Localised accumulation of body fat significantly influences the development of obesity related co-morbidities and cardiovascular disease (CVD) risk. Medium chain triglycerides (MCT) have been suggested to modulate body fat distribution. Phytosterols (PS) have demonstrated unequivocal cholesterol-lowering effects. A healthy dietary solution combining MCT and PS could thus become first-line obesity and CVD prevention. The aim of this study was therefore to investigate the effects of a functional oil (FctO) rich in MCT and PS on blood lipid levels and body adiposity, compared to olive oil. Twenty-three hypercholesterolemic, overweight men, were randomly assigned, in a single-blind crossover study, to consume a FctO, or olive oil, incorporated into a 40% fat diet for 6 wks. Blood lipid levels were measured and body composition was assessed. Total and LDL cholesterol were significantly reduced in subjects consuming the FctO versus the control oil. No significant differences for weight or adiposity loss of subjects were observed between the two oils. Results support the cardio-protective role of this FctO.

Childhood overweight and obesity has become a significant health concern worldwide. Obese youth are now being diagnosed with health complications and chronic diseases previously observed only among older adults. In order to improve their health and decrease their risk of premature mortality, secondary prevention is essential. To help guide development of an effective intervention program for obese youth referred to specialized clinical care, a chart review was conducted on adolescents seeking physician treatment for obesity. Data indicate that this patient population suffers from obesity-related health complications, faces social issues and exhibits lifestyle practices predisposing them to weight gain. Given that physical inactivity is one major risk factor for obesity in this population, a logic model and training module have been developed for a physical activity intervention program, with nutrition interventions to soon be incorporated. This program, called Mentors in Motion, provides mentoring to obese youth as a means of enabling positive changes in physical activity behaviors, mental well-being and overall health. A pilot study research protocol was also developed as part of the thesis activity to test the effectiveness of Mentors in Motion and to determine further program needs and enhancements. The pilot study has been funded by the Canadian Institutes for Health Research and is underway.

<p>The increasing prevalence of obesity in both developed and developing countries and its associated health risks have brought the issue of obesity prevention and management a public health debate. Health care professionals have been identified to have a role to play in directing the future of obesity management. However, among the numerous barriers for effective management of obesity is lack of knowledge of causes of obesity and negative attitudes towards obese patients by health care professionals. With limited or no studies available for the physiotherapy setting, the aim of the study was to determine the knowledge and attitudes of students of Physiotherapy at the University of the Western Cape, South Africa towards obese individual. A descriptive quantitative research design using a cross-sectional survey was used. One hundred and seventy five (175) students of Physiotherapy took part in the study using a convenience sampling technique. Data was collected by means of a structured, self-administered questionnaire adopted from the Obesity Risk Knowledge-10 scale, Beliefs About Obese Person scale and the Fat Phobia Scale. A response rate of 77.3% was obtained. Descriptive and inferential statistics were employed to describe the relationship and association between variables. Alpha level was set at 0.05. The mean age of the sample was 21.54 (SD = 4.903). Females constituted 73.5% and males 26.5% of the sample. The results showed that majority of the students of Physiotherapy (85%) reported having received no formal education regarding obesity.</p>

<p>This dissertation consists of three parts of empirical analyses investigating temporal patterns and consequences of (childhood) overweight and obesity, mainly in the United States and the People's Republic of China. Based on the China Health and Nutrition Survey, the first part conducts hierarchical age-period-cohort analyses of childhood overweight in China and finds a strong cohort effect driving the overweight epidemic. Results from the growth-curve models show that childhood overweight and underweight are related such that certain socio-economic groups with higher levels of childhood overweight also exhibit lower levels of childhood underweight. The second part situates the discussion on childhood obesity in a broader context. It compares temporal patterns of childhood overweight in China with these of adulthood overweight and finds that the salient cohort component is absent in rising adulthood overweight, which is dominated by strong period effects. A positive association between human development index and overweight/obesity prevalence across countries is also documented. Using multiple waves of survey data from the National Longitudinal Study of Adolescent Health, the third part analyzes the (latent) trajectory of childhood overweight/obesity in the United States. It finds that individuals with obesity growth trajectories are less likely to avoid mental depression, tend to have higher levels of neuroticism and lower levels of agreeableness/conscientiousness, and show less delinquent behaviors.</p> / Dissertation

