Self-report dieting attempts and intentional weight loss in a general adult population : Associations with long-term weight gain and risk of type 2 diabetes

Obesity is a worldwide, major public health problem. It contributes to the risk of several noncommunicable diseases (NCDs), health conditions, and mortality; impairs functional capacity and the quality of life, and places substantial burden on health care systems and economies. Along with the obesity epidemic, dieting has become popular, and indeed successful weight loss has been demonstrated to decrease the risk of many NCDs. Weight loss, however, is difficult, and further, weight maintenance after weight loss appears to be nearly impossible for the majority of individuals. Accordingly, self-report dieting attempts and intentional weight loss (IWL) have been indicated to predict subsequent weight gain in the long term. Weight loss is not limited solely to individuals with obesity, but dieting is common among individuals within each weight category. Despite dieting being common at the population level, the research on its associations in general adult populations is scarce. The aims of this thesis were to study which factors (sociodemographic, lifestyle, metabolic, somatic health, and mental health) are associated with dieting; whether dieting modifies the association between quality of diet and obesity; whether dieting predicts long-term changes in body mass index (BMI) and waist circumference (WC), and the incidence of type 2 diabetes (T2D); and whether several background factors modify these associations. The study was based on data from the nationally representative Health 2000 Survey and on its follow-up, the Health 2011 Survey, 11 years later. The study sample consisted of participants aged 30 and older at baseline (n=8028). Of this sample, 6771 individuals participated in health examinations in 2000. Of the individuals invited to participate in Health 2000, 6319 were invited to participate in Health 2011. Of this sample, 4006 participated in health examinations in 2011. In Health 2000/2011, information on health, wellbeing and functional capacity was collected through health examinations (including measurements and blood samples), interviews and questionnaires. Information on dieting attempts (having tried to lose weight), IWL (having tried and having lost weight), and changes in weight during the previous year was collected via a questionnaire at baseline. A validated food frequency questionnaire (FFQ) was used to measure the habitual diet of the participants, and dietary data were used to form a modified Alternate Healthy Eating Index (mAHEI), representing quality of diet. Height, weight and WC were measured during the health examinations in both Health 2000 and Health 2011. Information on incident T2D during a 15-year follow-up was drawn from national health registers. The statistical analyses were based on linear and logistic regression models, and on Cox's proportional hazards model. In all, at baseline, 39% of women and 24% of men had attempted to diet and 15% of women and 10% of men had achieved IWL during the previous year. The dieters (BMI 29.1 [SD 4.97] kg/m2) were more obese than the non-dieters (BMI 25.7 [SD 4.17] kg/m2). Dieting attempts and IWL were associated with several sociodemographic, lifestyle, somatic health and psychological factors. Most of the factors had parallel associations among both sexes. However, dieting and BMI showed a stronger direct gradient in men than in women. Moreover, dieting was positively associated with having diabetes, hip or knee osteoarthritis, and short habitual sleep only among men. Dieting attempts modified the association between quality of