Donna H. Ryan

The relation of gender, race and socioeconomic status to obesity and obesity comorbidities in a sample of US adults

OBJECTIVE: To examine the obesity-related chronic diseases in the US adult population according to gender, race and socioeconomic status.METHODS: Data from the 1994–1996 Continuing Survey of Food Intakes by Individuals (1994–1996 CSFII) conducted by the US Department of Agriculture/Agricultural Research Service (USDA/ARS) were used in the analysis. Relevant data included self-reported weight and height, self-reported physician-diagnosed diabetes mellitus, hypertension, heart disease and high serum cholesterol. Analysis was conducted according to gender, race, income level and education level.RESULTS: There was a graded increase in diabetes, hypertension and high serum cholesterol with increasing body weight in nearly all gender, racial and socioeconomic groups. Among the obese individuals, the prevalence of hypertension was higher in black subjects and the prevalence of diabetes, hypertension and heart disease was higher in individuals with lower education compared to their counterparts. The odds of having diabetes, hypertension, heart disease and high serum cholesterol increased with increasing body weight after adjusting for age, gender, race, income, education and smoking.CONCLUSION: Although cross-sectional in nature, our results suggest that the disease burden associated with obesity in the population may be substantial. This burden increases with increasing severity of obesity. Our findings support the current opinion that, although the nature of obesity-related health risks is similar in all populations, the specific level of risk associated with a given level of obesity may be different depending on gender, race and socioeconomic condition.

NIH working group report: Innovative research to improve maintenance of weight loss.

The National Institutes of Health, led by the National Heart, Lung, and Blood Institute, organized a working group of experts to discuss the problem of weight regain after weight loss. A number of experts in integrative physiology and behavioral psychology were convened with the goal of merging their perspectives regarding the barriers to scientific progress and the development of novel ways to improve long‐term outcomes in obesity therapeutics. The specific objectives of this working group were to: (1) identify the challenges that make maintaining a reduced weight so difficult; (2) review strategies that have been used to improve success in previous studies; and (3) recommend novel solutions that could be examined in future studies of long‐term weight control.

A primary care weight management intervention for low-income African-American women.

Objective: To determine whether a tailored weight management program, addressing the needs of obese, low‐income African‐American women, would produce greater weight loss than standard medical care.

Corticotropin-releasing factor receptor antagonist infused into the locus coeruleus attenuates immobilization stress-induced defensive withdrawal in rats

It has been proposed that corticotropin-releasing factor (CRF) released during stress in the region of the locus coeruleus (LC) induces changes in behavior that are typical indices of anxiety. The experiments tested the ability of a CRF antagonist, alpha hCRF9-41, to attenuate stress-induced defensive withdrawal in rats. 1 microgram of alpha hCRF in 300 nl was infused bilaterally in the LC of rats 10 min prior to 30 min immobilization. The apparatus consisted of a small chamber set on one side of a 1 m open field, into which the rat was placed to start the test. Restraint induced defensive withdrawal in rats familiar with the apparatus and significantly increased latency time to emerge from the chamber, total time and mean time spent in the chamber. Infusion of alpha hCRF into the LC prior to restraint significantly decreased total and mean time spent in the chamber comparing to stressed animals. These results are consistent with anatomical, electrophysiological and neurochemical evidence that CRF receptors located in, or close to, the LC region influence behaviors induced by stress.

Advances in the Science, Treatment, and Prevention of the Disease of Obesity: Reflections From a Diabetes Care Editors’ Expert Forum

As obesity rates increase, so too do the risks of type 2 diabetes, cardiovascular disease, and numerous other detrimental conditions. The prevalence of obesity in U.S. adults more than doubled between 1980 and 2010, from 15.0 to 36.1%. Although this trend may be leveling off, obesity and its individual, societal, and economic costs remain of grave concern. In June 2014, a Diabetes Care Editors’ Expert Forum convened to review the state of obesity research and discuss the latest prevention initiatives and behavioral, medical, and surgical therapies. This article, an outgrowth of the forum, offers an expansive view of the obesity epidemic, beginning with a discussion of its root causes. Recent insights into the genetic and physiological factors that influence body weight are reviewed, as are the pathophysiology of obesity-related metabolic dysfunction and the concept of metabolically healthy obesity. The authors address the crucial question of how much weight loss is necessary to yield meaningful benefits. They describe the challenges of behavioral modification and predictors of its success. The effects of diabetes pharmacotherapies on body weight are reviewed, including potential weight-neutral combination therapies. The authors also summarize the evidence for safety and efficacy of pharmacotherapeutic and surgical obesity treatments. The article concludes with an impassioned call for researchers, clinicians, governmental agencies, health policymakers, and health-related industries to collectively embrace the urgent mandate to improve prevention and treatment and for society at large to acknowledge and manage obesity as a serious disease.

Clinical evaluation of the overweight patient

Evaluation of an overweight patient is the first step in any therapeutic program. The syndromes of obesity can be classified in several ways. The first is an anatomic classification based on the size, number, and distribution of fat cells and fat tissue. The second is an etiologic classification based on identification of specific diseases and settings that produce obesity. Hypothalamic injury and endocrine disease such as Cushings disease and the polycystic ovary syndrome are three identifiable causes of obesity. In this medicated society drugs are always candidates to produce weight gain. The most common causes, however, are stopping smoking, overconsumption of high-fat foods, a decrease in the level of activity, and aging. The natural history of obesity provides a useful framework in which to view both preventive and therapeutic strategies. Some individuals will never become overweight, but of those who do, about one-third will do so during the first two decades, and the remaining two-thirds will become overweight after age 20. A number of epidemiological and metabolic factors can serve as a guide to those individuals who are at high risk. Having overweight parents tops the list, but multiple births, cessation of smoking, and a sedentary lifestyle are additional factors. Therapeutic decisions should be based on risk-benefit decisions. The risk can be assessed from the body mass index, the distribution of fat in upper or lower body obesity, the rate of weight gain, and the degree of physical inactivity. After assessing risk, the therapeutic choices can be selected from the age category of the patient. With any therapeutic activity, involvement of the patient in a realistic approach to the treatment process is essential.

