Yvonne Linné

Weight development over time in parous women—The SPAWN study—15 years follow-up

BACKGROUND: Weight gain is common after pregnancy. Most studies suggest that weight gain associated with a pregnancy is between 0.5 and 3.8 kg up to 2.5 y of follow-up. However, 73% of the female patients at our obesity clinic identified pregnancy as an important trigger for marked weight retention. The majority retained more than 10 kg after each pregnancy. The aim of this study was to examine long-term weight development after pregnancy in a 15 y follow-up of women who took part in the Stockholm Pregnancy And Womens Nutrition (SPAWN) study.METHOD AND SUBJECTS: The SPAWN study is a long-term follow-up study of women who delivered children in 1984–85 in Stockholm (n=2342). A total of 1423 participants (response rate=61%) completed questionnaires, which covered eating behaviour and exercise, demographic information including social situation and status and details of the pregnancy before, during and up to 1 y after pregnancy. After 15 y, these women were invited to take part in the follow-up study. Anthropometric measurements and the same questionnaire data were collected from the 563 women who participated (response rate=40%). The sample was divided into two main groups: those who were normal weight before pregnancy and remained normal weight, and those who were normal weight before pregnancy and had become overweight at 15 y follow-up.RESULTS: Those women who became overweight had a higher pre-pregnant body mass index (BMI) (22.3±1.5 vs 20.5±1.6 kg/m2, P<0.001), gained more weight during pregnancy (16.3±4.3 vs 13.6±3.7 kg, P<0.001) and had retained more at 1 y follow-up. The women who became overweight had a steeper weight trajectory gaining more from 1 y follow-up to 15 y follow-up (11.1±6.5 vs 4.5±6.5 kg, P<0.001), with a higher BMI at 15 y follow-up of 27.5±2.6 vs 22.5±2.3 5 kg/m2 (P<0.001). However, differences between those who became overweight and those who did not could not be explained by age, number of children and various socioeconomic factors. Features of pregnancy that did differ between the two groups were breastfeeding and smoking cessation. However, women who became overweight had lower lactation scores than women who remained normal weight. Relatively more subjects of the group that became overweight stopped smoking during pregnancy.DISCUSSION: Pregnancy is a vulnerability factor for some women to become overweight. This study attempted to identify those factors that place initially normal weight women on a steeper weight trajectory as a result of pregnancy. Demographic, behavioural, physical and psychological characteristics only partly explain the weight gain observed at 15 y follow-up. Further research is required to investigate the relative role of these characteristics in predicting postpregnancy weight development.

BMI, waist-circumference and waist-hip-ratio as diagnostic tests for fatness in adolescents

OBJECTIVE:To evaluate the diagnostic accuracy of body mass index (BMI, kg/m2), waist-circumference (WC) and waist-hip-ratio (WHR) as diagnostic tests for detecting fatness in adolescents.DESIGN:A cross-sectional analysis of 474 healthy adolescents aged 17 y was used. Measurements of height, weight, WC, hip-circumference and body fat percentage (%BF) were obtained. The diagnostic accuracy for detecting excess fatness was evaluated through receiver operating characteristics (ROC) analyses with %BF, measured by densitometry (air-displacement plethysmography), as reference test.RESULTS:BMI and WC showed strong positive correlation (r=0.68–0.73; P<0.0001) with %BF in both sexes, but the correlation was weaker for WHR (r=0.30–0.41; P<0.0001). For overweight and obesity in boys and obesity in girls, the area under the ROC curve was high (0.96–0.99) for BMI and WC. WHR was not significantly better than chance as diagnostic test for obesity in girls. For BMI and WC, highly sensitive and specific cutoffs for obesity could be derived, while larger trade-offs were needed for detecting overweight in girls. The cutoffs producing equal sensitivity and specificity were lower than the ones minimizing the absolute number of misclassifications. The latter approached internationally recommended reference values, but were still several units lower for BMI in girls and several centimeters lower for WC in boys.CONCLUSION:BMI and WC were found to perform well as diagnostic tests for fatness, while WHR was less useful. The discrepancies between cutoffs producing equal sensitivity and specificity, cutoffs minimizing the absolute number of misclassifications and internationally recommended reference values for overweight and obesity highlight the importance of specifying the characteristics of classification systems for different settings.

