Weight Control Measures Research Articles

Distinct Effects of Body Mass Index and Waist/Hip Ratio on Risk of Breast Cancer by Joint Estrogen and Progestogen Receptor Status: Results from a Case-Control Study in Northern and Eastern China and Implications for Chemoprevention.

Obesity is a consideration in the pharmacologic intervention for estrogen receptor (ER) positive (ER+) breast cancer risk. Body mass index (BMI) and waist/hip ratio (WHR) have demonstrated different effects on breast cancer risk in relation to estrogen receptor (ER) status, but the results have been inconsistent. Furthermore, the situation in Chinese women remains unclear. We conducted a case-control study including 1,439 breast cancer cases in Northern and Eastern China. Both ER and progesterone receptor (PR) statuses were available for 1,316 cases. Associations between body size-related factors and breast cancer risk defined by receptor status were assessed by multiple polytomous unconditional logistic regression analysis. Body mass index and WHR were positively associated with overall breast cancer risk. Body mass index was positively associated with both ER+/PR positive (PR+) and ER negative (ER-)/PR negative(PR-) subtype risks, although only significantly for ER+/PR+ subtype. Waist-hip ratio was only positively correlated with ER-/PR- subtype risk, although independent of BMI. Body mass index was positively associated with risk of ER+/PR+ and ER-/PR- subtypes in premenopausal women, whereas WHR was inversely correlated with ER+/PR- and positively with ER-/PR- subtype risks. Among postmenopausal women, WHR >0.85 was associated with increased risk of ER-/PR- subtype. Both general and central obesity contribute to breast cancer risk, with different effects on specific subtypes. General obesity, indicated by BMI, is more strongly associated with ER+/PR+ subtype, especially among premenopausal women, whereas central obesity, indicated by WHR, is more specific for ER-/PR- subtype, independent of menopausal status. These results suggest that different chemoprevention strategies may be appropriate in selected individuals. The results of this study suggest that general and central obesity may play different roles in different breast cancer subtypes, supporting the hypothesis that obesity affects breast carcinogenesis via complex molecular interconnections, beyond the impact of estrogens. The results also imply that different chemoprevention strategies may be appropriate for selected individuals, highlighting the need to be particularly aware of women with a high waist/hip ratio but normal body mass index. Given the lack of any proven pharmacologic intervention for estrogen receptor negative breast cancer, stricter weight-control measures may be advised in these individuals.

BMI, Body Image, Emotional Well-Being and Weight-Control Behaviors in Urban African American Adolescents

While urban African American adolescents face significant health disparities associated with overweight and obesity that follow them into adulthood; there is limited data on body image, emotional well-being, and weight control behaviors in this population to design effective public health interventions. This study was designed to understand the association of weight status to adolescent weight control, body image, and emotional well-being responses, in African American high school students. The study cohort consisted of 776 students, mean age 15.8 years (±1.2). Data from Guidelines for Adolescent Preventive Services (GAPS) student surveys and anthropometric studies were collected at School-Based Health Centers. Associations between adolescent responses on the GAPS and body mass index (BMI) status (healthy weight: 5th to less than 85th percentile, overweight: 85th to less than 95th percentile, obese: 95th percentile or greater) were estimated using logistic regression and dose- response plots. There were statistically significant associations between BMI category and weight control (ranging from a mean 5.18 to 7.68 odds of obesity) and body image (3.40 to 13.26 odds of obesity) responses. Responses to weight control and body image questions exhibited a dose-response for odds of overweight and obesity. Feelings of depressed mood were associated with obesity (1.47 times the odds of obesity compared to students who did not endorse depressed mood; 95% CI, 1.01 to 2.13) but not overweight status. Overweight and obese urban African American adolescents are more likely to screen positively on weight control risk behaviors and negative body image questions than their normal weight peers. The weight control and body image measures on the GAPS may provide information to identify youth in need of services and those motivated for brief school-based weight control interventions.

Factors affecting patients' self-management in chronic venous disorders: a single-center study.