Background Overweight and obesity are considerable public health issues internationally as well as in Sweden. On a global level, the obesity prevalence has nearly doubled over the last 30 years. Currently in Sweden, more than one third of all women, and slightly more than half of all men, are either overweight or obese. The long-term results of obesity treatment programs are modest as reported by other studies. The importance of extending the focus to not only obesity treatment, but also prevention of weight gain, has therefore been emphasized. Aim The overall aim of this thesis is to explore the concept of primary weight maintenance (PWM) and to increase the knowledge of the attitudes, behaviours, strategies and surrounding circumstances that are important for PWM in a Swedish middle-aged population. Material and methods All study participants were recruited based on their previous participation in a health survey in their home setting; The Västerbotten Intervention Programme (VIP) in Västerbotten Sweden (paperI-IV), or the Upstate Health and Wellness Study in Upstate New York (IV), USA. All subjects had participated twice, with a time period of ten years between health surveys. The prevalence of obesity between the years 1990-2004 was calculated for VIP participants (paper I). Ten-year non-gain (lost weight or maintained body weight within 3% of baseline weight) or weightgain (≥3%) was calculated for individuals aged 30, 40, or 50 years at baseline. A multivariate logistic regression model was built to predict weight non-gain. In-depth interviews were conducted with 23 maintainers and four slight gainers in Sweden and analysed using Grounded Theory (paper II). A questionnaire study was conducted including 2138 Swedish and 2134 US participants (paper III and IV). Analysis of variance (ANOVA), correlation, and linear regression were performed to identify attitudes, strategies, and behaviours that are predictive of PWM in different age, sex and BMI subgroups in Sweden (paper III). Further, the pattern of ten-year weightchange (% and kg) in 1999-2009 was calculated for Swedish and US women within different subgroups (paper IV). ANOVA, correlation and chi-squaretests were conducted to contrast eating and exercise habits between the two countries that may explain the differences in weight change. Results The prevalence of obesity (BMI ≥30) in Västerbotten increased from 9.4% in 1990 to 17.5% in 2004 (I). Older age, being female, being overweight at baseline, later survey year, baseline diagnosis of diabetes, and lack of snuff use increased the chances of not gaining weight. Based on the in-depth interviews, describing attitudes, behaviours and strategies of importance for PWM, a model was constructed (II). Weight maintenance was characterized as “a tightrope walk” and four strategies of significance for PWM were described as “to rely on heritage”, “to find the joy”, “to find the routine” and “to be in control”. The questionnaire study aimed at identifying predictors of PWM in different age, sex and BMI groups (III). The pattern of significant predictors was widely disparate between different subgroups. Of 166 predictors tested, 152 (91.6%) were predictive of PWM in at least one subgroup. However, only 4.6% of these were significant in half of the subgroups or more. The mean percent weight changes (in all cases weightgain), between 1999-2009 for Swedish and US women, were 4.9% (SD=5.8) and 9.1% (SD=13.7) respectively (p for t-test˂0.001) (IV). For the US women, the largest weight change occurred among the 30 year olds for all three BMI strata. For the Swedish, it was seen among overweight and obese 30 year old women. The largest difference in ten-year weight change between the two countries for any two matched subgroups was seen in normal weight 30 year olds. Significantly more of the women in this Swedish subgroup stated having more of healthy behaviours. However, there was a tendency for unhealthy behaviours to be strongly associated with greater weight gain in the US, but much less so in Sweden. Conclusion: Younger individuals, those of normal body weight, and those without health conditions (e.g. diabetes type 2) and cardiovascular riskfactors – were the least likely to maintain their weight over the 10 year period (I). Educational efforts on the prevention of overweight and obesity should therefore be broadened to include those individuals. The in-depth interview study showed great variety with regard to attitudes, strategies and behaviours important for PWM (II). The results from this study informs health personnel about the need to tailor advice related to body weight, not only to different sub-groups of individuals trying to lose weight but also to subgroups of primary weight maintainers who are trying to maintain weight. This statement was also supported by the questionnaire data, where the large disparity in the pattern of significant variables between subgroups suggests that these interventions should be tailored to the person’s demographic (age,sex and BMI) (III). Paper IV showed that even though the prevalence of obesity among Swedish women has increased substantially during these ten years, it has not kept pace with the increase in the US. One explanation for this may be that normal 30 year old Swedish women have more healthy behaviours than do US women. However, the insensitivity of the Swedish women to weight gain for healthy versus unhealthy alternatives may also be a factor. If the exact reason behind this phenomenon can be identified this may contribute to a deeper understanding of PWM both in Sweden and the US.

