Height, weight and obesity in an industrial population.

Worldwide trends in childhood obesity.

Paediatric overweight and obesity are at epidemic proportions in both developed and developing countries around the world. The health issues for overweight and obese children are a significant concern to health professionals as they grow into chronic conditions as the child transitions to adulthood. Despite a plethora of literature highlighting the determinants of paediatric obesity, there has been little success in our ability to slow down the escalation of the condition. The gold standard to reduce weight in overweight and obese children is to decrease energy intake and increase expenditure to cause weight loss. The application of a simplistic approach based on eating less and moving more is outdated and unrealistic to fix a complex and multifaceted condition. Furthermore, health professionals expect necessary changes to be achieved by asking parents to engage in lifestyle changes that focus on behavioural changes, nutritional adjustments and encouraging physical activity for their families. This approach has resulted in limited successful outcomes for the parents of overweight and obese children, who lack insight and understanding into the complexity of their child’s condition. There is a need to conduct more investigations to understand why parents are unable to help their children lose weight using lifestyle approaches that employ a simple eat less and move more concept based on behaviour modification. This thesis investigated the experiences in particular of mothers who were raising obese children and explored the challenges they face when asked to get their children to eat less and move more in our contemporary obesogenic environment. Eighteen families were recruited from a private dietetic clinic providing treatment for overweight and obese children. Families were invited to participate in a mixed method research project which included both quantitative and qualitative components. My thesis argues that despite our current understanding that paediatric obesity is a multifaceted and complex condition, current treatment regimens do not consider the multi-determinants of health. Despite being framed as “family” interventions, they are based on individualistic approaches which simply includes advising mothers to get their obese children to eat less and move more. The exploration of the mothers’ experiences, when raising and obese child/ren and trying to decrease their weight, has highlighted the need to rethink our current practice. I argue that for effective treatments, attention needs to be given to the following three considerations: first, we need to move away from the simplistic eat less, move more theoretical underpinnings of our treatments; second, we need to move away from solely focusing on the child’s weight as the pivotal point to be addressed and instead, meaningfully address the multiple characteristics that obese children present with; third, we need to rethink our family-centred approaches which fail to recognise that “the family” in fact means the mother and that it is impossible for one person to have the skills, time and emotional energy required to navigate the complexity of the current obesogenic environment. Our understanding that there are multiple determinants that contribute to paediatric obesity is neglected when our focus is only on the mothers. Increased support and understanding are paramount for mothers who are struggling to raise obese children in a biased and stigmatised obesogenic environment that deflects the responsibility to mothers. This can be likened to the health issues associated with cigarette smoking where for decades the person was consistently blamed for their addiction. However, they were being enticed by cigarette companies to partake in an addictive practice that was promoted as fun and exciting. Existing obesogenic environments support the increased consumption of negative foods, and technological advances encourage decreased physical activity that causes weight gain in children. The development of overweight and obesity in paediatric populations evolved over several decades due to enormous and unprecedented environmental advancement and changes. Consequently, there is no single treatment or approach that can solve paediatric obesity. Therefore, the narrow individualist approach of targeting mothers needs to be addressed urgently because current obesogenic environments negate all parental attempts to make the necessary adjustments for their obese children to lose weight. We need to heed advice from the literature such as the World Health Organization’s Report on Ending Childhood Obesity, 2016: “Obesity prevention and treatment requires a whole-ofgovernment approach in which policies across all sectors systematically take health into account, avoid harmful health impacts, and thus improve population health and health equity (WHO, 2016, p.VI). Furthermore, the WHO also states that “No single intervention can halt the rise of the growing obesity epidemic” (WHO, 2016a, p.VI). Within the hierarchy structure of the determinants that contribute to paediatric obesity, we can identify that the top-level stakeholders appear to lack in their contributions that would support lower-level efforts. I argue that an all-inclusive approach, including all aspects of paediatric overweight and obesity, is paramount if this pandemic is to be stopped.

