Adult Obesity Rates Research Articles

A COMMUNITY HEALTH EDUCATION PROGRAM TO ENCOURAGE EXERCISE AND PROPER NUTRITION IN LATINOS

New Mexico now has the 32nd highest adult obesity rate (28.8% for 2015). Thirty one percent of this obesity rate encompasses Latinos; rates are the highest among the 26-44 years age group. Obesity rates in NM for children aged 2-11 range from 11 – 14%. Healthy Kids New Mexico adopted the 5-2-1-0 challenge. (American Academy of Pediatrics) which refers to eating 5+ vegetables, reducing screen time to 2 hours, 1 hour+ daily activity, and daily water intake (H20). Therefore, project I’M HIP2’s main goal was to educate parents and children, within an intergenerational context, on improving diet and activity levels to reduce obesity. The Intergenerational Mentoring on Health Information Pathways 2 (I’M HIP2) program involved 74 Hispanic families including one target child, one parent, and one other relative, e.g., aunt or grandparent. Monthly educational sessions focused on physical activity and adapting meals to be healthy. Project outcomes included exercise frequency, Body Mass Index (BMI), and a knowledge quiz assessing healthy meal facts, exercise knowledge via a 10-item quiz; all assessments pre- and post-program. Paired t-test analyses revealed significant changes in knowledge quiz total scores (t 70 = 5.03, p < .0001), increased exercise frequency (t 72 = 2.106, p < .05); no significant change in BMI from pre- to post-assessments. The families reported overwhelmingly positive responses to how the program had changed their eating styles and activity levels. This study has implications for how we can harness this invaluable resource of the generations to affect health impacts on Hispanic families.

Using photovoice to explore social determinants of obesity in two underserved communities in the southeast

Over the past 25 years, the adult obesity rate in the U.S. has increased 70%, with obesity placing a disproportionate chronic disease burden on African Americans. Using Photovoice methodology, this study aimed to: (1) explore the social determinants contributing to obesity from the perspectives of residents of two low-income municipalities in Birmingham, Alabama with varying levels of segregation, (2) better understand residents’ perceptions of contributors to obesity in their communities, and (3) examine residents’ perceptions of interventions that might be effective in promoting positive change. Focus groups (N = 10) segmented by race and community were conducted by trained moderators. Transcriptions were analyzed by theoretical thematic analysis. The study design and data analysis analyses were guided by a conceptual framework based on the Social Determinants of Obesity model. Findings from this study lend support to the efficacy of the conceptual framework as a multilevel approach describing obesity disparities in the south. Regardless of community and race, participants believed that elements of their built environment, such as fast food restaurants and unsafe walking conditions, contributed to obesity, and that schools and churches should play an active role in addressing the issue.

T Cells and Natural Killer Cells, but Not B Cells or Antibodies, are Affected in Overweight and Obese Saudi Females

Saudi Arabia has one of the highest adult overweight and obesity rates, especially in females, leading to increased mortality, morbidity, infections, and risk for many diseases. This study determined the counts and percents of lymphocyte subtypes (CD3, CD4, CD8, and CD16 +CD56 cells) and serum IgG, IgA, and IgM concentrations in blood samples collected from sixty-four Saudi female university employees with an age range of 24-52 years. There is only one other study on the counts/numbers of lymphocyte subtypes in overweight and obese Saudi females. Anthropometric measurements were used to categorize the subjects into groups according to the body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC). Results were all compared to the controls. Antibody concentrations were not significantly different. The CD3and CD4 counts were significantly higher for the obese BMI group and the overweight and obese BMI, respectively. The high-risk WHR group had a significantly lower CD 3% and a significantly higher CD16 + CD56 count. The high-risk WC group had significantly higher CD3 and CD4 counts and a significantly lower CD16 + CD56%. Thus, obesity leads to changes in the cellular adaptive and innate immune systems, while not affecting the humoral adaptive immune system.

