abstract: No studies have evaluated the impact of tracking resting energy expenditure (REE) and modifiable health behaviors on gestational weight gain (GWG). In this controlled trial, pregnant women aged >18 years (X=29.8±4.9 years) with a gestational age (GA) <17 weeks were randomized to Breezing™ (N=16) or control (N=12) for 13 weeks. The Breezing™ group used a real-time metabolism tracker to obtain REE. Anthropometrics, diet, and sleep data were collected every 2 weeks. Rate of GWG was calculated as weight gain divided by total duration. Early (GA weeks 14-21), late (GA weeks 21-28), and overall (GA week 14-28) changes in macronutrients, sleep, and GWG were calculated. Mediation models were constructed using SPSS PROCESS macro using a bootstrap estimation approach with 10,000 samples. The majority of women were non-Hispanic Caucasian (78.6%). A total of 35.7% (n=10), 35.7% (n=10), and 28.6% (n=8) were normal weight, overweight, and obese, respectively, with 83.3% (n=10) and 87.5% (n=14) of the Control and Breezing™ groups gaining above IOM GWG recommendations. At baseline, macronutrient consumption did not differ. Overall (Breezing™ vs. Control; M diff=-349.08±150.77, 95% CI: -660.26 to -37.90, p=0.029) and late (M diff=-379.90±143.89, 95% CI:-676.87 to -82.93, p=0.014) changes in energy consumption significantly differed between the groups. Overall (M diff=-22.45±11.03, 95% CI: -45.20 to 0.31, p=0.053), late (M diff=-23.16±11.23, 95% CI: -46.33 to 0.01, p=0.05), and early (M diff=20.3±10.19, 95% CI: -0.74 to 41.34, p=0.058) changes in protein differed by group. Nocturnal total sleep time differed by study group (Breezing vs. Control; M diff=-32.75, 95% CI: -68.34 to 2.84, p=0.069). There was a 11.5% increase in total REE throughout the study. Early changes in REE (72±211 kcals) were relatively small while late changes (128±294 kcals) nearly doubled. Interestingly, early changes in REE demonstrated a moderate, positive correlation with rates of GWG later in pregnancy (r=0.528, p=0.052), suggesting that REE assessment early in pregnancy may help predict changes in GWG. Changes in macronutrients did not mediate the relationship between the intervention and GWG, nor did sleep mediate relationships between dietary intake and GWG. Future research evaluating REE and dietary composition throughout pregnancy may provide insight for appropriate GWG recommendations. / Dissertation/Thesis / Doctoral Dissertation Nutrition 2019

