Posts Tagged ‘eating’

The Message or the Messenger, Part 2

September 27th, 2009

July 30, 2009 :: By Morgan Downey

The debate over President Obama’s selection of Dr. Regina Benjamin as the next Surgeon General has focused on whether someone who appears to be somewhat overweight can carry the messages of the public health community to eat better food and less of it and exercise more to achieve a healthy weight.

While the debate ranges over the BMI range of the top government spokesperson, no one, it seems, is looking at the message itself.

One can well question whether the educational messages are working. One recent study showed that adherence to the federal government’s five recommendations for healthy living has decreased from 15% to 8%. Adherence to healthy lifestyle habits in US adults…[Am J Med. 2009] – PubMed Result This has occurred during an extensive educational campaigns about obesity during this period.

Given the investment in getting out the message of the values of living a healthy lifestyle, there are some disconcerting findings. For example, a new, small study indicated that messages to exercise may lead to greater food intake. Immediate increase in food intake following exerci…[Obesity (Silver Spring). 2009] – PubMed Result This experiment showed that when subjects were receiving information on exercise from actual campaigns, their consumption of available foods increased over the control group which did not get the messages.

As much as I am wary of anecdotal messages, I am reminded of a recent meeting of persons wanting to lose weight. One woman said she was the mother of five children and they had a family gathering (Thanksgiving, Christmas, Easter, Passover, weddings, graduation, christenings, bar mitzvahs, bat mitzvahs, etc. ..fill in the blanks.) One daughter told the mother she needed to eat better. The mother was resentful. But when another daughter talked to her about changing her food choices, she was receptive. The second daughter was overweight and struggling with it; the first daughter was always lean.

We have assumed that the best messenger was one who walked the walk. But does that mean only a lean person can be the messenger? OR would we rather have a leader who is like us…strugglingsometimes failing and trying to get back into the saddle?

Resources

September 27th, 2009

Follow the debate on obesity as a disease at Obesity – ProCon.org

USDA MyPyramid MyPyramid.gov – United States Department of Agriculture – Home

Nutrition Fact Sheets from the American Dietetic Association Nutrition Fact Sheets

Diabetes Research Summaries from the American Diabetes Association Diabetes Research Summaries – Overweight, Obesity & Weight Loss – American Diabetes Association

Diet and Lifestyle Recommendations from the American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=851

Disease Management Association of America obesity resource page Welcome to the Obesity Resource Center

The Obesity Action Coalition’s mission is to assist persons trying to lose weight and facing discrimination in insurance and the workplace. OAC ­ Obesity Action Coalition

NCCOR | National Collaborative on Childhood Obesity Research

This is a fun site on the First Family’s food issues: Obama Foodorama

Here’s a toolkit for parents and caregivers of adolescents on eating and activity pattern changes BodyWorks – A Toolkit for Healthy Teens and Strong Families

We Can is a program of the National Institutes of Health focused on childhood obesity We Can! is an education program to prevent childhood overweight

The Campaign to End Obesity

Employer Incentives

September 27th, 2009

Employer Wellness Programs

In recent years, employers, mainly large ones, have developed wellness programs designed to promote healthier lifestyles among their employees while at the same time reducing their health care expenses. Recently, questions have arisen addressing how much of an incentive can an employer provide before it becomes a punitive measure. The National Business Group on Health has proposed as part of health care reform that the tax code be amended so that the expense of the employer-sponsored program is not taxed as income to the employee when provided off-site. Likewise, employees would be able to use their own health spending accounts for fitness and weight management.

Others have sought to change current laws to allow employers to provide significant financial rewards to persons with certain conditions under control or, from the other viewpoint, penalize workers who cannot bring such conditions, under control.

New research from the National Bureau for Economic Research indicates that financial rewards for weight loss simply do not work. Outcomes in a Program that Offers Financial Rewards for Weight Loss

Safeway, for example, has been promoting their plan called Health Measures. This plan gives employees reduction in their insurance premiums if they are, and stay, within certain limits on four medical risk factors: smoking, obesity, blood pressure and cholesterol. Rebates for achieving the goals total nearly $800 for an employee or $1,600 for a family. People who test within the limits get lower health premiums at the outset of the year. An employee who fails the obesity test can get a retroactive payment if he or she loses 10% of his or her body weight by the end of the year. But if the person’s BMI is still over 30 at the beginning of the following year, the payment is withheld until the employee reaches the permanent goal of under a BMI of 30. (See, Bensinger Gail, Corporate Wellness, Safeway style, http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/01/02/CM1714IPV8.DTL&type=health, accessed May 24, 2009)

Legally, the Safeway program may be pushing the envelope. Under the Health Insurance Portability and Accountability Act of 1996 (HIPPA), no person can be denied or charged more for coverage than other similarly situated person (e.g. full time, part time) because of health status, genetic history, evidence of insurability, disability or claims experience. HIPPA “makes it easy for health plans to reward members for participating in health-promotion programs but difficult to reward them for achieving a particular health standard, “ according to Mello and Rosenthal. In one allowable category for wellness programs, employee rewards are based solely on participation. The second category allows rewards based on attainment of a specific standard, such as losing a specific amount of weight, but the financial incentive is limited to less that 20% of the cost of the employee’s coverage. If the person cannot meet the standard if it is unreasonably difficult or medically inadvisable, that person must be offered a reasonable alternative standard. Other federal and state laws also apply to this situation. (Mello MM, Rosenthal MB, Wellness Programs and Lifestyle Discrimination – The Legal Limits, NEJM July 10, 2008; 359: 192-199) Wellness programs and lifestyle discrimination–th…[N Engl J Med. 2008] – PubMed Result

Safeway President Steven Burd has called for overturning the HIPPA 20% rule and the provisions of the Americans with Disabilities Act which prevent companies from being more aggressive about pushing employees reaching specific personal targets.

