing disease risk. This study compared the effects of two weight‐loss diets with different macronutrient compositions on adiponectin. Eighty‐one obese women in two cohorts were randomized to a low‐fat (LF) or a low‐carbohydrate (LC) diet. All subjects underwent equivalent weight‐loss intervention, with weight and other measures assessed at baseline and after 6 (cohort I) or 4 (cohort II) months. Body fat was measured by dual energy X‐ray absorptiometry. Adiponectin was measured by radioimmunoassay. Diet intake was assessed using 24‐h recalls and 3‐day diet records. Data were analyzed via t‐tests and repeated‐measures factorial ANOVA using time, diet, and replicate (cohort I vs. cohort II) as factors. Age, weight, body fat, BMI, adiponectin, and diet were similar at baseline. Following intervention, macronutrient composition of the diet was vastly different between the groups, reflecting the assigned diet. Both groups lost weight and body fat (P < 0.001), with effect in LC dieters greater than LF dieters (−9.1 kg vs. −4.97 kg weight, P < 0.05 and −5.45 kg vs. −2.62 kg fat, P < 0.001). Adiponectin increased in the LC (+1.92 mcg/ml, P < 0.01), but not the LF (+0.86 mcg/ml, P = 0.81), group. There was no correlation between weight loss and increase in adiponectin. These results confirm that diet‐induced loss of weight and body fat is associated with increased adiponectin concentrations. This effect is evident with weight loss of 10% or more, and may be greater with LC diets.

Psychosocial outcomes of a pilot multidisciplinary program for weight management.

It is estimated that employers spend more than 75 billion dollars annually on obesity-attributable health care. Interventions to reduce or prevent the risk of obesity are increasingly common at worksites and include health fairs, weight loss and nutrition classes, and fitness programs. However, many companies lack the resources to plan and implement these types of programs. Environmental approaches offer companies a low-cost option. A community-based participatory research model was used to bring academic researchers, human resources personnel, and health department educators together to plan and implement an environmental program aimed at increasing healthy eating and physical activity at four small manufacturing companies. The Diffusion of Innovations Theory guided the development of focus group questions. A focus group study was then conducted to gather information from employees and managers at these four companies. The questions identified workplace strategies that would aid in reducing barriers and developing appropriate communication channels to enhance employee participation in the program. The researchers identified themes from manager and employee focus groups regarding the following five environmental components: signs, walking paths, food changes, educational strategies, and advisory groups.