Difference In Body Mass Index Change Research Articles

Mobile health (m-health) smartphone interventions for adolescents and adults with overweight or obesity.

Mobile health (m-health) smartphone interventions for adolescents and adults with overweight or obesity.

Association of maternal body mass index change with risk of large for gestational age among pregnant women with and without gestational diabetes mellitus: a retrospective cohort study

Objective To investigate the associations of body mass index (BMI) change and large for gestational age (LGA) among prepregnancy normal-weight women with and without gestational diabetes mellitus (GDM). Methods The retrospective study including 9515 normal-weight pregnant women (1331 women with GDM and 8184 without GDM) was conducted in Fujian Maternity and Child Health Hospital in 2020. The BMI change was calculated as gestational weight gain in kilograms by maternal height in meters. The binary logistic regression, stratified analyses, restricted cubic spline models and additive interaction analysis were adopted to reveal the relationship between BMI change and LGA. Results Pregnant women with GDM had a lower level of BMI change but a higher incidence of LGA compared with those without GDM. After adjustment for covariates variables, we found that the risk of LGA was associated with the highest quartile of BMI change (OR = 1.89, 95%CI:1.27–2.8 for GDM and OR = 1.48,95%CI:1.27–1.75 for non-GDM). There were significant linear relationships of BMI change and LGA with the inflection point of 5.096 and 5.401 kg/m2 in GDM and non-GDM groups. Significant additive interaction was observed between parity and BMI change level concerning LGA. A significant difference in BMI change and gestational weight gain (GWG) for LGA prediction was detected. Conclusion Higher BMI changes were significantly associated with a higher risk of LGA in pregnant women with or without GDM in a linear dose-response relationship, with the threshold around 5.096 and 5.401 kg/m2, respectively. These suggested that BMI changes may be a useful predictor for the incidence of LGA in singleton pregnant women.

Effectiveness of a Family-Centered Pediatric Weight Management Program Integrated in Primary Care.

The evidence supporting the effectiveness of weight loss interventions with low to medium intensity is limited. To measure the effectiveness of a family-based weight management intervention in pediatric primary care to reduce body weight in children. Electronic medical record data of pediatric patients in Kaiser Permanente Orange County, California, who were enrolled in weight management between April 2014 and December 2018 (family-based behavior-changing weight management [FB-WMG], n = 162) and compared with a control group (CG) of patients who were referred but did not enroll (Ref-CG, n = 203) and an area-matched CG also matched by sex, age, zip code, and body mass index (BMI) (Area-CG, n = 287). BMI was measured at the first visit (or index date) and after 6 months. Children enrolled in the FB-WMG had 5 (interquartile range = 3-6) sessions over the first 6 months of the program. Most FB-WMG patients (69.1%) reduced or maintained BMI over 6 months, compared with 45.8% of Ref-CG (p < 0.001) and 57.8% of Area-CG (p = 0.02). In girls 3 to 12 years of age, 75% of participants reduced or maintained BMI, compared with 42% of Ref-CG (p < 0.001) and 59.8% of Area-CG (p = 0.07). On average, the difference in BMI change over the 6-month follow-up period was -0.85 kg/m² (95% confidence interval = -1.25 to -0.46 kg/m²) compared with Ref-CG and -0.28 kg/m² (95% confidence interval = -0.63 to 0.08 kg/m²) and Area-CG. Low- to moderate-intensity family-based weight management intervention in primary care can be successful after only 6 months compared with a referred control group.