Bakgrund: Övervikt och fetma bland barn är ett stort folkhälsoproblem. Problemet beskrivs som ett resultat av för hög konsumtion energi i förhållande till den fysiska aktiviteten. Påföljderna kan ge uttryck i både medicinska, psykologiska och sociala konsekvenser och aktuell behandling har visat begränsat resultat. Syfte: Studiens syfte var att belysa vårdpersonals bemötande av familjer till barn med övervikt och fetma. Metod: En allmän litteraturstudie utfördes på tio kvalitativa vetenskapliga artiklar som sammanställdes. Resultat: Aspekter som uppmärksammades var olika svårigheter och möjligheter som kan framträda i bemötandet. Resultatet påvisade svårigheter sammankopplade med familjernas livsstil och förändrade samhälleliga normer. Attityder och okunskap bland vårdpersonal och familjer, samt ämnets känsliga karaktär ansågs vara andra hinder i bemötandet. De möjligheter som observerades var uppbyggnaden av en tillitsfull relation mellan vårdpersonal och familj med hjälp av omsorgfull dialog. Vidare konstaterades familjefokuserad omvårdnad, samarbete mellan olika yrkesroller, prevention och utbildning som framgångsrika tillvägagångssätt. Slutsats: Ämnet har en känslig och komplex karaktär, vilket medför en rad svårigheter vid bemötandet av patientgruppen. Genom att utöka resurser och utbilda vårdpersonal inom behandlingsstrategier och bemötande kan omvårdnaden effektiviseras. Klinisk betydelse: Utökad kunskap och insikt om svårigheter och möjligheter i vårdpersonalens bemötande av familjer till barn med övervikt och fetma är betydelsefullt för inblandade parter då detta kan leda till förbättringar i omvårdnaden. / Background: Overweight and obesity among children is a major public health concern. The problem is described as a result of excessive consumption of energy in relation to the physical activity. Consequences may show through medical, psychological and social aspects, and current treatments have shown limited results. Aim: The aim of the study was to highlight nursing staff’s responses to families of children with overweight and obesity. Method: A literature review was done on ten qualitative scientific articles. Results: Various difficulties and opportunities that may emerge in the health professional’s responses were observed. The results revealed difficulties that are associated with family lifestyles and changed societal standards. Attitudes and lack of awareness among both health professionals and families, and the sensitive nature of the subject could pose obstacles in the approach. The opportunities that were observed were the building of a trusting relationship between health professionals and family with the help of a caring dialogue. Moreover, family - focused care, collaboration between professional roles, prevention and education showed to be successful patient approaches. Conclusion: The subject is of sensitive and complex nature, which therefore creates difficulties when approaching patients. In order to develop the care effectively there is a need to expand resources and educate health professionals in treatment strategies and patient approach. Clinical Value: Advanced knowledge and understanding of the difficulties and opportunities in nursing staff responses to families of children with overweight and obesity is important for those involved, as this can lead to improvements in care.