Obesity, defined as a body mass index of 30 kg/m2 or more, has reached epidemic proportions globally, with more than one-and-a-half billion adults overweight and at least 500 million clinically obese. The prevalence of obesity in the UK has increased by over 300% since 1980. In the UK 24% of adult women are obese and one in six women at an antenatal booking clinic is obese.
\nObesity has the potential for several detrimental effects on both the mother and the baby. Obese mothers are more likely to develop pre-eclampsia and eclampsia, gestational diabetes and venous thromboembolism. In addition, obese pregnant women are more likely to be induced, often resulting in complicated deliveries such as emergency Caesarean section and shoulder dystocia. Obesity significantly increases the risk of maternal mortality during or after pregnancy. Babies born to obese mothers are at an increased risk of congenital abnormalities, preterm deliveries and stillbirth, and children exposed to maternal obesity are at an increased risk of developing metabolic syndrome in later life.
\nThe aim of this work was to assess the extent and potential for the prevention of adverse impacts of obesity in pregnancy. The specific objectives were to: summarise the literature on maternal obesity and adverse pregnancy outcome; perform an epidemiological analysis using local data of obesity in pregnancy; conduct a systematic review of existing evidence on lifestyle interventions for obesity in pregnancy; and to develop and evaluate a multi-component pilot study for a community-based intervention for maternal obesity in South London.
\nAnalysis of delivery data from South London between January 2004 and May 2012 showed the overall prevalence of maternal obesity to be 15%, with considerable variation by ethnic group. There was a strong association between rising body mass index and risk of adverse pregnancy outcome, especially diabetes. The effect of obesity on diabetes in pregnancy was more pronounced in Asians and Orientals compared to other ethnic groups. Calculations of population attributable risk fractions showed that, if we were able to prevent obesity before pregnancy in this population, around one-third of diabetes in pregnancy could be prevented. The data alluded to the fact that the benefit of obesity reduction would be greater in Blacks than in other ethnic groups because of the higher prevalence of obesity in this group.
\nA complex community-based lifestyle intervention called the Community Activity and Nutrition (CAN) programme was developed for delivery by health trainers in children’s/Sure Start centres. The research showed that it is feasible to deliver the CAN intervention in children’s/Sure Start centres (Effra in Brixton, Jessop in Herne Hill and Jubilee in Tulse Hill) in an Inner London socially deprived community. The pilot study encountered problems with recruitment resulting from understaffing and lack of participant time. However, once recruited, retention on the programme was good. There was some evidence that the intervention improved selected clinical outcomes. Further work is ongoing to establish the clinical and cost effectiveness of the intervention. If CAN is shown to be clinically effective and cost-effective, the translation of this research and adoption by policy makers into the wider community may help to ameliorate the adverse outcomes associated with obesity in pregnancy.

