Medicine and Health Sciences Commons^™

Documentation Of Body Mass Index And Control Of Associated Risk Factors In A Large Primary Care Network, Stephanie A. Rose, Alexander Turchin, Richard W. Grant, James B. Meigs

Internal Medicine Faculty Publications

BACKGROUND: Body mass index (BMI) will be a reportable health measure in the United States (US) through implementation of Healthcare Effectiveness Data and Information Set (HEDIS) guidelines. We evaluated current documentation of BMI, and documentation and control of associated risk factors by BMI category, based on electronic health records from a 12-clinic primary care network.

METHODS: We conducted a cross-sectional analysis of 79,947 active network patients greater than 18 years of age seen between 7/05 - 12/06. We defined BMI category as normal weight (NW, 18-24.9 kg/m²), overweight (OW, 25-29.9), and obese (OB, ≥ 30). We measured documentation …

No Association Of Obesity And Type 2 Diabetes Mellitus Related Genetic Variants With Colon Cancer, Cheryl L. Thompson, Sarah J. Plummer, Thomas C. Tucker, Graham Casey, Li Li

Markey Cancer Center Faculty Publications

Background: Obesity and type 2 diabetes mellitus (T2D) are known risk factors for colon cancer. Recent reports from a number of genome wide association studies (GWAS) have identified several single nucleotide polymorphisms (SNPs) associated with obesity and T2D. Here we tested the hypothesis that these SNPs may also be associated with risk of colon cancer.

Methods: We genotyped nine SNPs reported in GWAS of obesity and/or T2D, including SNPs in HHEX, KCNJ11, SLC30A8, FTO, CDKN2, CDKAL1, TCF2, and the rs9300039 SNP in an intergenic region, in 561 colon cancer cases and 721 population controls.

Results: None of these SNPs were …

The Impact Of Exercise Training Compared To Caloric Restriction On Hepatic And Peripheral Insulin Resistance In Obesity, Robert H. Coker, Rick H. Williams, Sophie E. Yeo, Patrick M. Kortebein, Don L. Bodenner, Philip A. Kern, William J. Evans

Clinical and Translational Science Faculty Publications

Context: It has been difficult to distinguish the independent effects of caloric restriction versus exercise training on insulin resistance.

Objective: Utilizing metabolic feeding and supervised exercise training, we examined the influence of caloric restriction vs. exercise training with and without weight loss on hepatic and peripheral insulin resistance.

Design, Participants, and Intervention: Thirty-four obese, older subjects were randomized to: caloric restriction with weight loss (CR), exercise training with weight loss (EWL), exercise training without weight loss (EX), or controls. Based on an equivalent caloric deficit in EWL and CR, we induced matched weight loss. Subjects in the EX group received …

Comparing Clinician Knowledge And Online Information Regarding Alli (Orlistat), Stuart Nelson, Kevin O Hwang, Elmer V Bernstam

Journal Articles

BACKGROUND: Many consumers join online communities focused on health. Online forums are a popular medium for the exchange of health information between consumers, so it is important to determine the accuracy and completeness of information posted to online forums.

OBJECTIVE: We compared the accuracy and completeness of information regarding the FDA-approved over-the counter weight-loss drug Alli (Orlistat) from forums and from clinicians.

METHODS: We identified Alli-related questions posted on online forums and then posed the questions to 11 primary care providers. We then compared the clinicians' answers to the answers given on the forums. A panel of blinded experts evaluated …

Obesity And Cancer, Rickie Brawer, Phd, Mph, Nancy Brisbon, Md, James Plumb, Md

Department of Family & Community Medicine Faculty Papers

Obesity has become the second leading preventable cause of disease and death in the United States, trailing only tobacco use. Weight control, dietary choices, and levels of physical activity are important modifiable determinants of cancer risk. If multi-factorial approaches to prevention and management are not implemented, obesity will likely become the leading modifiable cause of death in the coming years. Physicians have a key role in integrating these approaches into clinical care and advocating for systemic prevention efforts. This article provides: 1) an introduction to the epidemiology and magnitude of childhood and adult obesity; 2) the relationship of overweight/obesity to …

Sedentary Behavior And Obesity In A Large Cohort Of Children, Jonathan A. Mitchell, Calum Mattocks, Andy R. Ness, Sam D. Leary, Russell R. Pate, Marsha Dowda, Steven N. Blair, Chris Riddoch

Faculty Publications

The purpose of this study was to examine the association between sedentary behavior and obesity among 12-year-old children, while adjusting for moderate-to-vigorous physical activity (MVPA) and other potential confounding variables.

