Household routines may help reduce BMI in minority children

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Pediatrics / Children's Health
Article Date: 10 Sep 2013 - 2:00 PDT Current ratings for:
Household routines may help reduce BMI in minority children

An intervention to improve household routines known to be associated with obesity increased sleep duration and reduced TV viewing among low-income, minority children, and the approach may be an effective tool to reduce body mass index (BMI) in that population, according to a study published by JAMA Pediatrics, a JAMA Network publication.

Racial and ethnic minority children and those who live in low-income households are disproportionately overweight and it is urgent to develop an intervention for them, Jess Haines, Ph.D., M.H.Sc., of the University of Guelph, Ontario, Canada, and colleagues, write in the study background. "The purpose of this study was to assess the extent to which a home-based intervention, compared with a mailed control condition focused on healthful development, resulted in improvements in household routines that may be preventive of childhood overweight and obesity among racial/ethnic minority and low-income families with children aged 2 to 5 years," the authors note. The study assigned 121 families with children at random into intervention (n=62) or control groups (n=59). A total of 111 children-parent pairings completed the six-month follow-up assessments. The intervention, which used home-based counseling and phone calls, was designed to change behaviors related to excess weight gain, but child weight was not discussed in the intervention. Compared with the control group, which received educational materials, intervention participants experienced increased sleep duration (0.75 hours/day), greater decreases in TV viewing on weekend days (-1.06 hours/day) and decreased BMI (-0.40), according to the study results. "In summary, after six months, we found that the Healthy Habits, Happy Homes intervention improved sleep duration and TV viewing behaviors, as well as decreased BMI among racially/ethnically diverse children from low-income households. Future studies with a longer follow-up are needed to determine maintenance of these behavior changes," the authors conclude.

In an editorial, Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, writes: "Everyone knows that an obesity epidemic exists in the United States right now."

"However, few dispute that preventing obesity is much easier than curing it. But obesity starts so young now that only by focusing more on young children, can we hope to stop overweight before it starts," Carroll continues. "Rather than drill down to a specific eating or exercise change, creating a healthier household may be a better way not only to improve weight, but overall physical and mental health as well."

"Plenty of caveats exist. The change in BMI was small, and it is unclear whether it will persist in the long-term. ... Of course, further work is needed to see how such an intervention could scale up into a larger program, let alone into public policy. But by focusing on behaviors that in and of themselves are good regardless of BMI, Haines et al have provided us with an intervention that can be considered in and of itself desirable even if the obesity effect is transient," Carroll concludes.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our obesity / weight loss / fitness section for the latest news on this subject. Article: JAMA Pediatr. Published online September 9, 2013. doi:10.1001/jamapediatrics.2013.2356.

Editorial: JAMA Pediatr. Published online September 9, 2013. doi:10.1001/jamapediatrics.2013.2405.

JAMA Pediatrics

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Obese teens who lose weight also at risk for eating disorders

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Main Category: Eating Disorders
Also Included In: Obesity / Weight Loss / Fitness;  Pediatrics / Children's Health
Article Date: 10 Sep 2013 - 1:00 PDT Current ratings for:
Obese teens who lose weight also at risk for eating disorders

When obese teenagers lose weight, family and friends usually look at this as a positive improvement for their health. But new research from the Mayo Clinic shows that overweight teens who lose weight can also be at risk of developing anorexia nervosa or bulimia nervosa.

The findings, published online in the journal Pediatrics, reveal that the positive reactions from friends, family and even medical professionals may be the very reason such eating disorders are not detected at an earlier stage.

Two cases of formerly overweight teens were presented in the study:

A 14-year-old boy who lost 87 pounds in 2 yearsAn 18-year-old girl who lost 83 pounds in 3 years, going from the 97th percentile for body mass index (BMI) to the 10th percentile.

In the first case, the boy's attempts to exercise and eat healthfully quickly turned into "severe restriction." Although he lost more than half his body weight, the study's authors say that his medical notes did not point to an eating disorder concern until his mother asked for an evaluation.

In the second case, the girl's mother worried about her daughter's low fat intake and eating habits, but doctors overlooked her concerns, writing off the teen's lack of menstrual period and dizziness as dehydration or maybe even polycystic ovary syndrome (PCOS).

In both cases, although the teens underwent regular medical examinations and showed "obvious signs of malnutrition," their eating disorders were not diagnosed and they worsened as a result.