Background: A reduction in muscle mass (MM), known as sarcopenia, and an increase in fat mass is one of the most striking and consistent changes associated with obesity in aging. Sarcopenia should be evaluated in older patients who present declines in physical activity and strength. A careful weight management may be useful to reduce fat mass and to preserve muscle mass in sarcopenic obese old patients. Objective: The main purpose of our study was to diagnose sarcopenia in obese older peoples and to assess the effect of a diet moderately rich in proteins on lean mass loss in sarcopenic obese older patients. Material and Methods: 1814 patients (1301 females, 20-75 years old) were enrolled in the study to determine new cut-off of muscle mass index (MMI) to evaluate sarcopenia. 1272 subjects (1030 females - age > 65 years; BMI > 30 Kg/m2) were recruited to verify the effect of a diet moderately rich in proteins (1,2 g/Kg/die) on lean mass loss in sarcopenic obese older patients. Nutritional status was assessed and MM was estimated. MMI was calculated as: MM/height2 in all populations. Results: MMI was significantly different in males and females, according to obese and normalweight conditions, as well as age. New MMI cut-off were calculated (as MMI – 2SD) in all groups. In particular, in obese adult men MMI cut-off was 8,54 Kg/m2, while it was 7,89 Kg/m2 in normalweight adult men. MMI cut-off was 7,28 Kg/m2 in obese adult women and 6,79 Kg/m2 in normalweight adult women. According to obese-derived MMI cut-off scores, 104 obese older women (out of 1030) and 9 obese older men (out of 242) were classified as sarcopenic. After dieting (1,2 g/Kg/die of proteins), significant reductions in BMI were detected in all sarcopenic populations (Females: 30,26 ± 0,02 vs 31,05 ± 0,03 Kg/m2; Males: 29,2 ± 0,4 vs 30,20 ± 0,03 Kg/m2, p < 0,01 vs baseline). MMI showed a significant increase in sarcopenic obese older women (7,13 ± 0,01 vs 6,96 ± 0,01 Kg/m2, p<0,01 vs baseline), but not in sarcopenic obese older men (8,8 ± 0,3 vs 8,27 ± 0,04 Kg/m2). Moreover, AMA did not present significant variations in all sarcopenic groups (Females: 43,11 ± 0,04 vs 43,59 ± 0,05 cm2; Males: 53,2 ± 4,0 vs 51,9 ± 3,3 cm2). Conclusions: MMI was significantly different in males and females, comparing obese and normalweight groups. In particular, MMI in our obese patients was higher than in normalweight peoples. New cut-off, derived from obese adult population, may be useful to estimate sarcopenia in obese older peoples. Diet moderately rich in proteins appeared to preserve muscle mass in sarcopenic subjects. Therefore, adequate protein intake could contribute to prevent lean mass loss associated with weight loss in obese older patients.

The prevalence of obesity and its associated negative health consequences are a significant public health concern. Recent research has demonstrated an association between mid life obesity and increased risk of later life dementia. This worrying relationship has prompted investigation and identification of an association between obesity and cognitive impairment in mid life. However, many questions remain regarding the domains of cognition affected; the independent contribution of obesity to cognitive function above and beyond obesity related comorbidities; and the subjective experience of such impairment in individuals with obesity. A series of three studies addressed these identified limitations of the literature. A systematic review assessed evidence of domain specific cognitive impairment, and the independent contribution of obesity to cognitive function in mid life adults (Aim 1). Seventeen articles were reviewed, with evidence of obesity related cognitive impairment in the domains of intellectual functioning, psychomotor performance and speed, visual construction, concept formation and set shifting, and decision making. However, as few studies considered comorbidities relevant to investigating an independent link, evidence regarding an independent relationship between obesity and cognitive function was limited. The remaining two empirical studies of this thesis examined a sample of 69 treatment seeking individuals with obesity and 65 healthy weight individuals (matched for age and gender). Individuals with obesity were recruited consecutively from a private surgical weight loss clinic in Melbourne, Australia. The healthy weight control group were volunteers recruited from the general community. Participants completed a range of clinical health, psychological, and neuropsychological measures. The first empirical paper assessed domain specific cognitive functioning in adults with obesity (Aim 2) and the independent contribution of obesity to this performance (Aim 3). Individuals with obesity demonstrated poorer cognitive performance (independent of education) compared to healthy weight control participants in psychomotor performance and speed, verbal learning and memory, complex attention, semantic verbal fluency, working memory, and concept formation and set shifting. Obesity related impairments remained significant in each of these domains (except verbal memory) following control for obesity related comorbidities (e.g., mood, sleep, and cardiovascular disease risk factors). The second empirical paper employed a self report questionnaire to investigate the subjective experience of cognitive impairment in adults of obese and healthy weight, and the variables associated with these reports (Aim 4). The majority of both obese and healthy weight participants reported low levels of self-reported cognitive dysfunction, with no differences demonstrated between groups. Self reported cognitive dysfunction was not associated with objective cognitive performance, but with depression and anxiety symptoms in both groups and fatigue and sleepiness in the healthy weight group. In multivariate analyses, anxiety was the only significant independent predictor of self reported cognitive dysfunction in both obese and healthy weight individuals. Overall, this thesis adds to the growing evidence of cognitive impairment in adults with obesity, along with providing initial evidence that obesity independently contributes to this performance. Findings that individuals with obesity report similar levels of cognitive dysfunction compared to healthy weight individuals indicate that these early cognitive deficits may not be subjectively experienced during mid life. Further research however, is required to clarify the brain regions and mechanisms underlying obesity related cognitive impairment, and confirm the clinical significance of this impairment. Ultimately, the long term aim of this research should be to examine whether mid life weight loss can improve mid life obesity related cognitive impairment and attenuate late life dementia risk. This will be particularly important in the context of the growing levels of obesity and an ageing population.