diet and obesity; while among the non-dieters, no association emerged, among the dieters, higher quality of diet was indicatively associated with a higher likelihood of overweight or obesity. Dieting attempts, weight loss, and weight fluctuation during the previous year were associated with an increase in BMI and WC during an 11-year follow-up. The increase was greater among dieters with normal weight than among non-dieters with normal weight. Conversely in those with initial obesity, the increases among dieters and non-dieters did not differ. During a 15-year register follow-up, 417 individuals developed T2D. IWL during the previous year predicted an increased risk of T2D during the follow-up. The association was indicatively accentuated in men, younger individuals, individuals with a lower educational level, individuals with some unfavorable lifestyle habits (low quality diet, low physical activity, and short habitual sleep), and in individuals with low energy intake. The results suggest that at the population level, self-report dieting may be associated with greater subsequent weight gain and an increased risk of developing T2D in the long term. These findings may derive from dieting-activated biological mechanisms (e.g. lowered resting energy expenditure and increased appetite) that promote weight gain. Failed dieting may lead to repeated weight loss attempts and thus, to weight cycling. Alternatively, it is possible that dieters differ from non-dieters and are initially at an elevated risk of weight gain and of developing T2D due to other factors. The results that the risk of T2D is tentatively pronounced among those with IWL and some unfavorable lifestyle habits suggest that poorly conducted dieting in conjunction with unhealthy lifestyle habits in particular may be associated with disadvantageous consequences. In spite of these results, individuals with obesity and medical needs for weight loss should not avoid dieting. Dieting, however, should be conducted properly with evidence-based strategies and an emphasis on weight maintenance after weight loss. Among individuals with normal weight, on the other hand, unnecessary dieting attempts should be avoided and instead, focus should be targeted to learning healthy lifestyle habits in order to maintain normal weight and to prevent weight gain in the future.Lihavuus on merkittävä maailmanlaajuinen kansanterveysongelma. Lihavuusepidemian myötä myös laihduttaminen on yleistynyt, ja onnistuneen laihtumisen onkin todettu olevan yhteydessä useiden kansantautien pienentyneeseen riskiin. Laihduttaminen ja laihduttamisen jälkeinen painonhallinta on suurimmalle osalle kuitenkin haastavaa. Havainnoivissa pitkittäistutkimuksissa on osoitettu, että laihduttamisyritykset ja tarkoituksellinen laihtuminen ovat yhteydessä myöhempään lihomiseen pitkällä aikavälillä. Laihduttaminen ei rajoitu pelkästään ylipainoisiin ja lihaviin, vaan se on yleistä myös normaalipainoisilla. Vaikka laihduttaminen on yleistä, sen yhteyksiä eri tekijöihin on tutkittu väestötasolla melko vähän. Tämän väitöskirjan tavoitteena oli tutkia, mitkä taustatekijät ovat yhteydessä itseraportoituun laihduttamiseen. Tavoitteena oli myös tutkia, eroaako ruokavalion terveellisyyden ja lihavuuden välinen yhteys niiden välillä, jotka olivat laihduttaneet ja eivät olleet laihduttaneet edellisen vuoden aikana. Lisäksi tutkittiin, ennustaako laihduttaminen painoindeksin (BMI) ja vyötärönympäryksen muutoksia ja tyypin 2 diabeteksen (T2D) ilmaantuvuutta pitkällä aikavälillä. Tutkimuksessa selvitettiin myös, onko taustatekijöillä vaikutusta laihduttamisen ja lihavuusmittareiden muutosten tai T2D:n ilmaantuvuuden välisiin yhteyksiin. Tutkimus perustui kansallisesti