This is a highly sensitive issue for several reasons:

  1. Obesity is caused by a multitude of factors a few of which are under an individual’s control. By the time a person enters the workforce, the number of fat cells (adipose tissue) has been established and will not change no matter what the intervention, including bariatric surgery. Genetic predisposition and an environment overwhelming favoring the easy availability of food are two extremely strong factors for an individual to try to overcome. Eating and exercise habits are ingrained. It is therefore of some concern that the person who designed the Safeway program, Ken Shaclmut, Senior VP for Strategic Initiatives, indicated, “I want to be clear – we were adamant about designing this program to cover only those things for which our employees had control and which were clearly behavioral in nature. We do not differentiate for genetics and we did everything prospectively and transparently so that everyone had equal opportunity to improve their behaviors.” ( Emphasis added. http://www.thehealthcareblog.com/the_health_care_blog/2008/10/safeway-uses-in.html Accessed May 24, 2009).

A few things about this statement. First, obesity has a strong genetic basis. See, Understanding Obesity.

Second, Mr. Shaclmut may overstate the level of individual control over the three other factors – smoking, blood pressure and cholesterol. What makes these risks controllable has little to do with behavior and more to do with a variety of prescription and over-the-counter drugs for their control. Obesity is, unfortunately, lacking the number and variety of such products.

Three, employers already discriminate against persons with obesity in firing, promotion and hiring decisions. A recent paper addressed 32 experimental studies in weight discrimination in employment. The findings demonstrated that overweight and obese individuals are disadvantaged in workplace interactions, evaluations, and employment outcomes as a result of negative weight stereotypes. (Roehling MV, Pilcher S, Oswald F, Bruce T, The effects of weight bias on job-related outcomes: a meta-analysis of experimental studies. Academy of Management Annual Meeting, Anahiem, CA, 2008 )

Fourth, another recent study for the negative association between BMI and wages is larger in occupations requiring interpersonal skills with presumably more social interactions. This wage penalty increases as employees get older. This study demonstrates that being overweight and obese penalizes the probability of employment across all race and gender groups except for black men and women. (Han E, Norton ED, Stearns SC, Weight and Wages: Fat Versus Lean Paychecks, Health Econ 2009; 18:535-548 Weight and wages: fat versus lean paychecks. [Health Econ. 2009] – PubMed Result)

Fifth, obese employees in firms which provide employer paid health care are paid less than their peers for the same work. This indicates that employers are offsetting the higher health care costs of obese employees with lower wages. Bundorf MK, Bhattacharya J. The Incidence of the Health Care Costs of Obesity, Abstr AcademyHealth Meeting 2004;21: No. 1329. Available at www.nber.org/papers/w11303 – 17k – 2005-05-02)

Sixth, the difficulties of weight loss and maintenance of weight loss need to be understood. About 1/3 of American adults are engaged in weight loss efforts at any given time. Yet, obesity increases. Why is that? Some dieters do succeed in weight loss but few, 5-10%, manage to keep the weight off over the long term. (See, Freedman MR, King J, Kennedy E, Popular Diets: A Scientific Review. 2001, Obesity Res. 9 Suppl.1: 1S-40S. Popular diets: a scientific review. [Obes Res. 2001] – PubMed Result Maintaining weight loss is extremely difficult. As soon as weight starts to decrease, energy expenditure also drops in obese individuals. Not only is resting metabolic rate decreased; non-resting energy expenditure is also less because less mass is being moved. Take the situation with persons with type 2 diabetes, a common chronic disease highly correlated with obesity. Weight loss in this population is very difficult. Typically, patients lose weight over 4-6 months then plateau. Patients generally lose about 4-10% of their baseline weight. Hypothalamic signals in defense of body weight increase and intervene to prevent further weight loss. This initiates a regain of the lost weight. Neurotransmitters are activated to such an extent that the signal levels of increased hunger and decreased satiety become extremely difficult to ignore. Also, most diabetic patients are on anti-diabetes medications, many of which, like insulin, actually cause weight gain. (See, Pi-Sunyer, FX, Weight Loss in Type 2 Diabetic Patients, Diabetes Care, June 2005, 28;6:1526-7 Weight loss in type 2 diabetic patients. [Diabetes Care. 2005] – PubMed Result )

Seventh, employer wellness programs, as they apply to obesity, are not precisely defined. At present they encompass a variety of approaches and do not have a standardized format. It does appear that they provide advice on nutrition and physical activity and perhaps the ill effects of obesity. As such, they would be similar to the behavioral format used as standard therapy for control groups in randomized clinical trials, usually of pharmacological compounds. Such interventions have not been particularly effective. (See, Poston WS, Haddock CK, Lifestyle Treatments in Randomized Clinical Trials of Pharmacotherapies for Obesity. Obesity Research 2001 9;9:552-563. Lifestyle treatments in randomized clinical trials…[Obes Res. 2001] – PubMed Result) However structured, it is impossible to think that an employer wellness program would be as intense and well-funded as the Diabetes Prevention Program (DPP). In this study over 3,000 non-diabetic persons with elevated fasting and plasma glucose concentrations ( but not diabetes) were assigned to placebo, metformin (a drug to treat diabetes) or an intensive life-style modification program with the goal of at least a 7% weight loss and at least 150 minutes of physical activity per week. “The lifestyle modification intervention reduced the incidence of diabetes by 58% compared to 31% in the metformin group. The advantage of lifestyle intervention over metformin was greater in older persons and those with a lower body-mass index than in younger persons and those with higher body-mass index.” The weight loss difference between the lifestyle group and the metformin group was barely 4 pounds after 4 years. Only 10 million persons in the United States resemble the participants in the DPP. (Diabetes Prevention Program Research Group, Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin, New England Journal of Medicine, 2/7/2002 346:393-403. Reduction in the incidence of type 2 diabetes with…[N Engl J Med. 2002] – PubMed Result)