A functional polymorphism in the uncoupling protein 2 (UCP2) gene promoter has been associated with obesity and type 2 diabetes (T2D) in some populations. The impact of UCP2 polymorphisms on diabetes and obesity is still under debate. Contradictory results have been reported in different populations world-wide. To clarify the contribution of the UCP2 gene -866 G/A polymorphism in the Iranian population, we studied its association with obesity and T2D. A total of 225 unrelated subjects were studied: 75 T2D patients without obesity, 75 obese patients without diabetes and 75 control subjects. The UCP2 -866 G/A polymorphism was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). In the normal Iranian population, GG polymorphism was significantly associated with an increased HDL-C level (P=0.027). G/A polymorphism was not associated with obesity and T2D in our study population, but the odds ratio (OR) between GG and G/A polymorphism was 0.61 with a confidence interval (CI) range of 0.34 - 1.08 in obese patients. Subjects with AA genotypes in all of the studied groups showed a lower body mass index (BMI) than subjects with the GG genotype. Although the data in our study population is not statistically significant, the A allele in the UCP2 gene promoter seems to be protective against obesity. This may suggest the possibility of UCP2 as a target molecule for studies on the etiology and treatment of obesity.

Objective The prevalence of obesity is constantly increasing. Multiple metabolic complications are related to obesity, including type 2 diabetes mellitus and non-alcholic fatty liver disease(NAFLD). Our study aimed to investigate the prevalence of obesity comorbidities and its association with BMI. Methods 765 individuals who visited the multidisciplinary clinic for obesity in Peking University First Hospital from 2015, Jun. to 2018, Sept. were enrolled in this study. The height, body weight, waist circumference, hip circumference were measured during the first visit. Body adipose percentage and basal metabolic rate were recorded. Questionnaires for daily food intake, comorbidity, and lifestyle were recorded. Fasting insulin, C peptide, glucose, HbA1C, uric acid, liver enzymes and lipid profile were measured. Statistical analysis was performed using SPSS 16.0, and P<0.05 was considered as statistical significant. Results Daily energy intake was higher in obesity group [obese vs non-obese, (2 136.6±739.4 vs 1 905.7±468.4)kcal/d, P=0.046]. Hypertension, NAFLD and gout risk increased significantly in obesity group (obese vs non-obese, 36.0% vs 24.5%, P=0.02; 76.5% vs 60.6%, P<0.01; 6.9% vs 1.8%, P=0.04, respectively). Family history of obesity and diabetes increased in obesity group (obese vs non-obese, 64.5% vs 53.6%, P=0.03; 47.4 % vs 37.3%, P=0.048). Fasting insulin and C-peptide levels were higher in obesity group [obese vs non-obese, (24.8±15.3 vs 13.6±9.5)μIU/ml, P<0.01; (3.72±1.40 vs 2.70±1.16)μIU/ml, P<0.01). Liver enzymes increased significantly in obesity group [obese vs non-obese, (47.2±45.4 vs 23.3±21.4)U/L, P<0.01; (30.4±24.0 vs 19.9±8.5)U/L, P=0.001]. Conclusions Obesity population had higher risk of hypertension, NAFLD and gout. Fasting insulin, C-peptide, liver enzymes, and UA also increased significantly in these patients. It is critically important to those obese individuals for regular screening of NAFLD and diabetes mellitus. Key words: Obesity; Comorbidity; Metabolic diseases