edustavaan Terveys 2000 -tutkimukseen ja sen seurantatutkimukseen, Terveys 2011 -tutkimukseen. Tässä tutkimuksessa käytettiin Terveys 2000 -tutkimuksessa 30 vuotta täyttäneiden otosta (n=8028). Tieto laihduttamisyrityksistä (yrittänyt laihduttaa), tarkoituksellisesta laihtumisesta (onnistunut laihduttamisessa) ja painonmuutoksista edellisen vuoden aikana kerättiin kyselylomakkeen avulla lähtötilanteessa. Validoidun frekvenssityyppisen ruoankäyttökyselyn (FFQ) avulla arvioitiin tutkittavien tavanomaista ruoankäyttöä ja ravintoaineiden saantia. Näihin tietoihin pohjautuen muodostettiin ruokavalion terveellisyyttä kuvaava ’terveellisen syömisen indeksi’ (modified Alternate Healthy Eating Index, mAHEI-indeksi). Tutkittavien pituus, paino ja vyötärönympärys mitattiin molemmilla tutkimuskerroilla terveystarkastusten yhteydessä. T2D:een sairastuneet 15 vuoden seurannan aikana tunnistettiin käyttäen kansallisia terveyttä koskevia rekistereitä. Tilastolliset analyysit perustuivat lineaarisen ja logistiseen regressiomalliin sekä Coxin malliin. Lähtötilanteessa kaikkiaan 39 % naisista ja 24 % miehistä oli yrittänyt laihduttaa ja 15 % naisista ja 10 % miehistä oli laihtunut tarkoituksellisesti edellisen vuoden aikana. Laihduttamisyritykset ja tarkoituksellinen laihtuminen olivat yhteydessä useisiin sosiodemografisiin, elintapa-, terveyteen liittyviin ja psykologisiin tekijöihin. Laihduttamisyritykset vaikuttivat ruokavalion terveellisyyden ja lihavuuden väliseen yhteyteen; ei-laihduttajilla yhteyttä ei ilmennyt, kun taas laihduttajilla terveellisempi ruokavalio oli yhteydessä suurempaan todennäköisyyteen olla ylipainoinen tai lihava. Laihduttamisyritykset, laihtuminen ja painon vaihtelu edellisen vuoden aikana olivat yhteydessä BMI:n ja vyötärönympäryksen kasvuun 11 vuoden seurannan aikana. Kasvu oli suurempaa alun perin normaalipainoisilla laihduttajilla verrattuna normaalipainoisiin ei-laihduttajiin. Sen sijaan lihavien kohdalla samanlaista eroa ei havaittu. T2D:een 15 vuoden rekisteriseurannan aikana sairastui 417 henkilöä. Edellisen vuoden aikainen tarkoituksellinen laihtuminen oli yhteydessä suurentuneeseen riskiin sairastua seurannan aikana. Tarkoituksellisen laihtumisen ja T2D:n ilmaantuvuuden välinen yhteys oli suuntaa antavasti korostunut mm. henkilöillä, joilla oli epäterveellisiä elintapoja. Tulosten perusteella itseraportoitu laihduttaminen voi olla väestötasolla yhteydessä suurempaan riskiin lihoa ja sairastua T2D:een pitkällä aikavälillä. Tuloksia voivat selittää laihduttamisen aktivoimat biologiset mekanismit (mm. madaltunut aineenvaihdunta, näläntunteen lisääntyminen), jotka pyrkivät ehkäisemään laihtumista ja edesauttamaan lihomista. Epäonnistunut laihduttaminen voi johtaa toistuviin laihduttamisyrityksiin ja painon ”jojoiluun”. Vaihtoehtoisesti on mahdollista, että laihduttajat eroavat ei-laihduttajista ja ovat alun perin muista tekijöistä johtuen suuremmassa vaarassa lihoa ja sairastua T2D:een. Tarkoituksellisen laihtumisen ja T2D:n ilmaantuvuuden suuntaa antavasti korostunut yhteys henkilöillä, joilla oli epäterveellisiä elintapoja viittaa siihen, että etenkin kehnosti toteutettu laihduttaminen voi olla yhteydessä haitallisiin seurauksiin. Huolimatta tämän tutkimuksen tuloksista, henkilöiden, joille on laihtumisesta terveydellistä hyötyä, ei tule välttää laihduttamista. Laihduttaminen tulee kuitenkin toteuttaa suunnitelmallisesti myönteisiin elintapamuutoksiin perustuen painottaen laihduttamisen jälkeisen painonhallinnan tärkeyttä. Normaalipainoisten henkilöiden tulisi välttää turhia laihduttamisyrityksiä, ja sen sijaan keskittyä terveellisten elintapojen omaksumiseen säilyttääkseen normaalipainonsa ja ehkäistäkseen painon nousu tulevaisuudessa