Effectiveness of a Family-Centered Pediatric Weight Management Program Integrated in Primary Care

The evidence supporting the effectiveness of weight loss interventions with low to medium intensity is limited. To measure the effectiveness of a family-based weight management intervention in pediatric primary care to reduce body weight in children. Electronic medical record data of pediatric patients in Kaiser Permanente Orange County, California, who were enrolled in weight management between April 2014 and December 2018 (family-based behavior-changing weight management [FB-WMG], n = 162) and compared with a control group (CG) of patients who were referred but did not enroll (Ref-CG, n = 203) and an area-matched CG also matched by sex, age, zip code, and body mass index (BMI) (Area-CG, n = 287). BMI was measured at the first visit (or index date) and after 6 months. Children enrolled in the FB-WMG had 5 (interquartile range = 3-6) sessions over the first 6 months of the program. Most FB-WMG patients (69.1%) reduced or maintained BMI over 6 months, compared with 45.8% of Ref-CG (p < 0.001) and 57.8% of Area-CG (p = 0.02). In girls 3 to 12 years of age, 75% of participants reduced or maintained BMI, compared with 42% of Ref-CG (p < 0.001) and 59.8% of Area-CG (p = 0.07). On average, the difference in BMI change over the 6-month follow-up period was -0.85 kg/m² (95% confidence interval = -1.25 to -0.46 kg/m²) compared with Ref-CG and -0.28 kg/m² (95% confidence interval = -0.63 to 0.08 kg/m²) and Area-CG. Low- to moderate-intensity family-based weight management intervention in primary care can be successful after only 6 months compared with a referred control group.

Home-Based Multicomponent Intervention Increases Exercise Activity and Improves Body Mass Index: Results of a 5-Year Randomized Trial Among Individuals with Alpha-1 Antitrypsin Deficiency-Associated Lung Disease.

The Step Forward Study (SFS) was designed to increase exercise activity and improve body mass index (BMI) among individuals with alpha-1 antitrypsin deficiency (AATD)-associated lung disease. The SFS is a randomized trial of an intensive distance intervention that was delivered via a series of mailings and teleconferences versus no additional intervention. All participants (n=500) were also enrolled in a disease management program designed for individuals with AATD-associated lung disease who have been prescribed augmentation therapy. The primary outcome was self-reported number of exercise minutes per week. The secondary outcome was BMI. Linear mixed model analyses were used to assess the difference in average weekly exercise minutes between the intervention arms over time. T-tests, signed rank and Wilcoxon rank-sum tests were used to evaluate changes in BMI between the intervention arms and within each BMI category. The study included 429 individuals with evaluable primary outcome data.There was a significant effect of intervention on exercise minutes over time (p=0.018). Participants in the intervention group reported an average of 167.14 minutes (standard deviation [SD]=10.68) of weekly exercise and those in the standard care group reported 148.31 minutes (SD=10.96). There was a significant difference in BMI change between the intervention (mean BMI decrease 0.74, SD=2.16) and the standard care group (mean BMI decrease 0.27, SD=1.63); p=0.0122. Individuals who were randomly assigned to the intervention group reported more exercise activity and improvements in BMI over the course of this multicomponent intervention compared to individuals assigned to standard care.

978. Changes in BMI Associated with Antiretroviral Regimens in Treatment-Experienced, Virologically Suppressed Individuals Living with HIV

BackgroundA potential association between integrase inhibitor (INSTI) use and weight gain has been reported in people living with HIV (PLWH). We examined body mass index (BMI) increases after a switch to dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), raltegravir (RAL), rilpivirine (RPV), or boosted darunavir (bDRV) among virologically suppressed ART-experienced PLWH.MethodsART-experienced, suppressed (ART-ES; baseline viral load < 200 copies/mL) PLWH ≥ 18 years of age initiating DTG, EVG/c, RAL, RPV, or bDRV for the first time were identified in the OPERA® cohort. The association between core agents and mean increases in BMI at 6, 12, and 24 months was estimated with multivariable linear regression. Inverse probability-of-censoring weights (IPCW) were used to account for censoring (regimen discontinuation, loss to follow-up, death, pregnancy, or no BMI measured). Analyses were stratified by baseline BMI categories (underweight: <18.5, normal weight: ≥18.5 to <25, overweight: ≥25 to <30, obese: ≥30).ResultsAt baseline, endocrine disorders were reported in >40% of PLWH receiving DTG and RAL; >60% were overweight/obese in all groups (Figure 1). Mean BMI (unadjusted) increased for all ARVs over time, with changes at 24 months ranging from 0.30 (DRV) to 0.83 (RPV, Figure 2). At 6 months, the adjusted mean BMI increase was statistically smaller with EVG/c, RAL, and bDRV (range –0.15 to –0.30) than with DTG (Figure 3); these differences only remained significantly different for bDRV at 12 (–0.29) and 24 months (–0.29, Figure 3). Among those with a normal baseline BMI, the adjusted mean change in BMI at 12 months was smaller with EVG/c, bDRV, and RAL than DTG (range –0.26 to –0.27). Among overweight PLWH, the adjusted mean BMI increase was statistically smaller with bDRV than DTG (–0.32, Figure 4). Results were consistent in IPCW estimates.ConclusionThe majority of PLWH on stable ART in this US-based cohort were overweight/obese at the time of switch to the regimens of interest. Small mean increases in BMI for all regimens were noted over time, for which the clinical significance is not yet known. Apparent differences in BMI changes favoring EVG/c, RAL, and bDRV vs. DTG over the short term were largely attenuated with longer follow-up, with significant differences mainly observed in those with a normal BMI at baseline. Disclosures All Authors: No reported Disclosures.

