BMC Obesity最新文献

Background: There is limited data on risk factors associated with childhood overweight and obesity in Ghanaian school children. Therefore, the aim of this study was to assess the prevalence of overweight and obesity and associated risk factors in Ghanaian school children.

Methods: Data for this study were obtained from a cross-sectional survey of 543 children aged 8 and 11 years, attending private and public primary schools in the Adentan Municipality of Greater Accra Region, Ghana. Anthropometric, dietary, physical activity, sedentary behaviours, sleep duration and socio-demographic data were collected. BMI-for-age Z-scores were used to classify children as overweight/obesity. Multivariable logistic regressions were used to assess the determinants of overweight and obesity.

Results: The overall prevalence of overweight/obesity was 16.4%. Children living in middle (OR = 1.88; 95% CI = 1.01-3.50) and high socioeconomic status (SES) households (2.58; 1.41-4.70) had increased odds of being overweight or obese compared to those living in low SES household. Attending private school (2.44; 1.39-4.29) and watching television for more than 2 h each day (1.72; 1.05-2.82) were significantly associated with increased likelihood of overweight and obesity. Children who slept for more than 9 h a night (0.53; 0.31-0.88) and walked or cycled to school (0.51; 0.31-0.82) had lower odds of being overweight or obese.

Conclusions: A number of modifiable risk factors were associated with overweight and obesity in this study. Public health strategies to prevent childhood obesity should target reduction in television watching time, promoting active transport to and from school, and increasing sleep duration.

Background: In Ethiopia, limited information is available about the epidemiology of over-nutrition. This study assessed the prevalence of, and factors associated with overweight and obesity among adults in Hawassa city, Southern Ethiopia.

Methods: A community-based cross-sectional survey was conducted in August 2015 in the city. A total of 531 adults 18-64 years of age were selected using multistage sampling approach. Interviewer administered qualitative food frequency questionnaire was used to assess the consumption pattern of twelve food groups. The level of physical exercise was measured via the General Physical Activity Questionnaire (GPAQ). Based on anthropometric measurements, Body Mass Index (BMI) was computed and overweight including obesity (BMI of 25 or above) was defined. For identifying predictors of overweight and obesity, multivariable binary logistic regression model was fitted and the outputs are presented using Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CI).

Results: The prevalence of overweight including obesity was 28.2% (95% CI: 24.2-32.2). Significant proportions of adults had moderate (37.6%) or low (2.6%) physical activity level. As compared to men, women had 2.56 (95% CI: 1.85-4.76) times increased odds of overweight/obesity. With reference to adults 18-24 years of age, the odds were three times higher among adults 45-54 (3.06, 95% CI: 1.29-7.20) and 55-64 (2.88, 95% CI: 1.06-7.84) years. Those from the highest income tercile were 3.16 times (95% CI: 1.88-5.30) more likely to be overweight/obese as compared to adults from the lowest tercile. Having moderate (3.10, 95% CI: 1.72-5.60) or low (4.80 95% CI: 2.50-9.23) physical activity was also significantly associated with the outcome. Further, daily intake of alcohol and, frequent consumption of sweets, meat and eggs were associated with overweight/obesity. Conversely, no significant associations were evident for meal frequency, practices of skipping breakfast, behavior of eating away from home and frequency of consumption of fast foods, fruits and vegetables.

Conclusions: Prompting active lifestyle, limiting intakes of sweets, advocating optimum consumption of alcohol and calorie dense animal source foods, especially amongst the better-off segment of the population, may reduce the magnitude of over-nutrition.

Background: New Zealand Pacific and Māori populations measure disproportionately high on the international body mass index (BMI). Information is needed on what behavioural weight loss goals to recommend and how to attract and retain them in interventions. Our team weight loss competition trial for participants with a BMI ≥30 used cash prizes to incentivise completion of nine daily behaviour goals. This paper evaluates the theoretical merit of and adherence to these goals.

Methods: A qualitative component evaluation methodology was used. Trial data on team activity, demographics and anthropometric outcome data were extracted to determine frequency of daily goal completion by teams throughout the competition and to describe participant characteristics. T-tests were used to compare completion rates of the challenges, challenge completion by day of week and between weekdays and weekends. To examine adherence to the daily challenge activity over 24 weeks the total amount of completed challenges adjusted for number of active teams was plotted by week. A Body Shape Index (ABSI) was used to determine individual anthropometric change from baseline to 8, 16 and 24 weeks. Program documents were analysed to identify barriers to adherence and retention of participants.

