Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review

BackgroundObesity and gestational weight gain impact maternal and fetal risks. Gestational weight gain guidelines are not stratified by severity of obesity.AimConduct a systematic review of original research with sufficient information about gestational weight gain in obese women stratified by obesity class that could be compared to current Institute of Medicine guidelines. Evaluate variance in risk for selected outcomes of pregnancy with differing gestational weight gain in obese women by class of obesity.MethodsA keyword advanced search was conducted of English-language, peer-reviewed journal articles using 3 electronic databases, article reference lists and table of content notifications through January 2015. Data were synthesized to show changes in risk by prevalence.FindingsTen articles met inclusion criteria. Outcomes assessed were large for gestational age, small for gestational age, and cesarean delivery. Results represent nearly 740,000 obese women from four different countries. Findings consistently demonstrated gestational weight gain varies by obesity class and most obese women gain more than recommended by Institute of Medicine guidelines. Obese women are at low risk for small for gestational age and high risk for large for gestational age and risk varies with class of obesity and gestational weight gain. Research suggests the lowest combined risk of selected outcomes with weight gain of 5–9 kg in women with class I obesity, 1 to less than 5 kg for class II obesity and no gestational weight gain for women with class III obesity.ConclusionsGestational weight gain guidelines may need modification for severity of obesity.     

Parent adoption and implementation of obesity prevention practices through building children's asking skills at family child care homes

BackgroundEarly childhood education programs provide a setting to reach children and parents to modify home environments to prevent obesity. The Healthy Opportunities for Physical Activity and Nutrition Home (HOP’N) Home project was a novel approach that linked Family Child Care Homes (FCCH) to home environments by developing children’s asking skills for healthful home environmental change through curricular activities.ObjectiveTo evaluate the feasibility of engaging parents in obesity prevention practices through building children's asking skills at FCCH.MethodsFCCHs (n = 5 settings) and children (n = 25; aged 3−5 years; female = 36 %; non-Hispanic white = 91 %; low socioeconomic status = 28 %; overweight/obese = 52 %) and parents (n = 25) participated in a pre-post cohort design. We assessed children's body mass index and self-report variables at three time points. HOP'N Home included continuous staff training, group time, dramatic play, meal prompts, songs, and home activities.ResultsFCCH providers implemented 83%–100% of intervention activities. All parents (100 %) adopted the program, most (87 %) returned completed homework activities to FCCHs, and over 90 % implemented changes in the home. Percent of overweight/obese children decreased from pre-intervention (50 %) to post-intervention (29 %,p = 0.06) and follow-up (38 %,p = 0.06).ConclusionsIt is feasible to build children's asking skills and pair this strategy with home activities to engage parents to prevent obesity.     

The effects of race,ethnicity, and age on obesity

About 30% of Americans are obese, which is roughly a 100% increase from 25 years ago. This study examines the effects of changes in the racial/ethnic composition and age distribution on the prevalence of obesity, identifies the portion of the increase in obesity caused by these changes, and projects the effects of future racial/ethnic and age changes on obesity using National Health and Nutrition Examination Survey data. Results indicate that racial/ethnic composition changes and age distribution changes have accounted for about 10% of the increase in obesity over the last 25 years. However, future racial/ethnic and age changes are not projected to increase obesity substantially.      

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.     

Australian Social Work Reviewers 2010

Abstract

Children placed in out-of-home care are a particularly disadvantaged group in society, who have often been exposed to trauma and socioeconomic disadvantage. As a result, they experience poorer health outcomes than children in the general population, especially mental health outcomes. One health outcome that has yet to be researched thoroughly is overweight and obesity of children placed in out-of-home care. Hence, the overall goal of this paper was to review the extant literature over the last decade on weight-related issues for children in out-of-home care, with particular emphasis on overweight and obesity. The findings of the review revealed that there is a lack of rigorous Australian research in relation to prevalence rates of overweight and obesity in children in out-of-home care; there is a lack of strategies or interventions designed specifically to combat overweight and obesity in children in out-of-home care; and one of the major limitations of Australian research to date is the use of self-report measures to assess the weight status of children in out-of-home care. It was concluded that prevention and intervention strategies are needed that target children as they enter out-of-home care.     

