European Guidelines for Obesity Management in Adults

Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management. (C) 2015 S. Karger GmbH, Freibur

Fuzzy logic as a decision-making support system for the indication of bariatric surgery based on an index (OBESINDEX) generated by the association between body fat and body mass index

Background: A Fuzzy Obesity Index (OBESINDEX) for use as an alternative in bariatric surgery indication (BSI) is presented. The search for a more accurate method to evaluate obesity and to indicate a better treatment is important in the world health context. BMI (body mass index) is considered the main criteria for obesity treatment and BSI. Nevertheless, the fat excess related to the percentage of Body Fat (%BF) is actually the principal harmful factor in obesity disease that is usually neglected. This paper presents a new fuzzy mechanism for evaluating obesity by associating BMI with %BF that yields a fuzzy obesity index for obesity evaluation and treatment and allows building up a Fuzzy Decision Support System (FDSS) for BSI.

Methods: Seventy-two patients were evaluated for both BMI and %BF. These data are modified and treated as fuzzy sets. Afterwards, the BMI and %BF classes are aggregated yielding a new index (OBESINDEX) for input linguistic variable are considered the BMI and %BF, and as output linguistic variable is employed the OBESINDEX, an obesity classification with entirely new classes of obesity in the fuzzy context as well is used for BSI.

Results: There is a gradual, smooth obesity classification and BSI when using the proposed fuzzy obesity index when compared with other traditional methods for dealing with obesity.

Conclusion: The BMI is not adequate for surgical indication in all the conditions and fuzzy logic becomes an alternative for decision making in bariatric surgery indication based on the OBESINDEX

Pediatric Obesity: Influence on Drug Dosing and Therapeutics

Obesity is an ongoing global health concern and has only recently been recognized as a chronic disease of energy homeostasis and fuel partitioning. Obesity afflicts 17% of US children and adolescents. Severe obesity (³120% of the 95th percentile of BMI-for-age, or a BMI of ³35 kg/m2) is the fastest growing subgroup and now approaches 6% of all US youth. Health consequences (e.g., type 2 diabetes, coronary heart disease) are related in a dose-dependent manner to severity of obesity. Since therapeutic interventions are less effective in severe obesity, prevention is a high priority. Treatment plans involving combinations of behavioral therapy, nutrition and exercise achieve limited success. Only one drug, orlistat, is FDA-approved for long-term obesity management in adolescents 12 years and older. As part of comprehensive medication management, clinicians should consider the propensity for a given drug to aggravate weight gain and to consider alternatives that minimize weight impact. Medication management must take into account developmental changes as well as pathophysiology of obesity and comorbidities. Despite expanding insight into obesity pathophysiology, there are gaps in its translation to therapeutic application. The historical construct of obesity as simply a fat storage disorder is fundamentally inaccurate. The approach to adjusting doses based solely on body size and extrapolating from therapeutic knowledge of adult obesity may be based on assumptions that are not fully substantiated. Classes of drugs commonly prescribed for comorbidities associated with obesity should be prioritized for clinical research evaluations aimed at optimizing dosing regimens in pediatric obesity

Television viewing time and risk of incident obesity and central obesity: the English longitudinal study of ageing

Background Research suggests television viewing time may be associated with incident obesity and central obesity in young adults. No study has investigated these associations in older English adults. The aim of this study was to investigate longitudinal associations between television viewing time and incident obesity and central obesity in a sample of older English adults. Analyses of data from the English Longitudinal Study of Ageing. At baseline (2008), participants reported their television viewing time. Research nurses recorded obesity and central obesity by body mass index and waist circumference, respectively, at four year follow-up. Associations between television viewing time and incident obesity (BMI > 30 kg/m2) and central obesity (waist >102 cm men; > 88 cm women) at four year follow-up were examined using adjusted logistic regression. Participants gave full written informed consent to participate in the study and ethical approval was obtained from the London Multicentre Research Ethics Committee. Results A total of 3777 initially non-obese participants (aged 64.8 ± 8.6 yrs, 46.4% male) were included in the analyses using BMI as an outcome and 2947 for the analyses using waist circumference. No significant associations were found between television viewing time and incident obesity. A significant association was found between watching ≥6 hrs/d of television (compared to <2 hrs/d) and central obesity (Odds Ratio 1.48; 95% confidence interval 1.07 to 2.03) after adjustment for covariables including physical activity. Conclusions In this sample of older community dwelling English adults greater television viewing time was associated with incident central obesity, but not total obesity when measured by BMI. Interventions to reduce the incidence of central obesity in this age group that focus on reducing TV time, as well as targeting other health behaviours (eg, increasing physical activity levels, improving dietary intake) might prove useful

Adult socioeconomic, educational, social, and psychological outcomes of childhood obesity: a national birth cohort study

