Obesity over the life course

Obesity in middle-aged humans is a risk factor for many age-related diseases and decreases life expectancy by about 7 years, which is roughly comparable to the combined effect of all cardiovascular disease and cancer on life span. The prevalence of obesity increases up until late middle age and decreases thereafter. Mechanisms that lead to increased obesity with age are not yet well understood, but current evidence implicates impairments in hypothalamic function, especially impairments in the ability of hypothalamic pro-opiomelanocortin neurons to sense nutritional signals. The rapid increase in the prevalence of obesity at all ages in the past decade suggests that, in the next two or three decades, diseases associated with obesity, especially diabetes, will begin to rise rapidly. Indeed, these trends suggest that for the first time in modern history, the life expectancy of people in developed societies will begin to decrease, unless the rapid increase in the prevalence of obesity can be reversed.     

Inequality as an Explanation for Obesity in the United States

Over the past several decades, there has been a sharp increase in obesity across all population groups in the United States. In fact, the United States has one of the highest rates of obesity compared to other countries throughout the world. Obesity has become a national public health concern because it is related to a number of negative health, social, psychological, and economic outcomes. It is particularly concerning because racial/ethnic minorities and populations with the least education and highest poverty rates bear the largest burden of obesity. In addition, disparities in obesity tend to be gendered, with women experiencing the largest disparities in obesity by income, education, and race/ethnicity. In this review, I describe how social inequality is linked to obesity in the United States. I highlight elements of disadvantage at the individual‐, family‐, school‐, and neighborhood‐level that are linked to energy intake and expenditure, which are directly related to obesity, and draw from evidence and theories from multiple fields of the social and medical sciences. I also highlight the important role stress may play in linking disadvantage to obesity, particularly for women. I argue that understanding the complex mechanisms and processes that link social inequality to obesity requires multidisciplinary and multilevel frameworks.     

Why can patients with erectile dysfunction be considered lucky? The association with testosterone deficiency and metabolic syndrome

Metabolic syndrome (MetS) is a diagnostic category, based on a cluster of risk factors (hyperglycemia/diabetes, abdominal obesity, hypertriglyceridaemia, low HDL cholesterol and hypertension), which identifies subjects at high risk for forthcoming type 2 diabetes mellitus and cardiovascular (CV) diseases. Recently, a close association between MetS, erectile dysfunction (ED) and male hypogonadism has been reported. In patients with MetS, hypogonadism can exacerbate sexual dysfunction and arteriogenic ED because of its typical symptoms, such as decreased sexual desire and mood disturbances. On the other hand, hypogonadism per se has been associated with an increased risk of CV and overall mortality. Obesity and in particular central obesity is nowadays considered the most important determinant of MetS-induced hypogonadism whereas hypertension and diabetes play a major role in ED associated with MetS. This review analyses the current literature regarding the relationship between ED, MetS and hypogonadism emphasising the epidemiological and psychopathological aspects and stressing the concept that ED subjects are ‘lucky’, because ED offers a unique chance to undergo medical examination and therefore to improve not only their sexual but, most importantly, their overall health.     

Does Metabolic Syndrome Impair Sexual Functioning in Adults With Overweight and Obesity?

Objectives: Obesity is a growing public health concern worldwide, and results in increased risk of cardiovascular disease, type 2 diabetes, metabolic syndrome, insulin resistance, dyslipidemia, hypertension, and reduced sex hormone production. Previous research suggests that obesity may contribute to sexual dysfunction. This review aims to determine the relationship between obesity and sexual dysfunction, and ascertain the associated cardiometabolic conditions that may contribute to impaired sexual functioning in individuals with obesity. Methods: Literature searches were conducted through PubMed and Embase from 1980 to 2016, to identify original research articles, reviews including systematic reviews and meta-analyses, using the search terms: obese, obesity, overweight, sexual function, sexual dysfunction, metabolic syndrome, CVD, T2D, hormones and weight loss. Results: This review found that individuals with obesity and cardiometabolic comorbidities were more likely to report the greatest degree or sexual dysfunction and/or reduction in sexual quality of life, compared to those without. Conclusions: Current evidence supports an association between sexual dysfunction and factors associated with obesity, such as reduced insulin sensitivity, dyslipidaemia, hypertension, and low oestrogen or testosterone. To establish efficacious treatments, research examining the impact of weight loss on the conditions associated with obesity, such as hypertension, reduced insulin sensitivity, dyslipidaemia, and low sex hormones and sexual functioning in individuals with overweight and obesity should be a priority.     

