Increasing Prevalence Of Obesity Research Articles

HIV, antiretroviral therapy and non-communicable diseases in sub-Saharan Africa: empirical evidence from 44 countries over the period 2000 to 2016.

IntroductionThe HIV‐infected population is growing due to the increased accessibility of antiretroviral therapy (ART) that extends the lifespan of people living with HIV (PLHIV). We aimed to assess whether national HIV prevalence and ART use are associated with an increased prevalence of cardiovascular risk factors.MethodsUsing country‐level data, we analysed the effect of HIV prevalence and use of ART on cardiovascular risk factors in 44 countries in sub‐Saharan Africa between 2000 and 2016. We used fixed‐effects estimation to quantify the effect of HIV and ART on the prevalence of diabetes, mean body mass index, the prevalence of overweight, obesity and hypertension, and mean systolic blood pressure. The models were adjusted for calendar time, the age structure of the population, income and education.ResultsDiabetes prevalence among PLHIV was 5.8 percentage points higher (95% confidence interval (CI) 1.8 pp to 9.8 pp) compared to individuals without HIV. People receiving ART had a 4.6 percentage point higher prevalence (95% CI 2.6 pp to 6.6 pp). The prevalence of obesity was increased by 14.7 percentage points (95% CI 2.5 pp to 26.9 pp) for PLHIV. Receiving ART was associated with an increased obesity prevalence by 14.0 percentage points (95% CI 4.8 pp to 23.2 pp), whereas it had no significant association with the prevalence of overweight. The population aged 40 to 59 had a significantly higher prevalence of diabetes, overweight and obesity. HIV prevalence and ART use had no significant association with the prevalence of hypertension.ConclusionsAn ageing HIV‐infected population on ART is associated with a significant increase in the prevalence of diabetes and obesity in sub‐Saharan Africa. The increasing prevalence of these cardiovascular risk factors emphasizes the need for comprehensive healthcare programmes that screen and treat both HIV and non‐communicable diseases to decrease the associated morbidity and mortality rates.

Effect of Obesity on Sympathovagal Activities in Hypertensive Indian Population.

Decreased physical activity, increased psychosocial stress and work stress have contributed to the increased prevalence of obesity and Hypertension (HTN). Irrespective of the aetiology, sympathetic over activity has been recognized as the main pathophysiologic mechanism in the genesis of obesity and HTN. Sympathovagal imbalance or dysregulation of autonomic functions owing to sympathetic over activity and vagal withdrawal is reported to be the basis of many clinical disorders. Obesity, hypertension and diabetes mellitus are known to be associated with dysregulation of autonomic functions independently. Heart Rate Variability (HRV) has emerged as a practical, non-invasive tool to quantitatively investigate cardiac autonomic dysregulation. The present study was undertaken to ascertain whether obesity has any effect on further disruption of autonomic functions particularly in hypertensive patients. A total of 96 male and female adults aged between 40-50 years visiting the Primary Health Centre, Yelwala, Mysuru district, India were recruited for this study. They were grouped in to 3 (n=32) as Groups I (Obese hypertensive), II (non-obese hypertensive) and II (non-obese normotensive, control), HRV was determined using the One minute during deep breathing method. Data were presented as Mean ± SD, inferential statistics was by One Way ANOVA and Tukey's Post Hoc test p value <0.005 at α0.05 HRV was significantly decreased in obese hypertensive patients compared to the non-obese hypertensive patients. Our present study supports that obesity and hypertension probably has additive effect in causing autonomic dysregulation.