Dr. Leslie Sim, an eating disorders expert from the Mayo Clinic and lead author of the study, says that early intervention is key when it comes to eating disorders:

"Given research that suggests early intervention promotes best chance of recovery, it is imperative that these children and adolescents' eating disorder symptoms are identified and intervention is offered before the disease progresses."

According to the study's authors, at least 6% of adolescents have an eating disorder, and more than 55% of high school girls and 30% of boys report disordered eating habits to lose weight, such as fasting, using diet pills, vomiting, using laxatives or binge eating.

Formerly overweight or obese teens who develop eating disorders, such as anorexia or bulimia, are not diagnosed as quickly as their peers in a normal weight range.

Dr. Sim notes that eating disorders carry high relapse rates and come with medical side effects that can be life-threatening. When undiagnosed - particularly in the cases of formerly overweight kids - the side effects of eating disorders can bring even more medical complications.

The study's authors write that though it is not widely known, a "substantial portion" of adolescents who are seen for eating disorders treatment have a weight history in the overweight or obese percentile, as defined for the Centers for Disease Control and Prevention (CDC).

According to the CDC, being overweight is defined as being between the 85th and 95th percentile for BMI in your age group, while obesity is defined as being over the 95th percentile.

The authors conclude the study by noting that any weight loss (even if it brings the child into the "average" range) should merit eating disorder screening. Regardless of the patient's weight, they say, every clinician should be on the lookout for symptoms of eating disorders.

Written by Marie Ellis

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our eating disorders section for the latest news on this subject.

Eating Disorders in Adolescents With a History of Obesity Leslie A. Sim, Jocelyn Lebow and Marcie Billings, Pediatrics, doi: 10.1542/peds.2012-3940, published online 9 September 2013.

Eating Disorders Often Go Undiagnosed in Patients Who Have a History of Obesity American Academy of Pediatrics release, accessed 9 September 2013.

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posted by Darliene H. on 10 Sep 2013 at 1:18 pm

The “well-intended” war on childhood obesity may have unintended consequences and causing serious problems with eating disorders.

As shown in the study, School Obesity Programs May Promote Worrisome Eating Behaviors and Physical Activity in Kids, the C.S. Mott Children's Hospital National Poll on Children's Health examined the possible association between school-based childhood obesity prevention programs and an increase in eating disorders among young children and adolescents. Thirty percent of parents of 6-14 year-olds reported at least one behavior in their children that could be associated with the development of an eating disorder.

I would like to recommend the free NAAFA Child Advocacy ToolkitSM (CATK) to assist you looking at programs. The total health of our nation's children is a serious responsibility.

The NAAFA Child Advocacy Toolkit shows how Health At Every Size® takes the focus off weight and directs it to healthful eating and enjoyable movement. It addresses bullying, building positive self-image and eliminating stigmatization of large children. Additionally, the CATK lists resources available to parents and educators or caregivers for educational materials, curriculum and programming that is beneficial for all children. It can be found at: http://tinyurl.com/7ma5bml

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Education protects women from the obesity associated with urban living

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Women's Health / Gynecology
Article Date: 10 Sep 2013 - 1:00 PDT Current ratings for:
Education protects women from the obesity associated with urban living

Research into the rise in obesity associated with the burgeoning industrial and service sectors in low- and middle-income countries found that education is a key factor in reducing the negative impact on women's health.

The study, conducted by researchers at UCL and published in the journal BMC Public Health, found that women with no formal education who were working in sedentary occupations were twice as likely to be 'centrally obese' - defined by measuring waist circumference - compared to women with no education working in agriculture.

However, for women with at least some degree of formal education, there was no such association. Educated women in sedentary occupations were no more likely to be centrally obese than educated women with agricultural occupations.

The study looked at a sample of 2,465 women aged 60+ years who participated in the Chinese Four Provinces study funded by Alzheimer's Research UK and conducted by Dr Ruoling Chen while based at UCL.

"China, like a number of other emerging economies, is undergoing a rapid economic transition with many people moving from agricultural to manual and service-based jobs in cities," says Dr Amina Aitsi-Selmi, the lead author of the study and a Wellcome Trust fellow at UCL (University College London).

"Millions of women leave their families of origin for the city to improve their living conditions and life prospects," she continues. "In parallel, Chinese markets are opening up to new consumer products and lifestyles which result in changes in diets and patterns of physical activity. As a result, the risk of obesity is increasing quickly in the Chinese population reflecting the impact of the growing obesity epidemic worldwide."