Cross-sectional analyses were carried out with data from 5434 children who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC). Fat mass was derived using dual x-ray emission absorptiometry (DXA), and height and weight measurements were used to calculate body mass index (BMI; kg/m²). The children wore an accelerometer for seven days. The cut points for sedentary behavior and MVPA were ≤199 cpm and ≥3600 cpm, …

Number Of Aberrant Crypt Foci Associated With Adiposity And Igf1 Bioavailability, Helen Swede, Joseph C. Anderson, Richard G. Stevens, Joel Levine, Bruce M. Brenner, Carl D. Malchoff, Valerie B. Duffy, Devon C. Pleau, Daniel W. Rosenberg

Articles - Patient Care

Background Dysregulation of the insulin-like growth factor (IGF) system, a common consequence of adiposity-induced insulin resistance, may be a key underlying mechanism linking excess body weight with colon cancer. Evidence has been derived from studies of cancer and polyps. Supporting data about aberrant crypt foci (ACF), putative pre-polyp changes, have been generated only from animal studies to date. Methods We randomly selected 26 patients with sex-specific elevated waist-hip-ratio (WHR) and 26 with normal values from a series of 150 patients seeking routine colonoscopy at the University of Connecticut Health Center. Cross-sectional analyses were performed of ACF number (<5, ≥5) in relation to total IGF1, IGF-binding protein-3 (IGFBP3), insulin, body mass index (BMI), WHR and waist circumference (WC). Visualized ACF in the 20 cm of the distal colon were counted using advanced endoscopic imaging. Results Patients …

Metabolic Syndrome And Risk Of Cancer Mortality In Men, Jason R. Jaggers, Xuemei Sui, Steven P. Hooker, Michael J. Lamonte, Charles E. Matthews, Gregory A. Hand, Steven N. Blair

Faculty Scholarship

Background—Metabolic syndrome (MetS) has been linked with an increased risk of developing cancer; however the association between MetS and cancer mortality remains less clear. Little research has focused on pre-cancer risk factors that may affect the outcome of treatment. The purpose of this study was to examine the association between MetS and all-cancer mortality in men. Methods—The participants included 33,230 men aged 20-88 years who were enrolled in the Aerobics Center Longitudinal Study and free of known cancer at baseline. Results—At baseline 28% of all the participants had MetS. During an average of 14 years followup there were a total …

Carbohydrate Intake And Overweight And Obesity Among Healthy Adults, Anwar T. Merchant, Hassanali Vatanparast, Shahzaib Barlas, Mahshid Dehghan, Syed Mahboob Ali Shah, Lawrence De Koning, Susan E. Steck

Faculty Publications

Background - Little is known about the dietary habits of people with optimal body weight in communities with high overweight and obesity prevalence.

Objective - To evaluate carbohydrate intake in relation to overweight and obesity in healthy, free-living adults

Design - We used a cross-sectional analysis

Subjects/setting - The Canadian Community Health Survey Cycle 2.2 is a cross-sectional survey of Canadians conducted in 2004-2005. There were 4,451 participants aged 18 years and older with anthropometric and dietary data and no comorbid conditions in this analysis.

Main outcome measures - Outcome variables were body mass index (BMI; calculated as kg/m^{2 …}

Chronic Illness And Smoking Cessation, Kushal Patel, David Schlundt, Celia Larson, Hong Wang, Anne Brown, Margaret Hargreaves

Public Health, Health Administration, and Health Sciences Faculty Research

Introduction

Smoking is among the leading causes of premature mortality and preventable death in the United States. Although smoking contributes to the probability of developing chronic illness, little is known about the relationship between quitting smoking and the presence of chronic illness. The present study investigated the association between diagnoses of one or more chronic diseases (diabetes, hypertension, or high cholesterol) and smoking status (former or current smoker). Methods