The aim of this paper was to analyze the association between different types of obesity and cardiovascular risk factors (CRFs)in school-aged children. 3508 children aged 6-18 years old including 2 054 non-obese and 1 454 obese children were chosen as the population under study, from Beijing Children and Adolescents Metabolic Syndrome Study. Demographic data was collected through questionnaires while height, weight, waist circumference, and blood pressure were measured through physical check-up. Fasting blood glucose and blood lipids were also tested. Children were divided into four groups:without obesity, with general obesity, with abdominal obesity and with combined obesity. CRFs including dyslipidemia, impaired fasting glucose (IFG), and hypertension were scored. Multiple linear regression and logistic regression analyses were performed to assess the association between different types of obesity and CRFs. From non-obese children, children under general-obesity, abdominal obesity and those with combined types of obesity, there appeared an increasing trend in the levels of blood pressure, blood glucose, and blood lipids, the prevalence dyslipidemia and hypertension (P < 0.001). There were no significant differences in the risks of IFG among four types of obesity. After controlling for age, sex, and puberty stage, when compared with non-obese children, those children with abdominal obesity or combined types of obesity had 1.54 and 2.51 times of risks to only one CRF, while generally obese children had similar risk of dyslipidemia. When compared to the non-obese ones, children with general obesity, abdominal obesity, or combined types of obesity showed 3.32, 2.21 and 7.42 times of risks to ≥ 2 CRFs and 3.10, 3.67 and 10.75 times of risks to ≥ 3 CRFs. The cluster of CRFs increased with the levels of obesity (P < 0.001). Levels and cluster of CRFs were increasing along with the levels of obesity in school-aged children in Beijing. Children with combined types of obesity had the highest risk of clustering CRFs, followed by those with abdominal obesity and general obesity.

Obesity is an epidemic health problem worldwide associated with increased risk of cardiovascular disease, metabolic syndrome, and cancer. Its incidence increased in pregnant women in the last two decades as well as observed in the general population. Maternal obesity is related to offspring obesity, and there is an increased risk of adverse outcomes for both mother and child. Visceral adipose tissue (VAT) is an important risk factor for metabolic imbalance in human subjects, also during pregnancy. So, our aim was to study epigenetic regulation and proteomic signature of obesity in morbid obese women with and without pregnancy. The first aim of this study was to investigate the miRNA-expression profile and the proteomic signature in VAT from obese women to identify miRNA/protein target pairs associated with obesity. Notably, most miRNAs were down-expressed in obese tissues, whereas most of the proteins from the investigated spots were up-expressed. Bioinformatics integration of miRNA expression and proteomic data highlighted two potential miRNA/protein target pairs: miR-141/YWHAG (tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein, gamma polypeptide) and miR-520e/RAB11A (Ras-related protein RAB-11A); the functional interaction between these miRNAs and their target sequences on the corresponding mRNAs was confirmed by luciferase assays. Both RAB11A and YWHAG proteins are involved in glucose homeostasis; YWHAG is also involved in lipid metabolism. Hence, the identified miRNA/protein target pairs are potential players in the obese phenotype. The second aim of this study was to investigate the effects of maternal pre-pregnancy obesity in placental tissue and in human amniotic mesenchymal stem cells (hA-MSCs) from morbidly obese women to highlight differential expression patterns to correlate with the obese phenotype. The miRNA-expression profile was studied in amnion from obese and control women. Seven miRNAs were expressed only in amnion from obese women, whereas 13 miRNAs were up-expressed and 12 miRNAs down-expressed in amnion from obese women compared to controls. Target genes of these miRNAs and miRNA-regulated pathways were predicted by bioinformatics. MiRNAs significantly down-regulated the neurotrophin, cancer/ErbB, mammalian target of rapamycin, insulin, adipocytokine, actin cytoskeleton and mitogen-activated protein kinase signaling pathways. In conclusion, this study shows that the miRNA profile is altered in amnion during obesity and we hypothesize that this could affect pathways important for placental growth and function, thereby contributing to an increase in the newborn's risk of future metabolic diseases. In hA-MSCs from obese (Ob-) and non-obese (Co-) pregnant women were studied both the miRNA and protein expression profiles to highlight differential expression patterns to correlate with the obese phenotype. Among the tested miRNAs 11 were up-expressed and 14 were down-expressed in Ob- compared to Co-hA-MSCs. Interestingly, 7 miRNAs were obesity-specific, being expressed only in Ob-hA-MSCs. Bioinformatics showed that differently expressed miRNAs significantly regulated genes belonging to several metabolic pathways, i.e. MAPK signalling, actin cytoskeleton, focal adhesion, axon guidance, insulin signaling, etc. Proteomic signature showed 40 differently expressed protein spots, 62% were increased and 38% were decreased in Ob- compared to Co-hA-MSCs. Globally, a total of 41 proteins were identified in these spots. They were involved into 5 pathways: Focal adhesion, Processing in endoplasmic reticulum, Metabolic pathways, Regulation of actin cytoskeleton, MAPK signaling. Further investigations are needed to validate proteomic data and to identify miRNA/protein target pairs in hA-MSCs. In conclusion, these data highlight in Ob-hA-MSCs altered pathways that were relevant for both metabolic function and structural integrity. Interestingly, these pathways were previously found to be altered in whole placenta or in adipose tissue from obese women, so supporting that cellular dysfunctions are present in utero during obesity and likely contribute to increase the newborns' risk for metabolic diseases in adult life.