BackgroundThe conservative treatment of chronic venous disorders (CVDs) includes pharmacotherapy, compression therapy, physiotherapy, and changes in lifestyle. These methods are available without prescription and not reimbursed by Polish National Health Service. Adherence to therapy is affected by poorly characterized patient-related factors.ObjectiveThe aim of the study was to perform an assessment of factors that affect the usage and resignation from conservative methods in CVD self-management.MethodsA structured interview concerning self-management was carried out with 407 consecutive CVD patients of mean age 64.4 years (range: 23–87 years). All the patients had recently undergone Doppler examination and were classified in accordance with Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification.ResultsPharmacotherapy was the most frequently (85.0% of respondents) used method in CVD self-management. Obese (odds ratio [OR] =1.75 [95% confidence interval {CI} 0.99–3.05]) and subjects with longer duration of the disease (OR =1.74 [95% CI 1.16–2.62]) were more likely to use venoactive drugs, while females used ointments commonly containing heparin (OR =1.82 [95% CI 1.08–3.03]). Compression therapy was perceived by respondents as the most difficult method in self-management (OR =2.50 [95% CI 1.61–3.88]) and was also recognized as the most effective method of treatment (OR =13.9 [95% CI 7.35–26.4]). Longer duration of CVD (≥15 years) increased (OR =1.78 [95% CI 1.16–2.71]) while obesity decreased (OR =0.38 [95% CI 0.20–0.72]) the utilization of compression therapy. Females were more likely to adhere to lifestyle changes than males (OR =1.68 [95% CI 0.97–2.90]). Physiotherapy was rarely used by the patients.ConclusionObesity and longer duration of CVDs increase the use of venoactive drugs. Subjects with longer duration of the disease and without obesity are more likely to utilize compression therapy, the method considered to be the most effective but difficult in CVD self-management. Females are more prone to lifestyle changes and the use of heparin-containing ointments. There is an unmet need for health promotion regarding available CVD treatment methods and proper weight control measures to support CVD self-management.

First Dutch guidelines on lipedema using the international classification of functioning, disability and health.

Introduction Lipedema is a chronic, progressive condition that can result in considerable disability. In 2011, the Dutch Society of Dermatology and Venereology organized a task force to create guidelines on lipedema, using the International Classification of Functioning, Disability and Health of the World Health Organization. Guideline development Clinical questions on significant issues in lipedema care were proposed, involving (1) making the diagnosis of lipedema; (2) clinimetric measurements for early detection and adequate follow-up; and (3) treatment. A systematic review of literature published up to June 2013 was conducted. Based on available evidence and experience of the task force, answers were formed and recommendations were stated. The guidelines define criteria to make a medical diagnosis of lipedema, a minimum data set of (repeated) clinical measurements that should be used to ensure early detection and an individually outlined follow-up plan, pillars on which conservative treatment should be based and recommendations on surgical treatment options. Conclusions Little consistent information concerning either diagnostics or therapy can be found in the literature. It is likely that lipedema is frequently misdiagnosed or wrongly diagnosed as only an aesthetic problem and therefore under- or mis-treated. Treatment is divided into conservative and chirurgic treatment. The only available technique to correct the abnormal adipose tissue is surgery. Recommendations To ensure early detection and an individually outlined follow-up, the committee advises the use of a minimum data set of (repeated) measurements of waist circumference, circumference of involved limbs, body mass index and scoring of the level of daily practice and psychosocial distress. Promotion of a healthy lifestyle with individually adjusted weight control measures, graded activity training programs, edema reduction, and other supportive measures are pillars of conservative therapy. Tumescent liposuction is the treatment of choice for patients with a suitable health profile and/or inadequate response to conservative and supportive measures.

Childhood Body Weight in Relation to Cause-Specific Mortality

The association between childhood body weight and adult health has been little-examined, and findings are inconsistent.In a representative sample of the Scottish nation (the Scottish Mental Survey of 1947), we examined the association between body mass index measured at 11 years of age and future cause-specific mortality by age 77 years. In this cohort study, a maximum of 67 years of follow-up of 3839 study members gave rise to 1568 deaths (758 from cardiovascular disease, 610 from any malignancy). After adjustment for covariates, there was some evidence of a relation between elevated childhood body mass index and rates of mortality ascribed to all-causes (hazard ratio per 1 SD increase in body mass index; 95% confidence interval: 1.09; 1.03, 1.14), cardiovascular disease (1.09; 1.01, 1.17), all cancers combined (1.12; 1.03, 1.21), smoking-related cancers (1.13; 1.03, 1.25), and breast cancer in women (1.27; 1.04, 1.56).In conclusion, we provide further observational evidence for the need for weight control measures in youth.

