Ethnic Differences in Prevalence of General Obesity and Abdominal Obesity among Low-Income Rural Kazakh and Uyghur Adults in Far Western China and Implications in Preventive Public Health Community pharmacy interventions for public health priorities: protocol for a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions The spread of the obesity epidemic in the United States, 1991-1998. A randomized trial of the clinical utility of genetic testing for obesity: Design and implementation considerations A community-based motivational personalised lifestyle intervention to reduce BMI in obese adolescents: results from the Healthy Eating and Lifestyle Programme (HELP) randomised controlled trial Effectiveness of a motivational intervention on overweight/obese patients in the primary healthcare: a cluster randomized trial Hip-Hop to Health Jr., an obesity prevention program for minority preschool children: baseline characteristics of participants. Relationship between weight status and delay discounting in a sample of adolescent cigarette smokers Assessing the efficacy of the healthy eating and lifestyle programme (HELP) compared with enhanced standard care of the obese adolescent in the community: study protocol for a randomized controlled trial The Lifestyle Challenge Program: A Multidisciplinary Approach to Weight Management Obesity management: attitudes and practices of French general practitioners in a region of France Overweight and obesity prevention for adolescents: a cluster randomized controlled trial in a school setting.
Background The global p and emic of obesity has become a disastrous public health issue that needs urgent attention . Previous studies have concentrated in high-income urban setting s and few cover low-income rural setting s especially nomadic residents in mountain areas . This study focused on low-income rural and nomadic minority people residing in China ’s far west and investigated their prevalence and ethnic differences of obesity . Methods A question naire-based survey and physical examination of 8,036 individuals were conducted during 2009–2010 , using stratified cluster r and om sampling method in nomadic Kazakhs and rural Uyghur residents ( ≥18 years old ) in 18 villages , Xinjiang , China , about 4,407 km away from capital Beijing .  Obesity was defined by BMI and WC . Results The overall prevalence of general and abdominal obesity in Kazakh adults were 18.3 % and 60.0 % , respectively and in Uyghur , 7.6 % and 54.5 % , respectively . Female ’s prevalence of obesity was higher than male ’s for general obesity ( 45–54 age group in Uyghur , P = 0.041 ) and abdominal obesity ( ≥55 years in Kazakhs , P55∼ = 0.010 , P65∼ = 0.001 ; and ≥18 years in Uyghurs , P<0.001 ) . Kazakh ’s prevalence of obesity was higher than Uyghur ’s ( general obesity : ≥35 years , P<0.001 ; abdominal obesity : ≥25 years in males and ≥65 years in females , P<0.01 ) . The prevalence of obesity increased after 18 years old and subsequently decreased after 55 years old . Meat consumption , older age , and female gender had a higher risk of obesity in these two minorities . Conclusions Both general and abdominal obesity were common in rural ethnic Kazakhs and Uyghurs .  The prevalence rates were different in these two minorities depending on ethnicity , gender , and age . Kazakhs , females and elderly people may be prioritized in prevention of obesity in western China . Because of cost-effectiveness in measuring BMI and WC , we recommend that BMI and WC be integrated into local preventive policies in public health toward screening obesity and related diseases in low-income rural minorities Background Community pharmacists can deliver health care advice at an opportunistic level , related to prescription or non-prescription medicines and as part of focused services design ed to reduce specific risks to health . Obesity , smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK , and interventions led by community pharmacists , aim ed at these three risk factors , have been identified by the government as public health priorities . In 2008 , the Department of Health for Engl and stated that ‘ a sound evidence base that demonstrates how pharmacy delivers effective , high quality and value for money services is needed ’ ; this systematic review aims to respond to this requirement . Methods / design We will search the data bases MEDLINE , Embase , CINAHL , PsycINFO , Social Sciences Citation Index , ASSIA , IBSS , Sociological Abstract s , Scopus and NHS Economic Evaluation Data base for studies that have evaluated interventions based on community pharmacies that aim to target weight management , smoking cessation and alcohol misuse . We will include all r and omised controlled trials ( RCTs ) , non-r and omised controlled trials ( N RCTs ) , controlled before-after studies ( CBAs ) and interrupted time series ( ITS ) and repeated measures studies . Data from included studies will be extracted by two independent review ers and will include study details methods , results , intervention implementation/costs and method ological quality . Meta- analysis will be conducted if appropriate ; if