To analyze the current prevalence rates of overweight, obesity, central obesity and the clustering of major cardiovascular risks among middle-aged population of China. 1 000 participants aged 35-64 years in each of the 12 populations under study, were examined with international standardized criteria in 2009-2010. Out of the 11 623 potential respondents, 10 340 of them were eligible for analysis. Current prevalence rates of overweight, obesity and central obesity, and the clustering of major cardiovascular risks were analyzed. Overweight and obesity were defined under the Chinese BMI criteria. The prevalence rates were 38.8% on overweight, 20.2% on obesity and 51.6% on central obesity, respectively. Overall, the prevalence was seen higher in females, in northern part of the country and in urban (P < 0.05). Participants with all of three risk factors (hypertension, diabetes and dyslipidemia) appeared 4.5 times in obese persons than in normal persons but 5.1 times in persons with central obesity. About half of middle aged Chinese were under abnormal weight, and most participants in our study were accompanied with cardiovascular risk factors related to obesity. It is of urgent need to develop strategies on prevention and intervention against obesity.

Objective To analyze the prevalence of overweight and obesity among Chinese population from 2010 to 2012. Methods Datas were collected from the Chinese Nutrition and Health Surveillance 2010- 2012. The subjects were selected through the method of probability proportion to size (PPS). A total of 8 333 subjects aged from 15 to 17 years old (4 173 people in urban areas, and 4 160 people in rural areas) and 120 546 subjects aged 18 years and above were analyzed (60 289 people in urban, and 60 257 people in rural areas). Overweight and obesity in adolescents and adults were defined according to the WHO recommended BMI for age and sex in 2007 and WHO recommended standards, which was body mass index ≥25 kg/m2 for overweight and body mass index ≥30 kg/m2 for obesity. Age-standardized results were calculated by incorporating a complex sample weighting using the population data from the National Bureau of Statistics in 2009. Results The prevalence of overweight and obesity among Chinese teenagers aged 15-17 were 7.8% and 2.6%, respectively. The prevalence of overweight and obesity were 8.4% and 3.6% for males, 7.2% and 1.5% for females. The prevalence of overweight and obesity for subjects in urban areas were 9.4% and 3.4%, respectively, while 6.6% and 2.0% in rural areas. The prevalence of overweight and obesity among Chinese adults were 27.1%, and 5.2%, respectively, and the total rate was 32.3%. And among them, the total rate of overweight and obesity in city adults was 35.4%, while 29.1% in rural adults. The rates of overweight and obesity in urban residents were 29.7% and 5.7% respectively, while 24.5% and 4.6% in rural adults. The rates of overweight and obesity in male were 27.8% and 5.1%, respectively, while 26.4% and 5.2% for female. Conclusion From 2010 to 2012, more than 1/10 of Chinese teenagers aged 15 to 17 were overweight or obese and nearly 1/3 of Chinese adults are overweight or obese. Overweight and obesity situation were very serious. Key words: Overweight; Obesity; Adolescent; Adult; Cross-sectional studies

