A Prospective study of the association between weight changes and self-rated health

<p>Abstract</p> <p>Background</p> <p>Obesity and self-rated health (SRH) are strong predictors of morbidity and mortality but their interrelation is sparsely studied. The aim of this study was to analyse the association between weight changes and changes in SRH among women. We also examined if poor SRH at baseline was associated with later weight gain.</p> <p>Methods</p> <p>The Danish Nurse Cohort Study is a prospective population study (1993–1999) and comprises 13,684 female nurses aged 44 to 69 years. Logistic regression analyses were used to examine the association between weight changes and changes in SRH.</p> <p>Results</p> <p>Women who gained weight during the study period had higher odds of reporting poorer self-rated health (Odds Ratio (OR): 1.18, 95% CI: 1.04–1.35). Weight loss among overweight women, did not result in an increase in self-rated health ratings, in fully adjusted analyses (0.96 (95% CI: 0.76–1.23). Poor self-rated health combined with normal weight at first examination was associated with higher odds of later weight gain (OR: 1.29, 95% CI: 1.10–1.51).</p> <p>Conclusion</p> <p>Weight changes may result in lower SRH. Further, poor self-rated health at baseline seems to predict an increase in weight, among women without any longstanding chronic diseases. Future obesity prevention may focus on normal weight individuals with poor SRH.</p

Effectiveness and cost-effectiveness of 'BeweegKuur', a combined lifestyle intervention in the Netherlands: Rationale, design and methods of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Improving the lifestyle of overweight and obese adults is of increasing interest in view of its role in several chronic diseases. Interventions aiming at overweight or weight-related chronic diseases suffer from high drop-out rates. It has been suggested that Motivational Interviewing and more frequent and more patient-specific coaching could decrease the drop-out rate. 'BeweegKuur' is a multidisciplinary lifestyle intervention which offers three programmes for overweight persons. The effectiveness and the cost-effectiveness of intensively guided programmes, such as the 'supervised exercise programme' of 'BeweegKuur', for patients with high weight-related health risk, remain to be assessed. Our randomized controlled trial compares the expenses and effects of the 'supervised exercise programme' with those of the less intensively supervised 'start-up exercise programme'.</p> <p>Methods/Design</p> <p>The one-year intervention period involves coaching by a lifestyle advisor, a physiotherapist and a dietician, coordinated by general practitioners (GPs). The participating GP practices have been allocated to the interventions, which differ only in terms of the amount of coaching offered by the physiotherapist. Whereas the 'start-up exercise programme' includes several consultations with physiotherapists to identify barriers hampering independent exercising, the 'supervised exercise programme' includes more sessions with a physiotherapist, involving exercise under supervision. The main goal is transfer to local exercise facilities. The main outcome of the study will be the participants' physical activity at the end of the one-year intervention period and after one year of follow-up. Secondary outcomes are dietary habits, health risk, physical fitness and functional capacity. The economic evaluation will consist of a cost-effectiveness analysis and a cost-utility analysis. The primary outcome measures for the economic evaluation will be the physical activity and the number of quality-adjusted life years. Costs will be assessed from a societal perspective with a time horizon of two years. Additionally, a process evaluation will be used to evaluate the performance of the intervention and the participants' evaluation of the intervention.</p> <p>Discussion</p> <p>This study is expected to provide information regarding the additional costs and effects of the 'supervised exercise programme' in adults with very high weight-related health risk.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN46574304">ISRCTN46574304</a></p

Exercise and Type 2 Diabetes: The American College of Sports Medicine and the American Diabetes Association: joint position statement

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications

Pretest variables that improve the predictive value of exercise testing in women

Aim. Graded exercise testing (GXT) is used in coronary artery disease (CAD) prevention and rehabilitation programs. In women, this test has a decreased accuracy and predictive value but there are few studies that examine the predictors of a veriied positive test. The aim of this study was to determine those pretest variables that might enhance the predictive value of the GXT in women clients. Methods. Medical records of 1761 patients referred for GXT\u27s over a 5 yr period of time were screened. Demographic, medical, and exercise test variables were analyzed. The GXT\u27s of 403 women were available for inclusion and they were stratiied into 3 groups: positive responders that were subsequently shown to have CAD (N.=28 veriied positive [VP]), positive responders that were not shown to have CAD (N.=84 non-veriied positive [NVP]) and negative GXT responders (N.=291). Both univariate and a multivariate step-wise regression statistics were performed on this data. Results. Pretest variables that differentiated between VP and NVP groups are: (an older age=65.8 vs. 60.2 yrs. P\u3c0.05; a greater BMI=30.8 vs. 28.8 kg/m2; diabetes status or an elevated fasting glucose =107.4 vs. 95.2 mg/dL P\u3c0.05; and the use of some cardiovascular medications. Our subsequent linear regression analysis emphasized that HDL cholesterol and beta blocker usage were the most predictive of a positive exercise test in this cohort. Conclusion. The American Heart Association recommends GXT\u27s in women with an intermediate pretest probability of CAD. But there are only two clinical variables available prior to testing to make this probability decision: age and quality of chest pain. This study outlined that other pre-exercise test variables such as: BMI, blood chemistry (glucose and lipoprotein levels) and the use of cardiovascular medications are useful in clinical decision making. These pre-exercise test variables improved the predictive value of the GXT\u27s in our sample