Objectives: To assess adult socioeconomic, educational, social, and psychological outcomes of childhood obesity by using nationally representative data. Design: 1970 British birth cohort. Participants: 16 567 babies born in Great Britain 5-11 April 1970 and followed up at 5, 10, and 29-30 years. Main outcome measures: Obesity at age 10 and 30 years. Self reported socioeconomic, educational, psychological, and social outcomes at 30 years. Odds ratios were calculated for the risk of each adult outcome associated with obesity in childhood only, obesity in adulthood only, and persistent child and adult obesity, compared with those obese at neither period. Results: Of the 8490 participants with data on body mass index at 10 and 30 years, 4.3% were obese at 10 years and 16.3% at 30 years. Obesity in childhood only was not associated with adult social class, income, years of schooling, educational attainment, relationships, or psychological morbidity in either sex after adjustment for confounding factors. Persistent obesity was not associated with any adverse adult outcomes in men, though it was associated among women with a higher risk of never having been gainfully employed (odds ratio 1.9, 95% confidence interval 1.1 to 3.3) and not having a current partner (2.0, 1.3 to 3.3). Conclusions: Obesity limited to childhood has little impact on adult outcomes. Persistent obesity in women is associated with poorer employment and relationship outcomes. Efforts to reduce the socioeconomic and psychosocial burden of obesity in adult life should focus on prevention of the persistence of obesity from childhood into adulthood

Relationship between breast feeding and obesity in children with low birth weight

Background: Breast feeding appears to play a role in determining obesity and abdominal obesity during childhood, specifically in children with a history of low birth weight. Objective: The purpose of this study is to investigate the relation of breast-feeding with either of abdominal obesity and obesity among Iranian school children. Materials and Methods: A total of 1184 students (625 girls and 559 boys), aged 10 to 13 years old, were selected from 112 governmental elementary schools in Iran. Height, weight, waist circumference and blood pressure were measured using standard instruments and a pretested standardized questionnaire was performed for compiling information about family economics and educational level, first–degree family history of obesity, history of breast feeding, food pattern and birth weight, as well. Results: 13.68% (n = 160) of students had a history of low birth weight, and 26.41% of them had abdominal obesity. Of all participants, 22.04% were overweight and 5.32% were obese which was more prevalent in girls than in boys (P = 0.03). First-degree family history of obesity (P = 0.001), excessive gestational weight gain (P = 0.001) and birth weight (P = 0.01) were significantly correlated with the prevalence of obesity and abdominal obesity during childhood. Moreover the prevalence of abdominal obesity in children with low birth weight was significantly correlated with breast feeding (P = 0.04); But this relation was not significantly about obesity in our participants (P = 0.9). Furthermore duration of breast feeding was significantly and inversely correlated with obesity and abdominal obesity in schoolchildren with low birth weight (P = 0.01). Conclusions: The results suggest that Breast feeding and its long-term consequences were important factors for preventing metabolic syndrome criteria in childhood and later years of life span. With regard to the increasing prevalence of obesity in children, more research is urgently needed to clarify whether breast feeding have negative consequences for the risk of chronic disease in children, especially in children with low birth weight

Fuzzy logic as a decision-making support system for the indication of bariatric surgery based on an index (MAFOI) generated by the association between body fat and body mass index.

Background: A fuzzy obesity index (MAFOI) for use as an alternative to bariatric surgery indication (BSI) is presented. The search for a more accurate method to evaluate obesity and to indicate a better treatment is important in the world health context. BMI (body mass index) is considered the main criteria for obesity treatment and BSI. Nevertheless, the fat excess related to the percentage of Body Fat (%BF) is actually the principal harmful factor in obesity disease that is usually neglected. This paper presents a new fuzzy mechanism for evaluating obesity by associating BMI with %BF that yields a fuzzy obesity index for obesity evaluation and treatment and allows building up a Fuzzy Decision Support System (FDSS) for BSI. Methods: Seventy-two patients were evaluated for both BMI and %BF. These data are modified and treated as fuzzy sets. Afterwards, the BMI and %BF classes are aggregated yielding a new index (MAFOI) for input linguistic variable are considered the BMI and %BF, and as output linguistic variable is employed the MAFOI, an obesity classification with entirely new classes of obesity in the fuzzy context as well as is used for BSI. Results: There is gradual, smooth obesity classification and BSI when using the proposed fuzzy obesity index when compared with other traditional methods for dealing with obesity.&#xd;&#xa;Conclusion: The BMI is not adequate for surgical indication in all the conditions and fuzzy logic becomes an alternative for decision making in bariatric surgery indication based on the MAFOI

Should strategies to tackle childhood obesity also focus on mental health?

Childhood obesity continues to be a concern in the UK as in many other countries. Although there has been a ‘levelling off’ of BMI recorded through the National Childhood Measurement Programme in recent years the upward trend continues in older and more deprived children. Childhood obesity has been linked to poor mental health but whether psychological and social problems are a consequence or a contributor to obesity is unknown. Childhood obesity programmes that recognise and address psychosocial problems are proving useful in addressing obesity problems but there continued support is subject to continued funding. School Nurses, by measuring children’s height and weight, can identify children at risk of obesity but this is ineffective on its own and more support and advice is needed for School Nurses on how to tackle the complex conditions surrounding childhood obesity

The Effect of Obesity on State Health Care Expenditures: An Empirical Analysis

The purpose of this study is to examine the effects of obesity rates on per capita state health care expenditures. A two-stage least square regression model is used. In the first stage of the estimation, factors influencing obesity rates are determined. The determinants of obesity rates are outlined throughout the research process. In the second stage, the impact of obesity rates on per capita health expenditures across states is evaluated. The empirical results indicate that obesity rates do indeed have a direct effect on state health care expenditures. After reviewing the project’s results, various solutions are proposed as possible methods to slow and perhaps reverse growing obesity rates with the objective of reducing health care expenditures. The solutions offered may possibly decrease the prevalence of obesity across the nation and in turn lower per capita health care spending