Background: Obesity is a chronic disease characterized by a body mass index (BM1) of ≥ 30 kg/m2 which negatively impacts the musculoskeletal system and has been found to be a major contributing factor to obesity-induced biomechanical alterations during activities of daily living (ADLs). A certain level of mobility is required for all populations to maintain independence and a good quality of life becomes more difficult with excess weight. Using a reduced weight-bearing activity, such as the Alter Gravity treadmill, would be beneficial in an obese population to reduce the load on the joints and potentially decrease the risk of weight bearing injury while maintaining normal gait mechanics. The purpose of this dissertation was to determine the biomechanical effects of excess weight and weight distribution on ADLs. To address this, two different weight gain models were created to simulate central (CL) and peripheral (PL) weight gain compared to an obese group (OW), and normal weight group (UL) during different activities of daily living (ADLs). The purpose of the third study was to compare lower extremity joint kinematics and muscle activation patterns between obese and normal individuals at different levels of body support (100, 75, and 50%) while walking in the AlterG treadmill. Methods: 14 normal weight (BMI: 22.4 ± 1.8 kg/m2, age: 23.4 ± 3.6 yrs) and 17 obese (BMI: 33.2 ± 2.3 kg/m2, age: 31.6 ± 8.0 years) adults participated in different ADLs (gait and descending a set of stairs). Normal weight participants were loaded with two different external loads sufficient to increase their BMI by 5 kg/m2 (~22.6% body mass). Kinematic and kinetic data were collected with 3D motion analysis. Frontal plane hip and knee angles and moments were calculated. Results: During gait, the obese group walked at a significantly slower velocity compared to UL. Step length was 8.7% longer in UL and 7.4% longer in the CL compared to the OW. PL more closely mirrored the OW group in step length, flexion moment and extension moment and the CL more closely mirrored the obese group in sagittal plane knee and hip excursion, and peak hip flexion moment and extension moment during gait During the transition from descending stair walking to level gait, it was found that the PL, but not CL, decreased step length, increased step width, and increased proportion of the gait cycle spent in stance. During the transition from walking down the stairs to level gait it was found that CL and PL affect temporal spatial variables differently. PL also reduced peak hip adduction angle, increased peak hip flexion moment, decreased peak hip extension, decreased sagittal plane hip excursion, and decreased frontal plane hip excursion. Conversely, CL reduced peak hip flexion moment and trended to reduce peak hip extension moment. To determine the effects of reduced body mass per se on improved biomechanics, we needed a model that would prevent associated changes in segmental volume. Therefore, using an AlterG treadmill facilitated this method. At 100 % BW support, mean ST and VM EMG activity were significantly higher in the obese compared to the normal weight groups. There were also differences found at 75 % BW support in ST in the obese being greater than the normal. Conclusions: Combined, the overall results of this dissertation suggest that weight gain is able to be modeled but is variable and task specific. The CL has proven to be the weight gain model that which elicits a better biomechanical obese response when normal weight individuals are loaded. Further work is needed to understand how to truly mimic obesity with an external load.

Obesity and eating disorders are pervasive concerns among young adult women, and profoundly impact physical and psychological functioning. Weight-related disorders are typically chronic conditions; their treatment is often complex and frequently ineffective. Moreover, Black and Latina women have disproportionately high rates of obesity, and experience rates of eating disorders comparable to those of their White peers; yet, they are less likely to be referred to appropriate treatment. Given the intractability of weight-related concerns and their detrimental consequences, attempts to prevent unhealthy eating attitudes and behaviors are essential. To date, few prevention programs have significantly reduced both obesity risk and eating disorder symptoms. The purpose of the current study was to develop and pilot an intervention designed to prevent obesity and eating disorders among young adult women (age 18-25). In the first phase of the study, focus groups were conducted with 30 young adult women to explore disparate racial and ethnic appearance ideals and assess cultural acceptability of the proposed intervention. Additionally, an innovative manualized intervention informed by the qualitative data and grounded in social psychological principles and dialectical behavior therapy was developed. In the second phase of the study, 29 young adult women were recruited to participate in the intervention. Participants completed a battery of questionnaires at pretest (baseline), posttest (8-weeks), and 4-week follow-up. Findings reveal vast differences in beauty standards among disparate racial/ethnic women and demonstrate the need to enhance the cultural sensitivity of current intervention approaches. Results suggest the feasibility and acceptability of a culturally sensitive prevention program intended to reduce the risk of both unhealthy weight gain and eating pathology.

The problem addressed in this phenomenological study is how culture and acculturation can potentially influence gestational weight during pregnancy, leading to overweight and obesity among immigrant Latinas. To understand the possible influence of culture and acculturation on the diet, exercise, and weight of pregnant immigrant Latinas, the experiences of immigrant Latinas who had undergone a pregnancy in Mexico and were pregnant in California were examined. The ecological model theory was applied as a framework for exploring the participants' experiences regarding nutrition, physical activity, and weight gain. Semistructured interviews with 10 qualified participants were conducted. Data analysis entailed an inductive approach based on the following phases of qualitative data analysis: data reduction, data display, and conclusion and verification. Clustered responses were presented around the major themes. Six major themes were derived from the data. These were: (a) bicultural lifestyles; (b) personal adjustments relating to pregnancy and prenatal care; (c) low levels of social and relational support; (d) adjustments regarding diet, nutrition, food security, and access; (e) changes in the form and extent of physical activity in the United States; and (f) rapid weight gain experienced during pregnancies undergone in the United States. Social change implications include encouraging public health professionals, health educators, and community health workers to focus on the importance of culture and acculturation on the health of Latinas in order to ensure positive infant and maternal health outcomes.

