Christopher K. Haddock

Pharmacotherapy for obesity: a quantitative analysis of four decades of published randomized clinical trials

AIM: This article provides the first comprehensive meta-analysis of randomized clinical trials of medications for obesity.METHOD: Based on stringent inclusionary criteria, a total of 108 studies were included in the final database. Outcomes are presented for comparisons of single and combination drugs to placebo and for comparisons of medications to one another.RESULT: Overall, the medications studied produced medium effect sizes. Four drugs produced large effect sizes (ie d>0.80; amphetamine, benzphetamine, fenfluramine and sibutramine). The placebo-subtracted weight losses for single drugs vs placebo included in the meta-analysis never exceeded 4.0 kg. No drug, or class of drugs, demonstrated clear superiority as an obesity medication. Effects of methodological factors are also presented along with suggestions for future research.

The Pediatrician's Role in Reducing Tobacco Exposure in Children

Objective. Pediatricians have a unique and important role to play in the prevention and treatment of childhood and adolescent tobacco use, the protection of patients from the harmful effects of environmental tobacco smoke, and the encouragement of smoking cessation among parents. However, because recent research indicates that physician training in tobacco dependence is woefully weak and lacks a model for training, this article constructs a useful approach to this problem. Methodology. A comprehensive review of the literature served as the basis for the development of a new model for pediatrician training in tobacco dependence. Results. A comprehensive model is presented for training pediatricians in the areas of reducing infant and child exposure to environmental tobacco smoke, preventing youth smoking initiation, and providing smoking cessation assistance for adolescents and parents. Conclusions. Pediatricians have been called on to play an active role in the antitobacco arena. Because of their unique opportunity to interact with children, adolescents, and parents, pediatricians can and should be antitobacco interventionists. For this to occur, however, additional guidance should be provided to pediatricians during their training to better prepare them to carry out effective assessment and intervention practices. smoking initiation, smoking prevention, smoking cessation, environmental tobacco smoke, pediatricians.

Weight loss in overweight Mexican American children: a randomized, controlled trial.

OBJECTIVES. Childhood overweight has increased significantly in the past 20 years, with the highest rates noted among Mexican Americans. Although this minority group is in significant need of intervention, few programs have demonstrated actual decreases in weight. In this study we evaluated an intensive healthy lifestyle program designed to result in weight reduction for overweight Mexican American children. We hypothesized that children randomly assigned to an intensive intervention would significantly reduce their standardized BMI when compared with children randomly assigned to a self-help condition. PATIENTS AND METHODS. A total of 60 children (33 boys; 55%) between the ages of 10 and 14 years at or above the 85th percentile for BMI were randomly assigned to a 6-month intensive-intervention or self-help condition. RESULTS. Children in the intensive-intervention condition significantly reduced their standardized BMI when compared with the children in the self-help condition. The change in standardized BMI was significantly different at both 3 and 6 months, with intensive-intervention participants showing greater decreases in weight. CONCLUSIONS. Overall, the results were promising, suggesting that an intensive, individualized intervention may be an effective means for promoting weight loss in overweight Mexican American children.

Obesity and incident injury among career firefighters in the central United States.

Firefighting is a dangerous profession with high injury rates, particularly musculoskeletal (MS), but limited longitudinal data is available to examine predictors of MS injuries in this population.

The validity of self-rated health as a measure of health status among young military personnel: Evidence from a cross-sectional survey

BackgroundSingle item questions about self ratings of overall health status are widely used in both military and civilian surveys. Limited information is available to date that examines what relationships exist between self-rated health, health status and health related behaviors among relatively young, healthy individuals.MethodsThe current study uses the population of active duty United States Air Force recruits (N = 31,108). Participants completed surveys that asked about health behaviors and health states and were rated their health on a continuum from poor to excellent.ResultsRatings of health were consistently lower for those who used tobacco (F = 241.7, p < .001), reported binge drinking (F = 69.0, p < .001), reported drinking and driving (F = 19.4, p < .001), reported taking health risks (F = 109.4, p < .001), were depressed (F = 256.1, p < .001) and were overweight (F = 39.5, p < .001).ConclusionGiven the consistent relationship between self-rated overall health and factors important to military health and fitness, self-rated health appears to be a valid measure of health status among young military troops.

D4 dopamine receptor gene exon III polymorphism and obesity risk.

Many genes have been identified that may play a role in increasing individua susceptibility to obesity. Reduced dopamine function appears to play a role in dysfunctiona eating patterns and may predispose some individuals to obesity. The long version of the D4 dopamine receptor gene (D4DR) has been shown to alter receptor function and reduce intracellular response to dopamine. It also has been associated with novelty-seeking-related personality traits that are found with greater frequency in obese individuals. We examined the association between the long alleles of the D4DR and obesity in a sample of 115 obese patients partici pating in a weight management program. No direct relationship was found between the D4DR and body mass or novelty-seeking-related personality traits. We constructed four models o increased obesity risk that included combinations of traditional risk factors (i.e., long-term history of obesity, parental obesity, a body mass index > 40) and elevations on the novelty-seeking-related scales of the Karolinska Scales of Personality. There was a significant increase in the frequency of the D4DR long alleles in individuals defined as high risk using the combination o novelty-seeking-related personality traits, severe obesity (i.e., BMI > 40), and any other tradi tional risk factor, but not with the traditional risk factors alone. These preliminary data sugges a potential role for the D4DR gene in increasing obesity susceptibility.