not , the synthesis will be restricted to a narrative overview of individual studies looking at the same question . Discussion The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management , smoking cessation and alcohol misuse . It will also explore if , and how , socio-economic status , gender , ethnicity and age moderate the effect of the interventions and will describe how the interventions included in the review have been organised , implemented and delivered , since context is an important factor governing the success of public health interventions . The findings from this review will have an impact on the commissioning of public health services aim ing to promote healthy weight , smoking cessation and prevent excessive alcohol consumption . Systematic review registration The review has been registered with PROSPERO ( registration no. CRD42013005943 ) . Available at : http://www.crd.york.ac.uk/ prospero /display_record.asp?ID = CRD42013005943 CONTEXT The increasing prevalence of obesity is a major public health concern , since obesity is associated with several chronic diseases . OBJECTIVE To monitor trends in state-specific data and to examine changes in the prevalence of obesity among adults . DESIGN Cross-sectional r and om-digit telephone survey ( Behavioral Risk Factor Surveillance System ) of noninstitutionalized adults aged 18 years or older conducted by the Centers for Disease Control and Prevention and state health departments from 1991 to 1998 . SETTING States that participated in the Behavioral Risk Factor Surveillance System . MAIN OUTCOME MEASURES Body mass index calculated from self-reported weight and height . RESULTS The prevalence of obesity ( defined as a body mass index > or = 30 kg/m2 ) increased from 12.0 % in 1991 to 17.9 % in 1998 . A steady increase was observed in all states ; in both sexes ; across age groups , races , educational levels ; and occurred regardless of smoking status . The greatest magnitude of increase was found in the following groups : 18- to 29-year-olds ( 7.1 % to 12.1 % ) , those with some college education ( 10.6 % to 17.8 % ) , and those of Hispanic ethnicity ( 11.6 % to 20.8 % ) . The magnitude of the increased prevalence varied by region ( ranging from 31.9 % for mid Atlantic to 67.2 % for South Atlantic , the area with the greatest increases ) and by state ( ranging from 11.3 % for Delaware to 101.8 % for Georgia , the state with the greatest increases ) . CONCLUSIONS Obesity continues to increase rapidly in the United States . To alter this trend , strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority Background Obesity rates in the United States have escalated in recent decades and present a major challenge in public health prevention efforts . Currently , testing to identify genetic risk for obesity is readily available through several direct-to-consumer companies . Despite the availability of this type of testing , there is a paucity of evidence as to whether providing people with personal genetic information on obesity risk will facilitate or impede desired behavioral responses . Purpose We describe the key issues in the design and implementation of a r and omized controlled trial examining the clinical utility of providing genetic risk information for obesity . Methods Participants are being recruited from the Coriell Personalized Medicine Collaborative , an ongoing , longitudinal research cohort study design ed to determine the utility of personal genome information in health management and clinical decision making . The primary focus of the ancillary Obesity Risk Communication Study is to determine whether genetic risk information added value to traditional communication efforts for obesity , which are based on lifestyle risk factors . The trial employs a 2 × 2 factorial design in order to examine the effects of providing genetic risk information for obesity , alone or in combination with lifestyle risk information , on participants ’ psychological responses , behavioral intentions , health behaviors , and weight . Results The factorial design generated four experimental arms based on communication of estimated risk to participants : ( 1 ) no risk feedback ( control ) , ( 2 ) genetic risk only , ( 3 ) lifestyle risk only , and ( 4 ) both genetic and lifestyle risk ( combined ) . Key issues in study design pertained to the selection of algorithms to estimate lifestyle risk and determination of information to be provided to participants assigned to each experimental arm to achieve a balance between clinical st and ards and method ological rigor . Following the launch of the trial in September 2011 , implementation challenges pertaining to low enrollment and differential attrition became apparent and required immediate attention and modifications to the study protocol . Although monitoring of these efforts is ongoing , initial observations show a doubling of enrollment and reduced attrition . Limitations The trial is evaluating the short-term impact of providing obesity risk information as participants are followed for only 3 months . This study is built upon the structure of an existing personalized medicine