Critical Social and Cultural Influences on Eating in a Multiethnic Population of Working Women: It’s Hard to Practice What You Know (P10-024-19)

ObjectivesMalaysia is currently experiencing the nutrition transition, with an increased consumption of refined carbohydrates and fats paralleling an increase in prevalence of obesity and chronic disease. These dietary changes have occurred despite 90% of urban women reporting awareness of the health risks posed by obesity. This study sought to characterize how working women, an understudied population at risk for diet-related chronic disease, navigate food decisions. As Malaysia is a multiethnic nation, we aimed to explore the sociocultural determinants of eating behavior in this unique population. MethodsA purposive design in combination with a convenience sampling approach was used to recruit 24 women ages 26 to 55 of Malay, Indian, and Chinese descent across 15 university departments in Kuala Lumpur, Malaysia. Audio recordings of the individual semi-structured interviews were transcribed and analyzed using grounded theory. ResultsWomen identified two important life transitions, getting married and having children, as particularly influential in changing eating behavior. Women reported a desire to eat healthier that was in tension with pressures to cater to the taste preferences of their household members and to accommodate their work schedules. Persistent social norms of eating in group settings and difficulty in accessing foods perceived as nutritious were reported as barriers to changing individual eating behavior. Regardless of education level and marital status, women agreed that the act of eating was closely connected with cultural values and embodied important meanings that took precedence over eating as a health-promoting behavior. While all participants expressed a desire to eat healthier, many reported limited confidence in their ability to consistently give up familiar and tasty foods for healthier alternatives. Shifts in eating behavior such as trying new healthy recipes and adopting a more restrictive diet were reported as most feasible and personally applicable after learning about a family member’s declining health. ConclusionsIn this urban, multiethnic population, increasing the accessibility of nutritious foods and changing cultural perceptions of the relationship between food and nutrition may be important for enabling healthy eating behaviors. Funding SourcesYale Sustainable Food Program, Yale School of Public Health.

1593-P: Time Trends in Diabetes Incidence and Obesity Prevalence in Six Countries

Data from several countries have shown a stabilization or decrease in diabetes incidence since the mid-2000s. It is intuitively appealing to think that trends in risk factors for diabetes would parallel these changes, although such trends have not been explored. We compared age-standardized (WHO standard population) trends in obesity prevalence, from nationally representative cross-sectional surveys, with trends in diabetes incidence, from national diabetes registries or administrative data sources, in six countries where data was available for both national obesity prevalence and diabetes incidence between 1990-2015. In 5 out of 6 countries, diabetes incidence increased until the mid-2000s followed by a decreasing trend; in Korea incidence decreased across the whole time period for which data were available. An increasing trend in obesity prevalence was observed in all 6 countries with no evidence for a fall in obesity prevalence, although the rate of increase in obesity prevalence slowed in United Kingdom in the early 2000s. Among the datasets in this study, current evidence on trends in obesity prevalence do not appear to explain the recent decrease in diabetes incidence, suggesting an uncoupling of these trends. Further research on trends in other major diabetes risk factors, such as prediabetes, and the influence of diagnostic guidelines and practice may provide additional insights into trends in diabetes incidence. Disclosure T.R. Hird: None. L. Chen: None. R.M. Islam: None. M.E. Pavkov: None. E. Gregg: None. M. Tabesh: None. D. Koye: None. E.L. Barr: None. J.E. Shaw: Advisory Panel; Self; Abbott, Merck Sharp &amp; Dohme Corp. Speaker's Bureau; Self; AstraZeneca, Mylan, Roche Diabetes Care, Sanofi-Aventis. D.J. Magliano: None. Funding Centers for Disease Control and Prevention

Towards Obesity Surveillance Using Multifaceted Online Social Relational Factors in Reddit

ObjectiveWe aim to better understand online social interactions and environments of individuals interested in weight management from a social media platform called Reddit.IntroductionOverweight and obesity are recognized as one of the greatest modern public health problems1, yet worldwide prevalence of obesity has nearly doubled over the past 30 years2. As part of a strategy to control the obesity pandemic, the WHO recommends an obesity surveillance at the population level3. Empirical studies have shown the importance of social networks in obesity4 and new strategies focusing on social interactions and environments have been proposed5 to prevent the further increase in obesity prevalence. With the increasing use of the internet, online social networks, interactions, and environments (i.e., online social relational factors) deserve more attention.Nearly three- quarters of Americans go online daily6, for functions like connecting with individuals via social network sites7. Like face to face interactions, studies have suggested that social interactions and networks on the internet can influence behavior changes8. Previous studies examining social networking sites typically examine a few selected social networking sites (example studies9,10), although individuals could be members of multiple social networking sites. To better leverage online social relational factors for the purpose of characterizing and monitoring population obesity trends, we investigate weight management community members’ other communities and their level of participation, a first step toward utilizing online multifactorial social interactions and environments.MethodsIn this study, we studied Reddit (http://www.reddit.com), a popular social interaction site, because Reddit hosts many subreddits (i.e., sub-communities), including weight management communities called r/loseit. First, we use a dataset11 — made available on Reddit — that had been used in many informatics studies12–14. For this study, we used a portion of the dataset from Jan 2015 to May 2015. In the first five months of 2015, 5,006,186 members were active in 96,462 subreddits, while submitting 17,851,561 posts and 266,268,920 associated comments. Second, we identified members with more than 3 posts on r/loseit in that period and removed ‘bot’ accounts by manually examining the top 20 frequent posters and their account IDs. Third, we extracted these members’ entire discussions made on Reddit, regardless of the subreddits. Fourth, we identified these members’ overall activities on Reddit and visualized in a network15.ResultsAfter removing bot accounts, we identified 7,734 members who had more than 3 posts in r/loseit from Jan 2015 to May 2015. On average, these members participated in 78.5 subreddits (standard error: 0.1; median: 49.0), while participating in 13,649 unique subreddits as a whole. Members’ participated subreddits are summarized in Figure 1. The size of the nodes represents the number of participating members and the thickness of edges represents the number of members who participated in both subreddits.ConclusionsWe present preliminary findings towards better understanding the online multifactorial social interactions and environments on a social networking site called Reddit. We provide evidence that members encounter many social interactions that occur outside of the community of our interest, the weight management community. However, what members discuss outside of the weight management community as well as the interactions’ influence on weight managements and changes remain unanswered. For example, many members also participate in a subreddit called r/fitness, a community that could share many similar interests with r/loseit. However, the purpose for participating in both communities is unknown. On the basis of our initial analysis, we suggest leveraging online multifaceted social relational factors for the purpose of characterizing and monitoring population obesity trends.

Cost-Effectiveness of Bariatric Surgery Compared With Nonsurgical Treatment in People With Obesity and Comorbidity in Colombia

BackgroundThe increase in obesity prevalence and its relationship with multiple cardiovascular complications have raised the burden of obesity in the general population. Bariatric surgery has shown to be more effective in reducing weight than the traditional pharmacologic and nonpharmacologic treatments. ObjectiveTo evaluate the cost-effectiveness of this alternative compared with standard treatment in the Colombian context. MethodsA Markov single cohort model was used to simulate the incremental cost per quality-adjusted life-year (QALY) gained every year over a base-case 5-year time horizon. The model considers 5 health states: comorbidity, remission, acute myocardial infarction, stroke, and death. Four comorbidity conditions were evaluated separately: diabetes, hypertension, dyslipidemia, and sleep apnea. The model was evaluated from a third-payer perspective. All costs were expressed in 2016 Colombian pesos ($1.00 = 3051 COP). A 5% annual discount rate was applied to both costs and outcomes. ResultsIn baseline analysis, bariatric surgery was a cost-effective alternative compared with nonsurgical treatment in the diabetes and hypertension cohort with an incremental cost-effectiveness ratio of $6 194 899 and $43 689 527 per QALY gained, respectively. In the sleep apnea cohort, surgery has greater effectiveness and lower costs, which is why it is a dominant strategy. In the dyslipidemia cohort, bariatric surgery is dominated by the nonsurgical approach. ConclusionThe current study provides evidence that bariatric surgery is a cost-effective alternative among some cohorts in the Colombian setting. For obese patients with sleep apnea or diabetes, bariatric surgery is a recommendable alternative (dominant and cost-effective, respectively) for the Colombian healthcare system.

Measuring Socioeconomic Inequalities in Obesity among Korean Adults, 1998⁻2015.

Obesity is a prominent global public health challenge as its prevalence has grown. Even though the increase in prevalence of obesity in Korea has been relatively low, it is expected to continually increase in the next several years, leading to social and economic burdens. This study aimed to assess socioeconomic inequalities in obesity among Korean adults. Using nationally representative survey datasets, the concentration index (CI) and decomposition of the CI were used to capture and quantify obesity-related inequalities from 1998 to 2015. The results suggested that pro-poor inequalities in obesity existed in Korea, indicating that obesity was more concentrated among individuals with lower income. In a gender-stratified model, obesity was more concentrated among women with lower income and men with higher income, showing that the trend and magnitude of inequalities in obesity each vary by gender. The decomposition approach revealed that, over the past 17 years, the main contributors to the existing inequalities were higher education and higher income levels. These findings suggest that comprehensive and multifaceted interventions at the local and national levels should be considered to address the identified income- and education-related barriers with respect to obesity among Korean adults.

WIC Food Package Changes: Trends in Childhood Obesity Prevalence.

To evaluate the association of the 2009 changes to the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package and childhood obesity trends. We hypothesized that the food package change reduced obesity among children participating in WIC, a population that has been especially vulnerable to the childhood obesity epidemic. We used an interrupted time-series design with repeated cross-sectional measurements of state-specific obesity prevalence among WIC-participating 2- to 4-year-old children from 2000 to 2014. We used multilevel linear regression models to estimate the trend in obesity prevalence for states before the WIC package revision and to test whether the trend in obesity prevalence changed after the 2009 WIC package revision, adjusting for changes in demographics. In a secondary analysis, we adjusted for changes in macrosomia and high prepregnancy BMI. Before the 2009 WIC food package change, the prevalence of obesity across states among 2- to 4-year-old WIC participants was increasing by 0.23 percentage points annually (95% confidence interval: 0.17 to 0.29; P < .001). After 2009, the trend was reversed (-0.34 percentage points per year; 95% confidence interval: -0.42 to -0.25; P < .001). Changes in sociodemographic and other obesity risk factors did not account for this change in the trend in obesity prevalence. The 2009 WIC food package change may have helped to reverse the rapid increase in obesity prevalence among WIC participants observed before the food package change.

Exploring network structure and the role of key stakeholders to understand the obesity prevention system in an Australian metropolitan health service: study protocol

IntroductionLittle progress has been made to address the increasing obesity prevalence over the past few decades, and there is growing concern about the far-reaching consequences for health and well-being related...

Pancreatic islet (of Langerhans) revisited.

One hundred and fifty years ago, Paul Langerhans described what would come to be known as pancreatic 'islet of Langerhans'. Since then, we have accumulated knowledge about the pancreatic islet, the cells that exist there and the hormones secreted by these cells. The increasing prevalence of obesity, diabetes and Alzheimer's disease in the population (three conditions that are linked to pancreatic islet function), the islet has been playing a significant role in endocrinological and metabolic studies searching how we can protect the pancreatic islet and its cell content, or how we can regenerate it. This review will be interested in the most recent and relevant aspects of knowledge regarding the pancreatic islet, always mentioning the evolution of knowledge and future perspectives for the treatment of diabetes and Alzheimer's disease. The most recent research with microRNAs and islet culture and pseudoislet culture (organoids) allows predicting advances in knowledge with new drugs to act on the islet/cells (such as the hormone glucagon-like peptide (GLP) -1) as well as induction of other islet cells like alpha-cells and delta-cells to transform into beta-cells.

The double burden of food insecurity and obesity among Latino youth: Understanding the role of generational status.

Obesity is linked to food insecurity and generational status; however, little is known about how both impact obesity risk among Latino youth. To investigate the joint effect of generational status and food insecurity on obesity prevalence among Latino youth. We pooled data from the 2011 to 2017 waves of the National Health Interview Survey to derive a sample Latino youth aged 12 to 17 (N=7532). Four generational categories were constructed: first generation (foreign-born children); second generation (US-born child; foreign-born parent[s]); 2.5 generation (US-born child; one foreign-born parent and one US-born parent); third generation (US-born child; U.S.-born parent[s]). Food insecurity was defined by monthly instances of food scarcity over the past year. Obesity was measured using age- and sex-specific body mass index percentile cut-offs. Log-binomial multivariable regression models estimated the association between generational status and food insecurity categories on obesity. Obesity percentages among food-insecure households ranged from 12.8% in the first generation, 15.8% in the second, 24.3% in the 2.5, and 19.2% in the third. In fully adjusted models, 2.5 generation food secure youth had the highest prevalence of obesity (aPR: 1.53; 95% CI, 1.09-2.16) when compared with first generation food secure youth, followed by third generation food insecure youth (aPR: 1.49; 95% CI, 1.01-2.20). Food security status is associated with increased obesity prevalence among Latino youth across the generations. Given that obesity is a risk factor for top causes of mortality and morbidity, growing rates among this population is of public health and clinical importance.

The reality of elementary schools: a call for urgent community nutrition programs

Objective: In the last decades, the prevalence of overweight and obesity in childhood has been increasing worldwide at an alarming rate [1]. The negative impact of this pandemic is reflected on children’s health and is perpetuated in their adulthood [2]. It is recognized that preventive strategies are priority in fighting childhood obesity, and that schools are a preferential environment for this approach [1–3]. Our aim was to evaluate a cohort of elementary school students to understand the need for preventive community nutrition programs. Material and methods: This were a cohort study with two points of evaluation in time, enrolling students of two elementary schools (Escola Básica Rosa Colaço and Escola Básica Chegadinho, Almada, Portugal). Students were annually evaluated through anthropometric measures, for two years. Data from anthropometric evaluation were gathered in WHO Anthro Plus, and results are presented according to WHO z-cores. Since 2016, this group of schools has been working to increase the physical activity of these students through a project supported by the Portuguese Ministry of Education and with scientific consulting of Nutritionists from Egas Moniz. However, the project does not include regular support of a nutritionist to educate and treat this vulnerable population. Results: In 2016-2017, 271 students were evaluated (133 females). Prevalence of obesity and overweight in Escola Básica Rosa Colaço was 7.4% and 22.1%, respectively. During the same period, in Escola Básica Chegadinho, that prevalence was 8.9% and 23.0%, respectively. Also, prevalence of underweight was 2.3% in Escola Básica Rosa Colaço and 0.7% in Escola Básica Chegadinho. In 2017-2018, 313 students were evaluated (147 females). Despite of a regular schedule for physical activity in these elementary schools implemented at the end of 2017, in 2017-2018, prevalence of obesity and overweight in Escola Básica Rosa Colaço was 12.7% and 26.6%, respectively; and in Escola Básica Chegadinho, that prevalence was 20.0% and 22.6%, respectively. This represent a total increase in obesity prevalence of 5.3% in Escola Básica Rosa Colaço, and of 11.1% in Escola Básica Chegadinho. Conclusion: Our results reveal a shocking reality in these two elementary schools. Also, this high prevalence of both obesity and overweight in children under the age of 10, in spite of the implementation of a regular program of physical activity in schools, evidence that community programs should include regular nutrition education and advisory. Our results also reinforce the need for the inclusion of Nutritionists in schools to work together with students, teachers, and families.

Knee problems are common in young adults and associated with physical activity and not obesity: the findings of a cross-sectional survey in a university cohort

BackgroundObesity and sedentary behaviour, risk factors for knee osteoarthritis in middle-age, are increasing in younger adults. The objectives of this study were to estimate the prevalence of knee problems in young adults, to characterise these problems and explore the relationship with physical activity, physical inactivity and obesity.MethodsPresence of knee problems was collected through self-report questionnaire from staff and students of one university aged 18–39; direct measurement of weight and height was taken and activity measured using the International Physical Activity Questionnaire. Twelve-month prevalence of knee problems was estimated. Logistic regression was used to investigate the relationship between knee problems and physical activity levels, sitting time and body mass index.ResultsThe prevalence of knee problems was high (31.8% [95% CI 26.9 to 37.2%]) among the 314 participants; knee pain was the most common dominant symptom (65%). Only high physical activity levels (OR 2.6 [95% CI 1.4–4.9]) and mental distress (OR 2.3 [95% CI 1.2–4.6]) were independent risk factors for knee problems.ConclusionsKnee problems were common among young adults, who were staff and students of a university. With increasing obesity prevalence, populations are being encouraged to become more active. More attention may need to be paid towards prevention of knee problems in such programmes, and further research is warranted.

Future trends in social inequalities in obesity in England, Wales and Scotland.

Previous studies have shown persistent or increasing socioeconomic inequalities in obesity in many European countries. The aim of this study was to project trends in social inequalities in obesity to 2035 in male and female adults (aged 16+) in the UK to ascertain if the gap is widening or narrowing. BMI data for the UK were extracted from the Health Survey for England (2004-14), Scottish Health Survey (2008-14) and the Welsh Health Survey (2004-14), respectively. A non-linear multivariate regression model was fitted to cross-sectional risk factor data to create longitudinal projections to 2035 stratified by sex, and occupational status or education level. Individuals in routine and manual jobs are projected to have the highest prevalence of obesity by 2035 and to experience the highest increases in obesity prevalence to 2035. Social inequalities based on occupation are projected to widen (except in English females). Social inequalities based on education are projected to decrease (except in Welsh females). A population strategy of prevention focused on the structural determinants of obesity is needed to change the trajectory of obesity prevalence trends and to tackle health inequalities.

Sleep Patterns and Obesity: Hispanic Community Health Study/Study of Latinos Sueño Ancillar Study

The relationship of poor sleep patterns to the increased risk of obesity has been reported, but the results are variable. This study evaluated the association between objectively measured sleep patterns and obesity in a representative adult population of Hispanic/Latino subjects living in the United States. This cross-sectional study was an analysis of a multicenter, community-based cohort of 2,156 participants aged 18 to 64 years from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Recruitment was conducted in San Diego, California; Chicago, Illinois; Bronx, New York; and Miami, Florida. Models were controlled for age, sex, ethnic background, site, income, education, and apnea-hypopnea index. Seven days of wrist actigraphy data were collected. Obesity was defined as BMI≥ 30kg/m2, and abdominal obesity was defined as waist circumference≥ 88cm in women and≥ 102cm in men. Napping was defined as more than one 15-min nap per week. An inverse linear relationship was found between sleep duration and prevalence of obesity (P linear trend≤ 0.01). A reduction of 1h sleep increased obesity prevalence by 4.1%(95%CI, 1.6-6.6; P= .002) and abdominal obesity prevalence by 3.6%(95%CI, 1.1-6.1; P= .007). Daytime napping increased obesity prevalence by 10.4%(95%CI, 3.5-17.3; P= .004) and abdominal obesity prevalence by 7.1%(95%CI, 1.0-13.2; P= .02). In a population of young to older adult Hispanic/Latino subjects, we found an inverse linear association between sleep duration and the prevalence of obesity. Daytime napping was strongly associated with greater adiposity. Interventional and longitudinal studies are needed to better understand how abnormal sleep patterns contribute to the obesity epidemic.

Adult body weight trends in 27 urban populations of Brazil from 2006 to 2016: A population-based study.

ObjectiveWe aimed to estimate trends in population-level adult body weight indicators in the 26 state capitals and the Federal District of Brazil.MethodsSelf-reported weight and height data of 572,437 adults were used to estimate the mean body mass index (BMI), and the prevalence of BMI categories ranging from underweight to morbid obesity, in Brazil’s state capitals and Federal District, from 2006 to 2016, by sex. All estimates were standardized by age.ResultsFrom 2006 to 2016, the main findings showed that: (i) the overall mean BMI increased from 25.4 kg/m2 to 26.3 kg/m2 in men, and from 24.5 kg/m2 to 25.8 kg/m2 in women; (ii) the overall prevalence of overweight increased from 48.1% to 57.5% in men, and from 37.8% to 48.2% in women; (iii) the overall prevalence of obesity increased from 11.7% to 18.1% in men, and from 12.1% to 18.8% in women; (iv) in general, the largest increases in overweight and obesity prevalence were found in state capitals located in the north, northeast, and central-west regions of Brazil; (v) the prevalence of severe obesity surpassed the prevalence of underweight in 22 and 9 state capitals among men and women, respectively; and (vi) the mean BMI trend was stable only in Vitória state capital in men.ConclusionsThe policies for preventing and treating obesity in Brazil over the past years were not able to halt the increase in obesity prevalence either in the state capitals or the Federal District. Thus, a revision of policies is warranted. Furthermore, although policies are necessary in all state capitals, our results suggest that policies are especially necessary in the north, northeast, and central-west regions’ state capitals, where, in general, the largest increases in overweight and obesity prevalence were experienced.

Patient perception of obesity versus physician documentation of obesity: A quality improvement study.

As the prevalence of obesity increases, the prevalence of associated comorbid diseases, obesity-related mortality rates and healthcare costs rise concordantly. Two main factors that hinder efforts to treat obesity include a lack of recognition by patients and documentation by physicians. This study evaluates the relationship between patient perception of obese weight and physician documentation of obesity. This quality improvement observational study surveyed patients of an academic internal medicine clinic on their perception of obesity. Responses were compared to longitudinal physician documentation of obesity and body mass index (BMI). A total of 59.9% of patients with obesity perceived their weight as obese. While 33.7% of patients with a BMI of 30 to 34.9 kg/m2 perceived themselves as having obesity, 71.4% of patients with a BMI of 45 to 49.9 kg/m2 perceived themselves as having obesity. A total of 42.4% of patients with obesity had physician documentation of obesity in the last year. While 25% of patients with a BMI of 30 to 34.9 kg/m2 had physician documentation of obesity, 85.7% of patients with a BMI of 45 to 49.9 kg/m2 had physician documentation of obesity. For patients with a BMI ≥50 kg/m2 , 52.9% perceived their weight to be obese and 76.5% had physician documentation of obesity in the last year. Both patient perception and physician documentation of obesity were significantly less than the prevalence of obesity. Patient perception of obesity and provider documentation of obesity increased as BMI increased until a BMI ≥50 kg/m2 . Both patients and providers must improve recognition of this disease.

Diabetes in the Middle East: Government Health Care Policies and Strategies that Address the Growing Diabetes Prevalence in the Middle East.

Diabetes is a primary public health concern and a challenge for health decision makers in this century. Though the number of people with diabetes is increasing all over the globe, the very high prevalence of diabetes in many Middle East countries has made this region one of the global diabetes hot spots. Due to rapid socioeconomic growth, lifestyle changes and increasing obesity prevalence, the number of people with diabetes is expected to double by 2045 in this region. This high prevalence of diabetes imposes a substantial socioeconomic impact on the individual and governments in this region. The governments in the Middle East have devised many policies, programs, and strategies to address the growing prevalence of diabetes. In this article, we aim to review such policies, programs, and the magnitude of diabetes in this part of the world. Faced with a challenge on a high scale, most governments in the Middle East are making progress in responding to diabetes. Diabetes is a chronic and costly disease; however, it can be prevented. The alarm of the rising tide of diabetes has not yet been successfully translated into action in the Middle East. The governments in the region need to devise more intense, broader policies and preventive measure programs based on local sociocultural practices to effectively combat the situation. Further improvements of the primary health care system and cross-governmental approaches are needed in the region to keep the growing epidemic of diabetes under control.