Bakgrund: Övervikt och fetma är ett växande bekymmer som medför hälsoproblem. En av de vanligaste orsakerna är ohälsosamma levnadsvanor gällande kost och fysisk aktivitet. För att hindra den negativa utvecklingen behövs livsstilsförändring. Därför är distriktssköterskans stöd och vägledning viktigt i arbetet med dessa patienter för att kunna få dem att bli motiverade. Syfte: Syftet var att belysa distriktssköterskors uppfattningar om vad som motiverar patienter med övervikt eller fetma till livsstilsförändring. Metod: En kvalitativ ansats med fenomenografisk metod har använts i studien. Tio distriktssköterskor inom primärvård intervjuades. Resultat: Ur analysen av datamaterialet framträdde fyra beskrivningskategorier: få patienten att reflektera, skapa förtroende, öka patientens förståelse och patienten upplever sig må dåligt med 11 uppfattningar. Konklusion: Resultatet kan bidra till att utveckla och förbättra distriktssköterkans möjligheter att vägleda och ge adekvat stöd till patienter med övervikt eller fetma som behöver livsstilsförändring. Detta möjliggörs av att en förtroendefull relation skapas genom att lyssna på patienten och respektera dennes val. Likaså ökar möjligheterna att vägleda och ge stöd när patientens livsstil synliggörs med hjälp av dennes egna reflektioner på detta. / Background: Overweight and obesity is a growing concern that causes health problems. These conditions are often due to unhealthy dietary habits and lack of exercise. A change in lifestyle is needed to stop this negative development. In order for the patient to become motivated for a lifestyle change requires support and guidance from the district nurse. Aim: The aim of the study was to illuminate district nurses’ perceptions of what motivates patients with overweight or obesity to a change in lifestyle. Method: A qualitative approach with a phenomenographic method was used. Ten interviews were performed with district nurses in primary health care. Results: Four description categories emerged from the analysis: have the patient reflect, to build trust, to increase the patient’s understanding and the patient’s experience of not feeling well with 11 perceptions. Conclusion: The results could contribute in developing and improving the district nurse’s possibilities for giving adequate support and guidance to patients with overweight or obesity in need of a lifestyle change. This is enabled by building trust which requires listening to the patient and respecting their choices. Also making the patient’s lifestyle visible through their own reflections of it enhances the possibilities to give support and guidance.

Övervikt och fetma är ett växande folkhälsoproblem som medför risker för att utveckla sjukdomar som hjärtsjukdom, diabetes och ledbesvär. En ökning av övervikt och fetma ses även hos barn och studier har visat att barn med fetma löper högre risk att drabbas av sjukdomar senare i livet. Vinster finns i att arbeta förebyggande mot övervikt, både på individ och på samhällsnivå. Skolsköterskan har en viktig roll i detta preventiva arbete. Syftet med denna studie var att beskriva skolsköterskors preventiva arbete mot övervikt och fetma hos barn i låg- och mellanstadiet samt uppfattningar om och reflektioner kring detta arbete. Metoden för insamling av data var semistrukturerade intervjuer och åtta skolsköterskor anställda inom kommunal grundskola deltog. Intervjuerna analyserades genom kvalitativ innehållsanalys och resultatet visade tre kategorier: arbetsmetoder i preventivt arbete mot övervikt och fetma som innefattar det arbete skolsköterskorna gör enskilt och i samarbete med andra yrkeskategorier och föräldrar; strategier i mötet med föräldrar och barn som innefattar skolsköterskornas egna strategier i preventionsarbetet riktat mot föräldrar och barn samt svårigheter och begränsningar i preventivt arbete som innefattar de barriärer som finns i det preventiva arbetet i fråga om tid och resurser, svårigheter med föräldrakontakten samt skolans värderingar.  Skolsköterskornas preventiva arbete är beroende av ett gott samarbete med rektor, lärare och inte minst föräldrar. Preventivt arbete mot övervikt och fetma hos barn är en utmaning som kräver resurser, tid och kunskaper hos skolsköterskan. Ett utökat samarbete med lärarna kan vara en viktig strategi för utvecklingen av preventionsarbetet. / Overweight and obesity is a growing public health problem that increases the risks for development of illnesses like heart disease, diabetes and joint problems. This increase in overweight and obesity is also seen among children and studies have shown that obese children run a higher risk of contracting illnesses later in life. There are gains in prevention of overweight both for the individual and the society. School nurses are crucial in overweight and obesity prevention. The aim of this study was to describe school nurses´ preventive work against overweight and obesity among children in lower and upper primary school as well as perceptions and reflections on this work. Data was collected through semi-structured interviews wherein eight school nurses, municipally employed, participated.  The interviews were analyzed through qualitative content analyze The result revealed three categories: working methods in overweight and obesity prevention which comprises the work that school nurses perform alone and in cooperation with other professionals and parents; strategies in meetings with parents and children which comprises school nurses own strategies for prevention aimed towards parents and children and difficulties and limitations in preventive work that comprises barriers with in regards to time and resources, difficulties with parent communication and school values. School nurses preventive work is dependent on a good cooperation with school principals, teachers and least of all parents. Preventive work against overweight and obesity in children is a challenge that requires a school nurse's resources, time and knowledge. An extended cooperation with teachers might be an important strategy for the development of preventive activities.