Introduction: Obesity is a growing global public health problem and is as prevalent among pregnant women as in the general population. It is well known that obese women have an increased risk for several complications during pregnancy and delivery and this is also true for the neonate. Excessive gestational weight gain among obese women seems to further increase these risks for adverse outcomes. It has not been known up to the time of this study whether a behavioral intervention program designed for obese pregnant women could result in a reduction of gestational weight gain. Aim: The overall aim of the present thesis was to study the effect of an intervention program designed to control weight gain among obese pregnant women during pregnancy and to then observe the outcomes of their pregnancies. In addition we wanted to learn if this behavioral intervention program could result in a weight gain of less than seven kilograms. Material and methods: The intervention group consisted of 155 obese (BMI &gt;30 kg/m2) pregnant women at the antenatal care clinic (ANC) in Linköping; the control group consisted of 193 obese pregnant women in two other cities. The women in the intervention group were offered, in addition to regular care at the ANC, motivational interviewing in weekly visits to support them in making this behavioral change. They were also offered aqua aerobic class once or twice a week. The women in the control group attended the routine antenatal program in their respective ANCs. Outcome measures were: weight in kg, pregnancy-, delivery and neonatal outcomes, prevalence of anxiety- and depressive symptoms and attitudes and experiences of participating in an intervention program. Results: The women in the intervention group had a significantly lower gestational weight gain and also had a lower postnatal weight than the women in the control group. The percentage of women in the intervention group who gained &lt;7 kg was greater than the percentage in the control group. There were no differences between the two groups in pregnancy-, delivery- and neonatal outcomes. In addition, there was no difference in prevalence of symptoms of anxiety and depressions between the intervention- and control group and the gestational weight gain did not have any effect on symptoms of depression or anxiety. The women in the intervention group with gestational weight gain &lt;7 kg, weighed less at the two years follow-up than the women in the control group. Most of the women who participated in the intervention program expressed positive attitudes and were positive towards their experiences with the intervention program and their efforts to manage the gestational weight gain. Conclusion: The intervention program was effective in controlling weight gain during pregnan-cy and did not change the pregnancy, delivery or neonatal outcomes or the prevalence of anxie-ty- and depressive symptoms. The group with a gestational weight gain &lt;7 kg showed the same distribution of complications as the group with a higher weight gain. The intervention program seems to influence the development of weight in a positive direction up to two years after childbirth. The women were also satisfied with their participation in the intervention program.

The mechanism of weight gain due to treatment with olanzapine, a serotonin receptor antagonist, has not been fully understood. Weight gain and food intake are under the control of neuropeptides/hormones, POMC (proopiomelanocortin), CART (cocaine and amphetamine regulated transcript), AgRP (Agouti-related peptide) and NPY (neuropeptide Y) that are synthesized and secreted from the arcuate nucleus (ARC) of hypothalamus. In this study, the altereration of the ARC neuropeptide/hormone levels both in humans and rats were determined as one of the weight gain mechanism. To examine olanzapine&rsquo / s weight gain effects, male first attack psychotic patients (pre-treatment), were hospitalized and treated for 4 -weeks (post-treatment), (n = 22), and healthy control group (n = 26) were included to the study. Case-control association design was used to analyze the changes in body mass index (BMI), peripheral leptin and the ARC neuropeptides levels. In patients, after 4-weeks of the olanzapine treatment / BMI and the waist circumference were significantly increased with average weight gain of 4.33 kg. In pre-treatment group, NPY levels were significantly lower while &alpha / -MSH, the anorexigenic product of POMC levels were significantly higher vs. control. At post-treatment, both leptin and NPY levels were significantly increased but the CART levels did not change. To further understand the underlying mechanism of olanzapine induced weight gain, the drug was orally administrated to 10 healthy male Wistar rats to analyze both the hypotalamic gene expression and peripheral levels of those candidate neuropeptides. In rats food consumption was increased and hypotalamic mRNA levels of NPY, AgRP and POMC were decreased while CART levels did not show any alteration. Consistent with the expression data, circulating levels of NPY, AgRP and &alpha / -MSH decreased significantly but CART levels were also reduced unexpectedly. In conclusion, it may be presumed that the antagonistic effect of olanzapine on the ARC neurons might be the basis for a disregulation of the neurohormones secretion which may cause weight gain in the treated psychotic patients.