Eight, employer wellness programs do have adequate evidence of their effectiveness at long term weight loss and maintenance. A CDC Report evaluating such programs reported, “The Task Force determined that insufficient evidence existed to determine the effectiveness of single-component worksite interventions focused on nutrition, physical activity, or other behavioral interventions among adults.” (Katz DL, et al, Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Worksite Settings, A Report on Recommendations of the Task Force on Community Preventive Services, MMWR, Oct. 7, 2005 Public health strategies for preventing and contro…[MMWR Recomm Rep. 2005] – PubMed Result) More recently, Goetzel and Ozminkowski looked at the health and cost benefits of work site health-promotion programs. Commenting on a 2007 systematic literature review they observed, “Health and productivity outcomes from these interventions were reported from 50 studies qualifying for inclusion in the review. The outcomes included a range of health behaviors, physiologic measurements, and productivity indicators linked to changes in health status. Although many of the changes in these outcomes were small when measured at an individual level, such changes when measured at an individual level were considered substantial.” 38 38 (Goetzel RZ, Ozminkowski RJ, The Health and Cost Benefits of Work Site Health-Promotion Programs. Annu. Rev. Public Health 2008;29:303-23 The health and cost benefits of work site health-p…[Annu Rev Public Health. 2008] – PubMed Result)

Ninth, wellnessand prevention programs also may actually be working at cross purposes. It is not uncommon to see programs stress smoking cessation and weight loss. Rarely, however, do they seem to address the perception that smoking cessation will lead to weight gain. A 1991 study by the Centers for Disease Control published in the New England Journal of Medicine found mean weight gain after smoking cessation was 2.8 kg for men and 3.8 for women. Major weight gain of over 13kg occurred in 9.8% of the men and 13.4% of the women. (Williamson DF, Madans J, Anda RF, Smoking Cessation and severity of weight gain in a national cohort. NEJM, 1991 Mar.14;324 (11):739-45. Smoking cessation and severity of weight gain in a…[N Engl J Med. 1991] – PubMed Result) Smoking creates insulin resistance and is associated with central fat accumulation. As a result, smoking increases the risk of the metabolic syndrome and type 2 diabetes. ( Chiolero A, Consequences of smoking for body weight, body fat …[Am J Clin Nutr. 2008] – PubMed Result ) Weight control advice was not associated with reduction in weight gain after cessation. (See, Parsons AC, Shraim M, Inglis J, Interventions for prevention weight gain after smoking cessation. Cochrane Database Syst. Rev. 2009 Jan. 21;(1):CD006219 Interventions for preventing weight gain after smo…[Cochrane Database Syst Rev. 2009] – PubMed Result

Tenth, to the extent that wellness programs which shift costs to employees create stress, they may actually lead to weight gain. We know that chronic stress is a contributor to obesity and the metabolic syndrome. (See, Kyroou I, Tsigos C Chronic stress, visceral obesity and gonadal dysfunction, Hormones 2008 7(4):287-293. Chronic stress, visceral obesity and gonadal dysfu…[Hormones (Athens). 2008 Oct-Dec] – PubMed Result) Overweight women experience more stressful lives events than normal women. Obese and extremely obese men and women are more likely to report several specific stressful life events and more stressful life events overall compared to normal weight individuals. ( See, Gender differences in associations between stressf…[Prev Med. 2008] – PubMed Result

Twelfth, more punitive employer wellness programs are likely to operate like a tax on overweight employees. Compliance with any weight loss regimen involves both time and money. While employers may bear some of this in their programs, the economic burden is likely to fall mainly on overweight/ obese employees, who have already paid a penalty in their wages for their largely inherited status.

Successful maintainers who have lost at least 30 lbs. for an average of five years expended and average of 1.5 hours a day on exercise and consume less that 1,400-1, 500 calories. (See, Klem, ML, Wing RR, McGuire MT, Seagle HM, Hill JO, A descriptive study of individuals successful at long-term maintenance of substantial weight loss. 1997 Am J Clin Nutr 66;239-246 A descriptive study of individuals successful at l…[Am J Clin Nutr. 1997] – PubMed Result))

A recent collaborative position paper explains the issues of money, place and time stated:

The Role of Money

One hypothesis linking SES variables and childhood obesity is the low cost of widely available energy-dense but nutrient-poor foods. Fast foods, snacks, and soft drinks have all been linked to rising obesity prevalence among children and youth. Fast food consumption, in particular, has been associated with energy-dense diets and to higher energy intake overall. Calorie for calorie, refined grains, added sugars and fats provide inexpensive dietary energy, while more nutrient-dense foods cost more, and the price disparity between the low-nutrient, high-calorie foods and healthier food options continues to grow. Whereas fats and sweets cost only 30% more than 20 years ago, the cost of fresh produce has increased more than 100%. More recent studies in Seattle supermarkets showed that the lowest energy density foods (mostly fresh vegetables and fruit) increased in price by almost 20% over 2 years, whereas the price of energy-dense foods high in sugar and fat remained constant.