study wherein participants have been provided with genetic information for other diseases . This nesting in a larger study may attenuate the effects of obesity risk information and has implication s for the generalizability of study findings . Conclusions This r and omized trial examines value of obesity genetic information , both when provided independently and when combined with lifestyle risk assessment , to motivate individuals to engage in healthy lifestyle behaviors . Study findings will guide future intervention efforts to effectively communicate genetic risk information Objective Approximately 7 % of children and young people aged 5–15 years in the UK have obesity at a level likely to be associated with comorbidities . The majority of multicomponent lifestyle programmes have limited applicability and generalisability for British adolescents . The Healthy Eating and Lifestyle Programme ( HELP ) was a specific adolescent-focused intervention , design ed for obese 12 to 18-year-olds seeking help to manage their weight . Participants were r and omised to the 12-session HELP intervention or st and ard care . The primary outcome was difference in mean body mass index ( BMI ) ( kg/m2 ) between groups at week 26 adjusted for baseline BMI , age and sex . Subjects 174 subjects were r and omised ( 87 in each arm ) , of whom 145 ( 83 % ) provided primary outcome data at week 26 . Results At week 26 there were no significant effects of the intervention on BMI ( mean change in BMI 0.18 kg/m2 for the intervention arm , 0.25 kg/m2 for the control arm ; adjusted difference between groups : −0.11 kg/m2 ( 95 % CI −0.62 to 0.40 ) , p=0.7 ) . At weeks 26 and 52 there were no significant differences between groups in any secondary outcomes . Conclusion At minimum this study reinforces the need for higher level , structured interventions to tackle the growing public health burden of obesity in the UK and internationally . The HELP intervention was no more effective than a single educational session for reducing BMI in a community sample of obese adolescents . Further work is needed to underst and how weight management programmes can be delivered effectively to young people from diverse and deprived background s in which childhood obesity is common . The study has significant implication s in terms of informing public health interventions to tackle childhood obesity . Trial registration number IS RCT N : IS RCT N99840111 Background Overweight and obesity are common health problems which increase the risk of developing several serious health conditions . The main difficulty in the management of weight-loss lies in its maintenance , once it is achieved . The aim of this study was to investigate whether a motivational intervention , together with current clinical practice , was more efficient than a traditional intervention , in the treatment of overweight and obesity and whether this intervention reduces cardiovascular risk factors associated with overweight and obesity . Methods Multi-centre cluster r and omized trial with a 24-month follow-up included 864 overweight/obese patients r and omly assigned .  Motivational intervention group ( 400 patients ) , delivered by a nurse trained by an expert psychologist , in 32 sessions , 1 to 12 fortnightly , and 13 to 32 , monthly , on top of their st and ard programmed diet and exercise . The control group ( 446 patients ) , received the usual follow-up . Results Weight reduction was statistically significant in the second year with a mean reduction of 1.0 Kg in the control group and 2.5 Kg in the intervention group ( p = 0 . 02 ) . While 18.1 % of patients in the control group reduced their weight by more than 5 % , this percentage rose to 26.9 % in the intervention group , which is statistically significant ( p = 0.04 ) . Patients in the motivational intervention group had significantly greater improvements in triglycerides and APOB/APOA1ratio . Conclusions The results highlight the importance of the group motivational interview in the treatment of overweight /obese patients in primary care , and in the improvement of their associated cardiovascular risks factors . Trial registration Clinical Trials.gov Identifier : NCT01006213 October 30 , 2009 BACKGROUND The prevalence of obesity in the United States is a significant public health problem . Many obesity-related risk factors are more prevalent in minority population s. Given the recalcitrant nature of weight loss interventions for adults , prevention of overweight and obesity has become a high priority . The present study reports baseline data from an obesity prevention intervention developed for minority preschool children . METHODS Hip-Hop to Health Jr. is a 5-year r and omized controlled intervention that targets 3- to 5-year-old minority children enrolled in 24 Head Start programs . Our primary aim is to test the effect of the intervention on change in body mass index . Data were collected on sociodemographic , anthropometric , behavioral , and cognitive variables for the children and parents at baseline . RESULTS Participants included 416 black children , 337 black parents , 362 Latino children , and 