A Proposal of the European Association for the Study of Obesity to Improve the ICD-11 Diagnostic Criteria for Obesity Based on the Three Dimensions Etiology, Degree of Adiposity and Health Risk

Diagnostic criteria for complex medical conditions caused by a multitude of both genetic and environmental factors should be descriptive and avoid any attribution of causality. Furthermore, the wording used to describe a disorder should be evidence-based and avoid stigmatization of the affected individuals. Both terminology and categorizations should be readily comprehensible for healthcare professionals and guide clinical decision making. Uncertainties with respect to diagnostic issues and their implications may be addressed to direct future clinical research. In this context, the European Association of the Study of Obesity (EASO) considers it an important endeavor to review the current ICD-11 Beta Draft for the definition of overweight and obesity and to propose a substantial revision. We aim to provide an overview of the key issues that we deem relevant for the discussion of the diagnostic criteria. We first discuss the current ICD-10 criteria and those proposed in the ICD 11 Beta Draft. We conclude with our own proposal for diagnostic criteria, which we believe will improve the assessment of patients with obesity in a clinically meaningful way

Perturbations of spacetime: gauge transformations and gauge invariance at second order and beyond

We consider in detail the problem of gauge dependence that exists in relativistic perturbation theory, going beyond the linear approximation and treating second and higher order perturbations. We first derive some mathematical results concerning the Taylor expansion of tensor fields under the action of one-parameter families (not necessarily groups) of diffeomorphisms. Second, we define gauge invariance to an arbitrary order $n$. Finally, we give a generating formula for the gauge transformation to an arbitrary order and explicit rules to second and third order. This formalism can be used in any field of applied general relativity, such as cosmological and black hole perturbations, as well as in other spacetime theories. As a specific example, we consider here second order perturbations in cosmology, assuming a flat Robertson-Walker background, giving explicit second order transformations between the synchronous and the Poisson (generalized longitudinal) gauges.Comment: slightly revised version, accepted for publication in Classical and Quantum Gravity. 27 pages including 4 figures, latex using 2 CQG style files: ioplppt.sty, iopl10.st

Impact des ultrasons diffus combinés au travail musculaire sur plaque vibrante sur la modification de la composition corporelle de femmes modérément obèses

Objectifs: Étudier les effets d’ultrasons diffus appliqués dans la région abdominale combinés au travail musculaire sur plaque vibrante chez des femmes obèses. Cette méthode a pour but d’accélérer la mobilisation de graisse du tissu adipeux abdominal.Méthodes: 40 femmes obèses sédentaires, âgées entre 18 et 55 ans, avec un IMC ≥ 30 kg/m2 et ≤ 40 kg/m2 ont été randomisées en 3 groupes. Un groupe témoin (CONTR, n=13), un groupe vibration (VIB, n=16), et un groupe vibration combiné à une ceinture abdominale à ultrasons (VIB+US, n=11).Résultats: Cette étude exploratoire a montré que le groupe VIB+US a réduit significativement la circonférence abdominale (de 8 %), et la masse grasse totale (de 7 %). Les résultats dans le groupe VIB étaient similaires (réduction de 7 et 5 % respectivement) mais ceux-ci ont été obtenus en 2 fois plus de temps (12 semaines plutôt que 6 semaines).Conclusion: Cette étude préliminaire montre l’efficacité de cette nouvelle méthode — qui associe une ceinture abdominale à ultrasons diffus à un exercice sur plateforme vibrante — sur la vitesse de déstockage de la masse grasse totale et notamment au niveau abdominal sous-cutané, dont la mobilisation est particulièrement difficile. Ces résultats nécessitent non seulement une confirmation dans un groupe d’obèses plus important et traité plus longtemps, mais aussi l’adjonction de mesures biochimiques, cellulaires et moléculaires afin d’en mieux comprendre les mécanismes sous-jacents.Objectives: To study, in obese subjects, the effect of diffuse ultrasound application in the abdominal area combined to muscular work on a vibrating platform. This dual method aims at accelerating the mobilisation of adipose tissue.Methods: 40 sedentary obese women, 18 to 55 years old, with a BMI ≥30 kg/m2 and ≤40 kg/m2 were randomized into 3 groups. 1) A control group (CONTR, n=13), 2) a vibration group (VIB, n=16), and 3) a vibration + ultrasonic group combined (VIB+US, n=11).Results: This exploratory study has shown that the group VIB+US has significantly diminished the rate of abdominal circumference reduction (by 8%), the total body fat mobilisation (by 7%). In the the VIB group, similar results were obtained (7 and 5% reduction respectively) but within 12 weeks rather than 6 weeks.Conclusion: this study indicates the efficiency of a dual treatment associating muscular work on the vibrating plateform to diffuse ultrasounds on the rate of mobilization of total body fat, in particular in the abdominal subcutaneous area, which is generally refractory to mobilization. These results could justify, for well selected patients, the use of this new method, together with others, in the treatment of the android obesity. These very preliminary results require further validations by independent laboratories in a much larger group of obese, with a study of longer duration in different phenotypes of obese, with biochemical, cellular and molecular approaches to better understand the underlying mechanism