The Association between Inappropriate Weight Control Behaviors and Suicide Ideation and Attempt among Korean Adolescents.

Suicide is a leading cause of death among adolescents globally, and body weight is also a recognized reason for adolescent suicide. Therefore, we investigated the association between weight control behaviors (WCB) and suicide ideation and attempt, focusing on inappropriate weight control measures. We used data from the 2014 Korea Youth Risk Behavior Web-based Survey, representing a total of 35,224 boys and 34,361 girls aged 12 to 18 years. Adolescents were classified into groups based on WCB: appropriate WCB, inappropriate WCB, and no WCB. We performed logistic regression models to examine associations between WCB and suicide ideation and attempt, controlling for covariates. Both boys and girls with inappropriate WCB were more likely to report suicide ideation and attempt. Underweight and normal weight boys with inappropriate WCB were more likely to think or attempt suicide, and underweight girls with inappropriate WCB were also more likely to attempt suicide. Among five common WCB combinations, the combination of "regular exercise, fasting, eating less" was highly associated with suicide ideation and attempt. We confirmed that inappropriate WCB is associated with suicide ideation and attempt among Korean adolescents. Given the high incidence rate of suicide among adolescents and the adverse effect of inappropriate WCB, encouraging adolescents to control their weight in healthy ways is imperative.

Trying to lose weight among non-overweight university students from 22 low, middle and emerging economy countries.

The aim of this study was to assess the prevalence of trying to lose weight among non-overweight in university students and its sociodemographic and behavioural factors from 22 low and middle income and emerging economy countries. In a cross-sectional survey we took anthropometric measurements and used a self-administered questionnaire among 15997 undergraduate university students (mean age 20.8, Standard deviation=2.8, age range of 16-30 years) from 22 universities in 22 countries. Body mass index (BMI) was used for weight status. Results indicate that 27.1% non-overweight students were trying to lose weight, 34.6% among women and 16.5% among men. Among underweight or normal weight students, 19.0% perceived themselves to be overweight, 11.3% were dieting to lose weight, and 53.5% considered to lose weight of high importance. Multivariate logistic regression found that being female, coming from a low income country, the perception of being overweight, high importance of losing weight, dieting to lose weight, trying to eat fibre, and avoiding foods with fat and cholesterol were associated with trying to lose weight in non-overweight university students. The study found a high prevalence of weight control practices and several specific risk factors were identified that can be utilized in interventions to target unhealthy weight control measures.

Breakfast Habit and Nutritional Status of Undergraduates in Ekiti State, Nigeria

The study was carried out to assess the breakfast consumption habit and nutritional status of undergraduates in Ekiti State, Nigeria. Two hundred and fifty students comprising of 186 female and 64 male were randomly selected in two higher institutions. A self administered questionnaire which elicits information on socio-demographic data and breakfast habit of the students was used. Nutrients intake of the respondents was assess using 24 hour dietary recall while the Body Mass Index (BMI) was used to assess the nutritional status of the respondents. The result revealed that 76.2% of the respondents were female while 23.8% were male. Slightly above average (52.8%) were within the age range of 16-20 years while 36.8% received more than ₦10, 000 as feeding allowances. In general, 52% of the students reported not to be taking breakfast on the day of the survey and 40.8% attributed this to insufficient feeding allowances. Nutritional status assessment showed that there was no significant difference (Χ2=4.16; P=0.24) between breakfast skipping and BMI. The 24 hour dietary analysis showed that there was a significant (P<0.05) difference between the mean protein and fat intake of breakfast skippers and eaters. The mean nutrients intake of breakfast skippers and eaters were; energy (2315.4kcal vs 2229.6kcal), protein (52.6g vs 58.4g), fat (42.1g vs 33.0g), carbohydrate (324.3g vs 306.3g), iron (12.4mg vs 12.6mg), and calcium (1106.2mg vs 1157.9mg ). The study concluded majority of the students’ skip breakfast, a reflection of insufficient feeding allowances, busy schedule and weight control measures. The study then recommends that parents should increase the feeding allowances of their children that are in tertiary institutions.