Lower cost foods make up a greater proportion of the diet of lower income persons. In U.S. Department of Agriculture (USDA) studies, female recipients of food assistance had more energy-dense diets, consumed fewer vegetables and fruit, and were more likely to be obese. Healthy Eating Index scores are inversely associated with body weight and positively associated with education and income .

The Importance of Place

Knowing the child’s place of residence can provide additional insight into the complex relationships between social and economic resources and obesity prevalence. Area-based SES measures, including poverty levels, property taxes and house values, provide a more objective way to assess the wealth or the relative deprivation of a neighborhood. All these factors affect access to healthy foods and opportunities for physical activity.

Living in high-poverty areas has been associated with higher prevalence of obesity and diabetes in adults, even after controlling for individual education, occupation, and income. In the Harvard Geocoding Study, census tract poverty was a more powerful predictor of health outcomes than was race/ethnicity. Childhood obesity prevalence also varies by geographic location. The California Fitnessgram data showed that higher prevalence of childhood obesity was observed in lower income legislative districts. In Los Angeles, obesity in youth was associated with economic hardship level and park area per capita. Thus, the built environment and disadvantaged areas may contribute in significant ways to childhood obesity.

The Poverty of Time

The loss of manufacturing jobs, the growth of a service economy and the increasing number of women in the labor force have been associated with a dramatic shift in family eating habits, from the decline of the family dinner to the emerging importance of snacks and fast foods. The allocation of time resources by individuals and households depends on socioeconomic status.

The concept of “time poverty” addresses the difficult choices faced by lower income households. When it comes to diet selection, the common tradeoff is between money and time. One illustration of the dilemma is provided by the Thrifty Food Plan (TFP), a recommended diet meeting federal nutrition recommendations at the estimated cost of $27 per person per week. While this price is attractive, it has been estimated that TFP menus would require the commitment of 16 hours of food preparation per week. By contrast, a typical working American woman spends only 6 hours per week, whereas a non-working woman spends 11 hours per week preparing meals . Thus, TFP may provide adequate calories at low cost, but requires an unrealistic investment in time. ( See, Caprio S, Daniels SR, Drewnowski A, Kaufman FR, Palinkas LA, Rosenbloom AL, Schwimmer JB Influence of race, ethinicity, and culture on childhood obesity: implications for prevention and treatment: a consensus statement of Shaping America’s Health and the Obesity Society. Diabetes Care 2008 Nov;31(11):2211-21. Influence of race, ethnicity, and culture on child…[Obesity (Silver Spring). 2008] – PubMed Result)

It is useful to consider that weight management is not the only thing people have to do. Time taken for physical activity and nutritional improvement is going to be time taken away from other activities, such as care for self and others, self-improvement, community activities and volunteering, time with children and family members, and recreation (including television viewing and using a computer/Internet)

Intrusive wellness programs have the potential to interfere with the employees’ right to privacy and complicate the doctor-patient relationship. Under the Safeway plan, for example, an employee can request an exception on recommendation of a physician. To whom the employee can request this is not clear. Nor is it clear under what circumstances the exception would be granted. Look at two common scenarios:

1. The employee has a disease like HIV/AIDs or cancer in which weigh loss is common and his or her physician does not want the employee to lose any weight if they can help it. Would the employee have to reveal this condition?

2. The employee has common diseases like type 2 diabetes or depression. The physician has recommended drugs which actually cause weight gain. Does the employee have to disclose this? What if the employer decides that another medication could be used? Does now the doctor, patient and often managed care plan have to discuss medical alternatives with Human Resources? In other words, will the employees health be endangered by the effort to live a healthy lifestyle?

Who is disadvantaged by employer wellness program? Programs such as Safeway’s may have unintended discriminatory effects. The biometrics used in such programs, to the extent they include obesity, elevated triglycerides and blood pressure, are part of what is known as the metabolic syndrome. Approximately 34% of adults meet the National Cholesterol Education Program’s criteria. Older males and females from 40-59 years of age are about 3 times as likely as those 20-39 to meet the criteria for the metabolic syndrome. Males and females over 60 were more than 4 and 6 times respectively to meet the criteria. Overweight and obese males were 6 and 32 times as likely as normal weight males to the meet the criteria and overweight and obese females were 5 and 17 times as likely to meet the criteria. (See, Ervin RB, Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006. National Health Statistics Reports; No. 13.National Health Statistics metabolic syndrome – PubMed Results )

Therefore, we can expect that such programs deliver little in the way of improvements in individual’s body weight, while having a disproportionate impact on minorities, the elderly and those with serious health conditions. To the extent that these employees see a reduction in their health insurance (possibly to the point of zero if the 20% limitation is totally removed), they will only increase the ranks of the uninsured, thereby frustrating the whole purpose of health care reform.