Physical activity and physique anxiety in older adults: Fitness, and efficacy influences

Employing a randomized controlled trial, this study documents the effects of six months of physical activity and six month follow-up on reduction in social physique anxiety (SPA) in older adults. In addition, the role played by changes in behavioral, physiological, and psychological predictors of changes in SPA were examined. Participants (n = 174, mean age = 65 yrs) were randomly assigned to one of two activity groups and engaged in a six-month structured exercise program. Measures of physique anxiety were taken at baseline, six and twelve months. Latent growth curve analyses revealed significant reductions in SPA over the course of the 12-month period. Structural analyses controlling for treatment condition indicated that improvements in self-efficacy and fitness were significant predictors of changes in SPA but that changes in body fat and exercise frequency did not contribute to variation in SPA. Overall this model accounted for 19% of the variation in SPA changes. The extent to which changes in SPA may contribute to continued physical activity participation in older adults and how exercise programs might effectively influence predictors of SPA are discussed

Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review

Lifestyle interventions can reduce body weight, but weight regain is common and may particularly occur with higher initial weight loss. If so, one may argue whether the 10% weight loss in clinical guidelines is preferable above a lower weight loss. This systematic review explores the relation between weight loss during an intervention and weight maintenance after at least 1 year of unsupervised follow-up. Twenty-two interventions (during at least 1 month) in healthy overweight Caucasians were selected and the mean percentages of weight loss and maintenance were calculated in a standardized way. In addition, within four intervention groups (n \u3e 80) maintenance was calculated stratified by initial weight loss (0-5%, 5-10%, \u3e10%). Overall, mean percentage maintenance was 54%. Weight loss during the intervention was not significantly associated with percentage maintenance (r = -0.26; P = 0.13). Percentage maintenance also not differed significantly between interventions with a weight loss of 5-10% vs. \u3e10%. Consequently, net weight loss after follow-up differed between these categories (3.7 vs. 7.0%, respectively; P \u3c 0.01). The analyses within the four interventions confirmed these findings. In conclusion, percentage maintenance does not clearly depend on initial weight loss. From this perspective, 10% or more weight loss can indeed be encouraged and favoured above lower weight loss goals. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity

Body mass index and health-related quality of life among young Swiss men

BACKGROUND: Studies about the association between body mass index (BMI) and health-related quality of life (HRQOL) are often limited, because they 1) did not include a broad range of health-risk behaviors as covariates; 2) relied on clinical samples, which might lead to biased results; and 3) did not incorporate underweight individuals. Hence, this study aims to examine associations between BMI (from being underweight through obesity) and HRQOL in a population-based sample, while considering multiple health-risk behaviors (low physical activity, risky alcohol consumption, daily cigarette smoking, frequent cannabis use) as well as socio-demographic characteristics. METHODS: A total of 5 387 young Swiss men (mean age = 19.99; standard deviation = 1.24) of a cross-sectional population-based study were included. BMI was calculated (kg/m2) based on self-reported height and weight and divided into 'underweight' (=30.0). Mental and physical HRQOL was assessed via the SF-12v2. Self-reported information on physical activity, substance use (alcohol, cigarettes, and cannabis) and socio-demographic characteristics also was collected. Logistic regression analyses were conducted to study the associations between BMI categories and below average mental or physical HRQOL. Substance use variables and socio-demographic variables were used as covariates. RESULTS: Altogether, 76.3 % were normal weight, whereas 3.3 % were underweight, 16.5 % overweight and 3.9 % obese. Being overweight or obese was associated with reduced physical HRQOL (adjusted OR [95 % CI] = 1.58 [1.18-2.13] and 2.45 [1.57-3.83], respectively), whereas being underweight predicted reduced mental HRQOL (adjusted OR [95 % CI] = 1.49 [1.08-2.05]). Surprisingly, obesity decreased the likelihood of experiencing below average mental HRQOL (adjusted OR [95 % CI] = 0.66 [0.46-0.94]). Besides BMI, expressed as a categorical variable, all health-risk behaviors and socio-demographic variables were associated with reduced physical and/or mental HRQOL. CONCLUSIONS: Deviations from normal weight are, even after controlling for important health-risk behaviors and socio-demographic characteristics, associated with compromised physical or mental HRQOL among young men. Hence, preventive programs should aim to preserve or re-establish normal weight. The self-appraised positive mental well-being of obese men noted here, which possibly reflects a response shift, might complicate such efforts