An examination of the benefits of health promotion programs for the national fire service

BackgroundFirefighters suffer from high prevalence of obesity, substandard fitness, and cardiovascular-related deaths. There have been a limited number of firefighter health promotion programs that have been developed and empirically-tested for this important occupational group. We evaluated the health of firefighters from departments with well-developed health promotion programs and compared them with those from departments not having such programs using a large national sample of career fire departments that varied in size and mission. We measured a broad array of important individual firefighter health outcomes (e.g., body composition, physical activity, and general and behavioral health) consistent with national fire service goals and addressed significant statistical limitations unaccounted for in previous studies.MethodsUsing the approach of purposive sampling of heterogeneous instances, we selected and conducted a national evaluation of 10 departments already implementing wellness and fitness programs (Wellness Approach; WA) with 10 departments that did not (Standard). Participants were 1,002 male firefighters (WA n = 522; Standard n = 480) who underwent assessments including body composition, fitness, and general/behavioral health (e.g., injury, depressive symptoms).ResultsFirefighters in WA departments were healthier than their Standard department counterparts. For example, they were less likely to be obese (adjusted [A]OR = 0.58; 95% CI = 0.41-0.82), more likely to meet endurance capacity standards for firefighting (AOR = 5.19; 95% CI = 2.49-10.83) and have higher estimated VO2max (40.7 ± 0.6 vs. 37.5 ± 1.3 for firefighters in Standard departments; p = 0.001). In addition, WA firefighter were substantially less likely to smoke (AOR = 0.30; 95% CI = 0.17-0.54) or ever have been diagnosed with an anxiety disorder (AOR = 0.27; 95% CI = 0.14-0.52) and they expressed higher job satisfaction across several domains. However, WA firefighters were somewhat more likely to have reported an injury to Workers’ Compensation (AOR = 1.74; 95% CI = 1.05-2.90). It was notable that both groups evidenced high prevalence of smokeless tobacco use and binge drinking.ConclusionsFirefighters in departments selected based on having strong wellness programs (WA) were healthier along a number of dimensions important to firefighter wellness and operational readiness. However, several health areas require greater attention including problematic alcohol consumption and smokeless tobacco use, suggesting that more emphasis on these behavioral health issues is needed in the fire service.

Alcohol use among firefighters in the Central United States.

BACKGROUND Although the US National Fire Service is concerned about alcohol use among firefighters, little research has been conducted on the topic. AIMS To survey alcohol use patterns among career and volunteer firefighters. METHODS Data were from a population-based cohort study of male firefighters conducted in randomly selected career and volunteer departments. Data were collected from 2008 to 2010. RESULTS There were 656 participants from 11 career and volunteer 13 departments included in the study with a response rate of 97%. Career firefighters drank approximately 10 days per month (just about half of their off duty days) and drank relatively heavily on those days. Fifty-eight per cent of career and 40% of volunteer firefighters averaged three or more drinks and similar percentages reported binge drinking on the days they consumed alcohol. In general, firefighters who drank but did not binge drink tended to have the best health outcomes, while those who binge drank typically were at highest risk of negative health outcomes. Nine per cent of career and 10% of volunteer firefighters who drank self-reported driving while intoxicated in the previous 30 days. CONCLUSIONS Given the high rates of heavy and binge drinking, local and nationally coordinated efforts to increase the surveillance of drinking behaviour among firefighters and the development of targeted prevention interventions are critically needed.

A population comparison of participants and nonparticipants in a health survey

OBJECTIVES This study examined the characteristics of Air Force recruits willing to take part in a health survey vs those unwilling to participate. METHODS US Air Force recruits undergoing basic military training (n = 32,144) were surveyed regarding demographic and health variables. RESULTS Respondents indicating an unwillingness to participate in a health survey reported less healthy lifestyles than those willing to participate. Prediction equations modeling the characteristics of those engaging in 4 risky behaviors were nearly identical regardless of whether those refusing to participate were included. CONCLUSIONS Results suggest that, despite some low estimates of health behaviors due to response bias, relationships between most risk factors are generally unaffected by those not responding to health surveys.

Evaluation of a primary care-oriented brief counselling intervention for obesity with and without orlistat.

Objective.  There is a significant need for an obesity treatment model suitable for the primary care environment. We examined the effectiveness of a brief counselling intervention alone, in combination with orlistat, and drug‐alone in a 12‐month randomized‐clinical trial at a medical school obesity centre.