Obesity has been linked to a wide range of health problems. Evidence suggests that overweight and obese (OW/O) women avoid or delay seeking medical care and routine health screenings, a choice that may result in poorer overall health. The objective of this study is to explore how an OW/O woman’s self-identity and her experiences in past medical encounters may affect her health-seeking behaviors. Twenty-three women who self-identified as being overweight (currently or in the past) were recruited using a flyer placed in a women’s exercise facility and through the snowball method. Each agreed to an audio-taped, in-depth, semi-structured interview. Interviews were transcribed and analyzed. This study employs multiple methods of analysis and multiple genres of representation of the data, an approach recently termed “crystallization.” Analysis of an autoethnographic narrative served as a guide for the generation of the research questions, which focused on how OW/O women conceptualize their identities in relation to their bodies, how their attitudes about their bodies may have impacted choices about seeking healthcare and their perception of their experiences within medical encounters, and what OW/O women believe to be potentially effective strategies for clinicians to adopt in caring for overweight patients. Interviews were scrutinized to identify story types using Arthur Frank’s well-established framework for the analysis of narratives of sudden life-threatening illness. Two additional story types, Reorientation and Acceptance, are proposed as potentially useful in analyzing stories of chronic health conditions. Grounded theory analysis was used to identify the factors that OW/O women perceive to contribute to their weight struggles, as well as to determine clinician attitudes and practices that OW/O women regard as effective and ineffective. Two emergent themes—othering and control—were discerned in the data and are discussed in terms of both how OW/O women are impacted by their weight and how practitioners can work to provide more effective care. An explanatory model linking social bias, personal identity, and medical interactions is proposed. Finally, a performance script is presented as a means of synthesizing and disseminating research findings.

p. 1-101 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-02T19:07:04Z No. of bitstreams: 1 7777777777777aaa.pdf: 645591 bytes, checksum: d42bcd7410890d638848d6e5f366302c (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:42:39Z (GMT) No. of bitstreams: 1 7777777777777aaa.pdf: 645591 bytes, checksum: d42bcd7410890d638848d6e5f366302c (MD5) / Made available in DSpace on 2013-05-04T17:42:39Z (GMT). No. of bitstreams: 1 7777777777777aaa.pdf: 645591 bytes, checksum: d42bcd7410890d638848d6e5f366302c (MD5) Previous issue date: 2009 / Objetivo: identificar fatores associados ao baixo risco cardiometabólico (RCM) em mulheres obesas (MOb) atendidas em ambulatórios especializados do SUS, Salvador – BR. Métodos: estudo caso-controle, pareado pela idade com 306 MOb, IMC ≥30kg/m², sendo 66 (21,6%) casos – todos não hipertensos, normolipídicos e não diabéticos e 240 (78,4%) controles. Dados secundários foram obtidos dos prontuários médicos e primários através de inquérito domiciliar e de exames laboratoriais. Foram realizadas análises: descritiva, bivariada e regressão logística condicional. Resultados: associações positivas, estatisticamente significantes, foram detectadas entre baixo RCM e consumo de ≥3 porções de frutas/dia (ORaj = 20,1; IC95%: 5,6 – 71,9); PCR do 1º. quartil (ORaj = 4,1; IC95%: 2,0 – 8,3) e da adiponectina plasmática (AdipoQ) a partir do 3º. quartil (ORaj = 2,3; IC95%:1,1 – 4,8). Conclusão: este estudo sugere que dieta rica em fibras solúveis (≥3 porções de frutas/dia), valores da PCR ≤3,70mg/L e da AdipoQ >10,00µg/mL podem dificultar, retardar ou impedir o aparecimento de outros fatores de risco ou doenças metabólicas em MOb. / Salvador

The obesity epidemic continues to be a major concern in the United States. The World Health Organization reported that 1.4 billion adults were either obese or overweight. African American (AA) women have the highest incidence of obesity worldwide. The obesity rate among AAs has continued to rise over the past 2 decades. The problem is that AA women prepare and consume high caloric foods that contribute to obesity. This qualitative descriptive study explored the perceptions that obese AA women have about altering how they prepare soul food to make it a healthier soul food. The empowerment model and the health belief model were used to frame this study. Data were collected using a non-probability purposeful sampling strategy. The sample for this study consisted of 4 focus groups with 6-7 obese AA women (n = 25) who prepare and consume high caloric soul foods and have a body mass index of 30 and above. Focus group transcripts were analyzed using a constant comparative analysis and NVivo 11 computer software. It was found that obese AA women were willing to alter their traditional soul food preparation only if it tastes good. It was also found that participants would maintain new healthier eating behaviors depending on the taste, availability of recipes to use, low cost of healthy ingredients, accessibility of the ingredients, learning how to substitute various herbs and spices, and amount of food waste. Barriers that could limit participation in an intervention designed to develop healthier eating habits were identified as ignorance and laziness, transportation issues, lack of motivation, lack of education, lack of time, no incentives, and bad reviews.