Characteristics and Behaviors of Non-overweight College Students Who are Trying to Lose Weight

The purpose of the current study was to examine characteristics and behaviors of college students who perceive themselves as underweight or about the right weight, yet report trying to lose weight, as compared to their counterparts. Participants included 944 students (M = 20.4 years, 61.1 % White; 64.7 % female) at a southwestern university. A composite of perceived weight and weight-related behavior was created. Participants who reported they were under- or about the right weight and trying to lose weight were included in this composite group. Cross-sectional logistic regression analyses were run to assess characteristics and behaviors of the composite group. Individuals in this group were significantly more likely to be women, in a fraternity/sorority, have a lower body mass index, engage in regular vigorous physical activity, exercise and/or diet to lose weight, and engage in unhealthy weight-control behaviors. These individuals were not more likely than their counterparts to consume 5 or more servings of fruits/vegetables daily, to engage in moderate physical activity, or to report smoking cigarettes in the past month. Further research is needed to understand why individuals who perceive themselves as under- or about the right weight engage in certain weight-loss behaviors. Interventions to target weight-related perceptions and behaviors among college-age individuals may need to address unhealthy weight-control measures.

Effects of neutering on weight and metabolism in cats

Obesity is the most common nutritional condition of domestic cats in the UK, and is associated with a number of detrimental effects on health. Neutering of cats, which is absolutely essential for obvious reasons of population control and animal welfare, has long been recognised as an important risk factor in its development. In this article, we will review the current knowledge on the mechanisms underlying this association between neutering and increased risk for obesity. Weight gain in neutered cats arises from metabolic changes which are induced by the falling level of estrogens; those changes include increased energy intake, decreased satiety signals, and decreased energy expenditure. In order to tackle weight gain in neutered cats, those modifications in the metabolism of neutered cats need to be explained to the owners, and addressed by appropriate weight control measures immediately after the surgery.

Obesity and weight control measures: Findings from female college students of Agra

Context: Obesity has negative health impacts. Obese people have higher risk of non-communicable diseases (NCDs). Overweight and obesity during young adulthood can track into later adulthood along with its higher risk for NCDs. Aims: To identify the weight control intention and dietary practices used among normal, overweight, and obese college females and to know the reasons for discontinuation among ever tried subjects. Settings and Design : A cross-sectional study conducted in urban and rural colleges of Agra. Materials and Methods: This was a cross-sectional study among 400 female college students. Height and weight were measured to assess body composition according to BMI (Body Mass Index) criteria (WHO 2002). Study included a semi-structured and semi-open-ended instrument to assess practices related to weight control. Their responses were collected, tabulated, analyzed, and interpreted. Statistical analysis used: Frequency. Results: The prevalence of overweight and obesity was found to be 18.5% and 4.5%, respectively, according to BMI (WHO 2002). One third of the subjects were recording their weight monthly. Slightly less than half of the subjects (46%) were trying to maintain optimum weight. Almost one third of these subjects (33.5%) were presently trying to lose weight. About one fifth of total 400 subjects (20.5%) were not concerned about their weight status. Majority of the subjects (85%) irrespective of their obesity status did not take any professional advice. More than half (52.7%) were resorting to physical activity to lose weight. Taking more fruits/vegetables (44.7%) was found to be the most common healthy dieting practices and most unhealthy was fasting (15.3%). More than one fourth (28.8%) of the subjects abandoned weight control practices because of shortage of time followed by 22.4% due to physical weakness. Conclusions: Collectively, results indicate female college students, regardless of weight status, would benefit from open discussions with health educators regarding healthy and effective dieting practices to achieve/maintain a healthy body weight.