Results: Of 19 teams (N = 130) who began only five teams performed daily goals across the whole 24 weeks. Adherence was highest during the first 8 weeks. No difference in performance between goals was found suggesting they were equally viable, though tasks worth less points were performed more frequently. Goal completion was higher on weekdays. The behaviour goals appeared to have theoretical merit in that more members of high performing teams experienced a positive change in their ABSI.

Conclusions: Incentives offer a promising strategy for encouraging retention in weight loss interventions. This study suggests that participants in a competition will perform incentivised tasks. The findings however, are limited by missing data and high drop out of individuals and whole teams. Further research is needed on how to increase retention.

Background: An understanding of capacity for physical activity in obese populations should help guide interventions to promote physical activity. Fear of falling is a phenomenon reported in the elderly, which is associated with reduced mobility and lower physical activity levels. However, although falls are reportedly common in obese adults, fear of falling and its relationship with activity has not been investigated in younger obese populations.

Methods: In a cross-sectional study, fear of falling was measured in 63 women aged 18 to 49 years, with mean BMI 42.1 kg/m² (SD 10.3) using the Modified Falls Efficacy (MFES), the Consequences of Falling (COF) and the Modified Survey of Activities and Fear of Falling in the Elderly (MSAFFE) scales. The choice of scales was informed by prior qualitative interviews with obese younger women. Physical activity levels were measured at the same time using the International Physical Activity Questionnaire. The mean score for fear of falling scales, with 95% confidence intervals, were estimated. Chi-square tests and t-tests were used to explore differences in age, body mass index and fear of falling scores between fallers and non-fallers. For each fear of falling scale, binomial logistic regression was used to explore its relationship with physical activity.

Results: Mean scores suggested high levels of fear of falling: MFES [mean 7.7 (SD 2.7); median 8.5]; COF [mean 31.3 (SD 9.4)]; MSAFFE [mean 25.9 (SD 8.7); median 23]. Scores were significantly worse in fallers (n = 42) compared to non-fallers (n = 21). MFES and MSAFFE were independently associated with lower levels of physical activity [odds ratio = 0.65, 95% Cl 0.44 to 0.96 and odds ratio = 1.14, 95% CI 1.01 to 1.28 respectively], when adjusted for age, BMI and depression.

Conclusions: This study confirms that fear of falling is present in obese women under 50 years of age. It suggests that it is associated with low levels of physical activity. These novel findings warrant further research to understand capacity for physical and incidental activity in obese adults in both genders and suggest innovative interventions to promote lifestyle changes and/or consideration of falls prevention in this population.

Background: Home-based lifestyle behaviour interventions show promise for treating and preventing childhood obesity. According to family theories, engaging the entire family unit, including parents, to change their family behaviour and dynamics may be necessary to prevent the development of childhood obesity. However, little is known about how these interventions, which may change the family dynamics and weight-related behaviours of parents, affect weight outcomes in parents. Our objective was to examine the effect of a pilot home-based childhood obesity prevention intervention on measures of anthropometrics and body composition in Canadian parents.

Methods: Forty-four families with children aged 1.5-5 years were randomized to one of three groups: 4 home visits with a health educator, emails, and mailed incentives (4 HV); 2 home visits, emails, and mailed incentives (2 HV); or general health emails (control). Both the 2 HV and 4 HV intervention were conducted over a period of 6 months. Body composition and anthropometric outcomes were measured at baseline and at 6 months and 18 months from baseline.

Results: In parents with baseline body mass index (BMI) ≥ 25 kg/m², the 2 HV group had significantly lower body mass and waist circumference at 6-month (CI = -5.85,-0.14 kg;-5.82,-0.30 respectively) and 18-month follow-up (CI = -7.57,-1.21 kg;-9.30,-2.50 cm respectively) when compared to control, and significantly lower BMI at 18-month follow-up when compared to control (CI = -2.59,-0.29 kg/m²). In parents with baseline BMI < 25 kg/m², the 4 HV group had significantly lower percentage fat mass (CI = -3.94,-0.12%), while the 2 HV group had significantly lower body mass (CI = -2.56,-0.42 kg) and BMI (CI = -0.77,-0.08 kg/m²) at 6-month follow-up, both compared to control; these effects were not maintained at 18-month follow-up.

