Edmonton Obesity Staging System Prevalence and Association with Weight Loss in a Publicly Funded Referral-Based Obesity Clinic

Objectives. To determine the distribution of EOSS stages and differences in weight loss achieved according to EOSS stage, in patients attending a referral-based publically funded multisite weight management clinic. Subjects/Methods. 5,787 obese patients were categorized using EOSS staging using metabolic risk factors, medication use, and severity of doctor diagnosis of obesity-related physiological, functional, and psychological comorbidities from electronic patient files. Results. The prevalence of EOSS stages 0 (no risk factors or comorbidities), 1 (mild conditions), 2 (moderate conditions), and 3 (severe conditions) was 1.7%, 10.4%, 84.0%, and 3.9%, respectively. Prehypertension (63%), hypertension (76%), and knee replacement (33%) were the most common obesity-related comorbidities for stages 1, 2, and 3, respectively. In the models including age, sex, initial BMI, EOSS stage, and treatment time, lower EOSS stage and longer treatment times were independently associated with greater absolute (kg) and percentage of weight loss relative to initial body weight P<0.05. Conclusions. Patients attending this publicly funded, referral-based weight management clinic were more likely to be classified in the higher stages of EOSS. Patients in higher EOSS stages required longer treatment times to achieve similar weight outcomes as those in lower EOSS stages

Whole-Body MRI and Ethnic Differences in Adipose Tissue and Skeletal Muscle Distribution in Overweight Black and White Adolescent Boys

It is unclear whether ethnic differences exist in adipose tissue (AT) and skeletal muscle (SM) distribution in black and white youth. Investigation into the pattern of AT and SM distribution in black versus white youth may provide insight into the previously reported health disparities between these ethnicities. Therefore, we examined total and regional AT and SM in overweight black and white boys. The study sample included overweight black (n = 19) and white (n = 21) boys (11–18 yr, BMI ≥ 85th) whose body composition was evaluated using whole-body MRI. Despite similar age, Tanner stage, and BMI, black boys had significantly (P < .05) less visceral AT than white boys and more (P < .05) total and lower-body subcutaneous AT (SAT) in both absolute (kg) and relative (%) terms. There was a main effect (P < .05) of ethnicity on the relationship between total and regional AT, such that for a given amount of total body AT (kg), black boys had a greater (P < .05) lower-body SAT and less visceral AT than their white peers. For a given amount of total SM, black boys had more (P < .05) SM in the thigh. Compared with overweight white boys, overweight black boys have less visceral fat, more subcutaneous fat, and more thigh skeletal muscle

The Influence of Urinary Concentrations of Organophosphate Metabolites on the Relationship between BMI and Cardiometabolic Health Risk

The objective was to determine whether detectable levels of OP metabolites influence the relationship between BMI and cardiometabolic health. This cross-sectional study was conducted using 2227 adults from the 1999–2008 NHANES datasets. Urinary concentrations of six dialkyl phosphate metabolites were dichotomized to above and below the detection limit. Weighted multiple regression analysis was performed adjusting for confounding variables. Independent of BMI, individuals with detectable metabolites had higher diastolic blood pressure (for dimethylphosphate, diethylphosphate, and diethyldithiophosphate; P<0.05), lower HDL (for diethyldithiophosphate; P=0.02), and higher triglyceride (for dimethyldithiophosphate; P=0.05) than those below detection. Contrarily, those with detectable dimethylthiophosphate had better LDL, HDL, and total cholesterol, independent of BMI. Individuals at a higher BMI range who had detectable diethylphosphate (interaction: P=0.03) and diethylthiophosphate (interaction: P=0.02) exhibited lower HDL, while little difference existed between OP metabolite detection statuses at lower BMIs. Similarly, individuals with high BMIs and detectable diethylphosphate had higher triglyceride than those without detectable levels, while minimal differences between diethylphosphate detection statuses were observed at lower BMIs (interaction: P=0.02). Thus, cardiometabolic health outcome differs depending on the specific OP metabolite being examined, with higher BMIs amplifying health risk

Edmonton Obesity Staging System: association with weight history and mortality risk

Abstract: We sought to determine whether the Edmonton Obesity Staging System (EOSS), a newly proposed tool using obesity-related comorbidities, can help identify obese individuals who are at greater mortality risk. Data from the Aerobics Center Longitudinal Study (n = 29 533) were used to assess mortality risk in obese individuals by EOSS stage (follow-up (SD), 16.2 (7.5) years). The effect of weight history and lifestyle factors on EOSS classification was explored. Obese participants were categorized, using a modified EOSS definition, as stages 0 to 3, based on the severity of their risk profile and conditions (stage 0, no risk factors or comorbidities; stage 1, mild conditions; and stages 2 and 3, moderate to severe conditions). Compared with normal-weight individuals, obese individuals in stage 2 or 3 had a greater risk of all-cause mortality (stage 2 hazards ratio (HR) (95% CI), 1.6 (1.3-2.0); stage 3 HR, 1.7 (1.4-2.0)) and cardiovascular-related mortality (stage 2 HR, 2.1 (1.6-2.8); stage 3 HR. 2.1 (1.6-2.8)). Stage 0/1 was not associated with higher mortality risk. Lower self-ascribed preferred weight, weight at age 21, cardiorespiratory fitness, reported dieting, and fruit and vegetable intake were each associated with an elevated risk for stage 2 or 3. Thus, EOSS offers clinicians a useful approach to identify obese individuals at elevated risk of mortality who may benefit from more attention to weight management. Further research is necessary to determine what EOSS factors are most predictive of mortality risk, and whether these findings can be generalized to other obese populations

Differences in physical activity domains, guideline adherence, and weight history between metabolically healthy and metabolically abnormal obese adults: a cross-sectional study