Food Is Medicine: Providing Medically Tailored Meals to Community Members with Disease-associated Nutritional Risk Supports Stable BMI and Decreased Hospitalization (P12-005-19)

ObjectivesMANNA, a Food is Medicine organization in Philadelphia, provides nutritional support for community members at nutritional risk from serious illness. MANNA’s program of medically-tailored meals and nutrition counseling have been associated with lower healthcare utilization and costs, however the specific health outcomes that contribute to these effects are unknown. The objective of this research is to analyze change in body mass index (BMI) and proportion of recent hospitalizations in association with MANNA’s program. MethodsA retrospective chart review was conducted for 103 clients who answered a 2016 Client Satisfaction Survey and received at least six months of MANNA’s program between Jan. 2015 and Dec. 2016. Data from the start of services and at 6-months follow-up were entered into Research Electronic Database Capture (REDCap) and analyzed using Statistical Analysis Software (SAS). ResultsThe median age of clients in the sample was 66.0 years (interquartile range (IQR) 58.0—72.0). Primary diagnoses were cancer (53%), renal disease (15.7%), diabetes (7.8%), HIV/AIDS (3.9%), heart disease (3.9%) and “other” (16.7%). Half of the sample (52.0%) reported having insufficient money to buy food. Per weight history, two-thirds (63.3%) of clients had decreasing weight before program enrollment, 28.9% had stable weight and 7.8% had increasing weight. Change in BMI between initial intake and recertification was: median = 0.04; IQR (–0.84,–1.02). Analysis of variance followed by a multiple comparisons with a Bonferroni adjustment found no evidence of any difference in BMI change between diagnoses. Bivariate analysis with t-tests found no evidence of any difference in BMI change between clients with enough money for food and those without (P = 0.4277). McNemar’s Test found evidence of a significant decrease in the proportion of clients who had recent hospitalizations at follow-up compared to the start of services (P = 0.0077). ConclusionsManna’s program was associated with stable BMI. Change in BMI was not significantly different based on primary diagnosis or insufficient money to buy food. The proportion of client hospitalizations was significantly less after MANNA’s program. Stabilization of BMI is a possible health outcome that contributes to lower healthcare utilization and cost savings in MANNA’s clients. Funding SourcesNone.

Multicomponent Obesity Prevention Intervention in Low-Income Preschoolers: Primary and Subgroup Analyses of the NET-Works Randomized Clinical Trial, 2012-2017.