The data analyzed were a subset of questions from a 155-item telephone-administered community survey that assessed smoking status, demographic characteristics, and presence of chronic disease. The study sample consisted of 3,802 …

Current Dietetic Practices Of Obesity Management In Saudi Arabia And Comparison With Australian Practices And Best Practice Criteria, A. Almajwal, P. Williams, Marijka Batterham

Faculty of Health and Behavioural Sciences - Papers (Archive)

Objective: To describe the dietetic practices of the treatment of obesity in Saudi Arabia and compare this with best practice criteria and the practice in Australia. Methods: Anonymous questionnaires were completed by dietitians in Saudi Arabia. The topics included barriers to obesity management, demand and level of service and strategies and approaches used for weight management. Best practice scores were based on those used to assess Australian dietitians. Results: 253 dietitians participated in the survey. Of these, 175 (69 %) were involved in the management of obesity. The best practice score for Australian dietitians was slightly but significantly greater than …

Am 6545: A Novel Peripheral Cb1 Antagonist, Seth Hosmer

Honors Scholar Theses

Obesity and other related metabolic disorders are a common problem in the United States. Consequently, several drug therapies have been developed in an attempt to address this problem. Many older appetite suppressants, such as amphetamines, were dangerous and potentially addictive. For the last few years, the endocannabinoid system was investigated as a potential target for appetite suppression. Unfortunately, early cannabinoid CB1 antagonists came with an unacceptable side effect profile of their own, which is largely due to central actions of these drugs. In an attempt to reduce the side effect profile, researchers are investigating peripherally acting cannabinoid antagonists, which do …

Prevalence Of Obesity In School-Going Children Of Karachi., Haider Javed Warraich, Faisal Javed, Mohammed Faraz-Ul-Haq, Fariha Batool Khawaja, Sarah Saleem

Community Health Sciences

Background: Obesity is an emerging problem in Pakistan. The authors sought to determine prevalence of obesity and malnutrition in school-going children, from grades 6(th) to 8(th) of different schools of Karachi and assess associations that affect the weight of the children.
Methodology/Principal Findings: A cross sectional Study Design with children studying in grades 6(th) to 8(th) grade, in different schools of Karachi. We visited 10 schools of which 4 consented, two subsidized government schools and two private schools. A questionnaire was developed in consultation with a qualified nutritionist. Height and weight were measured on calibrated scales. A modified BMI criterion …

Impact Of Obesity On Perioperative Morbidity And Mortality Following Pancreaticoduodenectomy, Timothy K. Williams, Ernest L. Rosato, Eugune P. Kennedy, Karen A. Chojnacki, Jocelyn Andrel, Terry Hyslop, Cataldo Doria, Patricia K. Sauter, Jordan Bloom, Charles J. Yeo, Adam C. Berger

Department of Surgery Faculty Papers

Background: Obesity has been implicated as a risk factor for perioperative and postoperative complications. The aim of this study was determine the impact of obesity on morbidity and mortality in patients undergoing pancreaticoduodenectomy (PD).

Study Design: Between January 2000 and July 2007, 262 patients underwent PD at Thomas Jefferson University Hospital (TJUH), of whom 240 had complete data, including body mass index (BMI) for analysis. Data on BMI, preoperative parameters, operative details, and post-operative course were collected. Patients were categorized as obese (BMI >30 kg/m2), overweight (25≤BMI<30), or normal weight (BMI<25). Complications were graded according to previous published scales. Other endpoints included length of postoperative hospital stay, blood loss, and operative duration. Analyses were performed using univariate and multivariable models.

Results: There were 103 (42.9%) normal weight, 71 (29.6%) overweight and 66 (27.5%) …

Enhanced Estrogen-Induced Proliferation In Obese Rat Endometrium, Qian Zhang, Qi Shen, Joseph Celestino, Michael R Milam, Shannon N Westin, Robin A Lacour, Larissa A Meyer, Gregory L Shipley, Peter J A Davies, Lei Deng, Adrienne S Mccampbell, Russell R Broaddus, Karen H Lu

Journal Articles

OBJECTIVE: We tested the hypothesis that the proliferative estrogen effect on the endometrium is enhanced in obese vs lean animals.

