No description available.

No description available.

No description available.

No description available.

Obesity is a current priority for governments in developed countries, due to its increasing prevalence and associations with poor health. Clinical psychologists are among the professionals who work with people who are obese, considering both their physical and psychological wellbeing. In section one; a narrative review argues that the role of clinical psychologists in obesity treatment should be re-constructed. It suggests that that the predominant focus oh non-psychological outcomes, such as weight loss, may be misplaced given the evidence that cognitive and behavioural therapies lack efficacy in facilitating weight loss in the long term. Moreover, the review argues that by working towards weight loss outcomes, within a society preoccupied with thinness, clinical psychology may be making contingent the relationship between weight and psychological wellbeing. The review therefore argues that clinical psychologists are justified in shifting their focus from weight loss to psychological outcomes, which may enable a disassociation between weight and psychological wellbeing. Section two reports findings from a quantitative study examining the role of emotions in binge eating behaviours in people who are obese and seeking treatment for their weight. Fifty one people participated in the study. The variables: perception of threat from sadness and anger, as well as emotional expressiveness and emotional eating were considered, alongside a known predictor of binge eating, depression. The results of the study indicated that depression and emotional eating predicted binge eating; however perception of threat from sadness, anger and emotional expressiveness did not significantly contribute to the additional variance in this behaviour. The findings suggest that binge eating may serve an 'affect regulatory' function, although further research is needed to examine the nuances of emotional experience in this group of people.

Thesis (M.Sc. (Biochemistry)) --University of Limpopo, 2009 / Obesity is a complex and chronic disease that is associated with many complications including type 2 diabetes (T2D). However, the mechanism leading to these events is unclear. To determine the role played by obesity in the development of T2D, it was purposed to examine serum protein profiles of diet-induced obese Wistar rats. These protein(s) will be used as potential biomarkers for early detection, diagnosis, as target for drug discovery and hopefully treatment of obesity and obesity-induced disorders. An animal model of obesity-induced T2D was established by feeding male Wistar rats a diet with a high fat content for 44 weeks. Weight changes and food intake were monitored weekly during the diet phase. Fasting blood glucose levels were measured while blood was collected for serumpreparation every second week for the first eight weeks; using these parameters, a model for the identification of diet-induced obese rats was established. Serum protein profiles were then compared between the two groups using 2D-PAGE analysis coupled to MALDI-MS at termination of the study. Several proteins showed differences in their expression when compared between the low fat (LF) and high fat (HF) groups. However, only proteins that showed expression that was either two fold low or high between the two groups were considered to be differentially expressed. High fat fed rats weighed significantly heavier starting at the fourth week on diet and throughout the study, their glucose homeostasis and serum protein expression was altered. Three protein spots were identified as dysregulated in the HF group, where Apolipoprotein-AIV was found to have been up-regulated whereas C-reactive protein and Fetuin-A were down-regulated. These proteins might help in the understanding of the mechanism(s)that underlie the pathogenesis of obesity and its related disorders. However, further studies are required to determine the relationship between these proteins, obesity development and its comorbidities.

Latest epidemiological data suggests that 1.5 billion adults worldwide are obese or overweight. Excess weight and adipocyte hypertrophy have long been associated with contributing to low-grade systemic inflammation through elevated adipokine secretion. These increased endocrine signals further augment the metabolic dysfunction related to the presence of obesity. A chronic exposure to obesity mediated inflammation is also suggested to be responsible for progression of renal pathology and eventual end-stage organ failure. In human clinical statistics, these factors indicate a gender disparity, as males demonstrate much faster progression rates of obesity-linked renal disease than females. Therefore, the aim of this thesis was to investigate the role of gender in obesity mediated inflammation in the development of renal disease using a large animal model i.e. sheep. Post-natal female and male sheep were exposed to a lean or obesogenic environment by restricting physical activity from ≈3 months to ≈17 months of age. Analysis of body composition and adipose tissue physiology, morphology and deposition identified the development of moderate obesity following chronic exposure to a low physical environment, although no differences were observed with gender. With obesity, both genders demonstrated metabolic irregularities; males showed hyperinsulinaemia and females displayed hypercortisolism. Gene expression analysis identified an up-regulation of inflammatory related genes in perirenal adipose tissue (PAT) and kidney in obese males, a finding not seen in females, although obese females exhibited an up-regulation in glucocorticoid receptor abundance in PAT. Furthermore, the males demonstrated adaptations in renal structure and function with obesity, modifications not observed in females. The main conclusion of my thesis is that after the development of obesity, males appear much more sensitive to the metabolic, inflammatory and renal adaptations associated with an obese condition. Females displayed a down-regulation of inflammatory genes with obesity which I propose acts as a protective mechanism against the progression of renal disease, perhaps mediated by an immunosuppressive glucocorticoid action in adipose tissue. It is also possible that sex hormones play a role in obesity inflammatory renal disease development, postulated to occur through HPA activation and epigenetic alterations.

Background: The prevalence of overweight, obesity and obesity-related disease, mainly cardiovascular disease (CVD), is increasing in both developed and developing countries. Ethnic differences have been reported in the prevalence of overweight, obesity and CVD. However, measures used to define overweight and obesity, and identify increased risk of CVD were developed and validated in predominately Caucasian populations in developed countries. Consequently, these measures may not accurately define disease risk in all population groups. Therefore the specific aims of this programme of study were: 1. To establish the relationship between adiposity and cardiovascular risk factors in different ethnic groups. 2. To identify field measures of adiposity, relating to cardiovascular risk in different ethnic groups. 3. To compare the relationship of adiposity and cardiovascular risk factors in a single ethnic group, that of a rural and an urban population in Zimbabwe. 4. To identify risk factors for CVD related to adiposity in a population of African origin. Study design: Three empirical studies were undertaken. In study one, 312 adult subjects from three ethnic groups (Afro-Caribbean (n=106), Caucasian (n=165) and South Asian (n=41)) were recruited from a University. Twenty-six (26) of each group were individually matched for age (±3 years) gender and BMI (±2 kg/m2) to allow for comparability. Measures of body composition included height, weight, waist and hip circumferences, skinfold thickness measures, body density and percentagebody fat. In study two, 81 subjects from two ethnic groups (Afro-Caribbean (n=39) and Caucasian (n=42)) were recruited and tested. They were matched for age, gender and BMI using the same criteria as study one. In addition to the body composition measures taken in study one, random non-fasting blood glucose, total cholesterol, triglycerides and blood pressure were taken. In study three, 55 men and 108 women from rural Zimbabwe, 8 men and 17 women from an urban low-density suburb in Harare Zimbabwe, and 28 male and 16 female students from the University of Zimbabwe were recruited and tested. In addition to all measures of body composition in studies one and metabolic analysis in study two, participants’ dietary intake was assessed by food frequency questionnaire and 24hour recall and physical activity was assessed by a physical activity questionnaire. Main findings: • The relationship between BMI and %BF was not the same in all ethnic groups. (aim 1) • There were ethnic differences in the cardiovascular risk predictors between Afro-Caribbean and Caucasian men and women. (aim 1) • It is not recommended that BIA is used as a substitute for TBW estimation in multi-compartment models. (aim 2) • In three groups of Zimbabweans from urban, rural and university locations, a pattern emerged. Amongst women, urban women were at greatest risk, reporting highest values for all variables, followed by rural then university women. Amongst men, urban men were at highest risk, however there were few differences between rural and university men. (aim 3). • Finally, increased WC and dyslipidemia are associated with increasing BMI in populations of African origin. (aim 4) Conclusions: The relationships between overweight, obesity and risk of obesity-related disease differ between different ethnic groups. Moreover, in the groups from Zimbabwe, differences in obesity-related risk were associated with being female and living in urban areas. Therefore, application of universal measures for defining obesity and related diseases may not be applicable to all ethnic groups.

L'obésité est une maladie complexe dont la prévalence est en constante augmentation à travers le monde. A l'instar de nombreux médicaments qui ont pour origine des molécules végétales, de nouveaux principes actifs ont été recherchés dans les plantes. Parmi eux, les phytoecdystéroïdes, notamment la 20-hydroxyecdysone présente dans le quinoa, ont montré des effets pharmacologiques bénéfiques, et seraient donc des candidats potentiellement efficaces contre l'obésité. L'objectif de cette thèse est de mettre en évidence les propriétés d'un extrait de quinoa enrichi en 20-hydroxyecdysone sur le surpoids et l'obésité et d'en caractériser les effets.Dans un premier temps, un apport alimentaire d'extrait de quinoa enrichi en 20-hydroxyecdysone chez la souris soumise à un régime hyperlipidique a permis de limiter le développement du tissu adipeux, sans modifier la prise alimentaire. Dans le tissu adipeux, ces effets ont été associés à une diminution de la quantité de transcrits de gènes impliqués dans le stockage lipidique et l'inflammation. L'analyse du bilan énergétique a mis en évidence un effet de l'extrait de quinoa sur l'augmentation de la dépense énergétique liée à une augmentation de l'oxydation des glucides, ainsi que sur la diminution de l'absorption intestinale des lipides. Ensuite, chez le sujet en surpoids ou obèse, l'extrait de quinoa a montré une tendance à la prévention de la reprise de poids et de masse adipeuse suite à une restriction énergétique. Cet effet s'est accompagné d'un maintien de l'amélioration de l'insulino-sensibilité. Enfin, des mesures de biodisponibilité de la 20-hydroxyecdysone chez la souris ont permis de quantifier sa teneur circulante et de suivre l'apparition de certains de ses métabolites dont le rôle reste à identifier. Ces résultats montrent un bénéfice potentiel de l'extrait de quinoa et de son principe actif, la 20-hydroxyecdysone, sur la stabilisation du poids et de la masse adipeuse suite à une réduction pondérale. D'autres études seront nécessaires afin de poursuivre la caractérisation de ces effets. / Obesity is a complex disease which is dramatically increasing worldwide. Following the example of many drugs that were developed from plants molecules, new natural active principles are currently being evaluated in order to prevent or to treat metabolic disorders. Among them, phytoecdysteroids, and mainly 20-hydroxyecdysone present in quinoa, have displayed beneficial pharmacological effects. Thus, they would be potentially active candidates against obesity. The objective of this thesis is to highlight the properties of a quinoa extract enriched in 20-hydroxyecdysone on overweight and obesity and to characterize their effects.First, the ingestion of 20-hydroxyecdysone enriched quinoa extract by mice fed a high-fat diet limited adipose tissue development, without modifying food intake. In adipose tissue, these effects were associated with a reduction of the amount of transcripts of genes involved in lipid storage and inflammation. Energy balance analyses showed that quinoa extract increased energy expenditure via an increase in glucose oxidation and diminished lipid intestinal absorption. Then, in overweight and obese subjects, quinoa extract displayed a tendency to prevent weight and fat mass regain after energy restriction. This effect was accompanied by the maintenance of insulin sensitivity improvement. Lastly, 20-hydroxyecdysone bioavailability measurements in mice allowed its plasma level quantification and the identification of metabolites whose role is still to be identified. These results show a potential benefit of the quinoa extract and its active principle, 20-hydroxyecdysone, on weight and adipose mass stabilization following weight loss. More studies are required to characterize further these effects.

Les candidats à la chirurgie bariatrique ont une trajectoire biopsychosociale singulière : obésité très sévère ou compliquée, psychopathologies fréquentes et histoires de vie difficiles et traumatiques. Considérant le traitement médical comme un échec, ils voient la chirurgie comme l’ultime solution. Le concept de résilience permet d’aborder la fragilité psychique et sociale de ces personnes. Les objectifs principaux de l’étude visent à mieux cerner leurs fonctionnements psychiques et à identifier leurs évolutions au cours d’un parcours de préparation à la chirurgie bariatrique, selon une approche semi-quantitative d’inspiration psychodynamique. Deux cents sujets candidats à la chirurgie bariatrique (153 femmes et 47 hommes ; âge : 43,5 ± 11,74 ans ; IMC : 45,54 ± 7,19 kg/m²) ont été recrutés au début de leurs parcours de préparation au CHRU de Nancy. Ce parcours qui dure un an est basé sur un abord cognitivo-comportemental et propose des ateliers collectifs d’éducation thérapeutique.Trois méthodologies ont été utilisées au début et à la fin de ce parcours pour explorer les différentes dimensions de la résilience dans le contexte de l’obésité sévère : des entretiens cliniques de recherche, des données projectives (102 protocoles Rorschach) et des auto-questionnaires permettant d’apprécier la qualité de vie (EQVOD et SF-36), les Troubles des Conduites Alimentaires (TCA) (DEBQ et BES), les psychopathologies (HAD et MINI), les mécanismes de coping (Briefcope), l’alexithymie (TAS), et la résilience (RSA). Le processus de résilience est inexistant en début de parcours. Les résultats indiquent que les sujets présentent une faible qualité de vie ainsi que de nombreuses psychopathologies : compulsions alimentaires (62,89 %, dont 56,6 % de Binge Eating Disorder (BED)), dépressions (15 %), anxiétés (34,5 %) ou encore addictions (29,5 %). Un nombre important d’événements de vie difficiles et traumatiques est relevé : 86 % des sujets ont un vécu polytraumatique remontant majoritairement à l’enfance et l’adolescence. Les réponses paradoxales données par certains sujets aux auto-questionnaires permettent de les classer selon un profil comportemental dit "discordant" (sous-évaluation du binge eating à la BES et surévaluation de la résilience à la RSA) qui se caractérise par un défaut de mentalisation relevé à l’entretien clinique et au Rorschach. Une nette amélioration de l’ensemble des indicateurs est constatée à la fin du parcours. La qualité de vie des sujets, notamment psychique, augmente. La prévalence des psychopathologies, elle, diminue fortement, avec des réductions significatives des TCA en termes de fréquence (64,78 %) et d’intensité (13,21 % avec forte compulsivité), des dépressions (3,14 %), de l’anxiété (8,18 %) et des comportements addictifs (13,84 %). Enfin, les difficultés de mentalisation ont régressé, bien que la majorité des sujets présente toujours une absence de processus résilient juste avant la chirurgie. Les sujets présentant un profil "concordant" d’après les auto-questionnaires, connaissent une amélioration significativement plus importante à la plupart des indicateurs, par rapport aux sujets "discordants" / Candidates for bariatric surgery have a singular biopsychosocial trajectory: very severe or complicated obesity, frequent psychopathologies and difficult and traumatic life histories. Considering medical treatment as a failure, they see surgery as the ultimate solution. Resilience’s concept enables to come closer the psychic and social fragility of these people. The main objectives of the study are to pinpoint their psychic functioning and to identify their evolution during a healthcare pathway of preparation for bariatric surgery, using a semi-quantitative approach of psychodynamic inspiration. Two hundred subjects who are candidates for bariatric surgery (153 women and 47 men, age: 43.5 ± 11.74 years, BMI: 45.54 ± 7.19 kg/m2) were recruited at the beginning of their healthcare pathway of preparation at CHRU of Nancy. This one-year circuit is based on a cognitive-behavioral access and offers collective therapeutic education working group.Three methodologies were used at the beginning and end of this circuit in order to explore the different dimensions of resilience in severe obesity context: clinical research interviews, projective data (102 Rorschach protocols) and self-questionnaires enabling the quality of life (EQVOD and SF-36), eating disorders (ED) (DEBQ and BES), psychopathologies (HAD and MINI), coping mechanisms (Briefcope), alexithymia (TAS), and resilience (RSA) to be assessed.The resilience process is nonexistent at the beginning of the circuit. Results indicate that the subjects have a poor quality of life as well as many psychopathologies: food compulsions (62.89%, including 56.6% of Binge Eating Disorder (BED)), depressions (15%), anxieties (34, 5%) or addictions (29.5%). A significant number of difficult and traumatic life events is noted: 86% of the subjects have polytraumatic past life experiences mostly going back to childhood and adolescence periods.Paradoxical responses given by some subjects at self-questionnaires authorize them to be classified according to a behavioral profile known as "discordant" (underestimate of binge eating at BES and overvaluation of resilience at RSA) which is characterized by a deficit of mentalization identified at the clinical interview and at Rorschach.A clear improvement of all these indicators is certified at the end of this circuit. The quality of life of subjects, especially psychic, increase. The prevalence of psychopathologies, it, strongly decreases, with significant reductions in eating behavior disorders in terms of frequency (64.78%) and intensity (13.21% with sizable compulsivity), depressions (3.14%), anxiety (8.18%) and addictive behaviors (13.84%). Lastly, mentalization’s difficulties decreased, although the majority of subjects still have an absence of resilient process just before surgery. Subjects with a "consistent" profile according to the self-questionnaires, know a significant improvement in the majority of indicators, compared to "discordant" subjects