The female athlete triad in student track and field athletes

Objectives: To explore the female athlete triad components in university track and field athletes, as well as calculate estimated energy availability.Design: Cross-sectional descriptive study design.Setting and subjects: Sixteen volunteer, white, female track and field athletes were recruited from North-West University.Outcome measures: Athletes completed a demographic, health and sport questionnaire; pathogenic body weight control questionnaire; menstrual history questionnaire; four 24-hour dietary recalls and one three-day diet and exercise record form. Body composition and bone mineral density (BMD) were assessed with dual energy X-ray absorptiometry. The bulimia, drive for thinness and body dissatisfaction subscales of the Eating Disorder Inventory, and the cognitive dietary restraint subscale of the Three-Factor Eating Questionnaire, was used to measure disordered eating behaviour. Estimated energy availability was calculated using a three-day dietary and exercise record form completed by the athlete on three heavy training days.Results: In the total group, 25% had menstrual pattern changes, 62.5% disordered eating behaviour, 73.3% (11/15) low estimated energy availability, and 12.5% reported stress fractures during the past two years. The average estimated energy availability was 18.5 (14.1-40.9) kcal/kg fat-free mass/day. Diet or fat-burning pills were the most popular pathogenic weight-control measures used by 37.5% athletes. Athletes with menstrual pattern changes had lower spine [1.043 (0.975-1.059) vs. 1.166 (1.090-1.234) g/cm2, p-value = 0.043] and femoral neck [0.905 ± 0.045 vs. 1.025 ± 0.027 g/cm2, p-value = 0.042) BMD. Altogether, 87.5% athletes presented with various components of .Conclusion: More than two thirds of this group of student track and field athletes had low estimated energy availability and more than three quarters were classified with various combinations of the components of the female athlete triad.

Alcohol consumption and body weight change in postmenopausal women: results from the Women's Health Initiative.

To determine whether alcohol consumption is associated with incident overweight or obesity in normal-weight, postmenopausal women. Prospective cohort study considering baseline alcohol consumption and subsequent weight change over 7 years. 15,920 normal-weight (body mass index (BMI): 18.5 to <25 kg m(-2)), postmenopausal women enrolled in the Women's Health Initiative Clinical Trial. Body weight change, and incident overweight and obesity (BMI, 25.0 to <30 and ≥ 30 kg m(-2)) over 7 years. One-third of the 13,822 women included in the analytical cohort reported no alcohol consumption. BMI differed little between abstainers (22.8±1.58 kg m(-2)) and alcohol consumers in the upper quintile (22.7±1.53 kg m(-2)). Among normal-weight women, the risk of becoming overweight or obese over a 7-year follow-up period was 35% or 88% lower, respectively, for women in the upper quintile of alcohol intake relative to abstainers (hazard ratio (HR), 0.65; 95% confidence interval (CI), 0.58-0.73; or HR, 0.12; 95% CI, 0.05-0.25, respectively). Risk for overweight and obesity was not significantly modified by age. Wine consumption showed the greatest protective association for risk of overweight (HR, 0.75; 95% CI, 0.68-0.84), followed by liquor (HR, 0.85; 95% CI, 0.78-0.93) and beer (HR, 0.90; 95% CI, 0.82-1.00). Postmenopausal women of normal weight who report moderate alcohol intake have a reduced risk of becoming overweight or obese over time. Perhaps, weight control measures in this population should target behaviors other than reduction in alcohol for those of normal BMI consuming moderate amounts.

Body Image and Modifiable Weight Control Behaviors Among Black Females: A Review of the Literature

Black women are at high risk for obesity and obesity-related health problems (1). Nearly 50% of black women compared to 30% of white women are obese (2,3). While many women who attempt to lose weight do so through caloric restriction and/or physical activity, smoking has been identified as an alternate strategy used for weight loss among black women with weight concerns or body image concerns (4). Nicotine’s suppression of body weight facilitates initiation and maintenance of smoking among women (5–7). Despite the deadly health risks associated with tobacco use, 23.1% of women smoke (8). Female smokers are more likely to report smoking cigarettes to control weight (6,9) and less likely to quit smoking due to weight concern (10). Perkins

Prevalence of eating disorder risk and body image distortion among National Collegiate Athletic Association Division I varsity equestrian athletes.