SLIDES: Ground Water Resources in Colorado

Presenter: Matthew Sares, Chief, Environmental Geology Section, Colorado Geological Survey. 21 slides

SLIDES: Ground Water Resources in Colorado

Presenter: Matthew Sares, Chief, Environmental Geology Section, Colorado Geological Survey. 21 slides

Communicating Ecodesign within Electrolux: a case study

The work presented in this paper is part of an on-going, three year, collaborative research project between Cranfield University and AB Electrolux, sponsored by EPSRC. The overall aim of this project is to develop a ‘tool’ for industrial designers working within the Electrical/Electronic product sector to enable them to undertake ecodesign more easily

Poor suitability for psychotherapy : a risk factor for treatment non-attendance?

Publisher Copyright: © 2021Background: Patient suitability has been suggested to predict treatment non-attendance but information on its effect is limited. Aim: To study the prediction of the Suitability for Psychotherapy Scale (SPS), on occurrence of treatment non-attendance. Methods: Altogether 326 outpatients, with depressive or anxiety disorder, were randomized to short-term psychodynamic psychotherapy (SPP), long-term psychodynamic psychotherapy (LPP), and solution-focused therapy (SFT). SPS was based on seven components from three suitability domains: nature of problems, ego strength, and self-observing capacity. Treatment non-attendance was defined as refusal of engaging therapy and of premature termination. The Cox model and logistic regression were used. Results: Treatment non-attendance was significantly more common in LPP patients with poor SPS (RR = 2.76, 95% CI = 1.45-5.26). This was mainly due to poor flexibility of interaction, poor self-concept, and poor reflective ability. Premature termination in SFT showed a similar trend but due to other SPS components: absence of a circumscribed problem, poor modulation of affects, and poor response to trial interpretation. On the contrary, individuals with good values of SPS were more prone to premature termination in SPP. Limitations: The prediction of suitability on refusal could only be studied in the LPP group due to few refusals in the short-term therapy groups. The sample consisted of patients who participated in a trial. Thus the findings may not be directly generalized to unselected patients in the public mental health setting. Conclusions: Poor suitability, apparently, predicts non-attendance in LPP and SFT, but not in SPP. More studies on large cohorts are needed.Peer reviewe

Family socio-economic status and childhood adiposity in Europe

Childhood obesity is a considerable public health problem worldwide. In Europe, lower parental socioeconomic status (SES) relates to higher childhood adiposity. This scoping review strives to discover, which SES indicators are the most commonly used and meaningful determinants of childhood adiposity (greater level of continuous adiposity indicator, e.g. body mass index z-score, or overweight or obesity categorized by established definitions). The review focused on studies about European general populations from the 21st century (January 2000–April 2021) considering children and adolescents aged 0–17 years. PubMed and reference lists of articles were searched in February–April 2021. Total of 53 studies with 121 association analyses between different SES indicators and adiposity indicators, were identified and reviewed. Different SES indicators were grouped to 25 indicators and further to six indicator groups. The most used indicator was mother's education (n of association analyses = 24) and the most used indicator group was parental education (n of association analyses = 51). Of all association analyses, 55% were inverse, 36% were non-significant, and 8% were positive. Composite SES (80%), parental education (69%) and parental occupation (64%) indicators showed most frequently inverse associations with obesity measures (i.e. lower parental SES associating with higher adiposity), while parental income (50% inverse; 50% non-significant) and property and affluence (42% inverse; 50% nonsignificant) indicators showed approximately even number of inverse and non-significant associations. Instead, majority of parental employment (60%) indicators, showed non-significant associations and 33% showed positive associations (i.e. higher parental SES associating with higher adiposity). Despite some variation in percentages, majority of the associations were inverse in each age group and with different outcome categorizations. In girls and in boys, non-significant associations predominated. It seems that children with parents of higher SES have lower likelihood of adiposity in Europe. Parents' employment appears to differ from other SES indicators, so that having an employed parent(s) does not associate with lower likelihood of adiposity. Positive associations seem to occur more frequently in poorer countries. Criteria for uniform childhood SES and adiposity measures should be established and used in studies in order to be able to produce comparable results across countries