ADOS: an educational primary prevention programme for preventing excess body weight in adolescents.

OBJECTIVE: The prevalence of adolescent obesity has increased considerably over the past decade in Switzerland and has become a serious public health problem in Europe. Prevention of obesity using various comprehensive programmes appears to be very promising, although we must admit that several interventions had generally disappointing results compared with the objectives and target initially fixed. Holistic programmes including nutritional education combined with promotion of physical activity and behaviour modification constitute the key factors in the prevention of childhood and adolescent obesity. The purpose of this programme was to incorporate nutrition/physical education as well as psychological aspects in selected secondary schools (9th grade, 14-17 years). METHODS: The educational strategy was based on the development of a series of 13 practical workshops covering wide areas such as physical inactivity, body composition, sugar, energy density, invisible lipids, how to read food labels, is meal duration important? Do you eat with pleasure or not? Do you eat because you are hungry? Emotional eating. For teachers continuing education, a basic highly illustrated guide was developed as a companion booklet to the workshops. These materials were first validated by biology, physical education, dietician and psychologist teachers as well as school medical officers. RESULTS: Teachers considered the practical educational materials innovative and useful, motivational and easy to understand. Up to now (early 2008), the programme has been implemented in 50 classes or more from schools originating from three areas in the French part of Switzerland. Based on the 1-week pedometer value assessed before and after the 1 school-year programme, an initial evaluation indicated that overall physical placidity was significantly decreased as evidenced by a significant rise in the number of steps per day. CONCLUSION: Future evaluation will provide more information on the effectiveness of the ADOS programme

A new accelerometric method to assess the daily walking practice.

OBJECTIVE: To describe a method to obtain a profile of the duration and intensity (speed) of walking periods over 24 hours in women under free-living conditions. DESIGN: A new method based on accelerometry was designed for analyzing walking activity. In order to take into account inter-individual variability of acceleration, an individual calibration process was used. Different experiments were performed to highlight the variability of acceleration vs walking speed relationship, to analyze the speed prediction accuracy of the method, and to test the assessment of walking distance and duration over 24-h. SUBJECTS: Twenty-eight women were studied (mean+/-s.d.) age: 39.3+/-8.9 y; body mass: 79.7+/-11.1 kg; body height: 162.9+/-5.4 cm; and body mass index (BMI) 30.0+/-3.8 kg/m(2). RESULTS: Accelerometer output was significantly correlated with speed during treadmill walking (r=0.95, P<0.01), and short unconstrained walks (r=0.86, P<0.01), although with a large inter-individual variation of the regression parameters. By using individual calibration, it was possible to predict walking speed on a standard urban circuit (predicted vs measured r=0.93, P<0.01, s.e.e.=0.51 km/h). In the free-living experiment, women spent on average 79.9+/-36.0 (range: 31.7-168.2) min/day in displacement activities, from which discontinuous short walking activities represented about 2/3 and continuous ones 1/3. Total walking distance averaged 2.1+/-1.2 (range: 0.4-4.7) km/day. It was performed at an average speed of 5.0+/-0.5 (range: 4.1-6.0) km/h. CONCLUSION: An accelerometer measuring the anteroposterior acceleration of the body can estimate walking speed together with the pattern, intensity and duration of daily walking activity