The “Obesity Epidemic”: Evolving Science,Unchanging Etiology

“Obesity epidemic” discourse relies on scientific and epidemiological research to justify subjecting certain bodies to healthist messaging and disciplinary technologies. The science and framing of obesity has evolved, potentially partially due to critical obesity scholars. However, critical obesity scholars are now reliant on outdated critiques of ever progressing evolving/adapting discourse. Recent discoveries have been made concerning the determinants of obesity and the complexity of weight loss. Scientific discourse often now references environmental factors as contributors to obesity, low levels of sustained weight loss, and limitations of common measures such as the body mass index. Despite this refinement, the ultimate conclusion of studies, as presented within the scientific articles or in related media reportage, remains unchanged. Individuals are still expected to attempt to “correct” their non‐normative bodies through lifestyle changes, regardless of the evidence underscoring the likely futility of these endeavors. This paper updates obesity science and public health responses and evaluates the extent to which new findings, with the potential to greatly subvert standard weight loss advice, have altered supposedly evidence‐based public health communications and recommendations. As emerging scientific insights have further muddied already‐complex obesity‐related pathways, solutions have largely remained the same.     

Obesity and urinary incontinence

Obesity is growing at an alarming rate worldwide. It poses a major health problem that in turn places a huge financial burden on health services. Medical conditions such as diabetes mellitus and ischaemic heart disease are commonly associated with obesity, but less well documented is the association between obesity and urinary incontinence. This article reviews the current literature to see whether: (1) obesity predisposes to urinary incontinence; (2) weight loss improves urinary incontinence and (3) obesity affects the surgical outcome. It also covers the surgical and anaesthetic implications of obesity. New minimally invasive surgical techniques make surgical risks acceptable for the obese patient but the anaesthetic risks remain high. Obese patients should not be denied surgery but be made aware of the higher risks. Future research should focus on the impact of obesity on surgical outcomes for continence surgery, particularly on intraoperative and postoperative complication rates as well as long-term cure rates.     

Determinants of obesity: The case of Germany

Obesity now has the rank of a global epidemic, but finds its severest expression in the economically advanced parts of the world. This study offers an interdisciplinary analysis of obesity in Germany, including socio-economic factors. In comparison to related studies, it uses a continuous BMI variable as well as an improved empirical design. The coefficient of the term for sport activities is significantly negative, and the coefficient for the age terms are significantly positive. The results for the income variable are ambiguous. Cigarette consumption does not indicate negative relationships with individual BMI-levels. No evidence was found for systematic differences in BMI between the eastern and western regions in reunified Germany.     

Acculturation,Socioeconomic Factors and Obesity Among Immigrants from El Salvador Living in the Washington,D.C. Area

Abstract

This study examined acculturation, SES and obesity in a convenience sample of 1205 Salvadoran immigrants from the Washington, D.C area. Acculturation was measured by language preference for print and electronic media and years residing in the U.S. Obesity was measured by the percent overweight based on body mass index norms. About 30% of respondents were overweight. Acculturation was positively associated with obesity and together with other variables in the model explained 45% of the variance in obesity. Preference for Spanish media was strongest in the older age group. Doctors and TV were the most frequently cited sources of health information. Social workers and health educators can use this information to develop culturally competent interventions and research in Hispanic populations.     