For further information, see;

Insurance coverage and incentives for weight loss …[Obesity (Silver Spring). 2008] – PubMed Result

Effects of a reimbursement incentive on enrollment…[Obesity (Silver Spring). 2007] – PubMed Result

Worksite Opportunities for Wellness (WOW): Effects…[Prev Med. 2009] – PubMed Result

The Working Healthy Project: a worksite health-pro…[J Occup Environ Med. 1999] – PubMed Result

LEAN Works: About CDC’s LEAN Works | DNPAO | CDC

Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Worksite Settings </P><P>A Report on Recommendations of the Task Force on Community Preventive Services

Financial incentive-based approaches for weight lo…[JAMA. 2008] – PubMed Result

Food Economics

September 27th, 2009

What and how much are Americans eating? Dietary Assessment of Major Trends in U.S. Food Consumption, 1970-2005

Raising prices or taxes on food may have effect long but not short term Food Prices and the Dynamics of Body Weight

Household survey shows differences in food consumption patterns. Household food expenditure patterns: a cluster analysis (EXCERPT), Monthly Labor Review Online, April 2007

Total calories available: http://www.cnpp.usda.gov/Publications/FENR/V16N2/fenrv16n2.pdf

Powerpoint: Economics of food pricing, Rudd Center faculty: http://www.yaleruddcenter.org/resources/upload/docs/what/economics/TheEconomics-FoodPricing.pdf

USDA: Why working parents outsource children’s meals 2008 Farm Act Makes It Easier for Food Assistance Households To Save – Amber Waves March 2009

USDA Economics of Obesity Workshop2004 http://www.ers.usda.gov/publications/efan04004/efan04004.pdf

Behavioral Economics and School Cafeterias http://www.ers.usda.gov/Publications/ERR68/ERR68.pdf

Time is money

No Time to Lose? Time Constraints and Physical Activity

Eating and Health, USDA time use study data Eating and Health Module (ATUS) – ERS/USDA Data

Who has time to cook? Who Has Time To Cook? How Family Resources Influence Food Preparation

Americans of different weights spend same amount of time eating How Much Time Do Americans Spend Eating? – June 2008

Understanding Obesity

September 26th, 2009

While body weight is made up of several components – bone, muscle, etc. when we talk about obesity we are referring to excess fat tissue, also called adipose tissue. There are two kinds of fat tissue, brown and white (like rice come to think of it). Brown tissue is mainly found in newborn babies which serves to protect babies by releasing heat. It is converted into white cells in adults. (Scientists are looking at whether white can be converted back into brown tissue and burnt off.) White adipose tissue is made up of cells called adipocytes. These contain fat made of triglycerides and other compounds. White fat cells secrete resistin, adiponectin and leptin. The average adult has 30 billion fat cells weighting about 30 pounds. Fat cells can increase in size about 4 fold before dividing and increasing the total number of fat cells present. Adipocytes also secrete estrogen which probably accounts for higher rates of some cancers in obese persons. Adipose tissue also secrete cytokines. Among the most interesting cytokines identified has been leptin, a molecule considered to send signals to the brain of satiety, i.e. the signal to the brain to stop eating.

Obesity A-Z

September 26th, 2009

There are numerous issues involved in understanding, preventing and treating obesity. Specific diseases are treated in the Health Effects section. Below are a number of other issues. The citations are not meant to be exhaustive but merely to help the reader begin the search for various sources of information. MD

Adherence

Adherence can also be called willpower or compliance. It refers to individual behavior continuing a program of recommended advice, from following a diet to taking medications. Adherence or compliance is a major issue in health care.

http://obssr.od.nih.gov/pdf/Workshop_final_report.pdf

In spite of many efforts to improve Americans life style, the percentage of Americans following all five recommendations has dropped to an all time low – just 8% Adherence to healthy lifestyle habits in US adults…[Am J Med. 2009] – PubMed Result

For more information, see NIH Office of Behavioral and Social Sciences Research (OBSSR) – Adherence

Adiponectin

Higher adiponectin levels associated with lower risk of type 2 diabetes Adiponectin levels and risk of type 2 diabetes: a …[JAMA. 2009] – PubMed Result

Adipose Tissue

Obesity is about excess adipose tissue. However, adipose tissue is essential for survival and reproduction of the species. In excess amounts, it can, of course cause poor health and early mortality. Researchers have made great strides in understanding this tissue.

The perfect storm: obesity, adipocyte dysfunction,…[Clin Chem. 2008] – PubMed Result

Impact of increased adipose tissue mass on inflamm…[Curr Diab Rep. 2009] – PubMed Result

The role of adipose tissue dysfunction in the path…[Physiol Behav. 2008] – PubMed Result

Fat storage and the biology of energy expenditure. [Transl Res. 2009] – PubMed Result

Adiposity Rebound

Adiposity or fatness increases in the first of year of life and then decreases. About age 6, fatness increases again. This is called adiposity rebound and it is considered to be a critical time when the conditions for adult obesity can become established.

Early adiposity rebound: review of papers linking …[Curr Opin Clin Nutr Metab Care. 2005] – PubMed Result

Adolescence

Food companies targeting adolescence in the digital age Interactive food and beverage marketing: targeting…[J Adolesc Health. 2009] – PubMed Result

Maternal gestational weight gain and offspring wei…[Obstet Gynecol. 2008] – PubMed Result

Adolescent pregnancy and subsequent obesity in Afr…[J Adolesc Health. 1994] – PubMed Result

Changes in physiology with increasing fat mass. [Semin Pediatr Surg. 2009] – PubMed Result

Drugs shown to have efficacy, safety for adolescents Efficacy of weight loss drugs on obesity and cardi…[Obes Rev. 2009] – PubMed Result

No difference between obese and non-obese adolescent food consumption Comparison of high-calorie, low-nutrient-dense foo…[Obes Res. 1999] – PubMed Result

Problem eating behaviors Problem eating behaviors related to social factors…[Int J Behav Nutr Phys Act. 2007] – PubMed Result