Made available in DSpace on 2014-12-17T15:37:05Z (GMT). No. of bitstreams: 1 PauloJFC_DISSERT.pdf: 1001139 bytes, checksum: 32624b3dc04255ae3e75e4e16600e75d (MD5) Previous issue date: 2011-08-08 / A disfun??o sexual corresponde a altera??es em uma ou mais fases da resposta sexual humana e apresenta maior preval?ncia na popula??o feminina. Ademais, a participa??o de alguns fatores como obesidade e n?veis dos horm?nios esteroidais na disfun??o sexual feminina (DSF) permanece incerta. O presente estudo deteve-se na an?lise da ocorr?ncia de DSF numa popula??o de mulheres portadoras de obesidade, cadastradas no Ambulat?rio de Cirurgia Bari?trica do Hospital Universit?rio Onofre Lopes, da Universidade Federal do Rio Grande do Norte, no munic?pio de Natal, RN. O estudo foi realizado em uma amostra composta por trinta e uma mulheres, com idade entre 20 e 50 anos, com ?ndice de massa corp?rea (IMC) > 30 Kg/m2. A todas as pacientes foi aplicado um question?rio composto por uma se??o com dados socio-econ?micos, e outra abordando a sa?de sexual feminina, sendo esta ?ltima correspondente ao Female Sexual Function Index (FSFI), para diagn?stico de DSF. A partir dessa caracteriza??o, as pacientes foram reunidas nos grupos CD (pacientes com disfun??o, n= 9) e SD (sem disfun??o, n= 22). Para a an?lise do efeito da obesidade na DSF, as pacientes foram reunidas nos grupos 1 (6 pacientes com IMC grau I e II: entre 30 e 40 Kg/m2) e 2 (25 com IMC grau III: acima de 40). Para o estudo da participa??o dos horm?nios esteroidais foram determinadas as concentra??es s?ricas de cortisol, estradiol e dehidroepiandrosterona (DHEA) pelo m?todo de quimiluminesc?ncia. A an?lise estat?stica dos dados foi realizada usando os testes ANOVA, MANOVA (Pillai), al?m de an?lise de Cluster. Para identificar as diferen?as entre os dom?nios do FSFI, foi usado o teste T de Student. A signific?ncia considerada para todos os testes foi para p< 0,01. Das pacientes estudadas, 25,8% apresentaram DSF de acordo com o escore total do FSFI. A an?lise estat?stica posterior evidenciou que as diferen?as ocorreram para os dom?nios desejo, excita??o e orgasmo. N?o foi encontrada rela??o da presen?a de DSF com os diferentes graus de obesidade ou com os n?veis hormonais dos ester?ides cortisol, estradiol ou DHEA. Contudo, foi encontrado aumento significativo nos n?veis s?ricos de estradiol para o grupo 1, que corresponde ao de menor ?ndice de IMC. Estes resultados mostram que a preval?ncia de DSF n?o diferiu entre os graus I,II e III de obesidade das pacientes deste estudo mas, quando presente, a disfun??o ocorre nos dom?nios desejo, excita??o e orgasmo. A maior concentra??o de estradiol encontrada nas pacientes de menor ?ndice de IMC sugere uma poss?vel rela??o entre as duas vari?veis que precisa ser investigada em estudos futuros. / Sexual dysfunction corresponds to changes in one or more phases of human sexual response and it has major prevalence in women. At the same time, the participation of some factors such as obesity and levels of steroid hormones in female sexual dysfunction (FSD) remains uncertain. This study analyzed the occurrence of DSF in a population of obese women part of the Bariatric surgery clinic at the Onofre Lopes Academic Hospital of the Federal University of Rio Grande do Norte, Natal, RN. The study was conducted in a sample of thirty-one women, aged between 20 and 50 years with body mass index (BMI) > 30 kg/m2. All patients answered a questionnaire consisting of two sections addressing socioeconomic conditions and female sexual health, the latter corresponding to the Female Sexual Function Index (FSFI) for the diagnosis of FSD. Using this characterization the patients were divided in groups CD (nine patients with dysfunction) and SD (twenty-two patients with no sexual dysfunction). To analyze the effect of obesity on the DSF, the patients were divided in groups 1 (6 patients with obesity grade I and II: BMI between 30 and 40 kg/m2) and 2 (22 patients with obesity grade III: BMI above 40). To investigate the role of steroid hormones, serum levels were determined for cortisol, estradiol, and dehydroepiandrosterone (DHEA), using chemiluminescence method. The statistical analysis was performed using ANOVA, MANOVA (Pillai) and cluster analysis. To identify the differences between the domains of the FSFI, was used the Student t test. The significance level for all tests was p <0.01. Of the patients studied, 25.8% had DSF according to the total FSFI score. The statistical analysis showed that the differences occurred for the domains desire, arousal and orgasm. No relationship was found for the presence of DSF with different degrees of obesity and steroid hormone levels. However, was found significant increase in estradiol serum levels for group 1, which corresponds to the lowest BMI. These results show that the presence of FSD did not differ between grades I, II and III of obesity in this study, but, when present, dysfunction occurs in the domains desire, arousal and orgasm. The highest estradiol concentration found in patients with the lowest BMI suggests a possible relationship between the two variables, and should be investigated in future studies.

[pt] A cultura de consumo é uma arena para a produção e circulação de representações identitárias. Nesse espaço, o estigma do peso pode afetar diretamente a criação de um projeto identitário. Diante de uma recorrente dificuldade de atenderem seus desejos próprios de consumo de vestuário, os projetos identitários de mulheres obesas acabam sendo impactados pelas condições estabelecidas pela indústria da moda, que, por décadas, adotou um posicionamento marginal em relação ao segmento plus size. Apesar do tamanho deste segmento, existe uma carência de estudos qualitativos direcionados ao consumo simbólico de moda plus size no Brasil, especialmente com um olhar voltado à reconstrução da identidade de mulheres submetidas à cirurgia bariátrica. Portanto, este trabalho investigou, a partir de uma perspectiva interpretativa, os significados simbólicos do consumo de vestuário plus size feminino e como a cirurgia bariátrica impacta na reconstrução da identidade de consumidoras obesas e sua relação com a moda. Foram realizadas entrevistas em profundidade com 15 mulheres bariatricadas, entre 30 e 50 anos de idade, selecionadas por meio da técnica bola de neve. Todas as entrevistas foram gravadas e transcritas integralmente, e analisadas de forma sistemática a partir de categorias que emergiram do campo. Os resultados sugerem a existência de uma variedade de aspectos subjetivos associados à reconstrução da identidade por essas mulheres, por conta da passagem pela cirurgia bariátrica, que refletem expressivamente os diversos significados atribuídos ao consumo simbólico de moda feminina, com destaque a novas percepções, hábitos, experiências e preferências de consumo. / [en] Consumer culture is an arena for the production and circulation of identity representations. In this space, the stigma of weight may directly impact the creation of an identity project. Faced with