Conclusions: This study provides support that a home-based childhood obesity prevention intervention may improve weight outcomes among parents. Future research should explore how home-based interventions influence family behaviour and dynamics to impact weight outcomes in children and their parents.

Trial registration: Prospectively registered August 2014, clinical trial identifier NCT02223234.

Background: Despite evidence that biological and genetic factors contribute strongly to obesity, many healthcare providers still attribute obesity more to controllable behavioral issues rather than factors outside a person's control. We evaluated whether medical school students' beliefs about obesity correlate with ability to effectively counsel patients with obesity.

Methods: Clerkship-year medical students at NYU School of Medicine completed an Objective Structured Clinical Experience (OSCE) that tests ability to effectively counsel standardized actor-patients with obesity. We surveyed these students to evaluate their beliefs about the causes of obesity and their attitudes towards people with obesity. We analyzed correlations between student beliefs, negative obesity attitudes, and OSCE performance.

Results: The response rate was 60.7% (n = 71). When asked to rate the importance of individual factors, students rated controllable factors such as unhealthy diet, physical inactivity, and overeating as more important than genetics or biological factors (p < 0.01). Believing obesity is caused by uncontrollable factors was negatively correlated with obesity bias (r = - 0.447; p < 0.0001). Believing that obesity is caused by factors within a person's control was negatively correlated with counseling skills (r = - 0.235; p < 0.05).

Conclusions: Attribution of obesity to external factors correlated with greater ability to counsel patients with obesity, suggesting that educating providers on the biological causes of obesity could help reduce bias and improve provider care.

Background: Goals for Eating and Moving (GEM) is a technology-assisted health coaching intervention to improve weight management in primary care at the Veterans Health Administration (VHA) that we designed through prior rigorous formative studies. GEM is integrated within the patient-centered medical home and utilizes student health coach volunteers to counsel patients and encourage participation in VHA's intensive weight management program, MOVE!. The primary aim of this study was to determine the feasibility and acceptability of GEM when compared to Enhanced Usual Care (EUC). Our secondary aim was to test the impact of GEM on weight, diet and physical activity when compared to EUC.

Methods: Veterans with a Body Mass Index ≥30 kg/m² or 25-29.9 kg/m² with comorbidities (n = 45) were recruited in two phases and randomized to GEM (n = 22) or EUC (n = 23). We collected process measures (e.g. number of coaching calls completed, number and types of lifestyle goals, counseling documentation) and qualitative feedback on quality of counseling and acceptability of call duration. We also measured weight and behavioral outcomes.

Results: GEM participants reported receiving high quality counseling from health coaches and that call duration and frequency were acceptable. They received 5.9 (SD = 3.7) of 12 coaching calls on average, and number of coaching calls completed was associated with greater weight loss at 6-months in GEM participants (Spearman Coefficient = 0.71, p < 0.001). Four participants from GEM and two from EUC attended the MOVE! program. PCPs completed clinical reminders in 12% of PCP visits with GEM participants. Trends show that GEM participants (n = 21) tended to lose more weight at 3-, 6-, and 12-months as compared to EUC, but this was not statistically significant. There were no significant differences in diet or physical activity.

Conclusions: We found that a technology assisted health coaching intervention delivered within primary care using student health coaches was feasible and acceptable to Veteran patients. This pilot study helped elucidate challenges such as low provider engagement, difficulties with health coach continuity, and low patient attendance in MOVE! which we have addressed and plan to test in future studies.

Trial registration: NCT03006328 Retrospectively registered on December 30, 2016.

Background: The Gulf Cooperation Council (GCC) countries have among the highest prevalence of adult obesity and type 2 diabetes in the world. This study aimed to estimate the recent prevalence of obesity among school-age children and adolescents in the GCC States.