Changes in adolescent beverage consumption Five-year longitudinal and secular shifts in adole…[J Am Diet Assoc. 2009] – PubMed Result

And in physical activity Longitudinal and secular trends in physical activi…[Pediatrics. 2006] – PubMed Result

International Journal of Obesity – Clinical research in adolescents: challenges and opportunities using obesity as a model

Comorbidities of overweight/obesity experienced in…[Arch Dis Child. 2009] – PubMed Result

Longitudinal and secular trends in weight-related …[Obesity (Silver Spring). 2008] – PubMed Result

Overweight, obesity, and health-related quality of…[Pediatrics. 2005] – PubMed Result

Depression in adolescents A prospective study of the role of depression in t…[Pediatrics. 2002] – PubMed Result

Agricultural subsidies

No effect on obesity, from USDA http://www.agecon.ucdavis.edu/extension/update/articles/v11n2_1.pdf

EconPapers: Farm subsidies and obesity in the United States: National evidence and international comparisons

Are rising obesity rates linked to U.S. farm aid? | McClatchy

Farm Subsidies Over Time

ScienceDirect – Food Policy : Farm subsidies and obesity in the United States: National evidence and international comparisons

Alcohol Calorie Calculator

http://www.collegedrinkingprevention.gov/CollegeStudents/calculator/alcoholcalc.aspx

Basal Metabolic Rate

The basal metabolic rate (closely related to the resting metabolic rate) is the amount of calories our bodies need to just maintain their normal functions, like metabolism, breathing, blood flow, etc. It is the baseline for determining one’s caloric input.

Basal Metabolism Rate Calculator (note: BMR calculators can have a high degree of variation : BMR Calculator

Breakfast

Is consumption of breakfast associated with body m…[J Am Diet Assoc. 2005] – PubMed Result

Breast-feeding

Mothers more likely to cease breastfeeding The association of maternal overweight and obesity…[J Pediatr. 2006] – PubMed Result

Overweight obese mothers less likely to breastfeed. A systematic review of maternal obesity and breast…[BMC Pregnancy Childbirth. 2007] – PubMed Result

Breastfeeding in infancy and adult cardiovascular …[Am J Med. 2009] – PubMed Result

Australian study shows mothers with obesity more likely to cease breastfeeding Maternal obesity and initiation and duration of br…[Matern Child Nutr. 2008] – PubMed Result

Exclusive breastfeeding of Swedish children and it…[BMC Pediatr. 2008] – PubMed Result

Calculators

Calories Burned UMMS: Calories Burned Calculator

Canada

See Canadian Obesity Network – Obesity Canada

Quality of life of patients with obesity The health status of obese individuals in Canada. [Int J Obes Relat Metab Disord. 2001] – PubMed Result

Prevalence of obesity in Canada. [Obes Rev. 2005] – PubMed Result

BMI and Mortality: Results From a National Longitu…[Obesity (Silver Spring). 2009] – PubMed Result

Child Abuse

Childhood maltreatment in extremely obese male and…[Obes Res. 2005] – PubMed Result

Relation of childhood sexual abuse and other forms…[Obes Surg. 2006] – PubMed Result

Childhood sexual abuse and obesity. [Obes Rev. 2004] – PubMed Result

Child abuse is associated with both obesity and depression in middle age women

Associations of child sexual and physical abuse wi…[Child Abuse Negl. 2008] – PubMed Result

Obesity risk for female victims of childhood sexua…[Pediatrics. 2007] – PubMed Result

Obesity and type 2 diabetes risk in midadult life:…[Pediatrics. 2008] – PubMed Result

Common Sense

‘Common sense’ when used to describe some obesity intervention usually is short for “there’s no data to support this.” Usually within 18 to 24 months there is study showing the ‘common sense’ recommendation didn’t work.

Cuba

Cuba presents an interesting case study. With the fall of the Soviet Union, Cuba, faced with reduction of subsidies from their former patron, went into an economic crisis, known as the “Special Period.” As a result, calories consumed per day dropped, physical activity increased and there was a modest 1.5 unit shift in BMI with reductions in obesity prevalence and increases in overweight and normal weight. Deaths attributed to diabetes, coronary heart disease, stroke and all causes declined as well, suggesting population wide measures might reduce disease and increase mortality. Obesity reduction and its possible consequences: w…[CMAJ. 2008] – PubMed Result and Impact of energy intake, physical activity, and po…[Am J Epidemiol. 2007] – PubMed Result (While the Cuban experience is an extremely interesting situation, the question must be asked whether a democratic government not in extreme economic peril could impose such a draconian situation on its people. MD)

Disparities

While rates of obesity are increasing in all demographic categories, large difference between groups are very evident, leading researchers to ask why different groups in the same environment should have such divergent outcomes.