Proximity to parks and natural areas as an environmental determinant to spatial disparities in obesity prevalence

Obesity is a significant public health concern in the United States. The relationship between recreational opportunity and health conditions have been examined at an individual level by several studies. However, few studies have examined this relationship at a regional or national level. Public health and regional science studies recently have examined spatial disparities of chronical disease and its related factors at a population level. We aimed to build a model for the estimation of the multi-level spatial relationships (global vs. local) between obesity and its related key determinants at the regional and national level, in the United States (US). This study specifically examined the association between obesity and socio-demographic, economic, and environmental factors using manipulated spatial data for 3,109 counties in the continental US. First, the dependent variable (age-adjusted adult obesity rate) was obtained from the CDC. Public and private levels of secondary data as independent variables were transformed into spatial data with the preservation of their attributes. Traditional regression (OLS) and Geographically Weighted Regression (GWR) was conducted in GWR 4.0.9. Specifically, GWR modeling could detect the differential associations between obesity rate and its key determinants at the local and national geographical levels. The results of OLS regression analysis supported previous research findings. The proportion of African-American people and poverty rate were positively related, while a university-level education was negatively related to obesity prevalence. In the analysis of GWR, park proximity showed the strongest negative association with obesity prevalence, especially in the western regions. Obesity prevalence was influenced by natural and recreational built environments in the continental US. The methodological approaches we employed may aid in the formulation of appropriate guidelines for the balanced provision of recreation and leisure services to mitigate spatial disparities in obesity prevalence from a regional recreation planning perspective.

Trends of endometrial cancer incidence from 2000 to 2015 in the United States.

5591 Background: Recent studies have shown that obesity related cancers are increasing in incidence in the US as the rates of obesity rise and some cancers, like colorectal cancer, are occurring in younger age groups. We studied trends in incidence of endometrial cancer (EC), one of the obesity related cancers, in a population wide analysis. Methods: We analyzed data from all cases of EC between 2000 and 2015 from 18 US cancer registries using the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. SEER*Stat was used to query the database for annual percent changes (APC), incidence ratios and percent change in incidence across different age groups, years of diagnosis, histologic subtypes, grade and race. We also studied the reported rates and trends of obesity in the US. Results: APC of age-adjusted EC incidence between 2000 and 2015 was +0.9% (95% confidence interval (CI) 1.1-0.6, p value&lt;0.05). Incidence of EC rose from 17.8 per 100,000 to 19.7 per 100,000 during the same duration. APC for EC incidence for age groups 20-39 and &gt;40 were +3.2% (p-value &lt;0.05) and +0.8% (p value &lt;0.05), respectively. For the age-group 20-39, endometrioid EC was the only histologic subtype that rose in incidence, with an APC of +5.5% and absolute percentage change of 156%. The APC of EC in 20-39 age group was more for whites (3.5%, p-value&lt;0.05) and Asians (2.2%, p-value&lt;0.05) than blacks (1.8, p-value &lt;0.05). CDC reported an increase in obesity rates in adults from 30.5% in 2000 to 37.7% in 2014. Table shows trends of EC incidence in age groups 20-39 and &gt;40 years across various histologic subtypes. (Abbreviations: S significant, NS not significant, NC non-calculable). Conclusions: Endometrial cancer, especially of endometrioid histology, is increasing in incidence and is occurring more often in the younger population. The concomitant rise in obesity rates during the same period point towards a possible causality of the increased in incidence of EC. Population based strategies are needed to decrease the trends in obesity so as to decrease the risk of endometrial cancer in younger women. [Table: see text]

Abstract 228: Comparison of the Effect of Local and Long-Distance Delivery Models for a School-Based Wellness Intervention on Health Behaviors of Middle School Students

