No description available.

Introduction: Pediatric obesity prevention and management is a high priority for pediatric providers. Pediatric providers use evidence-based clinical guidelines to integrate the best current recommendations into practice. The contention of this inquiry is that while practice guidelines and obesity programs address the "who, what, when, where, and why" of pediatric obesity interventions, the guidelines fail to address the "how" of the process that bolsters adherence and attacks the high attrition rates of obesity management. Objective: The objective of this practice inquiry is to evaluate Prevention and Treatment for Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion using the Appraisal for Guidelines and Research and Evaluation (AGREE II) instrument and to investigate techniques to improve adherence to the lifestyle changes recommended in the guideline, by synthesizing the current research for using motivational interviewing with obese pediatric patients, and propose a plan for translating the intervention to measurable outcomes. Methods: Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion was evaluated using the AGREE II instrument. The current recommendations are detailed based on the findings of a review of the literature. Using the RE-AIM framework, recommendations are made to determine the translation potential for the use of motivational interviewing to improve adherence to lifestyle recommendations, thus improving the current clinical practice guideline. Results: Review of the Endocrine Society's CPG using the AGREE II instrument yielded an overall guideline quality rating of 6/7. The guideline is recommended for use with modifications to improve applicability. Integration of MI to the practice guideline and the use of the RE-AIM framework to improve uptake of the intervention is proposed to address the weaknesses in applicability revealed in the guideline evaluation. Conclusion: The CPG reviewed in this PI provides quality recommendations for the treatment and prevention of pediatric obesity. By integrating MI techniques and using the RE-AIM framework, pediatric providers may be able to bolster adherence to the guideline recommendations and ultimately improve clinical outcomes and impede the rising pediatric obesity rates. Future research should include evaluation of MI interventions in the pediatric clinical setting.

No description available.

Insulin resistance, the cause of type 2 diabetes mellitus, is intimately linked to the dysregulation of adipose tissue. Recent decades have witnessed the discovery and characterization of numerous hormones produced by adipocytes, including leptin, adiponectin and resistin, underscoring the endocrine functions of adipose tissue. To better understand the role of the adipocyte in the mediation of obesity-related insulin resistance and inflammation, this study has optimized the primary adipocyte isolation technique to minimize inflammation inherent to the isolation procedure and has analyzed adiponectin levels and insulin sensitivities of various adipocyte size populations both in vitro and ex vivo.The data described herein suggest that cell size plays an important, but not solitary, role in the regulation of insulin action and adiponectin production. It is possible that obesity-related insulin resistance is associated with the failure of a population of small adipocytes to expand and produce the insulin sensitizing protein hormone, adiponectin.

Obesity is considered an underlying risk factor for metabolic disease including cardiovascular disease (CVD) and diabetes. The fractions containing flavonols from apple peel were evaluated for their antioxidant, anti-inflammatory, and hypolipidemic properties using in vitro and in vivo experimental model systems. The fractionated polyphenolics from apple peels showed a strong antioxidant property protecting against heat-induced oxidation of polyunsaturated fatty acids present in fish oil. Apple flavonols (AF), eicosapentaenoic acid (EPA) and the isoquercitrin-EPA ester (QE) significantly reduced serum triacylglycerols and elevated the high density lipoprotein (HDL)-cholesterol compared to the high fat control group. C-reactive protein and interleukin-6 were also reduced compared to the high fat control group and inflammation induced by lipopolysaccharides. Serum adiponectin and interferon-? concentrations were significantly altered by QE treatment. Overall, AF and QE exhibited anti-inflammatory and hypolipidemic effects under in vivo conditions. These beneficial physiological properties and mode of action of AF and QE need to be further investigated.

Background Obesity is associated with an increased risk of back pain, attributed to elevated mechanical load. Back injury risk is also determined by movement patterns (kinematics) and physiological factors (exertion, muscle activation). Lifting, particularly repetitive, is the most frequently cited injurious activity. However, in spite of the obvious relation, a paucity of information exists quantifying the interaction of obesity and repetition during lifting. Purpose To determine the effects of obesity and repetition on mechanical, kinematic and physiological lifting outcomes. Methods: An individual-specific, biomechanical model (based upon 3D photogrammetry) was developed to estimate the effect of obesity on back load during lifting (study 1). Lifting strategy and physiological outcomes related to obesity were examined in a fixed-pace, repetitive lifting task (study 2). The effect of task constraints on lifting strategy of high and normal BMI individuals were determined (study 3), followed by an evaluation of muscle activation responses during a repetitive trunk motion similar to that encountered during lifting (study 4). Results: Obesity-specific alterations of important determinants of back load (inertia, CMloc) were revealed. Obesity was related to a substantial increase in back load (M=+197.3, SE=16.8 Nm about L5/S1), however the effect differed across lifting tasks. The lifting strategy of high-BMI individuals was characterized by an increased distance to the external mass (M=+4.7, SE=1.8 cm) and shorter lift duration (M=230, SE=130 msec), with increased cardiovascular effort (M=+7.4, SE=3.4% HRmax) but no change in perceived exertion. Lifting frequency was not a major determinant of lifting strategy, however strategy was influenced by the presence and type of external pacing. A phase-specific, rapid alteration in muscle activation response was evident in the MMG signal during the initial repetitions of a repetitive trunk motion. Conclusion: The effect of obesity during lifting is task-dependent, and cannot be attributable solely to mechanical factors. Future studies should consider tasks that are unconstrained, and examine the initial familiarization period of repetitive tasks, specifically the lowering phase of motions. These findings have relevance to back injury mechanisms related to obesity and the design of injury prevention programs for individuals with a high BMI.