STUDY DESIGN: Using Zucker fa/fa obese rats and lean control, we examined endometrial cell proliferation and the expression patterns of certain estrogen-regulated proproliferative and antiproliferative genes after short-term treatment with estradiol.

RESULTS: No significant morphologic/histologic difference was seen between the obese rats and the lean rats. Estrogen-induced proproliferative genes cyclin A and c-Myc messenger RNA expression were significantly higher in the endometrium of obese rats compared with those of the lean control. Expression of the antiproliferative gene p27Kip1 was suppressed …

Environment And Obesity In The National Children's Study, Leonardo Trasande, Christine E. Cronk, Maureen S. Durkin, Marianne E. Weiss, Dale A. Schoeller, Elizabeth A. Gall, Jeanne B. Hewitt, Aaron L. Carrel, Philip J. Landrigan, Matthew W. Gillman

College of Nursing Faculty Research and Publications

Objective: In this review we describe the approach taken by the National Children’s Study (NCS), a 21-year prospective study of 100,000 American children, to understanding the role of environmental factors in the development of obesity.

Data sources and extraction: We review the literature with regard to the two core hypotheses in the NCS that relate to environmental origins of obesity and describe strategies that will be used to test each hypothesis.

Data synthesis: Although it is clear that obesity in an individual results from an imbalance between energy intake and expenditure, control of the obesity epidemic will require understanding of …

Weight Gain In Pregnancy And Risk Of Maternal Hyperglycemia, Sharon J. Herring, Emily Oken, Sheryl L. Rifas-Shiman, Janet W. Rich-Edwards, Alison M. Stuebe, Ken P. Kleinman, Matthew W. Gillman

Public Health Department Faculty Publication Series

OBJECTIVE:

The purpose of this study was to examine associations of weight gain from prepregnancy to glycemic screening with glucose tolerance status.

STUDY DESIGN:

Main outcomes were failed glycemic screening (1-hour glucose result >or= 140 mg/dL) with either 1 high value on 3-hour oral glucose tolerance testing (impaired glucose tolerance in pregnancy) or >or= 2 high values on 3-hour oral glucose tolerance testing (gestational diabetes mellitus). We performed multinomial logistic regression to determine the odds of these glucose intolerance outcomes by quartile of gestational weight gain among 1960 women in Project Viva.

RESULTS:

Mean gestational weight gain was 10.2 +/- …

Concepts Of Contraception For Adolescents With Obesity: Pathways Of Judicial Moderation, Donald E. Greydanus, Hatim A. Omar, Artemis Tsitsika

Pediatrics Faculty Publications

All sexually active youth, whether obese or normal weight, should be offered counseling regarding contraception and appropriate contraceptive methods. However, obese youth who are sexually active may be less likely than their normal weight peers to use contraceptives correctly. Methods of contraception for obese adolescents are reviewed in this discussion. Combined oral contraceptives (COCs) and the contraceptive patch have higher failure rates in obese versus normal weight females, though failure rates are lower than noted with barrier contraceptives. The risk for venous thrombosis is higher in obese youth on COCs. Progestin-only pills and the levonorgestrel intrauterine system appear to be …

Hyperandrogenism And Obesity: Ominous Co-Morbidities, Amit M. Deokar, Shawn J. Smith, Amanda J. Goodwin, Hatim A. Omar

Pediatrics Faculty Publications

This review has a two-fold objective. One, it addresses the association of hyperandrogenism and obesity and the complex metabolic derangements that are part of the problem. Clinical management of these co-morbidities is challenging and complex. Second, this article will aid health care providers with the key features to an early diagnosis and intervention to decrease the morbidities in the short as well as long term. Method: Systematic review of articles and information on the topic of interest that were published in the last 15 years. Conclusion: Obesity and hyperandrogenism are integral parts of Metabolic Syndrome/Polycystic Ovarian Syndrome (PCOS)/Hyperandrogenism, Insulin resistance, …

Overweight Children And Adolescents: Impact On Psychological And Social Development, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar

Pediatrics Faculty Publications

The global epidemic of childhood and adolescent overweight has become a major public health concern. Not only are these youth more likely to become obese as adults, and thus more prone to obesity-related diseases than their non overweight peers, they are also likely to suffer emotional and social effects associated with overweight. Overweight in youth has been linked to depression, low self-esteem, eating disorders, negative body image, and stigma. It appears to be bi-directional in nature, with overweight sometimes predicting certain psychological effects and psychosocial issues sometimes predicting overweight. Effective assessment and treatment of psychological and mental health issues in …

Obesity And Hyperandrogenism, Amit M. Deokar, Shawn J. Smith, Amanda J. Goodwin, Hatim A. Omar

Pediatrics Faculty Publications

This chapter has a two-fold objective. One, it addresses the association of hyperandrogenism and obesity and the complex metabolic derangements that are part of the problem. Clinical management of these co-morbidities is challenging and complex. Second, this article will aid health care providers with the key features to an early diagnosis and intervention to decrease the morbidities in the short as well as long term. Method: Systematic review of articles and information on the topic of interest that were published in the last 15 years. Conclusion: Obesity and hyperandrogenism are integral parts of Metabolic Syndrome/Polycystic Ovarian Syndrome (PCOS)/Hyperandrogenism, Insulin resistance, …

Obesity And Lack Of Physical Activity, Hatim A. Omar, Efrat Merrick-Kenig, Joav Merrick

Pediatrics Faculty Publications

Lack of physical activity and overweight status continues to be a significant health problem in the United States. To assess the actual prevalence of these problems, we reviewed data from the School-based Health Promotion Centers in one middle school, and one high school in central Kentucky. A total of 232 6th graders and 607 9th graders were included. A total of 92% of 6th graders and 45% of 9th graders reported complete lack of regular exercise. 37% of 9th graders and 59% of 6th graders had inappropriate nutrition, 47% of 9th graders and 33% of 6th graders had Body Mass …

Patterns Of Commodity Food Use Among American Indians, Michelle Chino, Darlene R. Haff, Carolee Dodge Francis

Environmental & Occupational Health Faculty Publications

Objectives: To better understand risks for obesity and diabetes among American Indians.

Methods: Adults from tribes across the country surveyed to explore commodity food use patterns and food choice.

Results: Respondents reported second and third generation commodity food use. Current commodity users stated preferences for canned and packaged meals and were more likely to participate in other federal food programs.

Conclusions: Low-income, nutritionally stressed families relying on federal food programs may be at increased risk of obesity and diet-related chronic conditions due to long-term use of foods that are high in fat and calories and low in fiber.

A Botanical Approach To Managing Obesity, Dilip Ghosh

Faculty of Health and Behavioural Sciences - Papers (Archive)

metabolic syndrome in check like obesity. There are few drugs in the market to ameliorate or prevent obesity but there are the costs, efficacy and side effects to consider. For centuries people across the countries have been using natural products and plant based dietary supplements for weight control. The current review will consists of one South Asian herb, Garcinia cambogia and one Chinese herb, Magnolia officinalis.

Fat Flat Frail Feet: How Does Obesity Affect The Older Foot, Julie R. Steele, Karen J. Mickle, Bridget J. Munro

Faculty of Health and Behavioural Sciences - Papers (Archive)

The prevalence of obesity is rising throughout the world at an alarming rate, and the elderly are no exception with 15% of men and 28% of women aged over 60 years considered to be obese [1]. Overweight and obesity have been shown to negatively affect foot structure and function in both children [2] and adults [3]. These structural changes appear to be associated with increased foot discomfort whereby overweight children have been found to report foot pain significantly more often than their leaner counterparts [4]. As feet are our base of support during most weight-bearing activities, it is postulated that …

Chasms In Care: Implications Of A Disparate System On Childhood Obesity, Sara Dianne Miller

Mahurin Honors College Capstone Experience/Thesis Projects

There are disparities that exist between public health and personal health care in addressing childhood obesity. Public health efforts to reduce the prevalence of this epidemic have focused on preventive strategies because a coordinated system of health care to address the treatment of obesity in children does not exist. For children who are already overweight, these strategies are not enough. What programs do exist are typically fee-for-service. This study examines the ethics and implications of the disparities that exists in our nation, as well as the role socioeconomic status plays in adolescent overweight and obesity and its primary behavior risk …