Background: Michigan’s upper peninsula (UP) is a remote area with only 3% of the state’s population, making it difficult to reach with health interventions. Nearly half of the UP counties have higher adult obesity rates than the state average. The Project Healthy Schools (PHS) middle school-based wellness program uses local and long-distance delivery models in Michigan’s lower peninsula (LP) and UP, respectively. Schools utilizing the local model (LP schools) have routine staff visits to assist in program implementation; conversely, long-distance model schools (UP) rely on telecommunication with PHS staff to implement the program. This study sought to determine if differences exist in health behaviors of LP and UP students at baseline, as well as post-PHS intervention to determine the effectiveness of the local and long-distance PHS delivery models. Methods: Data from 6 th grade students enrolled in PHS between 2014-2017 were analyzed. Students were divided into two groups, UP and LP students. Demographics and health behaviors at baseline and post-intervention were compared between groups. Results: Of 21,459 students, 695 (3.2%) were from the UP. Compared to LP students, UP students were more likely to be White and from lower and middle socioeconomic status communities. Pre-PHS intervention, UP students ate more fruits, vegetables, and chocolate candy, engaged in more moderate exercise, and spent less time on TV, computers, video games, and mobile devices than LP students. No significant differences in post-intervention impact on health behaviors were seen between UP and LP students. Conclusions: At baseline, UP students reported better health behaviors than LP students. However, the lack of differences in post-intervention impact suggest the local and long-distance delivery models were equally effective in influencing health behaviors. Future investigation of the effect of school-based interventions in remote communities, like the UP, are warranted.

HIGHER BODY MASS INDEX OF MISSISSIPPI'S WOMEN, BLACK, AND AGING ADULT CONGENITAL HEART DISEASE PATIENTS

Mississippi (MS) has the second highest adult obesity rate in the nation at 37.3%. It is unclear how this affects patients with CHD. The aim of this work is to analyze BMI in the adult congenital heart disease (ACHD) population of MS. We retrospectively analyzed electronic health data from a cohort

Assessment of dietary patterns, physical activity and obesity from a national survey: Rural-urban health disparities in older adults.

BackgroundObesity is a critical public health issue, affecting over one-third of all Americans, and is an underlying cause of numerous health issues across the lifespan. For older adults, obesity is linked to premature declines in physical and mental health and cognitive functioning. The occurrence of obesity and related health behaviors and chronic diseases are higher in rural areas than in urban areas. Furthermore, rural areas of the United States have a higher proportion of older adults than urban areas. Few studies, to date, have explored rural-urban differences in the relationships between dietary patterns and obesity among older adults. Therefore, the purpose of this study is to assess rural-urban differences in obesity rates in older adults, and the potential for the associations between obesity and physical activity and dietary patterns to vary by rural-urban status.MethodsData were abstracted from respondents aged 65 and above from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) database linked to Census-based county-level information on rural-urban status and socioeconomic status. Generalized linear models were utilized to assess rural-urban disparities in obesity, and the potential for associations between obesity and known risk factors (fruit consumption, green vegetable consumption and physical activity) to vary by rural-urban status, accounting for complex sampling and confounders.ResultsObesity rates were highest and fruit consumption was lowest in the most rural areas. However, for older adults in the most urban areas, there was a significant negative association between obesity and fruit and green vegetable consumption. This association was not observed in more rural older adults.ConclusionThese findings underscore the need to take into account place-based factors such as rural-urban status, when designing and implementing policies and interventions designed to reduce obesity through risk factor mitigation in older adults. To reduce rural-urban disparities in older adults, all policies, programs, and interventions should address the unique barriers and needs specific to rural and urban older adults.

Theoretical Explanation for Reduced Body Mass Index and Obesity Rates in Cannabis Users.

Introduction: Obesity is treatment-resistant, and is linked with a number of serious, chronic diseases. Adult obesity rates in the United States have tripled since the early 1960s. Recent reviews show that an increased ratio of omega-6 to omega-3 fatty acids contributes to obesity rates by increasing levels of the endocannabinoid signals AEA and 2-AG, overstimulating CB1R and leading to increased caloric intake, reduced metabolic rates, and weight gain. Cannabis, or THC, also stimulates CB1R and increases caloric intake during acute exposures.Goals: To establish the relationship between Cannabis use and body mass index, and to provide a theoretical explanation for this relationship.Results: The present meta-analysis reveals significantly reduced body mass index and rates of obesity in Cannabis users, in conjunction with increased caloric intake.Theoretical explanation: We provide for the first time a causative explanation for this paradox, in which rapid and long-lasting downregulation of CB1R following acute Cannabis consumption reduces energy storage and increases metabolic rates, thus reversing the impact on body mass index of elevated dietary omega-6/omega-3 ratios.