Obesity has clear and serious consequences for physical health, many of which emerge in adulthood. For obese children, poor psychological health may be the most obvious and immediate implication of their excess adiposity but the evidence to support this is mixed, particularly for community-based (i.e. non-clinical) groups. Given that associations between psychological health and body mass index (BMI) are likely to be bidirectional, longitudinal methodologies seem best suited to clarify the nature of these relationships. Furthermore, research conducted with community-based samples may be generalizable to the wider population of overweight and obese children. However, most research to date has been cross-sectional and conducted with clinical populations of obese children. In light of these evidence gaps, the first objective of this thesis was to determine the longitudinal relationship between psychological well-being and subsequent excess adiposity gain and obesity onset across childhood and adolescence. This was addressed in a systematic review (Paper 1) and a research paper (Paper 2). The systematic review, which selected population-based studies for maximum generalizability, suggested that poorer psychological well-being may increase the incidence of obesity and contribute to obesity persistence across adolescence. However, major limitations and inconsistencies were identified in the literature. Paper 2 of this thesis addressed a gap identified in the systematic literature review- the need for further good-quality research examining individual psychological predictors of adiposity change in the overweight or obese subgroup. It employed a longitudinal cohort of 5-9 year old children who were all initially overweight or mildly obese when they presented to primary care 4 years earlier. Parallel parent proxy- and child self- reported psychosocial measures were assessed as predictors of changes in body mass index (BMI; kg/m2) standard deviation scores (i.e. BMI z-scores). Results revealed little evidence that initial psychosocial functioning impacted on subsequent BMI z-score change. However, changes in several domains of psychosocial well-being, especially in relation to body-image and appearance, were associated with concomitant BMI z-score change. A strong degree of corroboration between parents and children strengthened the validity of the findings. The second objective of the thesis was to investigate whether and how BMI was associated with psychological outcomes among non-clinical overweight or obese children. Consistent with Paper 2, Paper 3 achieved this within a cohort of 5-9 year olds recruited from primary care for their overweight or mild obesity. Results confirmed that overall, psychological well-being at 4-year follow-up was weakly predicted by concurrent BMI and when impairments were found, they were most likely for peer and eating-behaviour domains. This study extended on existing knowledge by demonstrating that changes in BMI categories also contributed little variance to the psychological outcomes of initially overweight children. The implications of this research focus on informing effective prevention strategies to reverse the current trends in youth obesity. Recommendations include targeting poor psychological well-being prior to adolescence to yield the most benefit for preventing the onset of obesity. Intervention strategies for the quarter of children in the community who are overweight or obese could incorporate modules that target peer relationship and eating problems, the most relevant psychological comorbidities of excess adiposity. Enhancing well-being in these domains would be beneficial for immediate quality of life, future mental health and potentially initiate flow-on effects that improve physical health.

Obesity/overweight is the most prevalent nutritional problem in adult and pediatric populations in the United States. We review up-to-date data on obesity in general, with emphasis on research findings in children. We also focus on non-Hispanic Blacks, an ethnic group that is relatively under-researched, despite having higher rates of obesity than Whites. An electronic search of MEDLINE/ PubMed and several other bibliographic databases, including JSTOR, EBSCO, and Pro-Quest, was conducted, and all relevant articles in English were retrieved. Risk factors for childhood obesity are attributable to a combination of genetic and environmental factors. Literature has focused on the general population and genetic transmission from parents to children. Researchers agree that although genetics plays a major role, the risk of a child becoming obese is highly correlated with environment, as well. Relatively little research has been conducted to delineate obesity risk factors among Blacks, and virtually nothing is known on the determinants of obesity and obesity phenotype acquisition in the Black child. Genetic and environmental factors play a role in the development of childhood obesity. Despite the rich body of work on the topic, data that specifically address childhood obesity in Blacks are scanty. We need more information on childhood obesity in Blacks so that evidence-based prevention measures can be formulated to reduce the high prevalence of obesity in that population.

This study aimed to provide an epidemiological modeling in evaluating the risk of developing obesity within 5 years in Taiwan population aged 30 - 59 years. After excluding 918 individuals who were observed at baseline, a cohort of 14 167 non-obesity subjects aged 30 - 59 years in the initial year during 1998 - 2006, was formed to derive a Risk Score which could predict the incident obesity (IO). Multivariate logistic regression was used to derive the risk functions, using the check-up center (Taipei training cohort, n = 8104) of the overall cohort. Rules based on these risk functions were evaluated in the left three centers (testing cohort, n = 6063). Risk functions were produced to detect the IO on a training sample using the multivariate logistic regression models. Starting with variables that could predict the IO through univariate models, we constructed multivariable logistic regression models in a stepwise manner which eventually could include all the variables. We evaluated the predictability of the model by the area under the receiver-operating characteristic (ROC) curve (AUC) and to testify its diagnostic property on the testing sample. Once the final model was defined, the next step was to establish rules to characterize 4 different degrees of risk based on the cut points of these probabilities after transforming into normal distribution by log-transformation. At baseline, the range of the proportion of normal weight, overweight and obesity were 50.00% - 60.00%, 26.47% - 31.11% and 5.76% - 7.24% respectively in four check-up centers of Taiwan. After excluding 918 obesity individuals at baseline, we ascertained 386 (2.73%, 386/14 167) cases having IO and 2.66% - 2.91% of them having centered obesity in the four check-up centers respectively. Final multivariable logistic regression model would include five risk factors: sex, age, history of diabetes, weight deduction ≥ 4 kg within 3 months and waist circumference. The area under the ROC curve (AUC) was 0.898 (95%CI, 0.884 - 0.912) that could predict the development of obesity within 5 years. The curve also had adequate performance in testing the sample [AUC = 0.881 (95%CI, 0.862 - 0.900)]. After labeling the four risk degrees, 16.0% and 2.9% of the total subjects were in the mediate and high risk populations respectively and were 7.8 and 16.6 times higher, when comparing with the population at risk in general. The predictability and reliability of our obesity risk score model, derived based on Taiwan MJ Longitudinal Health-checkup-based Population Database, were relatively satisfactory, with its simple and practicable predictive variables and the risk degree form. This model could help individuals to self assess the situation of risk on obesity and could also guide the community caretakers to monitor the trend of obesity development.

Objective To investigate the correlation of increasing complication rate in obese patients undergoing laparoscopic adrenalectomy. Method A retrospective chart review was performed on 80 patients undergoing laparoscopic adrenalectomy between January 2009 and January 2017. Clinical data was reviewed retrospectively. The correlation of increasing complication rate in obese patients undergoing laparoscopic adrenalectomy was analyzed. Result A total of 80 patients underwent laparoscopic adrenalectomy. Forty three patients were considered obese based on the body mass index criteria. Thirty-seven patients were considered healthy weight. Operative time, sex, mean age, mass size, operation side, estimated blood loss, and comorbidities did not differ significantly between the 2 cohort groups. Complications occured in a patients of the obese population and occured in 2 patients of the healthy weight population. The rate of complication in the obese population was higher than that in the healthy weight population (P=0.04). The multivariate regression analysis revealed that the main determinants of increasing complication rate after laparoscopic adrenalectomy were age and the body mass index≥30 kg/m2. Conclusion A significant increase occurred in intraoperative and postoperative complications for obese individuals undergoing laparoscopic adrenalectomy compared with healthy weight individuals. However, obese individuals should be paid attention to perioperation period before laparoscopic adrenalectomy. It is effective, with decreasing complication rate in obese patients undergoing laparoscopic adrenalectomy. Key words: Laparoscope; Adrenalectomy; Obesity; Complications