Participation in appearance-based sports, particularly at the collegiate level, may place additional pressures on female athletes to be thin, which may increase the likelihood of their resorting to drastic weight control measures, such as disordered eating behaviors. (1) To estimate the prevalence and sources of eating disorder risk classification by academic status (freshman, sophomore, junior, or senior) and riding discipline (English and Western), (2) to examine riding style and academic status variations in body mass index (BMI) and silhouette type, and (3) to examine these variations across eating disorder risk classification type (eg, body image disturbances). Cross-sectional study. Seven universities throughout the United States. A total of 138 participants volunteered (mean age = 19.88 ± 1.29 years). They represented 2 equestrian disciplines English riding (n = 91) and Western riding (n = 47). Participants self-reported menstrual cycle history, height, and weight. We screened for eating disorder risk behaviors with the Eating Attitudes Test and for body disturbance with sex-specific BMI silhouettes. Based on the Eating Attitudes Test, estimated eating disorder prevalence was 42.0% in the total sample, 38.5% among English riders, and 48.9% among Western riders. No BMI or silhouette differences were found across academic status or discipline in disordered eating risk. Overall, participants perceived their body images as significantly larger than their actual physical sizes (self-reported BMI) and wanted to be significantly smaller in both normal clothing and competitive uniforms. Disordered eating risk prevalence among equestrian athletes was similar to that reported in other aesthetic sports and lower than that in nonaesthetic sports. Athletic trainers working with these athletes should be sensitive to these risks and refer athletes as needed to clinicians knowledgeable about disordered eating. Professionals working with this population should avoid making negative comments about physical size and appearance.

Resectional gastric bypass outcomes in active duty soldiers: a retrospective review

Background As in civilian life, some active duty service members have developed severe obesity that is refractory to diet alteration and exercise. In addition to controlling obesity, surgical weight control measures in an active duty population must consider the effect of the postbariatric state on a service member's ability to continue to be deployable to a war zone or other austere military assignment. We report our experience with such patients undergoing open resectional gastric bypass. Methods We retrospectively reviewed the perioperative and long-term outcomes of 33 active duty service members who had undergone open gastric bypass by the same surgical team at a single institution during a 30-month period. Data were collected by chart review and questionnaires. Descriptive and inferential analyses were performed using Statistical Package for Social Sciences, version 14.0. Results The questionnaires were returned by 27 patients (13 women and 14 men). The mean age at surgery was 34.2 years (range 24–51). The mean follow-up was 218 weeks (range 162–369). The mean preoperative body mass index was 40.6 kg/m 2 (range 34.0–49.4). The mean postoperative BMI was 25.6 kg/m 2 (range 19–34.7). Using the Bariatric Analysis and Reporting Outcome System outcome criteria for these 27 patients, the results were fair for 4 patients (15%), good for 9 (33%), very good for 12 (44%), and excellent for 2 (7%). No patients had treatment failure according to the Bariatric Analysis and Reporting Outcome System criteria. Also, 5 patients who had previously been nonpromotable because of their weight were reclassified as promotable after the results of the bariatric intervention. Of the 27 patients, all but 3 maintained or achieved deployable status after surgical recovery. Conclusion As in civilian populations, bariatric surgery improves the quality of life of active duty service members who have failed nonoperative means of obesity control. Most service members who undergo bariatric intervention are able to successfully deploy to war zones without adverse effects on their military performance and retain or improve their competitiveness for career promotion.

Vegetarian Diets in Children and Adolescents

1. Meredith Renda, MD* 2. Philip Fischer, MD* 1. *Department of Pediatrics, Mayo Clinic, Rochester, Minn Vegetarianism is becoming more common among adults, with 1 in 40 adults currently choosing a vegetarian diet. Consequently, more children are raised as vegetarians. Vegetarianism is adopted for various reasons, including moral, religious, and health. Numerous studies have shown significant health benefits for individuals following this type of diet. Pediatricians should be well informed about vegetarianism and its role in our pediatric population. A first-time mother and her 2-month-old boy present to the clinic for a health supervision visit. The mother is breastfeeding, and her baby is growing appropriately. At the end of the visit, the mother mentions that she is a vegetarian and that she would like to raise her son in the same way. She would like to know what she should be doing as a breastfeeding mother and how she can make sure that her son has the appropriate nutrition in the future . The physician should begin by taking a dietary history from the mother to determine what type of vegetarianism she practices. He or she should explain to the mother that her infant's nutrition is based on her own dietary intake for as long as she continues to breastfeed. The pediatrician should counsel the mother on the importance of diet variety. If the mother is vegan, the pediatrician must take time to ensure that she is getting enough vitamin B12 and calcium in her diet. When she is ready to wean her infant, she should continue to focus on dietary variety. The mother should be cautioned that adult vegetarian diets that are high in bulk and low in calories are not always appropriate for the growing and developing child. Finally, the pediatrician should ensure that the mother has the appropriate resources to guide her in finding the best foods for her child's nutritional needs. …