Association of dietary restraint and disinhibition with eating behavior, body mass, and hunger.

This study investigated the association of dietary restraint and disinhibition with self-reported and actual eating behavior, body mass, and hunger. A sample of 124 women were categorized into one of four groups based upon high and low scores on measures of Dietary Restraint and Disinhibition using the Three Factor Eating Questionnaire. Half of the participants in each group consumed a high sugar/high fat chocolate pudding as a dietary preload. All participants were given a meal comprised of a standard macaroni and beef product. The interaction of Dietary Restraint and Disinhibition was related to differences in body mass. The Dietary Restraint factor was related to self-reported pathological eating behavior and influenced both perceived hunger and subjective hunger ratings. However, actual eating behavior measured by calories consumed and rate of intake was unrelated to the Dietary Restraint factor. Disinhibition was associated with excessive eating, an increased rate of eating, self-reports of eating disorder symptomatology, and perceived hunger. Hence, actual eating behavior was significantly influenced by the ingestive motivational factor, Disinhibition, but not by the cognitive factor, Dietary Restraint. These data also suggest that the Disinhibition construct is measuring overeating rather than disinhibited eating which implies the disruption of Dietary Restraint.

Americans on Diet: Results from the 1994-1996 Continuing Survey of Food Intakes by Individuals

OBJECTIVE To examine the prevalence of dieting to lose weight or for a health reason in a representative sample of US adults. DESIGN Cross-sectional study design. SUBJECTS/SETTING Data from 10,144 participants of the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII 1994-1996) were used in the analysis. All data were self-reported. STATISTICAL ANALYSIS Analysis included: cross-tabulation of dieting status by sociodemographic characteristics; comparison of the type of diet, the reason for dieting, and the source of diet used by men and women; comparison of the nutrient intake and health status of dieters and nondieters. RESULTS Prevalence of dieting varied by gender and race, being highest in white women (21%) and lowest in Hispanic men (8%). About 71% of all dieters reported that they were dieting to improve health, and 50% reported that they were dieting to lose weight. Dieters reported lower intakes of total fat, saturated fat, cholesterol, sodium, monounsaturated fat, polyunsaturated fat, calcium, and selenium compared with nondieters. The rate of chronic health conditions was higher among dieters than nondieters. Self-reported physical activity was similar in both groups. CONCLUSIONS The prevalence of dieting varies according to sociodemographic characteristics. The reason for dieting and the type of diet used by dieters also vary and need to be studied further. Our results suggest that the dieters generally consumed a more nutrient-dense diet than the nondieters but still low in certain nutrients.

Prevalence of binge eating disorder in obese adults seeking weight loss treatment

Binge eating has been identified as a common problem in samples of obese persons. Earlier studies found that approximately 30% of participants presenting for weigh loss treatment could be diagnosed with Binge Eating Disorder (BED). This study investigated the prevalence of BED using the Questionnaire on Eating and Weight Patterns (QEWP) and the Interview for the Diagnosis of Eating Disorders (IDED) in a sample of 468 obese adults seeking weight loss treatment at two research facilities. The study found that only a smal percentage of the participants met Diagnostic and Statistical Manual for Mental Disorders 4th Revision (DSM-IV) diagnostic criteria for BED using either the IDED (1.3%) or QEWP (7.3%). A larger percentage of the sample (10.7% based on the IDED and 20.5% based on the QEWP) reported binge eating, but did not endorse all criteria necessary to warrant a diagno sis of BED. The primary finding of the study was that the prevalence of BED in treatmen seeking obese adults was much lower than was reported in previous studies. Also, there was significant discrepancy in prevalence rates of BED as defined by self-report and interview assessment methods, with the interview method yielding lower estimates of prevalence These findings suggest that the prevalence of BED may be lower than estimates of earlier reports. We recommend that future studies of BED use reliable and valid interview methods and that this research focus on more diverse populations, including men and a variety o racial and ethnic groups.

Effect of Diet Composition on Energy Expenditure during Weight Loss: The POUNDS LOST Study

Background:Weight loss reduces energy expenditure, but the contribution of different macronutrients to this change is unclear.Hypothesis:We tested the hypothesis that macronutrient composition of the diet might affect the partitioning of energy expenditure during weight loss.Design:A substudy of 99 participants from the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) trial had total energy expenditure (TEE) measured by doubly labeled water, and resting energy expenditure (REE) measured by indirect calorimetry at baseline and repeated at 6 months in 89 participants. Participants were randomly assigned to one of four diets with either 15 or 25% protein and 20 or 40% fat.Results:TEE and REE were positively correlated with each other and with fat-free mass and body fat, at baseline and 6 months. The average weight loss of 8.1±0.65 kg (least-square mean±s.e.) reduced TEE by 120±56 kcal per day and REE by 136±18 kcal per day. A greater weight loss at 6 months was associated with a greater decrease in TEE and REE. Participants eating the high-fat diet (HF) lost significantly more fat-free mass (1.52±0.55 kg) than the low-fat (LF) diet group (P<0.05). Participants eating the LF diet had significantly higher measures of physical activity than the HF group.Conclusion:A greater weight loss was associated with a larger decrease in both TEE and REE. The LF diet was associated with significant changes in fat-free body mass and energy expenditure from physical activity compared with the HF diet.