To evaluate a multicomponent obesity prevention intervention among diverse, low-income preschoolers. Parent-child dyads (n = 534) were randomized to the Now Everybody Together for Amazing and Healthful Kids (NET-Works) intervention or usual care in Minneapolis, MN (2012-2017). The intervention consisted of home visits, parenting classes, and telephone check-ins. The primary outcomes were adjusted 24- and 36-month body mass index (BMI). Compared with usual care, the NET-Works intervention showed no significant difference in BMI change at 24 (-0.12 kg/m2; 95% confidence interval [CI] = -0.44, 0.19) or 36 months (-0.19 kg/m2; 95% CI = -0.64, 0.26). Energy intake was significantly lower in the NET-Works group at 24 (-90 kcal/day; 95% CI = -164, -16) and 36 months (-101 kcal/day; 95% CI = -164, -37). Television viewing was significantly lower in the NET-Works group at 24 (rate ratio = 0.84; 95% CI = 0.75, 0.93) and 36 months (rate ratio = 0.88; 95% CI = 0.78, 0.99). Children with baseline overweight or obesity had lower BMI in the NET-Works group than those in usual care at 36 months (-0.71 kg/m2; 95% CI = -1.30, -0.12). Hispanic children had lower BMI in the NET-Works group than those in usual care at 36 months (-0.59 kg/m2; 95% CI = -1.14, -0.04). In secondary analyses, NET-Works significantly reduced BMI over 3 years among Hispanic children and children with baseline overweight or obesity. ClinicalTrials.gov Identifier: NCT01606891.

5-year outcomes of 1-stage gastric band removal and sleeve gastrectomy

BackgroundNo verdict has been reached on single-stage removal of gastric banding with sleeve gastrectomy. ObjectivesTo report 5-year outcomes of 1-stage gastric band removal and sleeve gastrectomy (Conversion-LSG) compared with primary laparoscopic sleeve gastrectomy (Prim-LSG). SettingLarge single-surgeon prospective database. MethodsTwo patient groups were included: Conversion-LSG as the study group and Prim-LSG for comparison. Preconversion characteristics, conversion indication, weight loss, and complications were compared. The surgical protocol was reviewed, focusing on key technical recommendations. ResultsA total of 209 Conversion-LSG and 3268 Prim-LSG patients, aged 32.9±9.8 and 31.8±10.7 years respectively (P = .2), were studied. No significant differences in age, body mass index (BMI), or gender distribution existed. Conversion-LSG Baseline BMI was 47±12 kg/m2. Patients spent 6.2±2.6 years with the band before Conversion-LSG. BMI at 1, 2, 3, 4, and 5 years was 37±8, 31±9, 29±11, 30±9, and 30±11 kg/m2, respectively. No significant difference in BMI change between the 2 groups existed. In the Conversion-LSG group, 1 patient had a successfully stented leak but developed a gastrobronchial fistula 1 year later. In the Prim-LSG group, 3 leak cases were reported and managed successfully through endoscopic stenting, 1 patient had pulmonary embolism that responded to standard treatment, and 3 patients had postoperative bleeding. No other major complications occurred, and there was no mortality in either group. Additionally, no Conversion-LSG patients required further bariatric intervention. ConclusionEmploying the surgical technique described in this paper, conversion-LSG is as well tolerated and effective as primary sleeve gastrectomy.

The effect of HIV and the modifying effect of antiretroviral therapy on body-mass index and blood pressure levels in rural South Africa