The data used in the study were nationally representative of the Chinese population and recorded detailed demographic, social and health information from all participants. This included the measurement of waist circumference which was used as a sensitive marker of central obesity and is known to be associated with the risk of diabetes and heart disease.

The study asked whether educated women had lower levels of obesity than their uneducated counterparts when they made a move from agricultural to non-agricultural jobs. The study also allowed for the impact of health behaviours including dietary patterns, smoking and alcohol consumption which are all known to affect obesity risk.

"We are only beginning to examine the effect of the wider determinants of obesity, like education and employment, on women in low- and middle-income countries," says Dr Aitsi-Selmi. "Unlike high income countries where obesity tends to concentrate in poor women with low levels of education, obesity varies in its pattern depending on which social determinant we look at. This is important because it means we can target interventions to the right groups and it may give us clues as to the mechanisms behind obesity in emerging economies where the food and economic environment is historically unique."

"More research is required in order to explain our findings but it appears that education may provide cognitive skills that help people make better decisions about their health," concludes Dr Aitsi-Selmi. "Our study suggests that investing in women's education may offer a solution by empowering individuals to look after their health. However, it is not a substitute for good public health systems and the regulation of commercial activity like marketing that puts pressure on individuals to consume unhealthy products and take unnecessary risks with their health."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our obesity / weight loss / fitness section for the latest news on this subject.

Aitsi-Selmi A., Chen R., Shipley M., Marmot M., Education is associated with lower levels of abdominal obesity in women with a non-agricultural occupation: an interaction study using China's four provinces survey, BMC Public Health

University College London

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Over 55s more likely to complete exercise on referral

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Main Category: Obesity / Weight Loss / Fitness
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Article Date: 10 Sep 2013 - 8:00 PDT Current ratings for:
Over 55s more likely to complete exercise on referral

Older patients and those with heart problems are more likely to take up and complete exercise on referral programs than younger or obese patients.

Researchers from the UK's University of Northumbria in Newcastle upon Tyne presented these findings at the British Science Festival in Newcastle this week and reported them in a recent BMJ Open paper.

Their observational study covered over 2,000 patients referred to exercise schemes in the UK and found older age was a strong predictor of take up and adherence, as was the site where the scheme took place, whereas obesity was a significant negative predictor.

The researchers also say that while those who completed their 6-month schemes reported significant changes in self- reported physical activity, the levels achieved were well below the UK recommendations for 150 minutes of moderate physical activity per week.

Research shows that patients over the age of 55 are more likely to adhere to exercise schemes recommended by GPs.

Exercise on referral schemes have been widely used in the UK since they were launched in the 1990s. Patients are referred to them from primary and secondary care.

They were set up because, while we know regular physical activity is good for health and reduces risk of conditions like stroke that can lead to early death, less than 40% of men and 30% of women in England do enough to benefit their health, say the study investigators.

Health professionals use the scheme to encourage patients with mental and physical health concerns, such as weight, cardiovascular and musculoskeletal conditions, to take up exercise as part of their treatment plan.

A typical example is where a General Practitioner (GP) refers patients to a local leisure facility or gym and fitness center, where they consult with an exercise specialist and then follow a program of supervised physical activity for about 10 or 12 weeks.

Dr. David Shovlin, a GP at Burn Brae Medical Group in Northumberland, UK, refers some of his patients to such a scheme. He told the press:

"Regular exercise is known to both prevent and improve control in a number of long-term conditions, notably hypertension and type 2 diabetes. It is a useful way to motivate patients initially to become more active, leading to improvements in the management of their condition and reduced need for medication."

Richard Ripley, a 65-year-old patient from Cramlington, Northumberland, was referred to such a scheme to help treat his type 2 diabetes.

He says he doubled his attendance at the gym after being referred on the scheme, and over a year later, is still going there regularly.

After being diagnosed with angina, he added an extra visit a week to his gym workouts, as he explains:

"Finding out that I have angina was quite a shock and it has encouraged me to start an extra Friday session at the gym in September. The longer you attend, the better you get at the various activities which spurs you on to do even more. It definitely gives you a new outlook on life and I fully intend to keep my activity levels up."

The study was commissioned because it is not clear how many patients who participate in such schemes actually change their activity levels in the longer term, particularly given many of them only last 12 weeks. Is Richard a typical example, or an exception?