309 Latino parents . Using body mass index for age and sex > or = the 95th percentile as the definition of overweight , 15 % of the black children and 28 % of the Latino children were overweight . More than 75 % of the parents were either overweight or obese . DISCUSSION The development of interventions to effectively prevent or control obesity early in life is crucial . These data highlight the escalating problem of weight control in minority population Obesity and cigarette smoking are often cited separately as the top two preventable causes of death in the United States ; however , little research has explored the factors associated with being both obese and a smoker . Delay discounting is a behavioral characteristic that may underlie both of these conditions/behaviors . Delay discounting describes the extent to which an individual discounts the value of an outcome because of a delay in its occurrence . Higher rates of discounting are often considered as an index of impulsivity and have been linked with obesity and cigarette smoking . No research to date has explored  delay discounting  in a sample of obese smokers . For this study , adolescent smokers classified as obese ( body mass index > 95th percentile ) and healthy weight ( body mass index between the 5th and 85th percentiles ) were compared on a laboratory assessment of delay discounting .  Obese smokers  discounted significantly more by delay than healthy weight smokers . This difference remained statistically significant even after controlling for demographic variables that differed across groups . These findings suggest that the relationships between  delay discounting and obesity and cigarette smoking may be additive , such that extreme discounting might proportionally increase the risk of becoming an obese smoker . However , future prospect i ve study is needed to fully determine the veracity of this hypothesis Background The childhood obesity epidemic is one of the foremost UK health priorities . Childhood obesity tracks into adult life and places individuals at considerable risk for diabetes , cardiovascular disease , liver disease and other morbidities . There is widespread need for paediatric lifestyle programmes as change may be easier to accomplish in childhood than later in life . Study Design / Method The study will evaluate the management of adolescent obesity by conducting a Medical Research Council complex intervention phase III efficacy r and omised clinical trial of the Healthy Eating Lifestyle Programme within primary care . The study tests a community delivered multi-component intervention design ed for adolescents developed from best practice as identified by National Institute for Health and Clinical Excellence . The hospital based pilot reduced body mass index and improved health-related quality of life . Subjects will be individually r and omised to receiving either the Healthy Eating Lifestyle Programme ( 12 fortnightly family sessions ) or enhanced st and ard care . Baseline and follow up assessment s will be undertaken blind to allocation status . A health economic evaluation is also being conducted.200 obese young people ( 13 - 17 years , body mass index > 98th centile for age and sex ) will be recruited from primary care within the greater London area . The primary hypothesis is that a motivational and solution-focused family-based weight management programme delivered over 6 months is more efficacious in reducing body mass index in obese adolescents identified in the community than enhanced st and ard care . The primary outcome will be body mass index at the end of the intervention , adjusted for baseline body mass index , age and sex . The secondary hypothesis is that the Healthy Eating Lifestyle Programme is more efficacious in improving quality of life and psychological function and reducing waist circumference and cardiovascular risk factors in obese adolescents than enhanced st and ard care assessed at 6 and 12 months post baseline assessment .Improvement in quality of life predicts on-going lifestyle change and maximises the chances of long-term weight reduction . We will explore whether improvement in QOL may be intermediate on the pathway between the intervention and body mass index change . Trial registration IS RCT N : IS RCT BACKGROUND The increasing prevalence of overweight and obesity in the US has received widespread attention and is highlighted in recent government-issued health priorities . While there are many weight loss programs in different setting s , few include pharmacist involvement in spite of pharmacists ’ recognized easy accessibility to the public . OBJECTIVE To provide insight into a successful , collaborative , multidisciplinary approach to weight management and to encourage pharmacists and other healthcare professionals to adopt a similar approach to patient management . METHODS Adult patients > 18 years of age were recruited from an outpatient university-based setting to participate in a weight management program . The principles of the program included diet , exercise , and behavior modification . The program was conducted through weekly one-hour group sessions