<h2>Abstract</h2><h3>Background</h3> The trajectory of body-mass index (BMI) in long-term HIV patients on antiretroviral therapy (ART) compared with the non-HIV population has been poorly studied. <h3>Methods</h3> Methods In 2003 and 2010, height, weight, and blood pressure measurements were recorded in a subset (n=505) of the population in KwaZulu-Natal, South Africa—a region with a very high prevalence of HIV (30%) and intensive ART rollout since 2004. Difference analysis was used to study change in BMI and blood pressure over time in HIV-negative patients, HIV-positive patients who had been on ART for 0–<2 years (HIV⁺ART^{0–<2 years}; n=62), HIV patients who had been on ART for 2–5 years (HIV⁺ART^{2–5 years}; n=44), and HIV-positive patients who were not on ART (HIV⁺ART⁻; n=52). Multinomial logistic regression models were used to assess change in the risk of obesity and hypertension. <h3>Findings</h3> The HIV-negative and HIV-positive groups were both overweight at baseline (mean BMI 29·5, 95% CI 28·8–30·3; and 27·5, 25·9–29–3, respectively). The HIV-negative group was obese in 2010 (mean BMI >30); all other groups remained in the overweight range (25< BMI <30). The difference in change in BMI between the HIV-negative and the HIV-positive ART^{0–<2 years} group was −5·21 (95% CI −7·53 to −2·89; p=0·001). This difference in change in BMI was attenuated by increased ART use, with a difference in BMI change between the HIV⁻ and the HIV⁺ART^2–5 group of −1·07 (95% CI −2·5 to 0·361; p=0·086), suggesting a U-shaped association of BMI with ART use. The difference in change in BMI between the HIV⁺ART⁻ and the HIV⁺ART^{0–<2 years} group was −4·14 (95% CI −6·76 to −1·53; p=0·002). The HIV⁺ART⁻ group had the highest average systolic blood pressure in 2003. Compared with the HIV⁻ group, the overall systolic blood pressure in the HIV⁺ART⁻ group significantly declined by −7·55 mm Hg (95% CI −13·2 to −1.90; p=0·009). The effect of the dose of ART on systolic blood pressure change was not significant (p=0·853). <h3>Interpretation</h3> Short-term ART exposure (0–<2 years) was associated with a slight decline in BMI compared with all other populations, because patients are selected into ART on the basis of having advanced HIV disease. Long-term ART exposure (2–5 years) led to a return to a highly overweight BMI and an increased chance of being obese than normal weight by 2010. <h3>Funding</h3> None.

Total weight loss associated with increased physical activity after bariatric surgery may increase the need for total joint arthroplasty

BackgroundRetrospectively, our institution noticed an increased number of patients undergoing total joint arthroplasty (TJA) after bariatric surgery. Considering that bariatric surgery is a proven modality to reduce osteoarthritic pain, we sought to identify a reason some patients may later require TJA. The objective of this study was to investigate the hypothesis that rapid or increased weight loss after bariatric surgery may be a risk factor for TJA. MethodsWeight loss parameters were retrospectively assessed in 15 bariatric surgery patients who subsequently received a primary TJA and compared with matched bariatric controls. ResultsPatients who required a TJA lost 27.9% more of their body mass index (BMI) compared with controls (P = .049). Furthermore, patients who underwent TJA 25–48 months postbariatric surgery lost 78.2% more of their BMI compared with controls (P<.001). Total knee arthroplasty patients lost 43.9% more of their BMI compared with controls (P = .02), and the difference in BMI change for total hip arthroplasty patients was not significant versus controls. ConclusionThese results contradict the tenant that weight loss is universally protective against arthritis and merit larger prospective investigations.

Weight Gain among Men and Women Who Have a Child Enter Their Home

Parenthood is associated with decreased physical activity and dietary changes. Previously, mothers have been the focus of studies examining the influence of children on parents’ body mass index (BMI), largely ignoring whether parenting affects fathers. This study assessed weight gain in mothers and fathers (by birth or other), using longitudinal repeated-measures models to assess BMI changes over time; parents were compared with nonparents. Data were from the Coronary Artery Risk Development in Young Adults cohort study and included 2,881 black and white adults, ages 18 to 30 years, without children at baseline (1985-1986), and from four urban locations. At each time point (years 2, 5, and 7), changes in BMI from baseline were analyzed, comparing those who had their children in their household at that time point (parents) and those without children (nonparents). The “child effect” is the mean difference in BMI change in parents compared with nonparents. In fathers, overall, the child effect was not significant (black males: 0.30; P=0.09; white males: 0.03; P=0.77). Among black men, however, interactions between age and parental status were significant (P=0.02). Black men who were aged 18 to 24 years at baseline and became fathers during the next 7 years demonstrated a significant child effect, gaining an average of 0.68 more in BMI than nonfathers (P=0.003). Mothers of both races demonstrated the child effect; for blacks it was 0.65 (P=0.003) and for whites it was 1.12 (P≤0.001). These data reveal that becoming a parent can affect the BMI of some adults and suggest that obesity-prevention interventions for children and adult-focused healthy-lifestyle interventions could have additional impact through a family focus targeting both parent and child outcomes.

