The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. Literature review shows that there have been many different methods utilized to halt obesity's progression, however rates continue to increase. The United States Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other agencies recommend obesity screening and counseling at every patient encounter, but most hospitals do not have a current obesity policy in place to accomplish this task. The purpose of this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A's framework to increase screening and referrals of obese, adult patients ages 18 and over. The logic model was utilized to guide the program development, implementation, evaluation, and dissemination. The program was accepted by the hospitalist group and nurse leaders for full development and evaluation. Key stakeholders and content experts were convened to create a proposal and algorithm to guide the project. The obesity program will increase screenings and referrals upon full adoption. Increase in screenings and referrals will improve care, quality of life, weight status, and decrease health care expenditure. The results of dissemination of the program may stimulate other facilities to adopt the program to combat obesity and contribute to social change The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. Literature review shows that there have been many different methods utilized to halt obesity's progression, however rates continue to increase. The United States Preventative Services Task Force (USPSTF), American Heart Association (AHA), and other agencies recommend obesity screening and counseling at every patient encounter, but most hospitals do not have a current obesity policy in place to accomplish this task. The purpose of this project is to develop a program proposal for a hospital-based, obesity tool based on the 5 A's framework to increase screening and referrals of obese, adult patients ages 18 and over. The logic model was utilized to guide the program development, implementation, evaluation, and dissemination. The program was accepted by the hospitalist group and nurse leaders for full development and evaluation. Key stakeholders and content experts were convened to create a proposal and algorithm to guide the project. The obesity program will increase screenings and referrals upon full adoption. Increase in screenings and referrals will improve care, quality of life, weight status, and decrease health care expenditure. The results of dissemination of the program may stimulate other facilities to adopt the program to combat obesity and contribute to social change The rate of obesity continues to rise in the United States and globally, placing populations at increased risk of obesity-related conditions, such as diabetes, hypertension, heart disease, cancer, and other disease states. A review of the literature showed that multiple methods have been used to address the rate of progression; however, obesity rates continue to increase. The U.S. Preventative Services Task Force, American Heart Association, and other agencies recommend obesity screening and counseling at every patient encounter; most hospitals do not have a policy to accomplish this task. The purpose of this project was to develop an obesity screening and referral tool for the hospital setting. The resulting tool was based on the 5 As framework to increase screening and referrals of obese patients. The logic model was used to guide program development, implementation, evaluation, and dissemination. Results of the obesity screening and referral program showed an increase in screenings and referrals upon a trial adoption, raising the number of identified referrals to 23, compared to 2 patients identified for referral prior to program implementation (p = 0.035). An increase in screenings and referrals can bring about positive change by improving care, quality of life, and weight status of patients and decreasing health care expenditure.

Obesity is a pandemic that has a substantial impact among African American women. Biological, social, and cultural acceptance of obesity, collectively referred to as biosociocultural factors, represents an obstacle to efforts to address this health risk among this group. The purpose of this study was to develop a better understanding of the relationship between biosociocultural factors and motivation to lose weight. Self-determination theory, objectification theory, and social learning theory formed the study's theoretical framework. The key research question concerned the extent to which the investigated constructs (BMI, internalized body image, and social networks) helped to explain motivation for weight loss among nonpregnant obese African American heterosexual or bisexual women who preferred to date and mate with African American men. The study used a quantitative and correlational cross-sectional survey design. Data were collected from a sample of 183 African American women with obesity. Survey components included a demographic questionnaire, Pulvers's Culturally Relevant Body Image Scale and Questionnaire, the Social Support for Eating Habits Survey, and the Dieting Readiness Test. Multiple regression analyses were used to examine the predictive strength of these factors (BMI, 3 components of internalized body image, and 4 components of social network) for motivation to lose weight. A statistically significant positive relationship was found between motivation to lose weight and 3 predictors (2 components of body image and 1 component of social network). Further examination indicated that body image was the most reliable construct predicting motivation to lose weight. Insights gained from this study may inform the development of culturally sensitive approaches to obesity prevention and intervention for this population.