Study leader Coral Hanson, who is working toward her PhD at Northumbria, is also lead for exercise on referral in Northumberland. She says:

"We found that there was little insight into the activity levels associated with exercise on referral schemes. Additionally, of the research in existence, the majority of it took place over just 3 months and it is widely understood that it can take up to 6 months to establish behavioural change."

The study investigated 2,233 patients who took part in exercise on referral schemes across Northumberland. The schemes lasted for 24 weeks and took place at nine local authority leisure sites. The patients were referred from primary and secondary care between July 2009 and September 2010.

Although 81% of patients referred to the schemes took part, only 53.5% completed 12 weeks and 42.9% completed the full 24 weeks of supervised activity.

Participants who completed the full 24 weeks significantly increased their self-reported levels of exercise after 24 weeks. Those who completed the full program attended an average of 23 out of 48 target supervised sessions.

Increasing age, being female and leisure site were linked to uptake, and increasing age and leisure site were also among the variables linked to adherence at 12 weeks.

Hanson says their study offers "more robust findings that can be used by healthcare professionals to adapt their schemes and ultimately deliver more effective programs."

Dr. Shovlin says the findings should help reduce the waste that results from unused appointments and tailor schemes to give better results for patients:

"This research shows that people who complete the Exercise on Referral programme are more likely to engage in physical activity in the medium term. Additionally, getting a better understanding of which patients are more likely to drop out will make it possible to identify reasons for non-completion and explore alternative ways of helping those individuals to increase their activity levels."

In another US study published recently, researchers found that every minute of minute of brisk exercise counts in the war against weight gain. This is in contrast to recommendations that state bouts of exercise have to last at least 10 minutes to have such an effect.

Written by Catharine Paddock PhD
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Insulin levels determine effect of weight loss on vascular function

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Main Category: Obesity / Weight Loss / Fitness
Also Included In: Vascular;  Diabetes
Article Date: 06 Sep 2013 - 0:00 PDT Current ratings for:
Insulin levels determine effect of weight loss on vascular function

Researchers have discovered that obese people who have lost considerable weight are more likely to have better blood vessel function if they show high levels of insulin following weight loss.

The study, published in the Journal of the American College of Cardiology, was conducted by researchers from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC).

According to the American Heart Association, there are around 78 million obese adults in the US alone. Although obesity can cause numerous health concerns, cardiovascular-related issues, such as ischemic heart disease and stroke, are the leading cause of death from the weight condition.

Obese or overweight individuals who undergo various weight-loss strategies improve their cardiovascular functions, but previous studies have suggested that plasma insulin levels may determine the extent to which cardiovascular benefit can be achieved following weight loss.

To study this further, the researchers followed 208 overweight or obese patients undergoing medical, dietary or bariatric surgical weight-loss treatment over a period of 1 year.

At both the baseline of the study and following weight loss, the patients' plasma metabolic parameters and vascular endothelial functions (state of the inner lining of blood vessels) were measured using ultrasound. Median plasma insulin levels were also recorded.

Results of the study revealed that those who had higher plasma insulin levels who also achieved greater than 10% weight loss showed significant improvements in blood vessel functions.

However, those with lower insulin levels did not show the same level of improvement, even when they lost a similar amount of weight.

Additionally, when the researchers analyzed patients who had a weight loss of up to 5%, only microvascular responses improved in the group with higher insulin levels.

Noyan Gokce, associate professor of medicine at BUSM and director of echocardiography at BMC, says:

"Our study has shown that insulin status is an important determinant of the positive effect of weight reduction on vascular function with hyperinsulinemic patients deriving the greatest benefit.

Reversal of insulin resistance and endothelial dysfunction may represent key therapeutic targets for cardiovascular risk reduction in obesity."

The researchers say this study suggests that a minimum of 10% weight loss is required in order to achieve extensive cardiovascular benefit.

More evidence was presented that obesity may lead to heart disease in a recent study from the National Heart, Lung and Blood Institute, which suggested that those who are obese for 20 years or more have double the risk of hardened coronary arteries.

But researchers from the Department of Epidemiology and Public Health at University College London conducted a study last year suggesting that obese people are not always at higher risk of cardiovascular disease or death, as long as they are metabolically healthy.

Written by Honor Whiteman

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Insulin status and vascular responses to weight loss in obesity, published in the Journal of the American College of Cardiology, 3 September 2013.