High birth weight (also known as macrosomia) is a problem that has as of yet received little attention by health researchers, in particular, health economists. High birth weight is a concern mostly due to the increased difficulties it presents during birth for both the mother and the baby but there is also concern that high birth weight may continue to present negative effects later in the baby’s life. Many factors have been attributed as risk factors for high birth weight including mother’s age, ethnicity, parity, obesity, weight gain during pregnancy, infant gender, and gestation length. However, there is a dearth of careful analysis dedicated to determining the extent of causality of these risk factors where endogeneity concerns are present. In this thesis, I examine various issues surrounding high birth weight. I describe the situation in New Zealand (Chapter 2) to see if our experience with high birth weight reflects that found in international research. I analyse the relationship between socio-economic status and high birth weight (Chapter 3) to explore whether high socio-economic status has a unique effect on high birth weight compared to other health disorders in which it generally helps alleviate the incidence. I further investigate the relationship between obesity and high birth weight (Chapter 4) in an attempt to disentangle the causal effect of obesity on high birth weight risk from the mere correlation that has been well documented. I explore the possibility of vitamin and mineral supplements taken during pregnancy being a risk factor for high birth weight (Chapter 5), then address the potential endogeneity issues to identify a causal impact. Finally, I return to the definition of high birth weight (Chapter 6) and consider the optimal way to define the “problematic” weight threshold and whether this threshold should depend on gestation length or the ethnicity of the mother. My findings suggest that in New Zealand, the incidence of macrosomia varies by the ethnicity and weight group of the mother and the gender of the infant. Socio-economic status does seem to affect high birth weight risk but the nature of the relationship is complex. Obesity only appears to have a significant causal effect on high birth weight risk for women who are morbidly obese, but even for these women conventional estimation that disregards the endogeneity of obesity greatly exaggerates the effect. There does appear to be a correlation between iron supplementation and high birth weight risk but the relationship does not withstand controlling for endogeneity. My findings indicate that the currently accepted threshold used to define macrosomia is justified as it does consistently predict adverse health outcomes. However, flexible definitions which consider different grades of macrosomia or different thresholds for different ethnicities could improve on the current definition.

No description available.

Bariatric surgery is a life-altering procedure that leads to substantial weight loss for most patients with obesity. Psychiatric conditions that may interfere with eating behavior and other behavioral prescriptions after surgery are common. Disordered eating is an established risk factor for inferior weight loss but the effects of negative mood and impulsivity are largely unknown. This thesis aims to investigate the prevalence of and associations between these potential risk factors and eating behavior in bariatric surgery patients. Study I assessed the prevalence of adult Attention Deficits/Hyperactivity Disorder (ADHD) symptoms in bariatric surgery patients. Symptoms of adult ADHD were elevated compared to the normal population and associated with symptoms of disordered eating, anxiety, and depression. Study II investigated whether treatment with Behavioral Activation (BA) could ameliorate binge eating and other symptoms of disordered eating in patients with obesity and Binge Eating Disorder. The results showed that BA was effective in increasing activity levels and improving mood but not in ameliorating binge eating in these patients. Study III was a prospective study on disordered eating, symptoms of depression and anxiety, symptoms of adult ADHD, and alcohol risk consumption before surgery and at follow-up after 12 months. After controlling for age, no variable measured before surgery could predict weight loss after surgery. Disordered eating after surgery was associated with inferior weight loss in men and a subgroup of older female participants. The present thesis concludes that symptoms of adult ADHD are common among bariatric surgery patients and associated with disordered eating. There is no indication that symptoms of adult ADHD are associated with short-term inferior weight loss after surgery. However, adult ADHD may be a risk factor for postsurgical alcohol abuse. The treatment study showed no direct association among activity, mood, and binge eating. BA, while effective in improving mood, was found not to be an effective treatment for BED, at least in the short group format investigated.

Purpose: To investigate the effect of the 12-week Active Living Every Day (ALED) internet-based PA intervention on PA levels, health profile and health-related psychosocial factors in bariatric patients. Methods: Efficacy of the ALED program was compared across pre-intervention, post-intervention and six-month post-surgery time points. PA was measured using the Omron pedometer (HJ-720ITC) and Actigraph GT3X accelerometer in 19 bariatric patients (2 male, 17 female, 43  12 years). Results: Mean steps/day and time spent in sedentary, light, and MVPA increased from pre-intervention through six-months post-surgery. Significant improvements (P < 0.05) in body composition occurred from pre-intervention to post-intervention and from post-intervention to six-month post-surgery. Conclusion: The 12-week ALED PA intervention did not significantly improve PA levels in previously sedentary bariatric surgery patients who were non-compliant prior to bariatric surgery or six-months post-surgery; however, the intervention led to improvements in cardiovascular risk factors, RPE and self efficacy. / School of Physical Education, Sport, and Exercise Science