Moringa oleifera Lam. prevents the development of high fructose diet-induced fatty liver

Ingestion of fructose-rich diets has been associated with the increase in the global prevalence of obesity, dyslipidemia and non-alcoholic fatty liver disease across all age groups. Phytochemicals from the plant Moringa oleifera Lam. reportedly therapeutically reduce obesity, correct hyperlipidemia and decrease excess hepatic lipid accumulation in adults. In light of the increasing prevalence of diet-induced metabolic dysfunction in children, this study was designed to investigate the protective effects of a methanolic leaf extract of M. oleifera on fructose-induced obesity and hepatic lipid accumulation in growing female rats. Fifty-one 21-day-old female Sprague Dawley rats were weaned and randomly allocated to six treatment groups. The rats had ad libitum access to commercial standard rat food. In addition, they also had plain drinking water (negative control; C), or a 20% fructose solution (H), or 400 mg.kg−1M. oleifera absolute methanolic leaf extract daily with or without fructose solution (M + H or Mo), or 100 mg.kg−1 fenofibrate daily with or without fructose solution for drinking (F + H or FNF). Growth parameters, circulating metabolites, visceral fat pads, hepatic lipid storage, and biochemical markers of general health were assessed after 10 weeks of the interventions. A significant increase in circulating triglycerides (mmol.l−1) (2.30 ± 0.43 vs 1.70 ± 0.30; P < .01, ANOVA) and hepatic lipid stores (11.00 ± 0.21 vs 9.60 ± 0.21%; P < .05, ANOVA) was observed in fructose-fed rats (H) compared with the negative (C) control. The methanolic leaf extracts of M. oleifera (M + H) prevented the fructose induced elevation in hepatic lipid stores (9.80 ± 0.77 vs 11.00 ± 0.21%; P < .05, ANOVA). In the fructose-fed rats the Moringa leaf extracts (M + H) and fenofibrate (F + H) did not prevent the fructose induced hypertriglyceridemia (P < .05, ANOVA) observed in fructose only fed rats (H). However, rats supplemented with M. oleifera leaf extracts alone (Mo) and fenofibrate alone (FNF) had similar triglyceride concentrations to the negative control (C) (P > .05, ANOVA). Visceral fat pads (g) were significantly lower in the fenofibrate treated group (FNF) compared to those on combined fructose and M. oleifera (M + H) (11.00 ± 3.00 vs 17.00 ± 3.40; P < .01, ANOVA). Fructose intake did not result in a significant elevation (P > .05) in plasma cholesterol, however, rats on fenofibrate alone had lower (P < .05) cholesterol concentrations compared to those on fructose alone and compared to the negative control group. Significantly elevated fasting blood glucose levels, tissue non-specific alkaline phosphatase activity, and hepatomegaly were observed only in fenofibrate treated groups (P ≤ .05, ANOVA). No significant differences were observed in the serum insulin concentration (P > .05, ANOVA), HOMA-IR index (P > .05, ANOVA), plasma creatinine (P > .05, ANOVA), body mass gain (P > .05, ANOVA), linear growth (tibia and femur length, P > .05), body mass index (P > .05, ANOVA) and waist circumference (P > .05, ANOVA) between the different treatment groups. The prophylactic potential of M. oleifera methanolic leaf extract should be considered as an alternative prophylactic natural agent against non-alcoholic fatty liver disease, and thus needs to be further explored in humans.

Obesity: the major preventable risk factor of obstructive sleep apnea

An incre asing prevalence of obesity has led to an increase in the incidence of sleep disordered breathing in the general population. Obesity is associated with anatomic alterations that predispose to upper airway obstruction during sleep, leading to complete or partial cessation of respiration called obstructive sleep apnea. The awareness of this global issue is rising, and health care systems are providing preventive measures, diagnostic, and treatment options for both conditions. To decrease obesity, lifestyle modification (eating behaviors, smoking, drinking alcohol, etc.) and understanding the importance of exercise are needed. If these lifestyle modifications are widely applied, then not only obesity and sleep apnea will be reduced but also the incidence of serious consequences such as cardiovascular disease and health care costs will decrease greatly.