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Weight control: every minute of brisk exercise counts

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Article Date: 03 Sep 2013 - 0:00 PDT Current ratings for:
Weight control: every minute of brisk exercise counts

Every minute of high intensity physical activity counts in the war against weight gain, according to a new study published this week. Researchers from the University of Utah found a brief bout of intense exercise that works the heart and lungs has the same effect on preventing weight gain as the current recommendation of 10 or more minutes at a time.

The current guideline for Americans recommends that adults should do at least 150 minutes of moderate to vigorus physical activity in bouts of 8 to 10 minutes each week.

Moderate to vigorous physical activity is defined as a minimum of 2,020 counts per minute measured on an activity device called an accelerometer. Someone walking briskly at 3 miles per hour would reach this level.

Study leader Jessie X. Fan, professor of family and consumer studies at Utah, says:

"What we learned is that for preventing weight gain, the intensity of the activity matters more than duration."

She explains the finding is important because less than 5% of adults in the US are reaching the recommended level of physical activity.

"Knowing that even short bouts of 'brisk' activity can add up to a positive effect is an encouraging message for promoting better health," Fan adds.

What the researchers found is that higher intensity activity was linked to a lower risk for obesity, even when the periods of brisk exercise were less than 10 minutes.

In other words, even taking the stairs, leaving your car at the far end of the parking lot and walking briskly to the store count towards making a positive health difference.

The team says this could be good news for women in particular, because they tend to be less active than men on average, although their study found neither group came close to reaching 150 minutes a week with bouts of 8 to 10 minutes.

But when they counted shorter periods of higher intensity exercise, they found men reached 246 minutes per week on average, which is quite a bit more than the recommendation, and women came very close, at 144 minutes per week.

So the message is, where brisk exercise is concerned, every minute counts for health.

The study involved 2,202 women and 2,309 men who took part in NHANES, the National Health and Nutrition Examination Survey.

The team selected participants aged between 18 and 64, excluding certain groups, such as pregnant women and people unable to walk.

For a week between 2003 and 2006, the participants wore accelerometers to record their physical activity. The team reviewed these results against other health and demographic data collected as part of NHANES.

The physical activity results were ranked into four categories according to duration and intensity:

Long bouts of higher intensity exercise (over 10 minutes, more than 2,020 counts per minute or cpm on the accelerometer)Short bouts of higher intensity (under 10 minutes, more than 2,020 cpm)Long bouts of lower intensity (over 10 minutes, 760-2,020 cpm)Short bouts of lower intensity (under 10 minutes, 760-2,020 cpm).

The researchers compared the exercise results against body mass index (BMI), a standard measure of body fat based on height and weight that applies to adult men and women. A BMI between 18.5 and 24.9 is considered healthy weight, a BMI between 25 and 29.9 is overweight; and over 30 is obese.

Small bursts: an extra minute of high-intensity exercise daily lowers obesity risks by 5% for women and 2% for men.

The analysis showed that each extra daily minute of higher intensity exercise lowered the chances of being obese by 5% for the women and 2% for the men.

For women, each daily minute of higher intensity short bouts was tied to a reduction in BMI of 0.07. In other words, each daily minute of brisk exercise burned the calorie equivalent of 0.41 pounds.

This is similar to saying that comparing two women of height 5 ft, 5 in, the one who regularly does a minute of brisk exercise more per day will weigh nearly a half-pound less - all other things being equal.

The results for men were similar.

According to the US Centers for Disease Control and Prevention (CDC) moderate intensity activity is where you are working hard enough to raise your heart rate and break a sweat. One way to tell is that you can talk - but not sing - the words to your favorite song.

Brisk walking, riding a bike on level ground, or pushing a lawn mower are good examples of moderate intensity activity.

Moving to vigorous intensity activity would involve swapping the brisk walking for jogging, for example, because that is defined as breathing hard and fast, so your heart rate goes up quite a bit more. At this level, you will not be able to say much without pausing for breath.

A study published earlier this year found simply wearing a pedometer got people moving more and sitting less.

Written by Catharine Paddock PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our obesity / weight loss / fitness section for the latest news on this subject.

Moderate to Vigorous Physical Activity and Weight Outcomes: Does Every Minute Count?; Jessie X. Fan, Barbara B. Brown, Heidi Hanson, Lori Kowaleski-Jones, Ken R. Smith, Cathleen D. Zick; American Journal of Health Promotion, September 2013; 10.4278/ajhp.120606-QUAL-286 ; Abstract

Additional sources: University of Utah news release 1 September 2013; CDC physical activity guidelines, accessed 2 September 2013.

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