BACKGROUND: Despite the accepted health consequences of obesity, emerging research suggests that a significant segment of adults with obesity are metabolically healthy (MHO). To date, MHO individuals have been shown to have higher levels of physical activity (PA), but little is known about the importance of PA domains or the influence of weight history compared to their metabolically abnormal (MAO) counterpart. OBJECTIVE: To evaluate the relationship between PA domains, PA guideline adherence, and weight history on MHO. METHODS: Pooled cycles of the National Health and Nutritional Examination Survey (NHANES) 1999–2006 (≥20 y; BMI ≥ 30 kg/m(2); N = 2,753) and harmonized criteria for metabolic syndrome (MetS) were used. Participants were categorized as “inactive” (no reported PA), “somewhat active” (>0 to < 500 metabolic equivalent (MET) min/week), and “active” (PA guideline adherence, ≥ 500 MET min/week) according to each domain of PA (total, recreational, transportation and household). Logistic and multinomial regressions were modelled for MHO and analyses were adjusted for age, sex, education, ethnicity, income, smoking and alcohol intake. RESULTS: Compared to MAO, MHO participants were younger, had lower BMI, and were more likely to be classified as active according to their total and recreational PA level. Based on total PA levels, individuals who were active had a 70 % greater likelihood of having the MHO phenotype (OR = 1.70, 95 % CI: 1.19–2.43); however, once stratified by age (20–44 y; 45–59 y; and; ≥60 y), the association remained significant only amongst those aged 45–59 y. Although moderate and vigorous PA were inconsistently related to MHO following adjustment for covariates, losing ≥30 kg in the last 10 y and not gaining ≥10 kg since age 25 y were significant predictors of MHO phenotype for all PA domains, even if adherence to the PA guidelines were not met. CONCLUSION: Although PA is associated with MHO, the beneficial effects of PA may be moderated by longer-term changes in weight. Longitudinal analysis of physical activity and weight change trajectories are necessary to isolate the contribution of duration of obesity, PA behaviours, and longer-term outcomes amongst MHO individuals

The International Bathymetric Chart of the Southern Ocean Version 2 (IBCSO v2)

The Southern Ocean surrounding Antarctica is a region that is key to a range of climatic and oceanographic processes with worldwide effects, and is characterised by high biological productivity and biodiversity. Since 2013, the International Bathymetric Chart of the Southern Ocean (IBCSO) has represented the most comprehensive compilation of bathymetry for the Southern Ocean south of 60°S. Recently, the IBCSO Project has combined its efforts with the Nippon Foundation – GEBCO Seabed 2030 Project supporting the goal of mapping the world’s oceans by 2030. New datasets initiated a second version of IBCSO (IBCSO v2). This version extends to 50°S (covering approximately 2.4 times the area of seafloor of the previous version) including the gateways of the Antarctic Circumpolar Current and the Antarctic circumpolar frontal systems. Due to increased (multibeam) data coverage, IBCSO v2 significantly improves the overall representation of the Southern Ocean seafloor and resolves many submarine landforms in more detail. This makes IBCSO v2 the most authoritative seafloor map of the area south of 50°S

Assessing the utility of cardiorespiratory fitness, visceral fat, and liver fat in predicting changes in insulin sensitivity beyond simple changes in body weight after exercise training in adolescents

To examine the utility of changes in cardiorespiratory fitness (CRF) and body composition in response to exercise training in adolescents with obesity beyond simple measures of body weight change. This is a secondary analysis of our previously published randomized trials of aerobic, resistance, and combined training. We included 104 adolescents (body mass index (BMI) ≥85th percentile) who had complete baseline and post-intervention data for CRF, regional body fat, insulin sensitivity, and oral glucose tolerance. Associations between changes in body composition and CRF with cardiometabolic variables were examined adjusted for age, sex, Tanner stage, race, exercise group, and weight loss. At baseline, CRF, visceral fat and liver fat were correlated with insulin sensitivity with and without adjustment for BMI percentile. Training-associated changes in CRF, visceral fat, and liver fat were also correlated with insulin sensitivity changes, but not independent of body weight change. After accounting for body weight change, none of the body composition or CRF were associated with changes in insulin sensitivity, glucose tolerance, systolic blood pressure, or high-density lipoprotein cholesterol. Although CRF and body composition were strong independent correlates of insulin sensitivity at baseline, changes in CRF and visceral fat were not associated with changes in insulin sensitivity after accounting for body weight change. Clinicaltrials.gov registration nos.: NCT00739180, NCT01323088, NCT01938950. Novelty • With exercise training, changes in body weight, CRF, visceral fat, and liver fat were correlated with changes in insulin sensitivity. • Changes in body composition or CRF generally did not remain significant correlates of changes in insulin sensitivity after adjusting for body weight changes.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Exercise and the fatty liver

Fatty liver is an increasingly prevalent condition that is associated with several metabolic derangements, thus necessitating the development of effective therapeutic interventions. Growing evidence from cross-sectional studies suggest that physical activity may be a promising therapy for fatty liver. Unfortunately, longitudinal evidence supporting this observation in humans is sparse, as the majority of intervention studies have examined the relationship between liver fat and physical activity in conjunction with caloric and dietary fat restriction. Studies in rats demonstrate a beneficial effect of exercise on liver fat, mainly in situations of high fat feeding or obesity. Thus, the independent contribution of physical activity on variations in liver fat is unknown, but remains a promising intervention that requires further investigation. There is some evidence to suggest that both physical activity and liver fat are independent correlates of cardiovascular and type 2 diabetes risk. The relative contribution of each remains unclear, but implies that both should be considered when developing therapeutic interventions for chronic metabolic disease