Nanofiltração à escala laboratorial na remoção de cianotoxinas

Dissertação de mest., Engenharia do Ambiente, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2010A presença de cianobactérias na massa de água altera o equilíbrio ecológico dos ecossistemas aquáticos, dando origem à formação de compostos que contribuem para o desenvolvimento de gosto e odor na água, para além de produzirem cianotoxinas que representam um elevado risco para a saúde pública (Sivonen & Jones, 1999). De modo a diminuir este risco, a concentração de cianotoxinas na água deve ser minimizada ou até mesmo eliminada. É de aceitação geral que a nanofiltração é uma opção eficaz na remoção de cianobactérias e cianotoxinas na água para consumo humano. Este estudo é uma continuidade do trabalho de Ribau Teixeira, (2005). Assim com este trabalho pretende-se demonstrar a eficiência da nanofiltração na remoção de microcistina-LR dissolvida em águas naturais ao longo do tempo de operação (durante 100h) à escala laboratorial, já que as membranas perdem eficiência com o tempo de operação. Pretende-se ainda simular a operação normal de uma etapa de tratamento de uma Estação de Tratamento de Águas em situações de blooms de cianobactérias. Os resultados obtidos evidenciam que a remoção destas toxinas mantêm-se elevada, com remoções na ordem dos 95 a 99%, e sem perda da qualidade de permeado ao fim das 100h de operação, nem diminuição significativa de fluxo permeado. Os valores obtidos no permeado para a microcistina-LR encontram-se abaixo do limite imposto pela OMS de 1 μg/l, e os baixos valores de matéria orgânica natural no permeado evidenciam o baixo potencial para formação dos subprodutos da desinfecção. Desta forma, a inclusão da nanofiltração no processo de tratamento das águas para consumo humano seria uma medida eficaz na redução do risco associado à presença das cianotoxinas nestas águas

Self-Report Dieters: Who Are They?

Dieting attempts have become popular worldwide. Dieting, however, seems to have both positive and negative health-related consequences. So far, only a few studies have focused on the determinants of dieting in detail. This study explores the association between self-report dieting attempts and intentional weight loss (IWL) during the previous year and several demographic, lifestyle, health, and psychological factors in a cross-sectional study design using data from the representative Finnish Health 2000 Survey. The sample comprised 2147 men and 2378 women, aged 30–69. Information for potential determinants was assembled via health examinations, interviews, and questionnaires. Approximately 24% of the men and 39% of the women reported dieting attempts and 10% of the men and 15% of the women reported IWL. Dieting attempts were associated with younger age, education, BMI, formerly smoking, more favourable values in lifestyle variables, and unfavorable values in serum HDL and triglycerides, a worse sense of coherence, concerns about one’s appearance, and concerns about one’s health. Among men, diabetics and those sleeping ≤6 h a night more frequently reported dieting attempts and those with osteoarthritis reported IWL. Moreover, the gradient between BMI and dieting attempts was significantly stronger in men than in women. Men seem to attempt dieting when they have actual health-related reasons, while such reasons are not so strongly associated with dieting in women. These findings can be used for determining subpopulations with obesity and real weight-loss needs and, alternatively, subpopulations with normal weight unnecessarily attempting dieting

Nem belo, nem feio: GROTOX. pelo direito de dançar a diferença.

The present research was developed in the extent of the Master in Dance of the Dance Post Graduation Program of the Federal University of Bahia and its mainspring is thinking the body/dancer with disability and his access to art. We studied the presence of the disabled person in the artistic scene of the dance considering as bottom line the observation of the GROTOX choreographic work. Authored by the Prof. Ms. José Henrique Amoedo Barral, the choreography was performed by the group Dancing with the Difference, from Madeira Island/Portugal, in association with the House of Music, from the City of Porto/Portugal, during the “Everyone Can Reach” Festival, in 2009. As methodological proposal, we decided to analyze the work critically, considering as a reference the precepts of the Genetic Criticism, as well as the studies in Creation Processes, defended by Cecília de Almeida Salles. Our analysis observes the way the body/dancer with disability is shown in this scenic formulation, specifically: which are the possibilities of the performed dance, if the aesthetic of the “poor little body” or a work of movement investigation, if the proposition of an aesthetic constructed by this body with disability. The GROTOX has “the beautiful and the ugly” as a topic, and the choreographer, in his artistic research, resorted to the books of Umberto Eco: The story of the beauty (2010) and The story of the ugliness (2007). Based on this reference, we tried to understand the relationships established during the process of work creation, as well as the relationships established in scene among the singularities of the dancing bodies. In this pursuit, and to compose the theoretical of our research, we brought: the Corpomídia Theory (GREINER/KATZ, 2004), the Concept of Mass (HARDT/NEGRI, 2005), e the concept of Beleaguered Body (CORREIA, 2007).A presente pesquisa foi desenvolvida no âmbito do Mestrado em Dança do Programa de Pós Graduação em Dança da Universidade Federal da Bahia e tem como mola propulsora pensar o corpo/dançarino com deficiência e seu acesso à arte. Estudamos a presença da pessoa com deficiência na cena artística da dança tomando como ponto de partida a observação da obra coreográfica GROTOX. De autoria do Prof. Ms. José Henrique Amoedo Barral, a coreografia foi interpretada pelo Grupo Dançando com a Diferença, da Ilha da Madeira/Portugal, em parceria com a Casa da Música, da Cidade do Porto/Portugal, dentro do Festival Ao Alcance de Todos, no ano de 2009. Como proposta metodológica definimos analisar criticamente a obra tendo como referencial os preceitos da Crítica Genética, bem como os estudos em Processos de Criação defendidos por Cecília de Almeida Salles. Nossa análise observa a forma pela qual o corpo/dançarino com deficiência é mostrado nessa elaboração cênica, especificamente: quais as possibilidades de dança apresentadas, se a estética do “corpo coitadinho” ou um trabalho de investigação do movimento, se a proposição de uma estética construída por esse corpo com deficiência. O GROTOX tem “o belo e o feio” como tema, e segundo o coreógrafo em sua pesquisa artística recorreu aos livros de Umberto Eco: A história da beleza (2010) e A história da Feiura (2007). Partindo dessa referência buscamos entender as relações que se estabeleceram no processo de criação da obra, bem como as relações estabelecidas em cena entre as singularidades dos corpos dançantes. Nessa busca trouxemos para compor o referencial teórico de nossa pesquisa: a Teoria Corpomídia (GREINER/KATZ, 2004), o conceito de Multidão (HARDT/NEGRI, 2005) e o conceito de Corpo Sitiado (CORREIA, 2007)

Self-Report Dieters: Who Are They?

Dieting attempts have become popular worldwide. Dieting, however, seems to have both positive and negative health-related consequences. So far, only a few studies have focused on the determinants of dieting in detail. This study explores the association between self-report dieting attempts and intentional weight loss (IWL) during the previous year and several demographic, lifestyle, health, and psychological factors in a cross-sectional study design using data from the representative Finnish Health 2000 Survey. The sample comprised 2147 men and 2378 women, aged 30–69. Information for potential determinants was assembled via health examinations, interviews, and questionnaires. Approximately 24% of the men and 39% of the women reported dieting attempts and 10% of the men and 15% of the women reported IWL. Dieting attempts were associated with younger age, education, BMI, formerly smoking, more favourable values in lifestyle variables, and unfavorable values in serum HDL and triglycerides, a worse sense of coherence, concerns about one’s appearance, and concerns about one’s health. Among men, diabetics and those sleeping ≤6 h a night more frequently reported dieting attempts and those with osteoarthritis reported IWL. Moreover, the gradient between BMI and dieting attempts was significantly stronger in men than in women. Men seem to attempt dieting when they have actual health-related reasons, while such reasons are not so strongly associated with dieting in women. These findings can be used for determining subpopulations with obesity and real weight-loss needs and, alternatively, subpopulations with normal weight unnecessarily attempting dieting