Secondary Hypertension: Obesity and the Metabolic Syndrome

The epidemic of obesity in the United States and around the world is intensifying in severity and scope and has been implicated as an underlying mechanism in systemic hypertension. Obese hypertensive individuals characteristically exhibit volume congestion, relative elevation in heart rate, and high cardiac output with concomitant activation of the renin-angiotensin-aldosterone system. When the metabolic syndrome is present, insulin resistance and hyperinsulinemia may contribute to hypertension through diverse mechanisms. Blood pressure can be lowered when weight control measures are successful, using, for example, caloric restriction, aerobic exercise, weight loss drugs, or bariatric surgery. A major clinical challenge resides in converting short-term weight reduction into a sustained benefit. Pharmacotherapy for the obese hypertensive patient may require multiple agents, with an optimal regimen consisting of inhibitors of the renin-angiotensin-aldosterone system, thiazide diuretics, beta-blockers, and calcium channel blockers if needed to attain contemporary blood pressure treatment goals.

Women gain weight and fat mass despite lipectomy at abdominoplasty and breast reduction

In animal models, fat removal results in compensatory weight gain. No study has reported measurement of weight following lipectomy in humans. We have examined changes in weight in patients who underwent lipectomy. In a retrospective analysis, 16 patients who had abdominoplasty and 17 patients who underwent bilateral breast reduction were compared with 16 patients who had carpal tunnel syndrome release. Following this, a prospective study was carried out on 7 subjects awaiting abdominoplasty and 12 subjects awaiting bilateral breast reduction surgery. In the retrospective study, all three patient groups gained weight following surgery. The abdominoplasty group was heavier before surgery and showed greatest weight gain but there was no statistically significant difference in weight gain between the groups. In the prospective study, the abdominoplasty group had a mean fat removal of 1.77 kg and breast reduction group had a mean of 3.22 kg. Eighteen months following surgery the abdominoplasty group showed a significant mean increase in body weight (mean increase: 4.82 kg) and body mass index (BMI) (mean increase: 1.66 kg/m(2)). In the bilateral breast reduction group, there was a non-significant mean gain in weight (mean increase: 0.67 kg) and BMI (mean increase: 0.21 kg/m(2)). Patients undergoing lipectomy during abdominoplasty and bilateral breast reduction will gain weight in the long term. This weight gain probably reflects the expected gain in weight without surgery as a similar finding is observed in patients who have undergone surgery without lipectomy. These results highlight the limitation of lipectomy as a weight control measure.

Prevalence, awareness and control of diabetes in the Seychelles and relationship with excess body weight

BackgroundThe evidence for a "diabesity" epidemic is accumulating worldwide but population-based data are still scarce in the African region. We assessed the prevalence, awareness and control of diabetes (DM) in the Seychelles, a rapidly developing country in the African region. We also examined the relationship between body mass index, fasting serum insulin and DM.MethodsExamination survey in a sample representative of the entire population aged 25–64 of the Seychelles, attended by 1255 persons (participation rate of 80.2%). An oral glucose tolerance test (OGTT) was performed in individuals with fasting blood glucose between 5.6 and 6.9 mmol/l. Diabetes mellitus (DM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were defined along criteria of the ADA. Prevalence estimates were standardized for age.ResultsThe prevalence of DM was 11.5% and 54% of persons with DM were aware of having DM. Less than a quarter of all diabetic persons under treatment were well controlled for glycemia (HbA1c), blood pressure or LDL-cholesterol. The prevalence of IGT and IFG were respectively 10.4% and 24.2%. The prevalence of excess weight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) was respectively 60.1% and 25.0%. Half of all DM cases in the population could be attributed to excess weight.ConclusionWe found a high prevalence of DM and pre-diabetes in a rapidly developing country in the African region. The strong association between overweight and DM emphasizes the importance of weight control measures to reduce the incidence of DM in the population. High rates of diabetic persons not aware of having DM in the population and insufficient cardiometabolic control among persons treated for DM stress the need for intensifying health care for diabetes.