Jessica L. J. Greenwood

Preventing or Improving Obesity by Addressing Specific Eating Patterns

The problem of obesity and overweight is an epidemic in the United States. Weight is a product of energy balance: energy intake versus energy expenditure. The purpose of this review is to identify adult eating behaviors that are known to strongly affect the energy intake side of the energy balance and that may be readily amenable to prevention and intervention efforts in primary care. Restaurant and fast food consumption, large portion sizes, and consumption of beverages with sugar added increase energy intake and are highly associated with weight gain and obesity. Conversely, consumption of low energy dense food, ie, fruits and vegetables, and routine healthy breakfast consumption can help to maintain or lose weight. These distinct behaviors represent concrete negative and positive eating patterns on which primary care providers can focus when counseling overweight and obese patients. They also represent behavioral targets for designing and testing clinical interventions.

Maternal and neonatal outcomes for pregnancies before and after gastric bypass surgery.

Background:Interaction between maternal obesity, intrauterine environment and adverse clinical outcomes of newborns has been described.Methods:Using statewide birth certificate data, this retrospective, matched-control cohort study compared paired birth weights and complications of infants born to women before and after Roux-en-Y gastric bypass surgery (RYGB) and to matched obese non-operated women in several different groups. Women who had given birth to a child before and after RYGB (group 1; n=295 matches) and women with pregnancies after RYGB (group 2; n=764 matches) were matched to non-operated women based on age, body mass index (BMI) prior to both pregnancy and RYGB, mother’s race, year of mother/s birth, date of infant births and birth order. In addition, birth weights of 13 143 live births before and/or after RYGB of their mothers (n=5819) were compared (group 3).Results:Odds ratios (ORs) for having a large-for-gestational-age (LGA) neonate were significantly less after RYGB than for non-surgical mothers: ORs for groups 1 and 2 were 0.19 (0.08–0.38) and 0.33 (0.21–0.51), respectively. In contrast, ORs in all three groups for risk of having a small for gestational age (SGA) neonate were greater for RYGB mothers compared to non-surgical mothers (ORs were 2.16 (1.00–5.04); 2.16 (1.43–3.32); and 2.25 (1.89–2.69), respectively). Neonatal complications were not different for group 1 RYGB and non-surgical women for the first pregnancy following RYGB. Pregnancy-induced hypertension and gestational diabetes were significantly lower for the first pregnancy of mothers following RYGB compared to matched pregnancies of non-surgical mothers.Conclusion:Women who had undergone RYGB not only had lower risk for having an LGA neonate compared to BMI-matched mothers, but also had significantly higher risk for delivering an SGA neonate following RYGB. RYGB women were less likely than non-operated women to have pregnancy-related hypertension and diabetes.

The Relationship between Body Esteem, Exercise Motivations, Depression, and Social Support Among Female Free Clinic Patients

PURPOSE Obesity is a significant public health problem in womens health. This study examined relationship between body esteem, exercise motivations, depression, and social support among female free clinic patients. Low-income women who are at risk for obesity and other health concerns would benefit from health education efforts. METHODS We compared 299 female and 164 male free clinic patients 18 years or older using assessments for body esteem, motivation to exercise, depression, and social support. RESULTS Although female participants reported lower levels of body esteem and higher levels of depression compared with male participants (p < .01), female participants were more motivated to exercise for weight-related reasons than male participants (p < .05). U.S.-born female participants reported lower exercise motivations compared with non-U.S.-born female participants (p < .01). Social support might be an important factor to increase exercise motivation among female free clinic patients (p < .05); depression lowers levels of body esteem (p < .01). CONCLUSIONS The results of this study suggest that female free clinic patients should receive gender-specific interventions to promote positive body image and physical activity. It is important for health educators to engage a myriad of physical activity motives to increase the likelihood that clients will experience enjoyment and sustained adoption of exercise into their lifestyle. Future practice and research should warrant the implementation of body image and physical activity programs and the potential impact of using exercise to reducing depression among female patients at free clinics.

The complexity of weight loss counseling.

Counseling is a complex and dynamic interaction between provider and patient. Many questions surface with regard to the management of overweight and obese patients. The article, “What Do Physicians Recommend to their Overweight and Obese Patients?” in this issue of The Journal of the American

Measuring body mass index according to protocol: how are height and weight obtained?

Abstract: Previous investigation at our resident‐teaching, family medicine clinics determined that >80% of adult patients have body mass index (BMI) recorded in the electronic medical record. The quality of this measure, however, is not known. The objective of this study was to determine the accuracy of documented BMI. We used an observational study design to determine the means by which clinic staff obtain height and weight values from patients. We found that staff only obtained 35.4% of these measurements according to protocol. The major reason for noncompliance with protocol was that shoes were not removed for the measurements. Our investigation indicated that providers, quality improvement teams, and researchers should not assume the accuracy of the recorded BMI. Future investigation is warranted to improve the quality of these measurements in the outpatient setting.

Two industrial cohorts: Baseline characteristics and factors associated with obesity

Objective: To describe demographic and health characteristics, and factors associated with obesity among production workers. Methods: This cross-sectional study analyzed baseline data from two occupational cohorts. Regression modeling was used to assess associations between worker characteristics and obesity. Results: A total of 1974 subjects were included in these analyses. The mean body mass index was 29.5 kg/m2 (SD = 6.5). Having smoked in the past and currently smoking decreased the odds of being obese in the WISTAH Distal Upper Extremity cohort, whereas those feeling depressed had increased odds of being obese. Being a Pacific Islander/Native Hawaiian and married increased the odds of obesity in the BackWorks Low Back Pain cohort. Conclusions: Factors associated with obesity differed substantially between the two cohorts. Recognizing factors associated with obesity in specific work settings may provide opportunities for optimizing preventive workplace interventions.

Stages of weight change among an occupational cohort

Objective: To assess the readiness to change dietary intake and body weight among production workers. We also ascertained differences between self-perceived and measured body mass index. Methods: This cross-sectional study queried physical activity, psychosocial factors, fruit and vegetable intake, and readiness to change based on the transtheoretical model. Results: Sixty-three (28%) workers were overweight, and 114 (50%) were obese. Obese workers were in the following stages of weight change: precontemplation (4%), contemplation (45%), preparation (13%), action (21%), and (17%) maintenance. Ten percent of overweight workers erroneously reported their body mass index to be normal. Conclusions: About half of overweight/obese workers were in the precontemplation or contemplation stages for healthy dietary changes or weight loss. Recognizing the stages of change with regard to weight and the self-perception of weight status may help tailor workplace health promotion programs.

Healthy Eating Vital Sign: A New Assessment Tool for Eating Behaviors

Introduction. Most dietary questionnaires are not created for use in a clinical setting for an adult health exam. We created the Healthy Eating Vital Sign (HEVS) to assess eating behaviors associated with excess weight. This study investigated the validity and reliability of the HEVS. Methods. Using a cross-sectional study design, participants responded to the HEVS and the Block Food Frequency Questionnaire (BFFQ). We analyzed the data descriptively, and, with Pearsons correlation and Cronbach coefficient alpha. Results. We found moderate correlation (rho > 0.3) between multiple items of the HEVS and BFFQ. The Cronbachs alpha was 0.49. Conclusion. Our results support the criterion validity and internal reliability of the HEVS as compared to the BFFQ. The HEVS can help launch a dialogue between patients and providers to monitor and potentially manage dietary behaviors associated with many chronic health conditions, including obesity.

Predictors Associated with Changes of Weight and Total Cholesterol among two Occupational Cohorts over 10 Years

Objective: To ascertain worker health characteristics and psychosocial factors associated with changes in body weight and total cholesterol (TC) among two production operation populations. Methods: We performed descriptive and predictive analysis of questionnaire data and biomedical measurements from two prospective cohort studies. Our key outcomes were changes in weight, and TC over 5 to 10 years between baseline and exit assessments. Results: A total of 146 subjects were analyzed. Increases in weight were associated with belief in being overweight and baseline overweight and obesity. Increases in TC levels were associated with female sex, belief that TC levels were “not good,” and feeling depressed. Conclusions: Most of the reported associations with increases in weight and TC levels are amenable to interventions and may be a target for workplace intervention programs.

Surveillance of human papilloma virus using reference laboratory data for the purpose of evaluating vaccine impact.

Nationwide positivity rates of high-risk human papillomavirus for the United States before and since the introduction of a Human Papillomavirus (HPV) vaccine in 2006 would provide insight into the population impact of HPV vaccination. Data for high-risk HPV testing results from January 1, 2004 to June 1, 2013 at a national reference laboratory were retrospectively analyzed to produce 757,761 patient records of women between the ages of 14 and 59. Generalized linear models and finite mixture models were utilized to eliminate sources of bias and establish a population undergoing standard gynecological screening. Unadjusted positivity rates for high-risk HPV were 27.2% for all age groups combined. Highest rates occurred in women aged 14 to 19. While the positivity rates decreased for all age groups from 2004 to 2013, the higher age categories showed less downward trend following vaccine introduction, and the two age categories 20 to 24 and 25 to 29 showed a significantly different downward trend between pre- and post-vaccine time periods (-0.1% per year to -1.5% per year, and 0.4% per year to -1.5% per year, respectively). All other age groups had rates of change that became less negative, indicating a slower rate of decline.