Changing trends of prostate cancer in Asia

Although Asian people have the lowest incidence and mortality rates of prostate cancer in the world, these rates have risen rapidly in the past two decades in most Asian countries. Prostate cancer has become one of the leading male cancers in some Asian countries. In 2000, the age-adjusted incidence was over 10 per 100?000 men in Japan, Taiwan, Singapore, Malaysia, the Philippines and Israel. Although some of the increases may result from enhanced detection, much of the increased incidence may be associated with westernization of the lifestyle, with increasing obesity and increased consumption of fat. The differences in incidences between native Americans and Asian immigrants are getting smaller, reflecting a possible improvement of diagnostic efforts and changes of environmental risk factors in Asian immigrants. Nevertheless, the huge variations in incidences among ethnic groups imply that there are important genetic risk factors. The stage distributions of prostate cancer in Asian populations are still unfavorable compared to those of Western developed countries. However, a trend towards diagnosing cancer with more favorable prognosis is seen in most Asian countries. Both genetic and environmental risk factors responsible for elevated risks in Asian people are being identified, which may help to reduce prostate cancer incidence in a chemopreventive setting.     

The role of physical activity in primary cancer prevention

Few modifiable lifestyle factors have been shown to be associated with reduced cancer risk. For physical activity, more than 200 epidemiologic studies have provided evidence that its association with cancer risk is convincing for colon and breast cancers; probable for endometrial cancer; possible for prostate, gastric, and ovarian cancers; and insufficient for all other cancer sites. Relative risk reductions are in the range of 10–30 %. On the absolute scale, about 9–19 % of the most frequent cancers can be attributed to a lack of sufficient physical activity. As modifiable health behavior, exercise thus has a strong potential for primary cancer prevention and the evidence is sufficiently established to recommend physical activity as a means for the primary prevention of cancer. Current recommendations call for at least 30–60 min of moderate to vigorous activity daily. However, further research is needed to provide a stronger evidence base specifically for these recommendations. The exact type, dose, and timing of physical activity remain unclear but ongoing and planned research will elucidate these associations. In addition, possible biologic mechanisms whereby physical activity may influence carcinogenesis, independently and/or jointly with other factors of the energy balance equation, need further attention in future research.     

Reliability of work-related assessments

Insufficient evidence of the reliability of work-related assessments is a major concern in this area of practice. Despite this concern there has been ongoing development of new assessments, while existing assessments have been revised, modified and updated and others are no longer used or available. OBJECTIVES: The purpose of this study was to determine the extent and quality of evidence for the reliability of work-related assessments. STUDY DESIGN: This study examined available literature and sources in order to review the extent which reliability has been established for 28 work-related assessments. RESULTS: The levels of evidence and reliability are presented for each assessment. This indicates that a number of commercially available work-related assessments have insufficient evidence of reliability. For the limited number of work-related assessments with an adequate level of evidence on which to judge their reliability, most demonstrate a moderate to good level. Few assessments, however, have demonstrated levels of reliability sufficient for clinical (and legal) purposes. CONCLUSION: With this study clinicians will be able to examine their options with regard to the reliability of the assessments they choose to use. Interpretation of changes in test results can be considered in the light of the evidence for the reliability of the instrument used.     

Validity of work-related assessments

Insufficient evidence of the validity of work-related assessments is frequently reported as a major concern in occupational rehabilitation. Despite this concern, and the continuing development of new and old assessments, no comprehensive evaluation of the evidence has been conducted. OBJECTIVES: The purpose of this study was to first determine the extent and quality of available evidence for the validity of work-related assessments, and then where sufficient evidence was available, determine the level of validity. STUDY DESIGN: This study examined available literature and sources in order to review the extent to which validity has been established for 28 work-related assessments. RESULTS: The levels of evidence and validity are presented for each assessment. Most work-related assessments have limited evidence of validity. Of those that had adequate evidence, validity ranged from poor to good. There was no instrument that demonstrated moderate to good validity in all areas. Very few work-related assessments were able to demonstrate adequate validity in more than one area, or with more than one study, even when contributory evidence was included. CONCLUSION: With this study clinicians will be able to examine their options with regard to the validity of the assessments they choose to use.     

Childhood Obesity: An Overview

This article reviews recent research evidence, largely from systematic reviews, on a number of aspects of childhood obesity: its definition and prevalence; consequences; causes and prevention. The basis of the body mass index (BMI) as a means of defining obesity in children and adolescents is discussed: a high BMI for age constitutes obesity. In recent years the prevalence of obesity has increased dramatically across most of the world, and in the UK obesity prevalence is high and continuing to increase. Despite a widespread perception that obesity in childhood or adolescence is a cosmetic issue, the research evidence shows that it does matter to physical and psychological health and that there are adverse health risks for both the obese child and the adult who was obese as a child. Few interventions aimed at preventing or treating childhood obesity have been successful. There is an urgent need for more research on better strategies that will enable children and adolescents to make long‐term changes to their dietary and physical activity behaviour in order to prevent obesity.     

