Victoria A. Catenacci

Obesity: overview of an epidemic.

The obesity epidemic in the United States has proven difficult to reverse. We have not been successful in helping people sustain the eating and physical activity patterns that are needed to maintain a healthy body weight. There is growing recognition that we will not be able to sustain healthy lifestyles until we are able to address the environment and culture that currently support unhealthy lifestyles. Addressing obesity requires an understanding of energy balance. From an energy balance approach it should be easier to prevent obesity than to reverse it. Further, from an energy balance point of view, it may not be possible to solve the problem by focusing on food alone. Currently, energy requirements of much of the population may be below the level of energy intake than can reasonably be maintained over time. Many initiatives are underway to revise how we build our communities, the ways we produce and market our foods, and the ways we inadvertently promote sedentary behavior. Efforts are underway to prevent obesity in schools, worksites, and communities. It is probably too early to evaluate these efforts, but there have been no large-scale successes in preventing obesity to date. There is reason to be optimistic about dealing with obesity. We have successfully addressed many previous threats to public health. It was probably inconceivable in the 1950s to think that major public health initiatives could have such a dramatic effect on reducing the prevalence of smoking in the United States. Yet, this serious problem was addressed via a combination of strategies involving public health, economics, political advocacy, behavioral change, and environmental change. Similarly, Americans have been persuaded to use seat belts and recycle, addressing two other challenges to public health. But, there is also reason to be pessimistic. Certainly, we can learn from our previous efforts for social change, but we must realize that our challenge with obesity may be greater. In the other examples cited, we had clear goals in mind. Our goals were to stop smoking, increase the use of seatbelts, and increase recycling. The difficulty of achieving these goals should not be minimized, but they were clear and simple goals. In the case of obesity, there is no clear agreement about goals. Moreover, experts do not agree on which strategies should be implemented on a widespread basis to achieve the behavioral changes in the population needed to reverse the high prevalence rates of obesity. We need a successful model that will help us understand what to do to address obesity. A good example is the recent HEALTHY study. This comprehensive intervention was implemented in several schools and aimed to reduce obesity by concentrating on behavior and environment. This intervention delivered most of the strategies we believe to be effective in schools. Although the program produced a reduction in obesity, this reduction was not greater than the reduction seen in the control schools that did not receive the intervention. This does not mean we should not be intervening in schools, but rather that it may require concerted efforts across behavioral settings to reduce obesity. Although we need successful models, there is a great deal of urgency in responding to the obesity epidemic. An excellent example is the effort to get menu labeling in restaurants, which is moving rapidly toward being national policy. The evaluation of this strategy is still ongoing, and it is not clear what impact it will have on obesity rates. We should be encouraging efforts like this, but we must evaluate them rigorously. Once we become serious about addressing obesity, it will likely take decades to reverse obesity rates to levels seen 30 years ago. Meanwhile, the prevalence of overweight and obesity remains high and quite likely will continue to increase.

A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity.

To evaluate the safety and tolerability of alternate‐day fasting (ADF) and to compare changes in weight, body composition, lipids, and insulin sensitivity index (Si) with those produced by a standard weight loss diet, moderate daily caloric restriction (CR).

Low/No calorie sweetened beverage consumption in the National Weight Control Registry: LNCSB Consumption in the NWCR

The aim of this cross‐sectional study was to evaluate prevalence of and strategies behind low/no calorie sweetened beverage (LNCSB) consumption in successful weight loss maintainers.

Objectively Measured Physical Activity and Sedentary Behavior in Successful Weight Loss Maintainers

The objective of this study was to compare patterns of objectively measured moderate‐to‐vigorous physical activity (MVPA, ≥ 3.00 metabolic equivalents [METs]), light‐intensity physical activity (LPA, 1.50‐2.99 METs), and sedentary behavior (SB, < 1.50 METs) in successful weight loss maintainers (WLMs), normal weight controls (NC), and controls with overweight/obesity (OC).