25-Hydroxyvitamin D Supplementation and BMI Change: A Meta-Analysis of Randomized Controlled Trials.

The impact of 25-hydroxyvitamin D (25[OH]D) supplementation on weight change remains controversial. The objective of this study was to summarize the effects of 25[OH]D supplementation (cholecalciferol or ergocalciferol) on BMI change through a meta-analysis of published clinical trials. We completed a systematic review of English articles, using MEDLINE (Ovid, Pubmed) from January 1, 1998 through January 1, 2013. The articles selected focused on 25[OH]D supplementation and body mass index (BMI) in randomized controlled trials (RCT’s). The association between 25[OH]D and mean BMI change was estimated utilizing a random effects model. A total of 30 studies were reviewed and 9 were included in the meta-analysis. Total participants included 1651 adults (82.6% women and mean age 47.9 years) and mean follow-up ranged between 6 to 196 weeks and mean daily 25[OH]D dose ranged from 200 IU to 1,110 IU. Five of the 9 studies included calcium supplementation in both groups. Average baseline BMI was 30.7 and 30.4 kg/m2 in the intervention and control groups, respectively. Five studies suggested a beneficial effect for 25[OH]D supplementation for BMI change whereas 3 studies showed no effect of 25[OH]D supplementation on BMI change, and one showed a non-perceptible change. Meta-analysis of BMI values at end of trial showed no statistically significant difference in BMI change by use of 25[OH]D supplementation. Based on existing published trials, oral 25[OH]D supplementation does not significantly impact BMI change.

What Difference Can a Year Make? Changes in Functional and Aesthetic Body Satisfaction Among Male and Female Adolescents Over a Year

The current study explored changes in functional and aesthetic body satisfaction among Australian adolescents over a year. Data were collected from 1,342 Australian adolescents (567 males, 775 females) across two grade cohorts (Grades 8 and 10) at Wave 1 (W1; mean age = 13.7) and again 12-months later at Wave 2 (W2). Participants' functional and aesthetic body satisfaction, body mass index (BMI), and relative pubertal timing were measured. Body image change was explored across both grade cohort and gender, controlling for differences in BMI change and relative pubertal timing. Females reported lower overall (functional and aesthetic) body satisfaction than males. Participants reported higher functional and aesthetic body satisfaction at W1 than W2. Although both males and females reported a significant decrease in body satisfaction over the 12‐month period, this decrease was stronger among female participants. †Cohort differences were also found with older adolescents reporting lower functional body satisfaction.

Body mass index following natural menopause and hysterectomy with and without bilateral oophorectomy.

ObjectiveThe directional and temporal nature of relationships between overweight and obesity and hysterectomy with or without oophorectomy is not well understood. Overweight and obesity may be both a risk factor for the indications for these surgeries and a possible consequence of the procedure. We used prospective data to examine whether body mass index (BMI) increased more following hysterectomy with and without bilateral oophorectomy compared to natural menopause among middle-aged women.MethodsBMI was assessed annually for up to 10 years in the Study of Women’s Health Across the Nation (SWAN (n=1962). Piecewise linear mixed growth models were used to examine changes in BMI before and after natural menopause, hysterectomy with ovarian conservation, and hysterectomy with bilateral oophorectomy. Covariates included education, race/ethnicity, menopausal status, physical activity, self-rated health, hormone therapy use, antidepressant use, and age the visit prior to the final menstrual period (FMP; for natural menopause) or surgery (for hysterectomy/oophorectomy).ResultsBy visit 10, 1780 (90.6%) women reached natural menopause, 106 (5.5%) reported hysterectomy with bilateral oophorectomy, and 76 (3.9%) reported hysterectomy with ovarian conservation. In fully adjusted models, BMI increased for all women from baseline to FMP or surgery (annual rate of change=.19 kg/m2 per year), with no significant differences in BMI change between groups. BMI also increased for all women following FMP, but increased more rapidly in women following hysterectomy with bilateral oophorectomy (annual rate of change=.21 kg/m2 per year) as compared to following natural menopause (annual rate of change=.08 kg/m2 per year, p=.03).ConclusionIn this prospective examination, hysterectomy with bilateral oophorectomy was associated with greater increases in BMI in the years following surgery than following hysterectomy with ovarian conservation or natural menopause. This suggests that accelerated weight gain follows bilateral oophorectomy among women in midlife, which may increase risk for obesity-related chronic diseases.