Methods: The literature search for obesity prevalence data was carried out in July 2017 in Google Scholar, Physical education index, Medline, SCOPUS, WHO, 2007-2017, and updated in November 2018.In addition, 22 experts from the GCC were contacted to check the search results, and to suggest studies or grey literature which had been missed. Eligible studies were assessed for quality by using the Joanna Briggs Institute (JBI) tool for prevalence studies. Conduct of the systematic review followed the Assessment of Multiple Systematic Reviews Tool (AMSTAR) guidance. A narrative synthesis was conducted.

Results: Out of 392 studies identified, 41 full-text reports were screened for eligibility; 11 of which were eligible and so were included, from 3 of the 6 GCC countries (United Arab Emirates, Kuwait, Saudi Arabia). Surveillance seems good in Kuwait in compared to other countries, with one recent national survey of prevalence. Quality of the eligible studies was generally low-moderate according to the JNBI tool: representative samples were rare; participation rates low; power calculations were mentioned by only 3/11 studies and confidence intervals around prevalence estimates provided by only 3/11 eligible studies; none of the studies acknowledged that prevalence estimates were conservative (being based on BMI-for-age). There was generally a very high prevalence of obesity (at least one quarter-one third of study or survey participants obese according to BMI-for-age), prevalence increased with age, and was consistently higher in boys than girls.

Conclusions: The prevalence of obesity among school-age children and adolescents appears to have reached alarming levels in the GCC, but there are a number of major gaps and limitations in obesity surveillance in the GCC states. More national surveys of child and adolescent obesity prevalence are required for the GCC states.

Trial registration: PROSPERO registration number CRD42017073692.

Background: To describe the characteristics of participants who registered for multiple annual offerings of a community-based weight loss program called The Challenge, and to determine participant characteristics associated with weight change over multiple offerings of The Challenge occurring during the years 2010-2016.

Methods: Multivariable linear mixed effects analyses were conducted to describe percent weight change within and between offerings of The Challenge by participant characteristics.

Results: There were 669 and 575 participants included in the within and between analyses, respectively, for offerings of The Challenge. Among the 434 participants who lost weight in their first attempt at The Challenge and completed the initial weigh-in for a subsequent offering of The Challenge, 22.4% maintained their weight loss or had greater weight loss by the next Challenge, 40.3% gained back some weight, and 37.3% gained back all or more of the weight they lost during their first Challenge. Men had a significantly greater percent weight loss compared to women in their first and second Challenge and men were more likely to gain weight between Challenges. Participants who returned to more Challenges had a greater accumulated percent weight loss compared to those who returned to fewer Challenges.

Conclusions: The current weight loss Challenge appears to contribute to helping a percentage of participants lose weight and maintain some or all of the weight loss.

Background: The rate of overweight and obesity in Australia is among the highest in the world. Yet Australia lags other countries in developing comprehensive educative or regulatory responses to address sugary drink consumption, a key modifiable risk factor that contributes substantial excess sugar to the diet. Measurement of sugary drink consumption is typically sporadic and nutrition focussed and there is limited knowledge of community perceptions and awareness of the health risks associated with excess sugary drink consumption. The aim of this study was to assess the demographic characteristics, behavioural risk factors and attitudes and knowledge associated with sugar-sweetened beverage (SSB) and 100% fruit juice consumption.

Methods: A face-to-face household survey was conducted in 2014 using a stratified random sampling strategy to represent the South Australian population aged 15 years and over. The survey contained questions on sugary drinks, with past week SSB consumption and 100% fruit juice consumption used as outcome variables. Associations were examined with demographic characteristics, behavioural risk factors, and sugary drink attitudes and knowledge.

Results: Of the 2732 respondents, 35% had consumed SSBs 1-6 times (moderate consumers) and 16% had consumed SSBs 7 or more times (frequent consumers) in the past week. Furthermore, 35% had consumed 100% fruit juice in the past week, with 10% consuming every day. Rates of SSB consumption were consistently higher among males, younger age groups, and groups with lower education attainment, as well as smokers and frequent consumers of fast food. Awareness of health risks and sugar content of SSBs was low, especially among frequent SSB consumers. Fruit juice consumption was higher among males, younger age groups, the physically active and among those believing that 100% fruit juice did not contain more sugar than SSBs.

Conclusions: Consumption of SSBs and 100% fruit juice is common but awareness of health risks and sugar content of these drinks is low. There is a need for greater consumer understanding which could be achieved through educative approaches such as public education campaigns, on-package warning labels and improved nutrition information panels.