Daytime bright light exposure, metabolism, and individual differences in wake and sleep energy expenditure during circadian entrainment and misalignment

Daytime light exposure has been reported to impact or have no influence on energy metabolism in humans. Further, whether inter-individual differences in wake, sleep, 24 h energy expenditure, and RQ during circadian entrainment and circadian misalignment are stable across repeated 24 h assessments is largely unknown. We present data from two studies: Study 1 of 15 participants (7 females) exposed to three light exposure conditions: continuous typical room ~100 lx warm white light, continuous ~750 lx warm white light, and alternating hourly ~750 lx warm white and blue-enriched white light on three separate days in a randomized order; and Study 2 of 14 participants (8 females) during circadian misalignment induced by a simulated night shift protocol. Participants were healthy, free of medical disorders, medications, and illicit drugs. Participants maintained a consistent 8 h per night sleep schedule for one week as an outpatient prior to the study verified by wrist actigraphy, sleep diaries, and call-ins to a time stamped recorder. Participants consumed an outpatient energy balance research diet for three days prior to the study. The inpatient protocol for both studies consisted of an initial sleep disorder screening night. For study 1, this was followed by three standard days with 16 h scheduled wakefulness and 8 h scheduled nighttime sleep. For Study 2, it was followed by 16 h scheduled wake and 8 h scheduled sleep at habitual bedtime followed by three night shifts with 8 h scheduled daytime sleep. Energy expenditure was measured using whole-room indirect calorimetry. Constant posture bedrest conditions were maintained to control for energy expenditure associated with activity and the baseline energy balance diet was continued with the same exact meals across days to control for thermic effects of food. No significant impact of light exposure was observed on metabolic outcomes in response to daytime light exposure. Inter-individual variability in energy expenditure was systematic and ranged from substantial to almost perfect consistency during both nighttime sleep and circadian misalignment. Findings show robust and stable trait-like individual differences in whole body 24 h, waking, and sleep energy expenditure, 24 h respiratory quotient—an index of a fat and carbohydrate oxidation—during repeated assessments under entrained conditions, and also in 24 h and sleep energy expenditure during repeated days of circadian misalignment.

Estimating energy expenditure using heat flux measured at a single body site.

INTRODUCTION The Personal Calorie Monitor (PCM) is a portable direct calorimeter that estimates energy expenditure (EE) from measured heat flux (i.e., the sum of conductive, convective, radiative, and evaporative heat). PURPOSE The primary aim of this study was to compare EE estimated from measures of heat flux with those measured using indirect calorimetry in a thermoneutral environment (26°C). A secondary aim was to determine whether exposure to ambient temperature below thermoneutral condition (19°C) influences the accuracy of the PCM. METHODS Thirty-four adults (mean ± SD: age, 28 ± 5 yr; body mass index, 22.9 ± 2.6 kg · m(-2)) were studied for 5 h in a whole-room indirect calorimeter (IC) in thermoneutral and cool conditions. Participants wore the PCM on their upper arm and completed two 20-min treadmill walking bouts (0% grade, 3 mph). The remaining time was spent sedentary (e.g., watching television, using a computer). RESULTS In thermoneutral conditions, EE values (mean (95% confidence interval)) measured by IC and PCM were 560.0 (526.5-593.5) and 623.3 (535.5-711.1) kcal, respectively. In cool conditions, EE values measured by IC and PCM were 572.5 (540.9-604.0) and 745.5 (668.1-822.8) kcal, respectively. Under thermoneutral conditions, mean PCM minute-by-minute EE tracked closely with IC, resulting in a small nonsignificant bias (63 kcal (-5.8 to 132.4)). During cool conditions, mean PCM minute-by-minute EE did not track IC, resulting in a large bias (173.0 kcal (93.9-252.1)) (P <; 0.001). CONCLUSIONS This study demonstrated the validity of using measured heat flux to estimate EE. However, accuracy may be impaired in cool conditions possibly because of excess heat loss from the exposed limbs.