Intelligence level in late adolescence is inversely associated with BMI change during 22 years of follow-up: results from the WICTORY study

The objective of this population-based retrospective cohort study was to examine the association between intelligence (IQ) at late adolescence and changes in body mass index (BMI) during 22years of follow-up until 40years of age, taking education level into account. Data from 5,286 males born 1950-1959 who had participated in the Westmannia Cardiovascular Risk Factors Study at 40years of age and attended the Swedish military conscription examination between the ages of 17 and 22 were used. From a mean age of 18years until follow-up at 40years of age, BMI increased with a mean (95% confidence interval (CI)) of 4.36 (4.28-4.43)kg/m(2), equalling 0.20kg/m(2) per year. The difference in BMI change between IQ levels was strongly statistically significant (P<0.001), with a strictly inverse relationship between IQ and BMI change. The lowest IQ level (<74) had a mean (95% CI) BMI increase of 5.19 (4.63-5.74) kg/m(2), equalling 0.24kg/m(2) per year, compared with 3.73 (3.40-4.07) kg/m(2), equalling 0.17kg/m(2) per year, for the highest IQ level (>126). Education level also had a strictly inverse relationship with BMI change. After adjusting for confounding variables, including education level, IQ still had a strictly inverse relationship to BMI change, with all IQ levels<111 having a significantly larger BMI change than IQ>126 (P<0.01 for all levels). Education level at 40years of age but not at 18years of age had a significant association with BMI change after adjusting for IQ.

Effects of a Multimodal Lifestyle Intervention on Body Mass Index in Patients With Bipolar Disorder

Patients with bipolar disorder are at increased risk of weight gain, which in turn increases the risk for somatic disease and nonadherence to maintenance therapy. Therefore, interventions addressing weight gain are expedient for the management of this disorder. We set out to evaluate the effects of a lifestyle intervention on body mass index (BMI) and cardiovascular and metabolic parameters in patients with bipolar disorder undergoing mood-stabilizing pharmacologic treatment. Fifty outpatients with bipolar disorder undergoing mood-stabilizing treatment participated in a randomized controlled trial (waiting control group: n = 24 and multimodal lifestyle intervention group: n = 26). Groups consisted of 2 cohorts (cohort 1: March 2005-February 2006; cohort 2: September 2005-August 2006). The intervention lasted 5 months and consisted of 11 group sessions and weekly fitness training. BMI and body weight as well as cardiovascular and metabolic parameters were determined at 3 assessment points: at pretreatment baseline, at 5 months (end of treatment), and at 11 months (6-month follow-up). Intention-to-treat analyses showed that the intervention significantly reduced BMI over time (P = .03), with significant and stable mean differences in BMI change between groups of 0.7 kg/m² (95% CI, 0.2-1.3) at 5 months and 0.8 kg/m² (95% CI, 0.1-1.6) at 11 months' follow-up assessment. The lifestyle intervention had no significant effect on cardiovascular and metabolic parameters (all nonsignificant). The BMI reduction was only seen in female patients (P = .003). BMI in patients with bipolar disorder can be reduced with a long-lasting effect by a multimodal lifestyle intervention. However, this effect was only seen in female participants, indicating the need for gender-specific interventions. clinicaltrials.gov Identifier: NCT00980863.