How to help the aging male? Current approaches to hypogonadism in primary care

Hypogonadism is a common condition which occurs more frequently in older men. It is characterized by low testosterone (T) and is associated with symptoms which are often nonspecific. A key symptom is low libido, but it can also be associated with erectile dysfunction, reduced muscle mass and strength, increased body fat, reduced bone mineral density and osteoporosis, reduced vitality, and depressed mood. Hypogonadism is linked with a variety of comorbid conditions including erectile dysfunction, metabolic syndrome, diabetes, obesity, and osteoporosis. However, the condition is often underdiagnosed. T supplementation in hypogonadism is associated with a range of benefits including improved sexual function, increased lean body mass and/or reduced fat mass, and improved bone mineral density. A variety of T supplementation formulations are available. Although there is no evidence of increased risk of initiating prostate cancer with T supplementation, it is contraindicated in men with prostate cancer. It is important that primary care physicians are aware of both the signs and symptoms of hypogonadism, the monitoring and testing that is required and the merits and advantages of the various T preparations to ensure optimal management of the condition with a treatment approach that best suits patients’ needs.     

THE EFFECTIVENESS OF FAMILY INTERVENTIONS IN THE TREATMENT OF PHYSICAL ILLNESS

Although a large body of research demonstrates that the family has a powerful influence on physical health, the evidence for the effectiveness of family interventions in physical illness is less conclusive. Family therapy and other family interventions appear to be most effective in chronic childhood illnesses such as asthma and diabetes. Family interventions have also been shown to be effective in the management of some cardiovascular and neurologic disorders and for the treatment of obesity. Family therapy appears to be more effective than individual therapy for some groups of patients with anorexia nervosa. This research supports the increasingly important role of medical family therapy in the new health care system. Recommendations for future research are discussed.     

Fat in the Fire? Science,the News Media,and the “Obesity Epidemic”2

In recent years, the “obesity epidemic” has emerged as a putative public health crisis. This article examines the interconnected role of medical science and news reporting in shaping the way obesity is framed as a social problem. Drawing on a sample of scientific publications on weight and health, and press releases and news reporting on these publications, we compare and contrast social problem frames in medical science and news reporting. We find substantial overlap in science and news reporting, but the news media do dramatize more than the studies on which they are reporting and are more likely than the original science to highlight individual blame for weight. This is partly due to the news media’s tendency to report more heavily on the most alarmist and individual‐blaming scientific studies. We find some evidence that press releases also shape which articles receive media coverage and how they are framed.     

Development and psychometric testing of the childhood obesity perceptions (COP) survey among African American caregivers: A tool for obesity prevention program planning

Currently, public health practitioners are analyzing the role that caregivers play in childhood obesity efforts. Assessing African American caregiver’s perceptions of childhood obesity in rural communities is an important prevention effort. This article’s objective is to describe the development and psychometric testing of a survey tool to assess childhood obesity perceptions among African American caregivers in a rural setting, which can be used for obesity prevention program development or evaluation. The Childhood Obesity Perceptions (COP) survey was developed to reflect the multidimensional nature of childhood obesity including risk factors, health complications, weight status, built environment, and obesity prevention strategies. A 97-item survey was pretested and piloted with the priority population. After pretesting and piloting, the survey was reduced to 59-items and administered to 135 African American caregivers. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was conducted to test how well the survey items represented the number of Social Cognitive Theory constructs. Twenty items were removed from the original 59-item survey and acceptable internal consistency of the six factors (α = 0.70–0.85) was documented for all scales in the final COP instrument. CFA resulted in a less than adequate fit; however, a multivariate Lagrange multiplier test identified modifications to improve the model fit. The COP survey represents a promising approach as a potentially comprehensive assessment for implementation or evaluation of childhood obesity programs.