Diss. (sammanfattning) Skara : Sveriges lantbruksuniv., 2009. / Härtill 4 uppsatser.

CenteringPregnancy is a model of group prenatal care that replaces routine, individual prenatal care. The program brings women together into small groups to receive their care and prenatal education, and is based on three components: risk assessment, education, and support. The model is client-centered, designed to empower pregnant women and support persons, and involves the woman in small group discussions of 8-10 other women of similar gestational age. The group discussions provide support, help women educate each other, and invoke self-monitoring. Currently, there have been few publications that closely examined maternal weight and obesity and associated outcomes in women involved in CenteringPregnancy; and there are a limited number of studies that examined Spanish-speaking CP groups with Latinas. Therefore, the primary purpose of this retrospective cohort study was to compare pregnancy outcomes of Latina women who completed CenteringPregnancy in a public health clinic to women who completed individual care in the same clinic during the same time. The secondary purpose of this study was to understand perceptions of care among multiparous women who recently completed CenteringPregnancy and completed individual prenatal care in the past. Both quantitative and qualitative methods were employed to examine differences in pregnancy outcomes and maternal factors in both prenatal care groups, and to understand women's perceptions and experience in both CenteringPregnancy and individual prenatal care. A total of 487 patient charts were obtained for data collection (Intervention n= 247, Comparison n=240) and 10 women who recently completed CenteringPregnancy at the health department and completed individual prenatal care in the past completed in person in-depth interviews. The results indicated that there were no differences in infant birthweight or gestational age at delivery between the groups. Compared to women in individual care, women in CenteringPregnancy had increased odds of: having a vaginal birth as opposed to a primary cesarean section, aOR =2.57, (95% CI: 1.23-5.36), attending prenatal care visits, aOR=11.03, (95% CI: 4.53, 26.83), attending postpartum care visits, aOR=2.21 (95% CI: 1.20, 4.05) and formula-only feeding their infants, aOR=6.07 (95% CI: 2.57-14.31). Compared to women in individual care, women in CenteringPregnancy had decreased odds of gaining below the recommended amount of gestational weight, aOR=0.41, (95% CI: 0.22, 0.78). Qualitative findings indicated that women who complete CenteringPregnancy were more satisfied with their care, received more education and support and were more empowered to make decisions about their pregnancy and childbirth. The program provides a system of social support that encapsulates all types of social support to provide relief of stress, encourage positive relationships and empower women to help facilitate healthy pregnancies. CenteringPregnancy at the Pinellas County Health Department increased health care utilization and informed and empowered women through social support.

Background Excessive gestational weight gain (GWG) poses significant risk for maternal and neonatal health. Various guidelines have recommended healthy diets and enhancing physical activity during pregnancy to prevent excessive GWG. However, results of intervention studies are inconsistent in the developed countries, and there are no official guidelines and few interventions for GWG in China. This paper aims to review and synthesize relevant studies on diet and physical activity interventions to prevent excessive GWG so that practical suggestions can be provided to public health authorities in China. Methods This systematic review was performed using PubMed, Google and Google Scholar to search all relevant studies in English and randomised controlled trials (RCTs) that investigated diet and physical activity interventions to limit excessive GWG up to May 2014. The quality of included studies was assessed using CONSORT statement and JADAD scale. Results Nine studies describing diet and physical activity interventions to prevent excessive GWG were incorporated in the systematic review. Overall, the contents of interventions were diverse, which consisted of one-to-one counselling, and community-based physical activity interventions. