Obesity Program Research Articles

Weight Loss Is Unaffected by Government-Recommended Versus Below-Recommended Exercise Amounts Completed Within a Self-Regulation–Focused Obesity Treatment in Women

Maintaining exercise in adults with obesity is challenging. Recommendations typically range from ≥150 minutes/week (≥5 moderate-intensity 30-minute sessions/week) to nearly double that amount. However, the value of exercise for weight loss might largely come from its psychological-improvement attributes rather than energy-expenditure attributes. Women participants (N = 73) of a community-based obesity program supporting self-regulation and exercise were evaluated for 6 months. Completing 3 to 4 sessions/week was associated with as much lost weight as completion of 5 to 7 sessions/week (mean overall = −5.80 kg; −6.1%). Increased exercise-related self-regulation predicted improved eating-related self-regulation and weight loss. Suggestions are provided enabling NPs to better support weight loss in patients with obesity.

Exergames to Limit Weight Gain and to Fight Sedentarism in Children and Adolescents with Obesity

Exergames are defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). The players interact with the game through whole-body movements improving energy expenditure. Exergames may be effective in improving physical and psychological aspects of children and adolescents with obesity. In this narrative review, we synthesized the current evidence regarding the role of exergames in modifying body composition and weight and in promoting changes in sedentary behavior to define the benefits of active video games as useful tools for fighting sedentarism and to outline the future directions of exergaming as a supplementation exercise rather than a replacement in educational programs for pediatric obesity. Data from the literature indicate that exergames may offer an interesting impact on childhood obesity and may be considered a potential strategy for controlling weight gain and body composition, promote PA, and decrease time spent on sedentary behavior in children and adolescents with obesity. However, exergame use also has some limits, such as children’s poor self-regulation and poor structuring of exergame use. Therefore, a prudent approach should be maintained, and additional high-quality research is needed to determine if exergames can be effectively used in the treatment of childhood obesity and if new digital media, as a supplementation of exercise rather than a replacement, could be considered to combat sedentary behavior in educational programs for pediatric obesity prevention.

Depression and Anxiety as Predictors of Metabolic and Bariatric Surgery Completion Among Ethnically Diverse Patients.

Mental health conditions including depression and anxiety are often prevalent among metabolic and bariatric surgery (MBS) patients, but it is not known if these conditions predict the decision to complete the procedure and if this varies by race and ethnicity. This study aimed to determine if depression and anxiety are associated with MBS completion among a race/ethnically diverse sample of patients. This prospective cohort study included participants who were referred to an obesity program or two MBS practices between August 2019 and October 2022. Participants completed the Mini International Neuropsychiatric Interview (MINI) instrument to determine history of anxiety and/or depression, as well as MBS completion status (Y/N). Multivariable logistic regression models determined the odds of MBS completion by depression and anxiety status adjusting for age, sex, body mass index, and race/ethnicity. The sample consisted of 413 study participants (87 % women, 40% non-Hispanic White, 39% non-Hispanic Black, and 18% Hispanic). Participants with a history of anxiety were less likely to complete MBS (aOR = 0.52, 95% CI = 0.30-0.90, p = 0.020). Women had increased odds of a history of anxiety (aOR = 5.65, 95% CI = 1.64-19.49, p = 0.006) and of concurrent anxiety and depression (aOR = 3.07, 95% CI = 1.39-6.79, p = 0.005) compared to men. Results showed that participants with anxiety were 48% less likely to complete MBS compared to those without anxiety. Additionally, women were more likely to report a history of anxiety with and without depression versus men. These findings can inform pre-MBS programs about risk factors for non-completion.

Leucine Supplementation Ameliorates Early-Life Programming of Obesity in Rats.

Early-weaned adult rats showed excess lipid accumulation and metabolic defects. Early weaning disrupts lipid metabolism and secretion of neuropeptide Y and insulin. The altered lipid metabolic gene expression in this study is vital in programming. Leucine mitigates metabolic disorders and hampers programmed obesity development.

The assessment of risk factors and risk perception status of breast cancer in Northern Iran

BackgroundBreast cancer (BC) is the most common malignancy in women. Identifying and avoiding the preventable risk factors of BC reduces its occurrence effectively. So, this study aimed to assess BC’s risk factors and risk perception status in Babol, Northern Iran.MethodsThis cross-sectional study was conducted on 400 women aged 18 to 70 in Babol, Northern Iran. According to the eligibility criteria, the selected participants completed the demographic characteristics and researcher-made valid and reliable questionnaires. The statistical software was SPSS20.ResultsThe significant risk factors related to BC were old age (60 years old and more) (30.2%), obesity (25.8%), history of radiation (10%), and familial history of BC (9.5%), respectively (P < 0.05). Suspected symptoms of BC were observed in 78 (19.5%) women, including indentations in 27 (6.75%), redness in 15 (3.75%), pain in 16 (4%), and enlargement of lymph nodes in 20 (5%). The BC risk perception score was 107.72±13.22.ConclusionMost participants had at least one risk factor for BC. It is essential to implement intervention programs to control obesity and BC screening programs in obese and overweight women to prevent BC and its complications. Further studies are needed.

Maternal high fat diets: impacts on offspring obesity and epigenetic hypothalamic programming.

Maternal high-fat diet (HFD) during pregnancy is associated with rapid weight gain and fetal fat mass increase at an early stage. Also, HFD during pregnancy can cause the activation of proinflammatory cytokines. Maternal insulin resistance and inflammation lead to increased adipose tissue lipolysis, and also increased free fatty acid (FFA) intake during pregnancy (˃35% of energy from fat) cause a significant increase in FFA levels in the fetus. However, both maternal insulin resistance and HFD have detrimental effects on adiposity in early life. As a result of these metabolic alterations, excess fetal lipid exposure may affect fetal growth and development. On the other hand, increase in blood lipids and inflammation can adversely affect the development of the liver, adipose tissue, brain, skeletal muscle, and pancreas in the fetus, increasing the risk for metabolic disorders. In addition, maternal HFD is associated with changes in the hypothalamic regulation of body weight and energy homeostasis by altering the expression of the leptin receptor, POMC, and neuropeptide Y in the offspring, as well as altering methylation and gene expression of dopamine and opioid-related genes which cause changes in eating behavior. All these maternal metabolic and epigenetic changes may contribute to the childhood obesity epidemic through fetal metabolic programming. Dietary interventions, such as limiting dietary fat intake <35% with appropriate fatty acid intake during the gestation period are the most effective type of intervention to improve the maternal metabolic environment during pregnancy. Appropriate nutritional intake during pregnancy should be the principal goal in reducing the risks of obesity and metabolic disorders.

Evaluation of a Childhood Obesity Program Serving a High-Need Population in Brooklyn, New York Using Survival Analysis

In this study, we used survival analysis to evaluate whether contact hours intensity was associated with a reduction in time to improvement of various BMI metrics over a 5-year follow-up period at the Live Light Live Right pediatric obesity program in Brooklyn, New York. This was a single-center retrospective longitudinal study of 406 patients during 2010-2016. Participants were categorized based on hours of exposure to Live Light Live Right's interventions; high contact hours (≥50 h) vs. low contact hours (<50 h). At baseline, 88% of patients in the high contact hour group had severe obesity and the mean age for this group was 10.0 ± 2.66. High contact hours were independently associated with a shorter time to BMI improvement in the sample. There was also a significant association between high contact hours and a longer duration in the improved state. Survival analysis was successful in evaluating the efficacy of the Live Light Live Right Program and demonstrated a positive association between greater intervention intensity and a healthier metabolic profile. Patients' active engagement in a robust treatment model exemplified by Live Light Live Right is recommended to address the childhood obesity crisis in central Brooklyn.

A Community Profile of Walking and Cycling for Exercise or Transportation in a Rural County in the Southeastern United States.

People living in rural areas of the United States, especially in the southern region, are much less likely to walk or cycle for leisure time or transportation. The purpose of this study is to provide a more detailed community-level estimate of walking and cycling behaviors and attitudes among adults living in a rural county (Hardeman County, TN) participating in a High Obesity Program (HOP) from the Centers for Disease Control and Prevention. Telephone interviews and online surveys regarding walking and cycling behaviors, attitudes, and perceptions of the built environment were completed by 634 adults. Questions originated from the 2002 National Survey of Bicyclist and Pedestrian Attitudes and Behavior. Respondents were classified as walkers, cyclists, or both. Chi-square and logistic regression were used for data analysis. Of adults in this county, 67.2% were walkers and 16.2% cyclists. Both forms of active living tended to decrease with age, especially after 50 years. Walking was associated with younger ages, 2-person households, positive perceived health, and a feeling that walking was good for them. Cycling was only associated with age. Most people felt that their communities were safe places to walk or bike. Walking was most often done on roads or road shoulder. Social support and intrinsic motivators may also play a role in walking and bicycling in rural areas. Interventions that promote walking and cycling in rural areas should provide a means for social support, creating activity-friendly routes perceived to be safe, and enhanced destinations for places to be physically active.

Facilitating Nutrition and Physical Activity-Focused Policy, Systems, and Environmental Change in Rural Areas: A Methodological Approach Using Community Wellness Coalitions and Cooperative Extension.

Obesity prevalence is higher among rural populations than urban, which may be related to differences in environments. Rural counties face barriers to accessing healthy foods and physical activity opportunities including isolation, transportation distances, and lack of facilities. As part of the Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity High Obesity Program, community-based wellness coalitions were established in six South Dakota counties with adult obesity prevalence >40%. The community coalitions were charged with improving access to healthy foods and safe and accessible places to participate in physical activity within their rural, underserved communities. Coalitions were created and members were recruited by Cooperative Extension staff who had existing relationships with key stakeholders within the community. Within these coalitions, champions were identified to provide leadership and ensure project implementation. Ongoing support and technical assistance were provided to the community coalitions by Cooperative Extension staff as they completed a community needs assessment, disseminated results of the needs assessment with the community, created action plans based on needs assessment data, implemented evidence-based interventions to support nutrition and physical activity policy, system and environmental changes, and assessed impact within their community. Overall, the purpose of this article is to share the project methodology, which capitalized on using Cooperative Extension, to build capacity to improve the nutrition and physical activity environment in rural, unserved communities. Sustainability of this work, along with lessons learned, is also discussed.

Barriers to participation in a telemedicine-based, family-based behavioral group treatment program for pediatric obesity: qualitative findings from rural caregivers

ABSTRACT This study examined factors influencing rural caregivers’ decision to decline participation in a healthy lifestyle intervention. Eligible caregivers of rural children who declined participation in a healthy lifestyle intervention were interviewed regarding reasons for declining. Inductive thematic analyses were conducted for responses. Caregiver interviews (n = 16) resulted in 5 saturated themes: (1) rural families’ household schedules prohibit participation, (2) preference for diverse treatment approaches, (3) desire for information across multimedia platforms, and more communication with a point-of-contact, (4) support for an inclusive approach integrated with existing school practices, and (5) caregivers had an understanding of behaviors that promote health.