Natural course of gestational diabetes mellitus: long term follow up of women in the SPAWN study

Objectives Long term follow up women with gestational diabetes mellitus (GDM).

Long‐term weight development after pregnancy

For some women pregnancy is a trigger for developing overweight and obesity. Seventy‐three per cent of 128 female patients at our Obesity Unit indicated that they had retained more than 10 kg after each of their pregnancies, and for this subgroup weight development after pregnancy was of crucial importance for their future health. Although mean weight increases after pregnancy generally are modest, there are wide individual variations. In studies at the Obesity Unit, weight retention ranging from up to 26.5 kg one year after pregnancy to a loss of 12.3 kg was reported, although the mean weight gained was only 0.5 kg. Numerous studies have analysed factors explaining weight development after pregnancy and delivery, with a range of subjects from several hundred thousand women to fewer than one‐hundred, but overall it has been surprisingly difficult to identify strong predictors of weight development. Numerous confounders have been identified; in a review up to 31 such confounders were reported. Methodological problems include weight development over time also in non‐pregnant women and problems of identifying the optimal time‐point when the overall impact of the pregnancy on weight development should be evaluated. Lactation has consistently been found to play a small role in explaining weight retention up to one year after delivery. Few studies have examined the role of physical activity during pregnancy and after delivery to explain weight development. Our own ongoing follow‐up of women who gave birth during 1984–85, the so‐called SPAWN (Stockholm Pregnancy and Women’s Nutrition) study, illustrates that 15 years after delivery, a significant proportion of the 1423 women initially studied were available for re‐examination. Drop‐out analyses indicate that for most variables under study, the remaining women were representative for the initial sample. Pregnancy and weight development are intertwined in a complex pattern, which includes a change in lifestyle factors, such as eating behaviour, physical activity, smoking cessation and degree of lactation, but which are still not fully understood.

Discrepancies between classification systems of childhood obesity

Despite growing concern about weight‐related problems among children, no universally accepted classification system for childhood obesity exists. There is a number of proposed international body mass index (BMI)‐based systems in use and national variants also exist in many countries. The absence of a universally accepted standard and confusion concerning which classification system to use on national levels complicate monitoring of the development of the obesity epidemic, stratification for selective interventions in public health, screening in clinical practice and comparisons between studies. Some proposed international classification systems have not only been recommended for global monitoring and comparisons between studies, but also for clinical and national epidemiological use in some countries. Possible discrepancies may thereby lead to inefficiencies in health care delivery and prevention programmes. The problems associated with misclassification of individuals at risk may lead to overconsumption of health care resources by lower‐risk individuals and underconsumption by higher‐risk individuals, which is costly both in terms of foregone health improvements and in terms of wasteful monetary usage. The aim of this paper was to review the specific problems associated with BMI as a measure of adiposity in childhood, the most commonly used classification systems for childhood obesity based on BMI, and how their performance can be evaluated.

Interrelationships between weight development and weight retention in subsequent pregnancies: the SPAWN study

Background Pregnancy is frequently associated with postdelivery weight retention in women. Most studies suggest weight retention associated with pregnancy of between 0.5 to 3.8 kg with up to 2.5 years of follow‐up. However, 73% of the female patients at our obesity clinic report that their pregnancies have been important trigger factors for marked weight gain and that they had gained more than 10 kg after each pregnancy. The aim of this study was to examine correlations in weight gain and weight retention after pregnancy in the long‐term perspective.

The criterion validity of a last 7-day physical activity questionnaire (SAPAQ) for use in adolescents with a wide variation in body fat: the Stockholm Weight Development Study

Objective:The aim of the present study was to assess the criterion validity of a newly developed self-reported last 7-day physical activity questionnaire (SAPAQ) for use in Swedish adolescents with a wide variation in body fatness.Measurements:We compared the self-reported total number of MET-minutes with objectively assessed variables of physical activity obtained by accelerometry in 49 (18 male, 31 female subjects) 17-year-old adolescents.Results:Self-reported physical activity was significantly and inversely related to time spent sedentary (r=−0.45; P<0.001) and significantly and positively associated with time spent in physical activity (r=0.51; P<0.001) and the total amount of physical activity (r=0.49; P<0.001). Gender and body fat did not affect the associations between self-reported and objectively assessed physical activity.Conclusion:Our results indicate that the newly developed questionnaire is a valid method for ranking individuals in terms of the total amount of physical activity in Swedish adolescents.

Intake of sweet foods and counts of cariogenic microorganisms in relation to body mass index and psychometric variables in women

OBJECTIVE: As a part of the SPAWN (Stockholm Pregnancy and Womens Nutrition) study, the intake of sweet foods (habitual and pre-menstrual intakes) and the number of cariogenic microorganisms in saliva was analysed in relation to body mass index (BMI) and psychometric variables.DESIGN: A cross-sectional study.SUBJECTS: Three hundred and sixty-two women with a median BMI of 24.2 kg/m2 (range 17.5–47.8) and 45 y of age (range 34–64).METHODS: A questionnaire of sweet food intake, salivary counts of mutans streptococci and lactobacilli and a self-rating scale on psychometric variables (CPRS-S-A).RESULTS: The number of mutans streptococci correlated with BMI (P<0.05), indirectly indicating a higher intake of sweet foods in obese women. The reported energy intake of sweet foods (more specifically the intake of chocolate), correlated with CPRS scores (P<0.01), indicating that women with more severe psychiatric symptomatology have higher intakes of sweet foods.CONCLUSIONS: This study suggests that women with higher CPRS score have higher energy intakes of sweet foods, indicating a possible link between mood regulation and the intake of sweet food.SPONSORSHIP: Karolinska Institute Research Funds.

Correlates of soft drink and fruit juice consumption among Swedish adolescents.

The aim of the study was to investigate how soft drink and fruit juice consumption in teenagers is associated with life-style, other food choices, eating behaviour and maternal characteristics. A cross-sectional study of 16-year-old girls (n 275) and boys (n 199) and their mothers was undertaken. Questionnaires were used to assess habitual dietary intake, eating behaviour, physical activity, smoking and educational level. Weight and height were measured. It was found that eating breakfast less than five times per week was independently associated with a high soft drink consumption in both girls and boys. A low intake of cooked meals and milk and a high intake of salty snacks were associated with soft drinks in boys only, and a low intake of fruits in girls only. A high maternal juice intake, low milk and high fruit consumption were independent correlates of fruit juice intake in both girls and boys. In girls, being a smoker, having a smoking mother, a high soft drink intake, scoring low on emotional eating and high on cognitive restraint were also associated with fruit juice intake. A low intake of soft drinks and cooked meals was associated with fruit juice intake in boys only. Neither soft drinks nor fruit juice was associated with BMI. In conclusion, a high intake of both fruit juice and soft drinks were associated with a lower intake of foods such as milk and cooked meals. It might be possible to influence fruit juice intake among teenagers by aiming at their mothers, whereas the adolescents themselves should be targeted when the aim is to reduce soft drink consumption.

Older members perform better in an internet-based behavioral weight loss program compared to younger members.

Background: New technology offers increased opportunities for weight control. However, it is not clear whether older people with less computer training can make use of this tool. Our objective was to examine how members above the age of 65 years performed in an internet-based behavioral weight loss program, compared to younger members. Methods: Data from members (n = 23,233) of an internet-based behavioral weight loss program were analyzed. We restricted our study to active participants accessing the weight club, during a 6-month period (n = 4,440). The number of logins, food intake, and weight records were examined. Participants were divided into age tertiles separately for men and women. The oldest tertile was further subdivided into two groups: above and below the age of 65 years. Results: Participants aged 65 or older were more likely to remain active in the weight club for at least 6 months compared to younger age groups. They had the highest frequency of recordings of food intake and current weight. Among women, those older than 65 years had on average the highest percentage of weight loss (5.6 kg, 6.8%). Men above 65 years of age had the highest number of logins, on average 161 times during the 6-month period. Conclusion: Older participants are performing equally well or even better in an internet-based behavioral weight loss program than younger participants. Internet-based programs could be a promising and attractive option for older adults requiring assistance in losing weight.