held over a 20-week period . Faculty involved in the program included an attending physician specializing in nutrition , a pharmacist , and a behavioral psychologist . All data are expressed as mean ± SD unless otherwise specified . RESULTS Ninety participants ( 74 female , mean age 48 ± 10 y ) entered the program between April 2001 and April 2004 . Participants had multiple obesity-related comorbid diseases . The weight of completers ( n = 59 ) decreased from 100.9 ± 20 kg at baseline to 97.3 ± 19.5 kg at 10 weeks and 95.9 ± 20 kg at 20 weeks . Thirty-nine patients completed both baseline and final assessment s , which showed improvement in health-related quality of life , binge-eating behavior , and depressive symptoms ( p < 0.05 ) . CONCLUSIONS This program is a successful multidisciplinary model for the management of overweight and obese patients in an outpatient-based hospital setting OBJECTIVES : To document the attitudes and practice s of French general practitioners ( GPs ) regarding  obesity management .  RESEARCH METHODS AND PROCEDURES : A cross-sectional survey of a r and omly selected sample of 744 French GPs was conducted , of which 607 question naires were returned . The measures included views on weight management , definitions of success , approaches to and strategies recommended for weight management and prevention , problems , frustrations , and expectations in managing obesity . RESULTS : GPs have a high awareness of obesity as a medically relevant issue , with 90 % of them considering it to be a disease . However , they are only 42 % to consider themselves well prepared to manage obesity and 51 % to find obesity management professionally rewarding . They are 66 % to believe that only a small percentage of patients can lose weight and maintain that loss but have unrealistic goals , with only 20 % of them considering weight maintenance as a success . They do not consider collaboration with other health professionals like dietitians as a priority . Only 34 % of the GPs believe that the currently available drugs are effective . Their views regarding bariatric surgery are in agreement with the recommendations of international experts . Their main expectations regarding obesity management are to improve their professional intervention through formation , education and easy-to-use tools , rather than improving their collaboration with other health professionals . DISCUSSION : There remains considerable opportunity to improve GPs ' practice in obesity management . Medical education , increased cooperation with dietitians , improved long-term follow-up , and implementing better use of the available documents are key issues BACKGROUND Given the increasing prevalence of obesity among youth over the past decade , prevention has become an international public health priority . PURPOSE To evaluate the 2-year effectiveness of three strategies aim ed at preventing overweight and obesity among adolescents in a high school setting . DESIGN PRomotion de l'ALIMentation et de l'Activité Physique ( PRALIMAP ) is a school-based RCT . Each study high school was assigned to receive or not , over a 2-year period ( Grade s 10 and 11 ) , each of three prevention strategies according to a 2 × 2 × 2 factorial school r and omization . Data were collected in 2006 - 2009 and analyzed in 2009 - 2011 . SETTING / PARTICIPANTS A total of 3538 adolescents ( aged 15.6±0.7 years at baseline ) in 24 public high schools in Lorraine ( northeastern France ) completed the PRALIMAP trial . INTERVENTIONS The prevention strategies were education ( development of nutritional knowledge and skills ) ; environment ( creation of a favorable environment by improving availability of " healthy " dietary items and physical activity ) ; and screening and care ( detection of overweight/obesity and , if necessary , adapted care management ) . MAIN OUTCOMES MEASURES The main outcome of interest was BMI ; BMI z-score and prevalence of overweight/obesity were considered as secondary outcomes . RESULTS Adolescents who completed the PRALIMAP trial were younger , less often suspected of having eating  disorders and depression , and came from a higher socioeconomic class than those who did not . The 2-year change of outcomes was more favorable in the 12 screening and care high schools compared to the no-screening ones : a 0.11 lower increase in BMI ( p=0.0303 ) ; a 0.04 greater decrease in BMI z-score ( p=0.0173 ) ; and a 1.71 % greater decrease in overweight/obesity prevalence ( p=0.0386 ) . Education and environment strategies were not more effective than no strategy intervention . CONCLUSIONS Although the screening and care strategy is an effective way to prevent , at 2 years , overweight and obesity among adolescents in a high school setting , its effects over and above no strategy intervention were small . TRIAL REGISTRATION This study is registered at www . clinical trials.govNCT00814554
We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk .
Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .
INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success .
About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .