Thesis (MNutr)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Introduction: The worldwide increase in the prevalence of childhood overweight and obesity has been identified as a major threat to children’s health and South Africa has not been spared. A child’s food environment is constrained and shaped by their parents/carers who provide food based on own food preferences and food selections, which in turn are determined by the larger cultural, social and economic context. Risk factors for childhood obesity are not well established. Existing prevention strategies, focusing on late childhood and adolescence, are largely unsuccessful. There is however an increasing body of evidence that the early life environment is an important determinant of risk of obesity in later life. Aim: To determine prevalence and socio-demographic risk factors associated with childhood overweight and obesity in the Stellenbosch area, Western Cape Province. Methods: Cross-sectional, comparison study. A representative group of 638 children (aged 6- 13 years) attending three randomly selected Stellenbosch primary schools were weighed and measured to calculate body mass index (BMI) using international obesity task force (IOTF) guidelines in the screening phase of the project to determine the prevalence of overweight and obesity. The comparison study phase identified 84 overweight and obese children and 84 children of normal weight (comparison group) to comprise a sample population of 168 children. Socio-demographic data were determined with a structured questionnaire and compared between the overweight/obese group and comparison group (normal weight) to identify associated risk factors and investigate the Ho. Results: The prevalence of overweight and obesity in the sample of primary school children was 13% (n=84) as determined by BMI, of which 9% (n=57) were classified as overweight and 4% (n=27) as obese. Socio-economic factors including maternal employment hours (p=0.0462), family characteristics e.g. number of children in the household (p=0.0231), eating behaviour like consuming brown rice (p=0.0371), pork (p=0.0143), canola/olive-based margarine (p=0.0398) or poly-unsaturated margarine (p=0.0481), doughnuts (p=0.0280) and time spent doing sport (p=0.0450) were significantly associated with overweight or obesity. Ho were thus rejected. Conclusion: The results suggest that maternal working hours, the number of children in the household, poor eating habits and time spent doing sport are important predictor variables for childhood overweight and obesity. Socio-economic status, infant feeding practices and family characteristics like marital circumstances, household number, and mother’s age did not appear to play a role in the development of childhood overweight and obesity in this population. In light of this evidence, preventative initiatives should pro-actively promote healthy eating behaviour and physical activity to children at an early age, in particular girls. Involving families and schools in these initiatives is recommended as well as a national childhood obesity monitoring system to identify children at risk and tracking trends of childhood obesity in guiding evidence-based interventions to tackle this major health problem. / AFRIKAANSE OPSOMMING: Inleiding: Die wêreldwye toename in die prevalensie van kinder-oorgewig en vetsugtigheid is geïdentifiseer as 'n groot bedreiging vir kinders se gesondheid en Suid-Afrika word nie gespaar nie. 'n Kind se voedingsomgewing is beperk en word gevorm deur ouers of versorgers wat voedsel voorsien gebaseer op hul eie kos voorkeure en voedsel keuses, wat op sy beurt deur die groter kulturele, sosiale en ekonomiese konteks bepaal word. Risiko faktore vir kinder-vetsugtigheid is nie goed gevestig nie. Bestaande voorkoming strategieë, wat fokus op die laat kinderjare en vroeë adolessensie, is grootliks onsuksesvol. Daar is egter voortdurende toename in bewyse dat die vroeë lewensomgewing ‘n belangrike bepalende risiko faktor is vir vetsugtigheid in latere lewe. Doelstellings: Bepaling van prevalensie en sosio-demografiese risiko faktore wat geassosieer word met kinder-oorgewig en vetsugtigheid in die Stellenbosch area, Wes-Kaap Provinsie. Metodes: Deursnit, vergelykende studie. ‘n Verteenwoordigende groep van 638 kinders (ouderdom 6-13 jaar) skoolgaande by drie ewekansig geselekteerde Stellenbosch primêre skole was geweeg en gemeet om Liggaamsmassa Indeks (LMI), volgens die internasionale obesiteit werkgroep (IOTF) riglyne te bereken in die siftingsfase van die projek ter bepaling van prevalensie van oorgewig en vetsugtigheid. Die vergelykende fase het 84 oorgewig en vetsugtige kinders geidentifiseer en 84 kinders met normale gewig (vergelykende groep) ter samestelling van ‘n steekproef populasie van 168 kinders. Sosio-demografiese data was verkry deur ‘n gestruktureerde vraelys en vergelykings was getref tussen oorgewig/vetsugtige groep en vergelykende groep (normale gewig) ter identifisering van geassosieerde risiko faktore en ondersoek van die Ho. Resultate: Prevalensie van oorgewig en vetsugtigheid in die steekproef van primêre skool kinders was 13%(n=84) waarvan 9%(n=57) geklassifiseer was as oorgewig en 4%(n=27) as vetsugtig. Sosio-ekonomiese faktore soos moeders se werksure (p=0.0462), familie kenmerke soos aantal kinders in ‘n huishouding (p=0.0231), eetgedrag nl. bruin rys (p=0.0371), varkvleis (p=0.0143), canola/olyf-gebaseerde margarien (p=0.0398) of polionversadigde margarien (p=0.0481), oliebolle (p=0.0280) en tyd gespandeer aan sport (p=0.0450) was beduidend geassosieer met oorgewig en obesiteit. Ho was dus verwerp. Gevolgtrekking: Die resultate dui daarop dat moeders se werksure, aantal kinders in ‘n huishouding, swak eetgewoontes en tyd gespandeer aan sport, belangrike voorspellers vir kinder-oorgewig en vetsugtigheid is. Sosio-ekonomiese status, baba-voedingspraktyke en familie kenmerke soos huwelikstatus, huishoudelike getal en moeders se ouderdom blyk nie ‘n rol te speel in die ontwikkeling van kinder-oorgewig en obesiteit in hierdie populasie nie. Na aanleiding van hierdie bevindinge moet voorkoming inisiatiewe pro-aktief gesonde eetgewoontes en fisiese aktiwiteit in kinders aanmoedig reeds op 'n vroeë ouderdom, veral in meisies. Die betrekking van gesinne en skole in hierdie inisiatiewe word aanbeveel asook 'n nasionale kinder vetsugtigheids-moniteringstelsel om risiko kinders te identifiseer en die tendense van kinder-vetsugtigheid te volg in die begeleiding van navorsings-gebaseerde intervensies om hierdie belangrike gesondheidsprobleem aan te spreek.

abstract: Dietary self-monitoring has been shown to be a predictor of weight loss success and is a prevalent part of behavioral weight control programs. As more weight loss applications have become available on smartphones, this feasibility study investigated whether the use of a smartphone application, or a smartphone memo feature would improve dietary self-monitoring over the traditional paper-and-pencil method. The study also looked at whether the difference in methods would affect weight loss. Forty-seven adults (BMI 25 to 40 kg/m2) completed an 8-week study focused on tracking the difference in adherence to a self-monitoring protocol and subsequent weight loss. Participants owning iPhones (n=17) used the 'Lose It' application (AP) for diet and exercise tracking and were compared to smartphone participants who recorded dietary intake using a memo (ME) feature (n=15) on their phone and participants using the traditional paper-and-pencil (PA) method (n=15). There was no significant difference in completion rates between groups with an overall completion rate of 85.5%. The overall mean adherence to self-monitoring for the 8-week period was better in the AP group than the PA group (p = .024). No significant difference was found between the AP group and ME group (p = .148), or the ME group and the PA group (p = .457). Weight loss for the 8 week study was significant for all groups (p = .028). There was no significant difference in weight loss between groups. Number of days recorded regardless of group assignment showed a weak correlation to weight loss success (p = .068). Smartphone owners seeking to lose weight should be encouraged by the potential success associated with dietary tracking using a smartphone app as opposed to the traditional paper-and-pencil method. / Dissertation/Thesis / M.S. Nutrition 2012

There has been a global rise in obesity in the last three decades, and at present one in five women are obese at antenatal booking. Maternal obesity is associated with an increased risk of adverse pregnancy outcomes, including increased fetal size and prolonged pregnancy. In the longer-term, offspring of obese are at increased risk of premature death from a cardiovascular event in their adulthood. One mechanism that has been linked to these outcomes is fetal exposure to glucocorticoids in utero. During normal pregnancy, the maternal hypothalamic pituitary adrenal (HPA) axis undergoes major changes, resulting in exponentially increasing levels of the major circulating glucocorticoid cortisol, and other HPA axis hormones, such as corticotrophin releasing hormone (CRH). Cortisol and CRH are vital for normal fetal growth and length of gestation, but in excess they are associated with fetal growth restriction and preterm labour. In non-pregnant obesity, it is thought that the HPA axis is dysregulated, although evidence is inconclusive. Little is known about the effects of maternal obesity in pregnancy on the HPA axis. The work in this Thesis used clinical studies to test the hypothesis that the HPA axis is dysregulated in obese pregnant women with altered release, clearance and placental metabolism of cortisol. Associations with clinical outcomes related to fetal size and length of gestation were also studied. The HPA axis activity during pregnancy was investigated in a prospective case-control study cohort. Fasting serum cortisol levels were measured at 16, 28 and 36 weeks of gestation (obese n=276, lean n=135). In a subset (obese n=20, lean n=20), corticosteroid binding globulin (CBG), CRH, estrogens and progesterone were measured. Salivary cortisol was measured in samples collected at bedtime, waking and 30 minutes after waking at 16 weeks. Urinary glucocorticoid metabolites were measured at 19 weeks and 36 weeks (obese n=6, lean n=5) and non-pregnant (obese n=7, lean n=7) subjects. All circulating hormone levels rose similarly in obese and lean during pregnancy, but were significantly lower in obese women. The diurnal rhythm of cortisol was maintained. Urinary glucocorticoids increased with gestation in lean, but not in obese, indicating a lesser activation of the HPA axis in obese compared with lean pregnancy. These findings associated with increased birthweight and longer gestation in obese pregnancy, suggesting that decreased HPA axis activity may underlie these obese related adverse pregnancy outcomes. Whether or not lower glucocorticoids in obese pregnancies are maintained at delivery was investigated by measuring active glucocorticoids (cortisol and corticosterone) and their inactive versions (cortisone and 11- dehydrocorticosterone, respectively) from matched maternal and cord plasma samples (n=259, BMI 18 – 55 kg/m2). Active glucocorticoids were significantly higher in maternal than cord blood, and inactive versions were significantly higher in cord than maternal blood. Increased maternal BMI associated with lower maternal cortisol, corticosterone and 11-dehydrocorticosterone. Despite significant correlations between maternal and cord blood glucocorticoid levels, increased maternal BMI did not associate with lower cord blood glucocorticoids. This suggests that conditions at delivery may overcome any potential negative effects of low maternal glucocorticoids on the fetus in the short-term. However, it may not preclude the longer-term effects of fetal exposure to lower glucocorticoid levels during obese pregnancy, and offspring follow-up studies are required. Potential mechanisms leading to altered HPA axis activity in obese pregnancy were explored by studying the pulsatile release and placental metabolism of glucocorticoid hormones. Glucocorticoid pulsatility is thought to be important for transcriptional regulation of glucocorticoid responsive genes, and disruptions to pulsatility have been reported in some disease processes. Glucocorticoids were measured in 10-minute serum sampling between 08.00h-11.00h and 16.00h- 19.00h. Peripheral tissue cortisol was measured from 20-minute sampling of interstitial fluid, over 24-hours, at 16-24 weeks and 30-36 weeks (obese n=7, lean n=8), and non-pregnant controls (obese n=4, lean n=3). Total circulating serum cortisol levels were higher in pregnancy than non-pregnancy in lean and obese, and increased significantly with advancing gestation in lean but not in obese. Pulsatility of cortisol was demonstrated in interstitial fluid in both non-pregnancy and pregnancy. In obese pregnancy, interstitial fluid pulse frequency was lower with advancing gestation. This may be a novel mechanism underlying the observed decreased HPA axis activity in obese pregnancy. Placental cortisol metabolism and transport was studied using an ex vivo placental perfusion model, perfused with a deuterium-labelled cortisol tracer combined with computational modeling. The findings challenge the concept that maternal cortisol diffuses freely across the placenta, but confirmed that 11β- HSD2 acts as major ‘barrier’ to cortisol transfer to the fetus, protecting the fetus from the high maternal circulating cortisol levels. In addition we showed preliminary evidence of local cortisol production within the placenta. The model is able to predict maternal-fetal cortisol transfer and can now be used in future experimental design. In conclusion, in obese pregnancy, lower maternal cortisol and urinary clearance suggested reduced HPA axis activity. Altered glucocorticoid pulsatility may underlie this change. Future studies of placental cortisol metabolism in maternal obesity could be conducted using an ex vivo perfusion model. The lower HPA axis activity in obese pregnancy represents a novel pathway underlying increased fetal growth.

Made available in DSpace on 2014-06-11T19:22:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-16Bitstream added on 2014-06-13T19:28:13Z : No. of bitstreams: 1 silveira_ls_me_prud.pdf: 365001 bytes, checksum: 40238d1df986d2089b1d648676738c50 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: A obesidade, por si só, é um fator de risco independente para o desenvolvimento de diversas doenças, e uma das que mais tem motivado investigações científicas é a Síndrome Metabólica (SM), caracterizada pelo agrupamento de, pelo menos, três componentes que caracterizam fatores de risco de origem cardiovascular, cuja prevalência em crianças e adolescentes é elevada. Uma das alternativas para o tratamento está no exercício físico e/ou reeducação alimentar. Objetivo: O objetivo do presente estudo foi avaliar os efeitos da intervenção de 20 semanas por meio do treinamento concorrente (aeróbio e resistido), na composição corporal e sobre a prevalência e os componentes da Síndrome Metabólica em adolescentes obesos. Metodologia: A amostra foi composta por 50 adolescentes obesos com idade entre 12 a 16 anos (13,4±1,1) classificados por meio do Índice de Massa Corporal. Para a análise da composição corporal foi empregada a técnica da absorptiometria de raios-X de dupla energia, verificando-se variáveis como percentual de gordura corporal (%GC), percentual de gordura de tronco (%GTronco) e massa corporal magra (MCM) . Foram avaliados também o colesterol total (COLtotal), HDL-colesterol (HDL), triglicérides (TRI), glicemia em jejum (GLI) e insulina plasmática. A intervenção consistia em treinamento concorrente com 50% do tempo voltado a exercícios aeróbios e a outra metade a exercícios resistidos, com sessões de 60 minutos, 3 vezes/semana, durante 20 semanas. Análise estatística: foram calculadas a mediana e intervalo interquartílico de todas as variáveis... / Introduction: Obesity, by itself, is an independent risk factor for the development of various diseases, one that has motivated even more scientific research is the metabolic syndrome (MS), characterized by the clustering of at least three components that characterize risk factors of cardiovascular origin, whose prevalence in children and adolescents is high. An alternative to this treatment is diet and/or exercise. Objective: The objective of this study was to evaluate the effects of 20 weeks intervention of concurrent training (aerobic and resistance), on body composition and on the prevalence and the components of metabolic syndrome in obese adolescents. Methodology: The sample consisted of 50 obese adolescents aged 12-16 years (13.4±1.1) classified by Body Mass Index. For body composition analysis was employed the technique of Dual energy X-ray absorptiometry, in order to verify variables such as body fat percentage (%BF), percentage of trunk fat (%BFtrunk) and lean body mass (LBM) . We also evaluated total cholesterol (COLtotal), HDL-cholesterol (HDL), triglycerides (TRI), fasting glucose (GLU) and insulin. The intervention consisted of concurrent training (50% of the time of aerobic exercise and 50% of resistance exercise), the sessions lasts 60 minutes of duration, 3 times per week for 20 weeks. Statistical analysis: we calculated the median and interquartile range of all variables and the Wilcoxon... (Complete abstract click electronic access below)

>Magister Scientiae - MSc / Being overweight or obese are major factors contributing to the increased morbidity and mortality due to non-communicable diseases such as type 2 diabetes, cardiovascular disease and cancer. The treatment of obesity with pharmaceutical drugs is plagued by side effects. Plants and their phytochemicals possess a number of beneficial health effects including anti-oxidant,anti-mutagenic, anti-inflammatory, anti-obesity and anti-cancer effects, mediated by activation of the adenosine monophosphate protein kinase (AMPK).AMPK controls many metabolic processes including glucose uptake and utilisation, and adipogenesis, and is often referred to as the master regulator establishing cellular homeostasis.Cyclopia maculata, commonly known as honeybush, is an indigenous South Africa plant possessing anti-oxidant, anti-inflammatory and anti-cancer properties. Recently, others in our laboratory have shown that a hot water extract of fermented C. maculata inhibits adipocyte differentiation in 3T3-L1 pre-adipocytes, with some evidence of weight regulatory properties in a Wistar rat model of diet-induced obesity. In the rat study, 21 day old weanlings were fed a high fat, high sugar cafeteria diet for 3 months with (n=10) or without (n=10) C. maculata supplementation. This group of rats was referred to as the lean group (n=20). Another group of rats were fed a cafeteria diet for 4 months to induce obesity (obese group, n=20) and thereafter treated as described for the lean rats. The aim of this MSc study was to determine whether C. maculata induces AMPK activation.Proteins were extracted from the liver and muscle tissue of lean and obese Wistar rats using an optimized extraction method with a commercial lysis buffer and the TissueLyser.Treatment with the C. maculata extract had no effect on the protein yield in lean and obese rats. Interestingly, the protein yield in the liver of obese rats was significantly higher than that observed in lean rats. Although C. maculata treatment slightly increased AMPK activation (calculated as the ratio of phosphorylated AMPK to total AMPK) in the liver of lean and obese rats, the difference was not statistical significant. Conversely, C.maculata treatment decreased AMPK activity in muscle of lean and obese rats, with statistical significance observed in the lean group only (2.3-fold, p<0.05). Differences in AMPK activation between the groups were also noted, a 1.3-fold decreased activity observed in obese groups compared to their lean counterparts, although this was not statistically significant. Expression of PPARα, a downstream protein target affected by AMPK activation was reduced in the liver of lean and obese rats after C. maculata treatment. Moreover, PPARα expression was significantly higher in obese compared to lean rats (2.7-fold, p<0.001). PPARα is a transcription factor mediating fat metabolism (β-oxidation) and its expression is induced by circulating free fatty acids, which are increased in obese compared to lean rats. The expression of PPARα in muscle was too low for Western blot analysis and quantification.Cyclopia maculata treatment did not affect hepatic expression of UCP2, another protein important in establishing energy homeostasis. The expression of UCP2 was 2.9-fold higher in the liver of obese rats compared to their lean counterparts, although the difference was not statistically significant. The opposite results were observed in the muscle where C. maculata treatment decreased UCP2 expression in lean rats (2.8-fold,p<0.0001), and UCP2 expression was decreased 1.4-fold in obese rats compared to lean rats, although the difference was not statistically significant.ELISA results for AMPK activation revealed that C. maculata treatment increased AMPK activity, although not statistically significant. Histological analysis of retroperitoneal fat showed that C. maculata did not affect adipocyte size and number, although a slight decrease in adipocyte size was observed after treatment .This study has demonstrated that treatment of the cafeteria diet fed Wistar rats with 300 mg/kg of a hot water extract of fermented C. maculata does activate AMPK. This study revealed important differences between lean and obese rats. In particular, increased hepatic protein content, PPARα and UCP2 expression was observed in obese rats compared to the lean group. This suggests an adaptive response to the increased circulating free fatty acids during obesity and an increase in β-oxidation in these animals.

A) Bariatric surgery for the treatment of obesity has shown much promise. The Roux-en-Y gastric bypass is a procedure that combines both restrictive and malabsorptive elements. Post-operative weight loss and co-morbidity improvements previously achieved are over and above those which are seen during life style modification and drug therapy. 330 patients (2005-2007) with a mean BMI of 45.87 ± 0.63 were characterised pre-operatively with regard to clinical, anthropometric and DEXA scan measurements. 130 were matched for the same parameters post-operatively over a 9-12 month observation period. The data was analysed statistically using paired t-tests and regression analyses. Significant post-operative improvements were observed with regard to patients’ weight loss and co-morbidity improvement. Positive and significant correlations of anthropometric measures to biochemical parameters ensued. Risk factor scoring methodology produced an average total score of 17 points / 36. Average post-op weight loss at 9-12 months follow-up was 20% of initial pre-op weight. Co-morbid diseases and anthropometric measurements illustrated significant changes following surgery. Risk factor scoring is a valuable pre-op tool for assessing eligibility for medical aid re-imbursement for surgery. B) Obesity is a global epidemic and is increasing the worlds’ mortality rate. Genetic predisposition to obesity is recognized as being significant. Polymorphisms within the Melanocortin 4 Receptor (MC4R) gene, which encodes a G-protein coupled receptor responsible for post-prandial satiety signalling, have been associated with monogenic obesity. Obesity prevalence in South Africa is drastically increasing, however there has been no causative investigation done. Thus we sought to perform an initial assessment of the prevalence of MC4R polymorphisms within a South African representative group. Blood was drawn from a mixed Body Mass Index (BMI) cohort of 259 adult individuals and their DNA was extracted. The MC4R gene was PCR amplified from the DNA, the amplicon sequenced and the sequence data was analyzed for polymorphisms. A polymorphism prevalence of 13.51% was found within the patients across a BMI range that spanned from underweight (19.6) to super-obese (126.0). In addition to MC4R polymorphisms that had been identified previously, two new polymorphisms namely R7H and S36T were observed. Four haplotypes were also identified. MC4R mutation frequency was observed to be ethnically dependant; however the hypothesis of differing ethnic backgrounds illustrating varying mutational penetrance was not confirmed. The expected trend regarding MC4R polymorphism functional effect and associated pathogenicity was not followed in light of our results. The question of whether or not MC4R polymorphisms contribute to the development of obesity is indisputable; however the current accepted trend regarding their precise role may be incorrect and must be challenged. / Dissertation (MSc)--University of Pretoria, 2009. / Immunology / unrestricted

African American (AA) adolescents have higher rates of obesity than many other ethnic groups, which increases their risk for obesity-related diseases. Culturally sensitive obesity preventive interventions have been unsuccessful, resulting in a steady increase of obesity among AA adolescents. AA adolescents in the southern region of the United States are at a higher risk for obesity and physical inactivity; knowledge and understanding of causative factors remains limited. To identify the impact of programs, a systematic review of the literature focused on structured physical activity and/or dietary education interventions in Mississippi. The ecological framework was used to guide this study. The Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses was used to evaluate the effectiveness of programs on reducing the body mass index of AA adolescents in Mississippi. Two reviewers evaluated the identified articles and reached agreement in identifying the body of literature as well as including/excluding the same papers. Eight papers were selected for review. Recommendations from all 8 studies indicated that structured physical activity, dietary education programs, and parental/caregiver involvement in the development of healthy eating habits are necessary to decrease body mass index among AA adolescents. This project might contribute to social change by providing evidence to support programs to reduce obesity and improve health among AA adolescents in Mississippi.

This study examined health-related quality of life (HRQoL) across weight categories in adolescents using both a general and a condition-specific measure sensitive to fatigue symptoms. Participants (N = 918) completed the Pediatric Quality of Life (PedsQL) Inventory and PedsQL Multidimensional Fatigue Scale measures. Actual height and weight were used to calculate body mass index for age and sex percentiles and assign weight categories. No interaction effects between total HRQoL and weight category and gender were found; however, main effects were found for both weight category and gender. Future research should examine the impact of using different measures to assess HRQoL outcomes across weight categories.

Functional limitation, postural stability, and muscle recruitment of different categories of obesity were evaluated while performing an assembly workstation task. Three workstations, those designed for the 5th, 50th, and 95th percentile workers based on anthropometric data tables, were included in the study. Functional limitation was measured using electro-goniometers and the maximum frontal functional reach (MFFR) evaluation to measure the difference in joint angles, forces plates were used to study the differences in postural stability, and EMG was used to evaluate the muscle recruitment of the soleus, frontal deltoid, and trapezius muscles. Also, a regression analysis was performed to evaluate if production efficiency rate could be predicted based on body mass index (BMI) group, gender, pace type, workstation configuration and 13 body dimensions. The results revealed that the body joint angles and muscle activation parameters were not significantly different based on the main factor BMI groups; however, significant differences were found in the two-way interactions of the BMI groups and the other factors. In regard to postural stability, the results indicated that the obese class 2 and obese class 3 groups anterior posterior sway was significantly larger than the normal weight groups. The results also revealed differences based on gender for the joint angles and muscle activation when performing the small part assemblies; however, postural sway was not affected by gender differences. Pace type (self –paced or timed-paced) significantly affected the postural stability and muscle activation when performing the work task. These differences in pace type were most prevalent when comparing the 95th percentile workstation configuration against the 5th percentile workstation configuration. In regards to productivity, gender, weight, waist-to-hip ratio and pace type seem to have a large role in the production efficiency rate. Even though an individual's BMI and the workstation layout were found to impact the body functional limitation and stability, the results showed that it doesn't affect production efficiency rate performance.

Obesity is a major risk factor for many health problems, including cardiovascular disease and diabetes. It is anticipated that the prevalence of obesity in the United States will grow as time passes. The objective of this study is to compare the health of obese women who engage in regular exercise to that of nonobese women. This literature review is drawn from eight library-based research articles at East Tennessee State University (ETSU). The search engine covers topics such as obesity, postmenopausal women, physical activity, nutrition, health, fitness, and lifestyle. Taking nutritional supplements and increased physical exercise minimizes the likelihood of health decline, according to the study's primary findings. Nurses should consider implementing education on regular physical exercise, well-balanced diet, and involvement in activities with those seeking the same goal. Among the limitations include a small sample size, a restricted variety of persons, self-reporting of physical activity, and more.