A Potential Role of the Widespread Use of Microwave Ovens in the Obesity Epidemic

Organisms acquire more calories from eating hot food than eating the identical food cold; thus, the widespread use of microwave ovens might have played a small role in the current obesity epidemic, just as the widespread use of refrigerators might have retarded the historic increase in obesity a century ago. Analysis of the British Cohort Study showed that, net of dietary habit, physical activities, genetic predisposition, and other demographic factors, the ownership of a microwave was associated with an increase of .781 in body mass index (BMI) and 2.1 kg in weight (when the ownership of other kitchen appliances was not associated with increased BMI or weight), and it more than doubled the odds of being overweight. In the United States from 1960 to 2015, the adult overweight, obesity, and extreme obesity rates were very highly correlated ( r = .94–.98) with the proportion of households with microwaves, and it was not because both were consequences of increasing wealth. Net of median household income, the proportion of households with microwaves was very strongly ( ds &gt; 1.0) associated with adult overweight, obesity, and extreme obesity rates, while median household income was not at all associated with them. Individual data from the United Kingdom and historical data from the United States highlighted the possible role of the widespread use of microwave ovens in the obesity epidemic.

Mobility and Vitality Lifestyle Program (MOVE UP): A Community Health Worker Intervention for Older Adults With Obesity to Improve Weight, Health, and Physical Function.

Background and ObjectivesObesity rates in adults ≥65 years have increased more than other age groups in the last decade, elevating risk for chronic disease and poor physical function, particularly in underserved racial and ethnic minorities. Effective, sustainable lifestyle interventions are needed to help community-based older adults prevent or delay mobility disability. Design, baseline recruitment, and implementation features of the Mobility and Vitality Lifestyle Program (MOVE UP) study are reported.Research Design and MethodsMOVE UP aimed to recruit 26 intervention sites in underserved areas around Allegheny County, Pennsylvania and train a similar number of community health workers to deliver a manualized intervention to groups of approximately 12 participants in each location. We adapted a 13-month healthy aging/weight management intervention aligned with several evidence-based lifestyle modification programs. A nonrandomized, pre–post design was used to measure intervention impact on physical function performance, the primary study endpoint. Secondary outcomes included weight, self-reported physical activity and dietary changes, exercise self-efficacy, health status, health-related quality of life, and accelerometry in a subsample.ResultsOf 58 community-based organizations approached, nearly half engaged with MOVE UP. Facilities included neighborhood community centers (25%), YMCAs (25%), senior service centers (20%), libraries (18%), senior living residences (6%), and churches (6%). Of 24 site-based cohorts with baseline data completed through November 2017, 21 community health workers were recruited and trained to implement the standardized intervention, and 287 participants were enrolled (mean age 68 years, 89% female, 33% African American, other, or more than one race).Discussion and ImplicationsThe MOVE UP translational recruitment, training, and intervention approach is feasible and could be generalizable to diverse aging individuals with obesity and a variety of baseline medical conditions. Additional data regarding strategies for program sustainability considering program cost, organizational capacity, and other adaptations will inform public health dissemination efforts.