More than two-thirds of Americans are obese or overweight. Obesity rates have risen to an epidemic level, contributing to health inequalities and leading to reduced health-related quality of life. When obese and overweight persons face weight bias by health care providers, fragmented care may occur. Ensuring positive relationships with healthcare providers is important in helping those who are obese or overweight. The purpose of this project was to understand the factors that contribute to negative weight bias in the provider-patient relationship and to identify the most effective interventions that would reduce stigmatizing attitudes and support self-awareness, acceptance, and resolution for both patient and provider. The theoretical foundations of cultural humility and self-appraisal in interpersonal relations were applied to inform this project. The Cochrane Handbook for Systematic Reviews framed this systematic literature review. Additionally, Melnyk's levels of evidence was used to evaluate each article. Articles for inclusion were limited to those published no earlier than 2013, full text available, English language, and peer-reviewed. The search identified 102 articles, of which 26 were selected for the final review. Five articles met the criteria for Level VII (opinions of experts), 18 were Level VI (qualitative studies), 1 was a Level V (qualitative review), and 2 were Level 1 (systematic review). The analysis of evidence clarified the issues related to weight bias and supported recommendations for nursing practice improvement in upholding the dignity of all persons with regard to weight. Nurses can pioneer positive social change by becoming role models who advocate for equality in healthcare delivery for persons who are obese or overweight.

This study aimed to describe children’s experience of living with overweight or obesity, by using a literature-review. The study includes eleven articles, data is from children between ages 5-15 year. The result occurring were in the areas; Quality of life and self-esteem, Social company, Body concept and weight reduction and Psychological unhealth. BMI above what is recommended gives a negative influence on quality of live and self-esteem. The exposure of teasing is rising, which also dieting and weight–related concerns do. Depression symptoms occur in varying degree, but the correlation to BMI is not direct. Girls in ages up to 14 years seem to be most influenced by being overweight or obese. The language children are using related to their own body may act as a barrier to apply its health- consequences on themselves. Health- care professionals should treat those children in a way that reinforce their view of themselves, by doing so they can help them reaching better health. To improve treat and treatment of the children, there is a need of more qualitative investigation in the subject. / Syftet med studien var att genom en litteraturstudie beskriva hur det som barn är att leva med övervikt eller fetma. Studien bygger på elva artiklar där data är från barn i åldrarna 5 - 15 år. Resultatet som framkom var inom områdena; Livskvalitet och självkänsla, Socialt umgänge, Kroppsuppfattning och viktnedgång samt Psykisk ohälsa. Resultatet visar att BMI över gränsen för övervikt/fetma ger en negativ påverkan på livskvalitet och självkänsla, graden av påverkan ökar med stigande BMI. Även utsatthet för mobbning och förekomsten av bantning och viktbekymmer ökar med stigande BMI. Förekomsten av depressiva symtom finns i varierande grad, men verkar inte vara direkt korrelerat till vikt. Flickor upp till 14 års ålder påverkas i högst grad av sin vikt. Språket barn använder relaterat till sin egen övervikt/fetma kan fungera som en barriär för att se dess hälsokonsekvenser som en möjlig realitet hos dem själva. Hälso- och sjukvårdspersonal måste bemöta dessa barn på ett sätt som kan stärka deras självbild och på så vis förbättra hälsan. Förbättrat bemötande och behandlingsarbete kräver mer kvalitativ forskning kring hur barnen upplever sin situation.

The main objective of this proposal was to investigate the effect of vitamin B6 on colon carcinogenesis in vivo. Two in vivo studies were conducted to determine the role of vitamin B6 as a biological modifier of colon carcinogenesis. It is hypothesized that vitamin B6 may serve as an antioxidant in vivo and will modulate colon carcinogenesis. In the first study, a 2X3 factorial experimental design was used to determine if three different levels of vitamin B6, classified as low, normal and high in conjunction with two different levels of protein intake, classified as normal or high, will affect post-initiation stages of colon carcinogenesis, in Sprague-Dawley rats. Male Sprague-Dawley male were injected with azoxymethane for two weeks (15mg/kg/week) and then one week later they were allocated to different dietary treatment groups. After eight weeks, the effects of dietary treatment on hematological status, oxidative stress markers and antioxidant enzymes, as well as enumeration of preneoplastic lesions, aberrant crypt foci (ACF), were evaluated. The lowest level of vitamin B6 intake with a high protein diet reduced the growth and development of ACF. Vitamin B6 had no significant effect on the oxidative stress markers. The level of protein was an important variable in modulating the levels of 3-nitrotyrosine and 8-OH-DG which were lower in high protein groups than normal protein counterparts. The objective of the second study was to investigate if a supraphysiological (5 fold higher than normal level) dosage of vitamin B6 could have an antioxidant effect in a metabolically compromised state like obesity and thereby lower the risk of colon cancer. Female Zucker obese (Zk-OB) rats received normal (Zk-OBN, 7 mg/kg) or high (Zk-OBH, 35 mg/kg) vitamin B6 (Pyridoxine-HCl) diets two weeks prior to, during and six weeks following injection with colon carcinogen AOM. The effects of supplemental vitamin B6 on hematological status, oxidative stress markers and antioxidant enzymes, as well as enumeration of ACF were carried out. High intake of vitamin B6 significantly lowered liver weights and plasma cholesterol compared to the normal intake (p≤0.05). Zk-OBH rats had significantly reduced number of ACF compared to Zk-OBN (p≤0.05). Hepatic GSH increased in the ZK-OBH group with a concomitant decrease in GPx activity. The findings demonstrate that in Zucker Obese rats, a high B6 intake augmented the antioxidant potential and decreased sensitivity to colon carcinogenesis. These findings suggest that high vitamin B6 plays an important therapeutic role in the compromised state of obesity.

The main objective of this proposal was to investigate the effect of vitamin B6 on colon carcinogenesis in vivo. Two in vivo studies were conducted to determine the role of vitamin B6 as a biological modifier of colon carcinogenesis. It is hypothesized that vitamin B6 may serve as an antioxidant in vivo and will modulate colon carcinogenesis. In the first study, a 2X3 factorial experimental design was used to determine if three different levels of vitamin B6, classified as low, normal and high in conjunction with two different levels of protein intake, classified as normal or high, will affect post-initiation stages of colon carcinogenesis, in Sprague-Dawley rats. Male Sprague-Dawley male were injected with azoxymethane for two weeks (15mg/kg/week) and then one week later they were allocated to different dietary treatment groups. After eight weeks, the effects of dietary treatment on hematological status, oxidative stress markers and antioxidant enzymes, as well as enumeration of preneoplastic lesions, aberrant crypt foci (ACF), were evaluated. The lowest level of vitamin B6 intake with a high protein diet reduced the growth and development of ACF. Vitamin B6 had no significant effect on the oxidative stress markers. The level of protein was an important variable in modulating the levels of 3-nitrotyrosine and 8-OH-DG which were lower in high protein groups than normal protein counterparts. The objective of the second study was to investigate if a supraphysiological (5 fold higher than normal level) dosage of vitamin B6 could have an antioxidant effect in a metabolically compromised state like obesity and thereby lower the risk of colon cancer. Female Zucker obese (Zk-OB) rats received normal (Zk-OBN, 7 mg/kg) or high (Zk-OBH, 35 mg/kg) vitamin B6 (Pyridoxine-HCl) diets two weeks prior to, during and six weeks following injection with colon carcinogen AOM. The effects of supplemental vitamin B6 on hematological status, oxidative stress markers and antioxidant enzymes, as well as enumeration of ACF were carried out. High intake of vitamin B6 significantly lowered liver weights and plasma cholesterol compared to the normal intake (p≤0.05). Zk-OBH rats had significantly reduced number of ACF compared to Zk-OBN (p≤0.05). Hepatic GSH increased in the ZK-OBH group with a concomitant decrease in GPx activity. The findings demonstrate that in Zucker Obese rats, a high B6 intake augmented the antioxidant potential and decreased sensitivity to colon carcinogenesis. These findings suggest that high vitamin B6 plays an important therapeutic role in the compromised state of obesity.

The prevalence of insulin resistance and type 2 diabetes mellitus (T2DM) in obese children and adolescents is growing at an alarming rate, especially in ethnic minorities. It is not clear whether young people of different ethnic backgrounds vary in their metabolic response to excessive adiposity. Differences in lipid partitioning in the abdominal fat compartments have been observed among different ethnic groups. The aim of this study was to evaluate whether there are ethnic differences in intramyocellular lipid (IMCL) levels that are related to differences in insulin sensitivity. Eighty-two obese children and adolescents underwent 1) 1H nuclear magnetic resonance (NMR) spectroscopy to non-invasively quantify IMCL levels in their soleus muscle, 2) an oral glucose tolerance test and (in a subset of subjects) a euglycemic-hyperinsulinemic clamp to assess insulin sensitivity, 3) a dual-energy X-ray absorptiometry (DEXA) scan to measure total percent body fat, and 4) magnetic resonance imaging to measure abdominal fat distribution. IMCL levels in Hispanic children and adolescents (1.50 ± 0.64%) were significantly greater than in their Caucasian (1.19 ± 0.40%) and African-American (1.09 ± 0.49%) peers. Visceral fat was significantly lower in African Americans (42.7 ± 18.8cm2) and were similar in Caucasians (70.9 ± 27.5cm2) and Hispanics (77.3 ± 41.9cm2). The three groups were not different with respect to insulin sensitivity. For the entire cohort, IMCL levels were inversely related to insulin sensitivity. There was a significant correlation between visceral fat and insulin resistance in Hispanics and Caucasians but not in African Americans. In conclusion, these data suggest that there are significant ethnic differences in lipid partitioning in both the muscle and abdominal compartment. These findings may explain ethnic differences in insulin sensitivity and further the understanding of the pathogenesis of insulin resistance and T2DM.

The endocannabinoid system is a novel pharmacological target in the treatment of metabolic syndrome. Antagonism of the endocannabinoid-1 receptor (CB1R) leads to a transient reduction in food intake, a sustained decrease in body weight and an improvement in metabolic parameters in animal models of obesity. Skeletal muscle is the primary tissue involved in glucose uptake in response to insulin, and insulin sensitivity of skeletal muscle is vital to the maintenance of whole-body euglycemia. Little is known regarding the effects of CB1R antagonism on skeletal muscle glucose transport activity. The purpose of this dissertation was to test the hypothesis that antagonism of the CB1R activates signaling molecules of the insulin signaling pathway to increase glucose transport activity in normal and insulin-resistant skeletal muscle, thereby improving whole-body glucose tolerance. CB1R antagonism with SR141716 directly enhanced basal and insulin-stimulated glucose transport activity in skeletal muscle from lean and obese Zucker while activation of the CB1R with ACEA, decreased glucose transport activity. Key proteins associated with regulation of glucose transport activity were not altered by either CB1R agonism (ACEA) or antagonism (SR141716). Chronic CB1R antagonist treatment (10 mg/kg SR141716 i.p. / 14 days) also enhanced insulin-stimulated glucose transport activity in skeletal muscle of both lean and obese animals, again with no alteration in relevant signaling factors. Plasma free fatty acids (FFAs) were decreased in chronically-treated lean and obese animals and whole-body insulin sensitivity was improved in obese Zucker rats. The enhanced insulin sensitivity seen in chronically-treated obese animals was associated with a dramatic reduction in insulin secretion following a glucose challenge. Acute CB1R antagonism in obese animals also elicited a reduction in insulin secretion following a glucose challenge; however, with no improvement of whole-body insulin sensitivity. Acute CB1R antagonist treatment did not alter skeletal muscle glucose transport activity or circulating FFAs for any animals. These data suggest that although CB1R antagonism directly enhances basal and insulin stimulated glucose transport in skeletal muscle of lean and obese rats, direct action on the skeletal muscle is not responsible for the improvement in insulin-stimulated glucose transport activity and whole-body insulin sensitivity seen in chronically-treated obese animals.

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