Obesity, Gynecological Factors, and Abnormal Mammo…[J Womens Health (Larchmt). 2009] – PubMed Result

State of disparities in cardiovascular health in t…[Circulation. 2005] – PubMed Result

Disparities in preventive care by body mass index …[Women Health. 2008] – PubMed Result

The obesity epidemic in the United States–gender,…[Epidemiol Rev. 2007] – PubMed Result

Racial divergence in adiposity during adolescence:…[Pediatrics. 2001] – PubMed Result

Gender-ethnic disparity in BMI and waist circumfer…[Obesity (Silver Spring). 2009] – PubMed Result

Women Obesity in black women. [Epidemiol Rev. 1987] – PubMed Result

Eating Behavior

The psychology of food craving. [Proc Nutr Soc. 2007] – PubMed Result

RAND | RAND Health | Eating as an Automatic Behavior

Food cravings and energy regulation: the character…[Int J Obes (Lond). 2007] – PubMed Result

Eating Disorders

[Night eating syndrome and nocturnal eating–what …[Psychother Psychosom Med Psychol. 2009] – PubMed Result

Teasing history, onset of obesity, current eating …[Obes Res. 2000] – PubMed Result

Childhood psychological, physical, and sexual malt…[Obes Res. 2001] – PubMed Result

Eating disorders and obesity: two sides of the sam…[Epidemiol Psichiatr Soc. 2009 Apr-Jun] – PubMed Result

http://www.womenshealth.gov/BodyImage/bodyworks/CompanionPiece.pdf

Does talking about weight lead to eating disorders? A Parent’s Innocent Word Can Trigger a Dangerous Eating Disorder – washingtonpost.com

Role of parents: Risk Factors for Full- and Partial-Syndrome Early …[J Am Acad Child Adolesc Psychiatry. 2009] – PubMed Result

Elderly

Obesity: What is an elderly population growing int…[Maturitas. 2009] – PubMed Result

Elderly risk for obese men Overweight and obesity and the burden of disease a…[Int J Obes Relat Metab Disord. 2004] – PubMed Result

Applicability of Federal Guidelines An evidence-based assessment of federal guidelines…[Arch Intern Med. 2001] – PubMed Result

Fat or Fit Debate

Relationship between low cardiorespiratory fitness…[JAMA. 1999] – PubMed Result

Fitness and abdominal obesity are independently as…[J Intern Med. 2009] – PubMed Result

Food

The obesity-by-choice debate. Effect of nutrient composition Obesity by choice revisited: effects of food avail…[Physiol Behav. 2007] – PubMed Result

Biology trumps knowledge in model of food choices Is Dietary Knowledge Enough? Hunger, Stress, and Other Roadblocks to Healthy Eating

USDA Food Plans: Cost of Food Cost of Food at Home

Eating and Health Module (ATUS)

Food and Beverage Marketing

See Institute of Medicine Report, Food Marketing and the Diets of Children and Youth – Institute of Medicine

CDC Congressional Testimony CDC Washington Testimony September 23, 2008

Use of branded web sites Food and beverage brands that market to children a…[J Nutr Educ Behav. 2009 Sep-Oct] – PubMed Result

Use of cartoon and other characters Marketing foods to children and adolescents: licen…[Public Health Nutr. 2009] – PubMed Result

The ‘Sydney Principles’ for reducing the commercia…[Public Health Nutr. 2008] – PubMed Result

Glycemic Index

Low glycaemic index or low glycaemic load diets fo…[Cochrane Database Syst Rev. 2007] – PubMed Result

Hunger

Hunger as powerful, primordial emotion The role of primordial emotions in the evolutionar…[Conscious Cogn. 2009] – PubMed Result

Ireland

Prevalence of overweight and obesity on the island…[BMC Public Health. 2007] – PubMed Result

Intensive Care

Effect of obesity on intensive care morbidity and …[Crit Care Med. 2008] – PubMed Result

Menu Labeling

Menu Labeling in Food Chains http://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddMenuLabelingReport2008.pdf

Microorganisms

Fat Factors – New York Times

Obesity – Extending the Hygiene Hypothesis. [Nestle Nutr Workshop Ser Pediatr Program. 2009] – PubMed Result

Interplay between obesity and associated metabolic…[Curr Opin Pharmacol. 2009] – PubMed Result

Gut microbiota and its possible relationship with …[Mayo Clin Proc. 2008] – PubMed Result

Military

Military family physician attitudes toward treatin…[Mil Med. 2008] – PubMed Result

Attitudes and practices of military family physici…[Mil Med. 2001] – PubMed Result

Mortality

For many years, the issue of whether obesity causes an increase in premature deaths has been hotly debated. The public frequently receives conflicting information on the topic. Is it ok to be overweight? Are only persons with severe obesity at risk? In the final analysis, I think the American Heart Association’s Scientific Consensus gets it right…at some point (the curve of body weight) the heavier have higher rates of premature deaths. At what exact point on the BMI scale that takes place is open to discussion, but the curve always goes up. MD)

See Mortality, health outcomes, and body mass index in…[Circulation. 2009] – PubMed Result

An August 2009 study shows obesity is responsible for about 95 million Years-of-Life-Lost. White femals account for more than 2/3 of that amount. Without changes in the obesity prevalence, the life expectancy of US adults may decrease. Individual and Aggregate Years-of-life-lost Associ…[Obesity (Silver Spring). 2009] – PubMed Result

New: Study estimates overweight/obesity and physical inactivity each responsible for 1 in 10 deaths in the US.The preventable causes of death in the United Stat…[PLoS Med. 2009] – PubMed Result

Will the rise in obesity affect future mortality rates? Trends in Health Behaviors and Health Outcomes

The preventable causes of death in the United Stat…[PLoS Med. 2009] – PubMed Result

Optimal Body Weight for the Prevention of Coronary…[Obesity (Silver Spring). 2009] – PubMed Result

Will the rise in obesity affect future mortality rates? Trends in Health Behaviors and Health Outcomes

Does intentional weight loss increase longevity? Long-term weight loss effects on all cause mortali…[Obes Rev. 2007] – PubMed Result

Obesity and Mortality after Stroke The Impact of Body Mass Index on Mortality After S…[Stroke. 2009] – PubMed Result