Indirect Effect of Self-Regulated Exercise on Mood Through Self-Efficacy Changes

To improve deficient long-term effects, an improved understanding of psychosocial factors occurring within behavioral obesity treatments is required. The aim of this study was to suggest paths from changes in self-regulation toward reduced negative mood to inform the direction of more comprehensive investigations and treatment foci. Initially low active women (N = 87) participated in a theory-driven community-based behavioral obesity program emphasizing self-regulation and exercise. There were significant (ps < .001) improvements in exercise amounts, exercise-related self-regulation and self-efficacy, negative mood, and emotional eating during the weight loss phase of baseline–Month 6, and significant (ps < .01) deteriorations during the weight-loss maintenance phase of Month 6–Month 24. During both phases, significant paths (95% CIs [-0.31, -0.01], [-0.14, -0.01], and [-0.50, -0.01]) from changes in self-regulation toward reduced negative mood were through self-efficacy, but not exercise change itself. The mood change-emotional eating change relationships were significant (95% CIs [0.16, 0.39] and [0.19, 0.48]). Although extensions of this research are required to better understand long-term obesity intervention processes, the present findings suggest importance of treatment foci on identified psychological mechanisms of exercise treatment-mood change relationships.

Exploring predictors and moderators of response to multimodal obesity treatment in children

ObjectiveThe aim of this study was to determine whether specific psychological factors influence intervention effects for children with severe obesity in a clinical setting.DesignSecondary analyses of data about attention deficit/hyperactivity...

Qualitative Exploration of Cultural Influence on a Rural Health-Promotion Initiative

ObjectiveTo develop a conceptualization of cultural influence on perceptions of a rural food and physical activity policy, systems, and environmental (PSE) change project to inform public health research and practice. DesignBasic qualitative research design, semistructured phone interviews with community health coalition members. SettingFive rural Southern counties (obesity prevalence > 40%). ParticipantsThirty-nine community coalition members. InterventionThe Centers for Disease Control and Prevention High Obesity Program. PSE initiatives to increase access to healthy food and physical activity opportunities through a community coalition model. Phenomenon of InterestSocial norms and cultural influences surrounding community members’ food preferences, physical activity behavior, and future hopes for community development. AnalysisAbductive content analysis. ResultsMajor categories on food social norms (subcategories: physical health, eating habits, and food preference), race relations, generational factors, physical activity social norms, and hopes for the community (subcategories: increased engagement, health, awareness, cohesion, and inspiration) were discussed in relation to the progress of PSE initiatives. Conclusions and ImplicationsBecause of community member perceptions, PSE initiatives became associated with factors beyond food and fitness, such as race relations, generational differences, and community cohesion. A focus on increased youth and church involvement, community values, relationship building, and input from diverse voices can be foundational to culturally-appropriate PSE efforts in rural settings.

Maternal Exercise Protects Male Offspring from Maternal Diet Programmed Non-Alcoholic Fatty Liver Disease Progression.

Maternal obesity programs risk for development of non-alcoholic fatty liver disease (NAFLD) in offspring. Maternal exercise is a potential intervention to prevent developmentally programmed phenotypes. We hypothesized that maternal exercise would protect from progression of NAFLD in offspring previously exposed to maternal obesogenic diet. Female mice were fed chow (CON) or HFFC and bred with lean males. A subset had an exercise wheel introduced 4 weeks after starting diet to allow for voluntary exercise. The offspring were weaned to HFFC diet for 7 weeks to induce NAFLD. Serum, adipose, and liver tissue were collected for metabolic, histologic, and gene expression analyses. Cecal contents were collected for 16S sequencing. Global metabolomics was performed on liver. Female mice fed HFFC diet had increased body weight prior to adding an exercise wheel. Female mice fed HFFC diet had an increase in exercise distance relative to CON during the pre-conception period. Exercise distance was similar between groups during pregnancy and lactation. CON-Active and HFFC-Active offspring exhibited decreased inflammation compared to offspring from sedentary dams. Fibrosis increased in offspring from HFFC-sedentary dams compared to CON-sedentary. Offspring from exercised HFFC dams exhibited less fibrosis than offspring from sedentary HFFC dams. While maternal diet significantly affected the microbiome of offspring, the effect of maternal exercise was minimal. Metabolomics analysis revealed shifts in multiple metabolites including several involved in bile acid, one-carbon, histidine, and acylcarnitine metabolism. This study provides pre-clinical evidence that maternal exercise is a potential approach to prevent developmentally programmed liver disease progression in offspring.

Weight management strategies in Middle-Aged Women (MAW): Development and validation of a questionnaire based on the Oxford Food and Activity Behaviors Taxonomy (OxFAB-MAW) in a Portuguese sample.

The Oxford Food and Activity Behaviors (OxFAB) taxonomy systematize the cognitive-behavioral strategies adopted by individuals who are attempting to manage their weight. The present study aimed to (1) develop a questionnaire based on the OxFAB taxonomy, specifically adapted for middle-aged women-the OxFAB-MAW-stage of life and sex, which present a high incidence of obesity, (2) assess the psychometric properties of this tool, and (3) evaluate the discriminative power of the OxFAB-MAW (normal weight vs. obesity). Overall, 1,367 Portuguese middle-aged women between 45 and 65 years (M = 52.3, SD = 5.15) filled in a sociodemographic, health, and menopause-related questionnaire, as well as the OxFAB-MAW. Confirmatory factor analysis demonstrated an acceptable model fit (comparative fit index = 0.928, Tucker-Lewis index = 0.913, root mean square error of approximation = 0.072, and standardized root mean square residual = 0.054). Five domains with one item were grouped into other domains, and the Weight Management Aids domain was also removed. The OxFAB-MAW showed factorial, convergent, discriminant, and external validity, as well as composite reliability. The OxFAB-MAW questionnaire is a valid, reliable, and theory-driven tool for assessing weight management strategies in middle-aged women, being able to discriminate between clinical and non-clinical groups (normal weight vs. obesity) in several domains. This instrument can be used to gather valid and reliable data, useful in both research and clinical settings (especially focused on structuring interventions and preventive obesity programs within this specific life cycle stage).

Results From La Vida Buena (The Good Life): A Quasi-Experimental Intervention of a Community Health Worker-Led Family-Based Childhood Obesity Program for Latino Children 5-8 Years of Age on the U.S.-Mexico Border.

To evaluate the effectiveness of the 8-week, community health worker (CHW)-led La Vida Buena childhood obesity program among Latino children 5 to 8 years old in a rural county along the U.S.-Mexico border. This quasi-experimental study used a community-based participatory research approach to compare the effectiveness of the La Vida Buena (The Good Life) curriculum as compared with a single educational session. We took anthropomorphic measures and administered parent-reported nutrition and physical activity surveys at baseline, 3 months, and 6 months. The study took place between 2017 and 2020 in Santa Cruz County, Arizona. Change in body mass index (BMI) z-score was negligible for both groups. The parent-reported behavior indicated a shift toward healthier family behaviors and environment in the intervention group. This study adds to the growing literature of CHW-led childhood obesity interventions. The engagement of the CHWs in all aspects of the intervention helped to facilitate important behavior changes. Future interventions should emphasize health and wellness rather than BMI z-score and include community, socioeconomic, and systems-level interventions to promote healthy environments.

Semaglutide 2.4-mg injection as a novel approach for chronic weight management.

Anti-obesity medications used with lifestyle intervention produce greater and more sustained weight loss than does lifestyle intervention alone. However, until 2021, FDA-approved medications for the long-term treatment of obesity in the general adult population had not demonstrated the sustained loss of 15% body weight needed to meet or exceed all guideline-recommended targets for weight-related complications. To meet this need, investigators launched the Semaglutide Treatment Effect in People with obesity (STEP) program of phase 3 clinical trials to assess the safety and efficacy of a weekly 2.4-mg subcutaneous injection of semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA). Following the results of STEPs 1 to 4, the FDA approved semaglutide therapy in patients with obesity. This article examines the design, efficacy, and safety of semaglutide therapy as revealed by the results of STEPs 1 to 4. These trials included adults with obesity who reported at least 1 unsuccessful attempt to reduce body weight by means of diet. STEP 2 studied effects on patients who also had type 2 diabetes (T2D); STEPs 1, 3, and 4 excluded patients with this condition. STEP 3 examined the effect of this pharmacotherapy plus intensive behavioral therapy and a 2-step, intensively restricted dietary plan. STEP 4 assessed the effects of continuing semaglutide 2.4 mg vs switching to placebo after an initial treatment period. In the trials comparing the effects of semaglutide 2.4‑mg treatment with those of placebo across 68 weeks and in patients with no T2D (ie, STEPs 1 and 3), patients treated with semaglutide achieved a mean -14.9% to -16.0% weight change. This far exceeds the 4.0% to 10.9% weight loss seen with other approved antiobesity medications. In STEPs 2 and 4, the estimated treatment differences between the semaglutide 2.4-mg and placebo arms were -6.2% and -14.8%, respectively. Safety and tolerability of this treatment in STEPs 1 to 4 was consistent with those of other GLP-1RA-based therapies. Ultimately, the results of the first 4 STEP trials demonstrated that semaglutide 2.4 mg is a safe, well-tolerated, and highly effective treatment to promote weight loss, avoid weight regain, and mitigate the effects of the prevalent, chronic disease of obesity. In November 2022, based upon the results of STEPs 1 to 3 and other trials, the American Gastroenterological Association recommended that semaglutide 2.4 mg "be prioritized over other approved [anti-obesity medications] for the long-term treatment of obesity for most patients."

The Relationship of Waist Circumference and Waist-to-Hip Ratio with Risk of Cardiovascular Disease in Indonesia

Cardiovascular disease (CVD) is one of the non-communicable diseases which is the mayor leading cause of death in the world. One of the modifiable factors of cardiovascular disease is central obesity. Assessment of central obesity status was carried out by measuring waist circumference (WC) and waist-to-hip ratio (WHR). This study aimed to determine the relationship between WC and WHR with the risk of cardiovascular disease. This was an observational study with a cross-sectional design. There were 106 respondents selected using a convenience sampling technique. In this study, the risk of cardiovascular disease was calculated using the Jakarta Cardiovascular Score. The Spearman Rho’s was used as bivariate analysis for this study. The findings showed that WC and the risk of cardiovascular disease indicates a significant relationship with a moderate correlation (p &lt;0.001 and r =0.467). Meanwhile, there was a significant relationship between WHR and the risk of cardiovascular disease (p&lt;0.001 and r =0.385). Nurse may use this study result as an evidence to develop a preventive central obesity program.

Economic burden of childhood overweight and obesity: A systematic review and meta-analysis.

To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.

Cognitive Fusion and Emotional Eating among Adolescents with Obesity: A Preliminary Cross-Sectional Study.

Cognitive fusion and avoidance are supposed to exert a key role in the development and maintenance of disordered eating behaviors related to obesity, such as emotional eating. A large portion of the research has focused on adult populations, while few data are available on adolescents so far. The current cross-sectional study is intended to explore the association between cognitive fusion, avoidance, and emotional eating in a sample of fifty-six Italian adolescents (13-17 years) with obesity (body mass index > 97th centile). For this purpose, participants attending a 3-week body weight reduction program were assessed using demographical, physical, and clinical data. A multivariate linear regression model was performed in order to preliminarily investigate the predictive role of cognitive fusion on emotional eating, controlling for possible confounding factors. Results showed a significant association between cognitive fusion and emotional eating. Regression revealed that cognitive fusion was a significant contributor for explaining emotional eating (controlling for sex) [R2 = 0.551; Adjusted R2 = 0.534; F(2,53) = 32.5; p < 0.001]. Even if preliminary, our findings suggest a predictive role of cognitive fusion on emotional eating, and also suggest that cognitive fusion can be considered a key component in understanding and addressing of disordered eating behaviors related to obesity. Future replications are required to expand the sample and collect longitudinal data. Intervention programs for childhood obesity could benefit from this line of research.