Övervikt och fetma är ett växande problem i Sverige och delar av världen. Det är en riskfaktor för andra somatiska sjukdomar och har en negativ inverkan på livskvalitén. Syftet med denna studie var att beskriva distriktsköterskors arbete med och reflektioner kring behandlingen av vuxna patienter med övervikt och fetma. Studien var av kvalitativ ansats med deskriptiv design och genomfördes genom semistrukturerade intervjuer med åtta distriktssköterskor på landstingsdrivna vårdcentraler i Uppsala län. Resultatet av studien visade att mätvärden och samtal var viktiga verktyg för att distriktssköterskorna ska kunna identifiera patientens övervikt eller fetma. I behandlingen av övervikt och fetma var motiverande samtal, tvärprofessionellt arbete, fysisk aktivitet på recept och kostråd centrala delar. Liksom de stöd som distriktssköterskan utgjorde för patienten i beteendeförändringen. Patientens brist på motivation eller vilja kunde försvåra samarbetet mellan patient och distriktssköterska. Slutsatsen av studien visade att distriktssköterskorna hade en betydande roll i patientens beteendeförändring mot en hälsosammare livsstil och viktminskning. Distriktssköterskorna hade kunskap och kompetens att hjälpa patienten i arbetet med beteendeförändringen men mer kunskap behövdes för att kunna utveckla vården. Riktlinjer för hur övervikt och fetma ska tas om hand och behandlas inom vården var viktiga och hjälpte distriktssköterskorna att motivera sitt arbete hos verksamhetschefer. Distriktssköterskorna följde delvis vårdprogrammet för fetma hos vuxna i Uppsala län.

En av de ledande dödsorsakerna i världen beror på övervikt och fetma, därför är det viktigt att barn utvecklar bra kostvanor under tidig ålder. Syftet med denna litteraturstudie var att undersöka sambandet mellan kostrelaterad övervikt/fetma och karies hos barn. Artiklarna söktes i den medicinska databasen PubMed. Åldersbegränsning gjordes på barn mellan 0-18 år på grund av att studien är fokuserad på barn. Resultatet baseras på 10 vetenskapliga artiklar. Alla utom två studier har kommit fram till att barn med övervikt eller fetma (BMI &gt;25) hade högre prevalens av karies jämfört med normalviktiga eller underviktiga barn. Flera av studierna redovisade också att de överviktiga barnen hade högre konsumtion av snabbmat, sockerrik dryck och mat som innehåller jäsbara kolhydrater. I de studier där fettrik föda intogs fanns inget samband med karies. I en av de studier där de inte fann något samband mellan övervikt (BMI &gt;25) och karies fanns istället samband mellan undervikt (BMI &lt;18) och karies. Studiens slutsats är att kosten kan innebära ett möjligt samband mellan övervikt/fetma och karies. Det behövs dock ytterligare forskning genom framförallt longitudinella studier inom området för att fastställa sambandet. / One of the leading causes of deaths in the world is a result of overweightness and obesity, which is why it is important for children to create well rounded dietary habits during their childhood years. The aim of this study was to evaluate if there is an association between overweightness/obesity and dental caries among children. The articles were searched in the medical database PubMed. An age restriction between 0-18 years was made due to that this study is focused on children. The result is based on 10 scientific studies. All studies in this literature review except two have concluded that overweight or obese children had a higher prevalence of dental caries compared to those who were normalweight or underweight. Several of the studies showed that the overweight children had higher consumption of fast food, sugary drinks and food containing fermentable carbohydrates. In the studies were the diets were fat-based, there was no correlation to caries. In one of the studies there was no correlation between overweightness (BMI &gt;25) and caries but instead a correlation between underweightness (BMI&lt;18) and caries. The study concludes that nutrition could have a possible common risk factor for overweightness and dental caries. Further research is however needed in this field, primarily through longitudinal studies in this area to establish the relationship.