Preventable causes of death The preventable causes of death in the United Stat…[PLoS Med. 2009] – PubMed Result

Effect of physical inactivity Effects of physical inactivity and obesity on morb…[Med Sci Sports Exerc. 1999] – PubMed Result

Obesity, Mortality and Nursing Home Residents Obesity and mortality in elderly nursing home resi…[J Gerontol A Biol Sci Med Sci. 2005] – PubMed Result

Morbid obesity is an independent determinant of de…[Crit Care Med. 2006] – PubMed Result

The body mass index paradox and an obesity, inflam…[Semin Dial. 2004 May-Jun] – PubMed Result

Overweight, obesity, and mortality from cancer in …[N Engl J Med. 2003] – PubMed Result

Nursing Homes

Elderly in nursing homes Obesity in nursing homes: an escalating problem. [J Am Geriatr Soc. 2005] – PubMed Result

Oral Bacteria

Is obesity caused by an oral bacteria? Is obesity an oral bacterial disease? [J Dent Res. 2009] – PubMed Result

Pets

The young and old, rich and poor, black and white are becoming more obese. Is it any wonder that our pets would also see increases in their weight? As a matter of fact, veterinarians are very concerned about obesity in pets and have even formed a society to address the problem. See Pet Obesity Facts and Risks

Overweight in dogs, but not in cats, is related to…[Public Health Nutr. 2009] – PubMed Result

Portion Size/Control

The contribution of expanding portion sizes to the…[Am J Public Health. 2002] – PubMed Result

The influence of food portion size and energy dens…[Am J Clin Nutr. 2005] – PubMed Result

Energy density and portion size: their independent…[Physiol Behav. 2004] – PubMed Result

Public Health

Prevalence of selected risk behaviors and chronic …[MMWR Surveill Summ. 2008] – PubMed Result

Reimbursement

Should medicare reimburse providers for weight los…[Am Psychol. 2007] – PubMed Result

http://www.obesityaction.org/advocacytools/insurance/OAC%20Insurance%20Piece.pdf

Social Networks

In the past couple of years, researchers have been exploring new theories for the rapid spread of obesity. One of these areas is social networks of individuals, i.e. their close friends and relatives.

One of the earlier studies can be found here The spread of obesity in a large social network ov…[N Engl J Med. 2007] – PubMed Result but also see Adolescent obesity and social networks. [Prev Chronic Dis. 2009] – PubMed Result

Weight loss may positively impact spouses Weight loss treatment influences untreated spouses…[Int J Obes (Lond). 2008] – PubMed Result

Stress

Shaping the stress response: interplay of palatabl…[Mol Cell Endocrinol. 2009] – PubMed Result

Chronic stress and comfort foods: self-medication …[Brain Behav Immun. 2005] – PubMed Result

Role of stress and weight gain Stress and obesity: the role of the hypothalamic-p…[Curr Opin Endocrinol Diabetes Obes. 2009] – PubMed Result

Sugar sweetened Beverages

Sugar-sweetened soft drinks and obesity: a systema…[Nutr Res Rev. 2008] – PubMed Result

Soft drinks and weight gain: how strong is the lin…[Medscape J Med. 2008] – PubMed Result

Intake of sugar-sweetened beverages and weight gai…[Am J Clin Nutr. 2006] – PubMed Result

Soft drinks and weight gain: how strong is the lin…[Medscape J Med. 2008] – PubMed Result

Sugary soda consumption and albuminuria: results f…[PLoS One. 2008] – PubMed Result

Soft drinks and ‘desire to drink’ in preschoolers. [Int J Behav Nutr Phys Act. 2008] – PubMed Result

Taxing Soft Drinkshttp://www.yaleruddcenter.org/resources/upload/docs/what/reports/RuddReportSoftDrinkTaxFeb2009.pdf

Taste

What is role of taste and obesity Taste and weight: is there a link? [Am J Clin Nutr. 2009] – PubMed Result

Technology

Smartphone apps for weight loss Smartphone Training Apps Help You Sweat the Details – NYTimes.com

Computerized BMI prompt increases counseling Effect of a computerized body mass index prompt on…[Fam Med. 2009 Jul-Aug] – PubMed Result

Television Viewing

According to this study, food advertising on TV is a major contributor to childhood obesity By how much would limiting TV food advertising red…[Eur J Public Health. 2009] – PubMed Result

http://www.nber.org/digest/aug06/aug06.pdf

Association between television viewing and poor di…[Int J Pediatr Obes. 2008] – PubMed Result

The association of television and video viewing wi…[Obesity (Silver Spring). 2006] – PubMed Result

Television viewing and television in bedroom assoc…[Pediatrics. 2002] – PubMed Result

Association of maternal obesity and depressive sym…[Arch Pediatr Adolesc Med. 2003] – PubMed Result

Time

USDA: Why working parents outsource children’s meals 2008 Farm Act Makes It Easier for Food Assistance Households To Save – Amber Waves March 2009

Eating and Health, USDA time use study data Eating and Health Module (ATUS) – ERS/USDA Data

Who has time to cook? Who Has Time To Cook? How Family Resources Influence Food Preparation

Americans of different weights spend same amount of time eating How Much Time Do Americans Spend Eating? – June 2008

United Kingdom

Tackling Obesities: Future Choices Project

Vending Machines

Vending machine offerings unhealthy The food and beverage vending environment in healt…[Pediatrics. 2009] – PubMed Result

Virus

Adenovirus Picture: adenovirus Ad-36 (implicated in obesity epidemic) by Russell Kightley MediaOb