Higher dietary flavone, flavonol, and catechin intakes are associated with less of an increase in BMI over time in women: a longitudinal analysis from the Netherlands Cohort Study

Background:Dietary flavonoids are suggested to have antiobesity effects. Prospective evidence of an association between flavonoids and body mass index (BMI) is lacking in general populations. Objective:We assessed this association between 3 flavonoid subgroups and BMI over a 14-y period in 4280 men and women aged 55–69 y at baseline from the Netherlands Cohort Study. Design:Dietary intake was estimated at baseline (1986) by a validated food-frequency questionnaire. BMI was ascertained through self-reported height (in 1986) and weight (in 1986, 1992, and 2000). Analyses were based on sex-specific quintiles for the total intake of 6 catechins and of 3 flavonols/flavones. Linear mixed effect modeling was used to assess longitudinal associations in 3 adjusted models: age only, lifestyle (age, energy intake, physical activity, smoking status, alcohol intake, type 2 diabetes, and coffee consumption), and lifestyle and diet (vegetables, fruit, fiber, grains, sugar, dessert, and dieting habits). Results:After adjustment for age and confounders, the BMI (kg/m2) of women with the lowest intake of total flavonols/flavones and total catechins increased by 0.95 and 0.77, respectively, after 14 y. Women with the highest intake of total flavonols/flavones and total catechins experienced a significantly lower increase in BMI of 0.40 and 0.31, respectively (between group difference: P < 0.05). This difference remained after additional adjustment for dietary determinants and after stratification of median baseline BMI. In men, no significant differences in BMI change were observed over the quintiles of flavonoid intake after 14 y. Conclusion:Our results suggest that flavonoid intake may contribute to maintaining body weight in the general female population.

School-based physical activity and changes in adiposity

School-based physical education (PE) is often proposed as a strategy for obesity prevention, but many trials have found non-significant effects on body mass index (BMI). We examined the impact of school PE on adiposity in adolescents, using an ecological analysis to relate the number of PE sessions to changes in BMI and waist circumference. Five-year, longitudinal, school-based study involving 34 secondary schools in London, England. Students were aged 11-12 years at baseline. Twenty-five schools reported one weekly session of PE, seven schools reported two sessions and two boys' schools reported three sessions. Weights, heights and waist circumferences were measured annually, and complete data from the first and fifth years of the study were available on 2727 students. Analyses compared anthropometric changes between students in schools with higher or lower amounts of PE time. In boys, the comparisons were between those receiving 1, 2 or 3 weekly sessions. In girls, comparisons were between those receiving one and two sessions. There were no differences in BMI changes or the percentage of students classified as obese between schools of higher and lower frequency of PE. However, using unadjusted data, there were lower gains in waist circumference in boys and girls from the higher PE schools. Controlling for baseline demographic and anthropometric characteristics, boys in schools providing 3 weekly PE sessions gained on average approximately 3 cm less than boys in schools providing one or two sessions (P<0.001). Differences in girls were in the same direction but not significant. Higher levels of school PE were associated with lower gains in adiposity in boys. This strengthens the case for including recommendations on school PE time as part of population strategies to control adolescent obesity.

Physical education in elementary school and body mass index: evidence from the early childhood longitudinal study.

We examined the effect of physical education instruction time on body mass index (BMI) change in elementary school. We examined data from a national sample of 9751 kindergartners in the United States who were reported on for 2 years. We used a difference-in-differences approach to examine the effect of an increase in physical education instruction time between kindergarten and first grade on the difference in BMI change in the 2 grades, using the same child as the control. One additional hour of physical education in first grade compared with the time allowed for physical education in kindergarten reduces BMI among girls who were overweight or at risk for overweight in kindergarten (coefficient = -0.31, P <.001) but has no significant effect among overweight or at-risk-for-overweight boys (coefficient = -0.07, P =.25) or among boys (coefficient = 0.04, P =.31) or girls (coefficient = 0.01, P =.80) with a normal BMI. Expanding physical education programs in schools, in the form in which they currently exist, may be an effective intervention for combating obesity in the early years, especially among girls.