APLICACIÓN DE UN PROGRAMA DE ELECTROESTIMULACIÓN PARA LA PÉRDIDA DE GRASA CORPORAL EN MUJERES

&lt;div&gt;Actualmente M&amp;eacute;xico encabeza el listado de pa&amp;iacute;ses con sobrepeso y obesidad en su poblaci&amp;oacute;n adulta, de modo que 7 de cada 10 adultos presentan este padecimiento, por lo que es considerado un problema de salud p&amp;uacute;blica dif&amp;iacute;cil de combatir a pesar de las estrategias implementadas para ello1. Es importante&lt;/div&gt;&lt;div&gt;el papel del profesional de enfermer&amp;iacute;a hacia esta poblaci&amp;oacute;n, ya que se encarga del control y seguimiento de los pacientes con esta enfermedad, siendo capaz&lt;/div&gt;&lt;div&gt;de dise&amp;ntilde;ar e implementar programas de nutrici&amp;oacute;n y actividad f&amp;iacute;sica que permitan mejorar la calidad de vida del paciente. El objetivo fue aplicar un programa&lt;/div&gt;&lt;div&gt;de electroestimulaci&amp;oacute;n encaminado a favorecer la p&amp;eacute;rdida de grasa corporal en mujeres de 30 a 40 a&amp;ntilde;os. Es una investigaci&amp;oacute;n de tipo experimental (experimental puro), prospectiva, longitudinal y anal&amp;iacute;tica. El nivel de la investigaci&amp;oacute;n es aplicativo. Se seleccionaron dos grupos de mujeres entre 30&lt;/div&gt;&lt;div&gt;y 40 a&amp;ntilde;os que realizan actividad f&amp;iacute;sica: Grupo experimental con 9 mujeres y grupo control con 10&lt;/div&gt;&lt;div&gt;mujeres. Las mediciones se realizaron diariamente a&lt;/div&gt;&lt;div&gt;trav&amp;eacute;s de los instrumentos para valoraci&amp;oacute;n y de una&lt;/div&gt;&lt;div&gt;c&amp;eacute;dula de cotejo. Se aplic&amp;oacute; el programa durante 7&lt;/div&gt;&lt;div&gt;semanas, obteniendo mediciones basales (2 semanas)&lt;/div&gt;&lt;div&gt;y mediciones experimentales (5 semanas) aplicando 3&lt;/div&gt;&lt;div&gt;sesiones por semana con una duraci&amp;oacute;n de 30 minutos.&lt;/div&gt;&lt;div&gt;Los resultados demostraron una disminuci&amp;oacute;n&lt;/div&gt;&lt;div&gt;significativa en el porcentaje de grasa corporal, &amp;iacute;ndice&lt;/div&gt;&lt;div&gt;cintura-cadera y el pliegue cut&amp;aacute;neo de la pantorrilla,&lt;/div&gt;&lt;div&gt;es decir, 3 de las 12 variables estudiadas. Lo que&lt;/div&gt;&lt;div&gt;resulta favorecedor en el bienestar biol&amp;oacute;gico y f&amp;iacute;sico&lt;/div&gt;&lt;div&gt;de las participantes.&lt;/div&gt;&lt;div&gt;&lt;br /&gt;&lt;/div&gt;

A Review of Childhood Behavioral Problems and Disorders in the Development of Obesity: Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Beyond.

Given the high rates of pediatric and adult obesity, it is imperative to identify early risk factors that might contribute to excess weight gain. This review aims to investigate the relationship between childhood behavioral problems with the development and persistence of obesity. Specifically, this review highlights the association of obesity with (1) neurocognitive constructs, such as executive functioning and inhibition/impulsivity, and (2) disorders commonly diagnosed in childhood, including attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Consistent evidence supports a relationship between childhood behavioral problems, executive functioning, inhibition/impulsivity, ADHD, and ASD with obesity across the lifespan. Longitudinal studies suggest behavior problems, neurocognitive functioning deficits, and ADHD symptoms in childhood predict weight gain over time. Identifying risk factors in childhood that promote obesity may help develop targeted intervention and prevention programs. Additional research should elucidate mechanisms that account for these relationships.

Assessing Social Contagion in Body Mass Index, Overweight, and Obesity Using a Natural Experiment