Family structure and obesity in early childhood

This study informs family and child health research by using longitudinal Fragile Families data to assess how family structure and transitions are associated with changes in children’s BMI and weight status between ages three and five. Concerns in family structure literature about biases due to selectivity are reduced through the use of change score models and by controlling for parental BMI. The findings indicate unhealthy BMI gain and an increased risk of becoming overweight/obese among children living with a mother who recently dissolved a union or had been living without a partner for at least 2 years compared with those in stable married parent families. Children with single mothers who entered a new union had significantly healthier BMI trajectories than those whose mothers remained single or recently became single. These results suggest the importance of two-parent family contexts for children’s healthy physical development, and that single mothers may need additional support to better manage their children’s BMI.     

Occupational conditions,self-care,and obesity among clergy in the United States

Prior research has shown that a variety of occupational conditions such as long work hours are associated with increased likelihood of obesity. In this study, we use the specific case of the clergy to explore how occupational conditions are linked to increased or decreased odds of being obese. We hypothesize that stressful conditions are associated with increased odds of obesity and that self-care practices are associated with decreased odds. Using the 2008/9 U.S. Congregational Life Survey’s national sample of clergy from multiple religious traditions, we find support for our hypotheses. Clergy who experience more stress, work more hours, or are bi-vocational have higher odds of obesity. Those who take a day off each week, have taken a sabbatical, or are involved in a support group experience lower odds. For Protestant clergy, being involved in a support group or taking a day off moderates the association between certain stressful occupational conditions and obesity.     

Change in behavioral exercise program-associated self-regulation enhances self-regulation-induced eating improvements across levels of obesity severity

Architects of behavioral weight-loss programs require improved understandings of psychosocial correlates of healthy eating behaviors to improve overwhelmingly poor outcomes. Exercise might benefit eating changes through a transfer of self-regulatory skill improvements. However, related research is minimal, and degrees of obesity might influence the utilization and efficacy of self-regulatory processes. Women of Class 1 obesity (body mass index [BMI] = 30–34.9 kg/m²; n = 53), Class 2 obesity (BMI = 35–39.9 kg/m²; n = 41), and Class 3 obesity (BMI ≥ 40 kg/m²; n = 53) enrolled in a community-based cognitive-behavioral weight-management program were assessed over 6 months on changes in exercise, self-regulation for both exercise and eating, and the consumption of fruits/vegetables and sweets. Within-group improvements were all significant, with the greater self-regulation changes consistent with lower degrees of obesity. Within serial multiple mediation analyses, the hypothesized path from exercise change→self-regulation for exercise change→self-regulation for eating change→eating behavior change was supported in both the prediction of changes in fruit/vegetable intake and sweets consumption. However, the direct effect of increased exercise on improved eating was not significant. BMI score or obesity class did not significantly moderate embedded relationships among variables. Findings suggested weight-loss programs incorporate supported exercise, and dedicate high proportions of their curricula to the development of self-regulatory skills.     

Obesity and breastfeeding: The strength of association

Obesity and attendant co-morbidities are an emergent problem in public health. Much attention has focused on prevention, especially during the perinatal period. Breastfeeding is considered a possible protective factor for obesity in childhood, influencing gene–neuroendocrine–environment–lifestyle interaction. Therefore, breastfeeding and its longer duration are probably associated with lower development of childhood obesity. Through human milk, but not formula, the child assumes greater bioactive factors contributing to immunological, endocrine, development, neural and psychological benefits. Contrarily, other studies did not confirm a critical role of breast milk. Confounding factors, especially maternal pre-pregnancy overweight, may influence breastfeeding effects. This review summarises what is known about the possible relationship between breastfeeding and prevention of obesity development.ConclusionBreastfeeding appears to represent a protective factor for obesity in childhood, although evidence is still controversial and underlying mechanisms unclear. Further research is needed to improve knowledge on overweight/obesity and breastfeeding.