a recurrent difficulty in meeting their own clothing consumption desires, the identity projects of obese women have been impacted by the conditions established by the fashion industry, which has adopted a marginal position about the plus size segment for decades. However, despite the size of this segment, there is a lack of qualitative studies aimed at the symbolic consumption of plus size fashion in Brazil, especially with a view to identity reconstruction of women who have undergone bariatric surgery. Therefore, this work proposes to investigate, from an interpretive perspective, the symbolic meanings of the consumption of female plus size clothing and how bariatric surgery impacts the identity reconstruction of obese consumers and their relationship with fashion. By exploring this phenomenon, aspects such as the social stigma to obesity, the segregation of the fashion universe, and the retail influences on these women shopping experiences were highlighted. In-depth interviewing was conducted with 15 bariatric women, between 30 and 50 years of age, using the snowball sampling technique. All interviews were fully recorded and transcribed. The analysis used categories that emerged from the field. The results suggest the existence of a variety of subjective aspects associated to the identity reconstruction of these women, due to the experience of bariatric surgery, which reflects expressively in the various meanings attributed to the symbolic consumption of women s fashion, with emphasis on new consumption perceptions, habits, experiences, and preferences.

Made available in DSpace on 2016-06-02T19:22:12Z (GMT). No. of bitstreams: 1 6350.pdf: 3538170 bytes, checksum: 7d36b58142cff837550ab8086a4637b7 (MD5) Previous issue date: 2014-11-07 / Universidade Federal de Sao Carlos / The Normal weight obesity (NWO) syndrome has been characterized on subjects with normal BMI and high body fat mass percentage (BF%>30 on with women) and is a risk factor for cardiometabolic dysregulation and cardiovascular mortality. The aim of this study was to evaluate whether circuit resistance training (CRT) improves body composition, heart size and functions, cardiometabolic parameters, and cardiorespiratory, cardiovascular and skeletal muscle fitness on women with NWO. Subjects/Methods: Data are mean [95%CI]. Twenty-nine white women participated in the study allocated to three groups: ten NWO-CRT (baseline: BMI=22.4 [21.4-23.3] kg/m2; BF%=44.5 [41.0-48.0]%) performed CRT during ten weeks; thirteen untrained NWO-control (baseline: BMI=21.7 [20.8-22.7] kg/m2; BF%=37.8 [34.6-41.1]%) and six non-obese (BMI=19.2 [17.9-20.6] kg/m2; BF%=23.6 [18.3-29.0]%). At baseline (all groups) and after ten weeks (NWO groups) performed: dualenergy- X-ray-absorptiometry, echocardiography, blood tests, arterial pressure, exercise testing, and total-overload-by-training-session (TOL) was calculated. Results: At baseline NWO-control showed almost double of body fat mass (BF) (22.41 [19.5-25.3] kg) than nonobese (11.88 [9.0-14.8] kg) (p=0.0001), and NWO-CRT had more BF than NWO-control (27.28 [23.9-30.6] kg) (p=0.0227). The NWO-CRT after training: reduced more than 8 kg of BF (p=0.000002); the BF% became lower than NWO-control (33.1 [30.1-36.0] < 37.0 [34.3- 39.6]%, p=0.0423) with 30% of NWO-CRT becoming non-obese; reduced 3 kg of trunk fat mass (p=0.000005); showed fasting glucose (72.8 [69.4-76.2] mg/dl) smaller than NWOcontrol (81.7 [78.6-84.8] mg/dl) (p=0.004) and non-obese (92.7 [86.6-98.8] mg/dl) (p=0.000003); increased TOL (5,087.5 [4,142.5-6,032.5] to 6 963.3 [6,226.4-7,700.2] rep.kg, p=0.0004); increased load at VO2peak (122.5 [106.8-138,2] to 137.5 [118.18-156.82] W, p=0.0051); reduced the double product/load at VO2peak ratio (277.4 [222.1-332.8] to 237.7 [194.2-281.2] mmHg.bpm/W, p=0.0015). The CRT increased left ventricular mass/body surface area ratio (84.29 [78.98-89.6] to 90.29 [81.45-99.12] g/m2, p=0.0215). Conclusions: CRT improves the body composition, cardiovascular and skeletal-muscle fitness and reduces fasting glucose without cardiorespiratory changes on normal weight obese women. / A síndrome de obesidade com peso normal tem sido caracterizada em indivíduos com índice de massa corporal normal e elevado percentual de massa gorda corporal (%MG), maior que 30% em mulheres, e é considerado um fator de risco para distúrbios metabólicos e mortalidade cardiovascular. Assim, o objetivo deste trabalho foi avaliar se um treinamento de circuito resistido melhora a composição corporal, parâmetros estruturais e funções cardíacas, parâmetros cardiometabólicos e capacidades cardiorrespiratória, cardiovascular e muscular esquelética em mulheres adultas sedentárias obesas de peso normal. Dados são mostrados em média [intervalo de confiança de 95%]. Vinte e nove mulheres participaram do estudo sendo alocadas em três grupos: dez mulheres inicialmente obesas de peso normal (IMC=22,4 [21,4-23,3] kg/m2; %MG=44,5 [41,0-48,0]%) que realizaram dez semanas de treinamento resistido em circuito (grupo MOPN-TRC); treze mulheres no grupo MOPN-controle (IMC=21,7 [20,8-22,7] kg/m2; %MG 37,8 [34,6-41,1]%) que permaneceram sedentárias nas dez semanas; e seis mulheres num grupo controle de nãoobesas sedentárias avaliadas (IMC=19,2 [17,9-20,6] kg/m2; %MG=23,6 [18,3-29,0]%) somente inicialmente como valores de referência geral. Inicialmente todos os grupos realizaram: avaliação a composição corporal por absortometria radiológica de dupla energia dual-energy-X-ray-absorptiometry (DXA), ecocardiografia com doppler, perfil lipídico glicemia de jejum, teste ergoespirométrico máximo em ciclo-ergômetro, pressão arterial e a sobrecarga total da sessão de treino foi calculada. Após dez semanas os dois grupos MOPN refizeram estas análises. Inicialmente o grupo MOPN-controle apresentava mais que o dobro de massa gorda corporal (MG) (22,41[19,5-25,3] kg) que as não-obesas (11,88 [9,0-14,8] kg) (p=0,0001), enquanto o grupo MOPN-TRC possuía MG (27,28 [23,9-30,6] kg) ainda maior MOPN-controle (p=0,0227). Após o treinamento as MOPN-TRC: reduziram mais de 8 kg de MG (p=0,000002); o %MG que era maior tornou-se menor que o das MOPN-controle (33,1 [30,1-36,0] < 37,0 [34,3-39,6]%, p=0,0423) e 30% das voluntárias tornaram-se não-obesas; reduziram 3 kg de massa gorda no tronco (p=0,000005); apresentaram glicemia de jejum (72,8 [69,4-76,2] mg/dl) menor que os grupos MOPN-controle (81,7 [78,6-84,8] mg/dl) (p=0,004) e não-obeso (92,7 [86,6-98,8] mg/dl) (p=0,000003); aumentou a sobrecarga total da sessão de treino (5.087,5 [4.142,5-6.032,5] para 6.963,3 [6.226,4-7.700,2] rep.kg, p=0,0004); aumentou a carga no VO2pico (122,5 [106,8-138,2] para 137,5 [118,18-156,82] W, p=0,0051); reduziu a taxa duplo produto/carga no VO2pico (277,4 [222,1-332,8] para 237,7 [194,2-281,2] mmHg.bpm/W, p=0,0015). Conclui-se que o treinamento resistido em circuito realizado melhora a composição corporal, as capacidades cardiovascular e muscular esquelética, enquanto reduz a glicemia de jejum sem alterar a capacidade cardiorrespiratória de mulheres obesas de peso normal.