Little is known about whether the substantial clustering of obesity and overweight within social and geographic networks results from causal pathways, such as social contagion and shared environments, or from self-selection. This study aimed to determine whether exposure to communities with higher rates of obesity increases the body mass index (BMI) of individuals, calculated as weight in kilograms divided by height in meters squared, and their risk of being overweight or obese, and whether social contagion, shared environments, or self-selection can account for identified differences. This natural experiment study used the routine assignment of military service members to installations as a source of exogenous variation in exposure to communities with higher vs lower rates of obesity. The study, which used data collected by the Military Teenagers' Environments, Exercise, and Nutrition Study, examined families from 38 military installations around the United States to determine if individuals had higher BMI and greater odds of overweight and obesity when assigned to installations in counties with higher rates of obesity. The study also examined if the relationship persisted after controlling for shared built environments. The participants included 1 parent and 1 child aged 12 or 13 years from 1519 families of Army-enlisted personnel. Data analysis was completed from November 2016 to October 2017. Adult obesity rate in the county where the assigned installation of the service member was located. Time at installation and location of residence (on-installation vs off-installation) were used to measure the degree of exposure. For parents, outcomes were BMI, overweight/obesity (BMI, ≥25) and obesity (BMI, ≥30). For children, outcomes were BMI z score, overweight/obesity (BMI percentile for age and sex, ≥85), and obesity (BMI percentile for age and sex, ≥95). These outcomes were based on self-reports for parents, self-reports and parent reports for all children, and anthropometric measurements for a subsample of children. Members of 1519 families participated, including 1314 adults (of whom 740, or 56%, were fathers) and 1111 children (of whom 576, or 52%, were boys); anthropometric measurements were performed on 458 children. The sample was 40% white, 22% black, 24% Hispanic, and 14% other races/ethnicities. A 1-percentage point higher county obesity rate was associated with a higher BMI (a difference of 0.08; 95% CI, 0.02-0.13) and greater odds of obesity (adjusted odds ratio [aOR], 1.05; 95% CI, 1.02-1.08) in parents, and a higher BMI z score (0.01; 95% CI, 0.003-0.02) and greater odds of overweight/obesity (aOR, 1.04; 95% CI, 1.01-1.06) in children. The evidence supported stronger associations among families with more time at installation and off-installation residence. Associations persisted even after controlling for shared built environments. Exposure to counties with higher rates of obesity was associated with higher BMI and higher odds of overweight and/or obesity in parents and children. There was no evidence to support self-selection or shared built environments as possible explanations, which suggests the presence of social contagion in obesity.

Nonalcoholic fatty liver disease burden - Saudi Arabia and United Arab Emirates, 2017-2030.

Background/Aim:Due to epidemic levels of obesity and type 2 diabetes mellitus (DM), nonalcoholic fatty liver disease (NAFLD) and resulting nonalcoholic steatohepatitis (NASH) will be driving factors in liver disease burden in the coming years in Saudi Arabia and United Arab Emirates (UAE).Materials and Methods:Models were used to estimate NAFLD and NASH disease progression, primarily based on changes in adult prevalence rates of adult obesity and DM. The published estimates and expert interviews were used to build and validate the model projections.Results:In both countries, the prevalence of NAFLD increased through 2030 parallel to projected increases in the prevalence of obesity and DM. By 2030, there were an estimated 12,534,000 NAFLD cases in Saudi Arabia and 372,000 cases in UAE. Increases in NASH cases were relatively greater than the NAFLD cases due to aging of the population and disease progression. Likewise, prevalent cases of compensated cirrhosis and advanced liver disease are projected to at least double by 2030, while annual incident liver deaths increase in both countries to 4800 deaths in Saudi Arabia and 140 deaths in UAE.Conclusions:Continued high rates of adult obesity and DM, in combination with aging populations, suggest that advanced liver disease and mortality attributable to NAFLD/NASH will increase across both countries. Reducing the growth of the NAFLD population, along with potential therapeutic options, will be needed to reduce liver disease burden.

Using Simulation Modeling Approach to Analyze the US County-Level Adult Obesity Rate

Using Simulation Modeling Approach to Analyze the US County-Level Adult Obesity Rate

Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease.

Nonalcoholic fatty liver disease (NAFLD) and resulting nonalcoholic steatohepatitis (NASH) are highly prevalent in the United States, where they are a growing cause of cirrhosis and hepatocellular carcinoma (HCC) and increasingly an indicator for liver transplantation. A Markov model was used to forecast NAFLD disease progression. Incidence of NAFLD was based on historical and projected changes in adult prevalence of obesity and type 2 diabetes mellitus (DM). Assumptions were derived from published literature where available and validated using national surveillance data for incidence of NAFLD‐related HCC. Projected changes in NAFLD‐related cirrhosis, advanced liver disease, and liver‐related mortality were quantified through 2030. Prevalent NAFLD cases are forecasted to increase 21%, from 83.1 million (2015) to 100.9 million (2030), while prevalent NASH cases will increase 63% from 16.52 million to 27.00 million cases. Overall NAFLD prevalence among the adult population (aged ≥15 years) is projected at 33.5% in 2030, and the median age of the NAFLD population will increase from 50 to 55 years during 2015‐2030. In 2015, approximately 20% of NAFLD cases were classified as NASH, increasing to 27% by 2030, a reflection of both disease progression and an aging population. Incidence of decompensated cirrhosis will increase 168% to 105,430 cases by 2030, while incidence of HCC will increase by 137% to 12,240 cases. Liver deaths will increase 178% to an estimated 78,300 deaths in 2030. During 2015‐2030, there are projected to be nearly 800,000 excess liver deaths. Conclusion: With continued high rates of adult obesity and DM along with an aging population, NAFLD‐related liver disease and mortality will increase in the United States. Strategies to slow the growth of NAFLD cases and therapeutic options are necessary to mitigate disease burden. (Hepatology 2018;67:123‐133).

Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States.

This paper investigates the effect of food environments, characterized as food swamps, on adult obesity rates. Food swamps have been described as areas with a high-density of establishments selling high-calorie fast food and junk food, relative to healthier food options. This study examines multiple ways of categorizing food environments as food swamps and food deserts, including alternate versions of the Retail Food Environment Index. We merged food outlet, sociodemographic and obesity data from the United States Department of Agriculture (USDA) Food Environment Atlas, the American Community Survey, and a commercial street reference dataset. We employed an instrumental variables (IV) strategy to correct for the endogeneity of food environments (i.e., that individuals self-select into neighborhoods and may consider food availability in their decision). Our results suggest that the presence of a food swamp is a stronger predictor of obesity rates than the absence of full-service grocery stores. We found, even after controlling for food desert effects, food swamps have a positive, statistically significant effect on adult obesity rates. All three food swamp measures indicated the same positive association, but reflected different magnitudes of the food swamp effect on rates of adult obesity (p values ranged from 0.00 to 0.16). Our adjustment for reverse causality, using an IV approach, revealed a stronger effect of food swamps than would have been obtained by naïve ordinary least squares (OLS) estimates. The food swamp effect was stronger in counties with greater income inequality (p < 0.05) and where residents are less mobile (p < 0.01). Based on these findings, local government policies such as zoning laws simultaneously restricting access to unhealthy food outlets and incentivizing healthy food retailers to locate in underserved neighborhoods warrant consideration as strategies to increase health equity.

A5321 - The comparison of adipokines and inflammatory factors between Chinese bariatric candidates and normal weight population

Obesity and type 2 diabetes, dyslipidemia and related metabolic disease has become a threat to our national life and health which is showing a trend. Compared with countries such as the UK and USA, China had a lower rate of obesity in adults in 2013, but the absolute number of obese people in China is exceeded only by that in the USA. In addition, we are wonder whether adipokines and inflammatory cytokines have some correlation in different severity obese patients. It is worth to explore adipokines and inflammatory factors levels guide us to choice the different surgical approach to different severity obese patientst.

Blood-Brain Barriers in Obesity.

After decades of rapid increase, the rate of obesity in adults in the USA is beginning to slow and the rate of childhood obesity is stabilizing. Despite these improvements, the obesity epidemic continues to be a major health and financial burden. Obesity is associated with serious negative health outcomes such as cardiovascular disease, type II diabetes, and, more recently, cognitive decline and various neurodegenerative dementias such as Alzheimer's disease. In the past decade, major advancements have contributed to the understanding of the role of the central nervous system (CNS) in the development of obesity and how peripheral hormonal signals modulate CNS regulation of energy homeostasis. In this article, we address how obesity affects the structure and function of the blood-brain barrier (BBB), the impact of obesity on Alzheimer's disease, the effects of obesity on circulating proteins and their transport into the brain, and how these changes can potentially be reversed by weight loss.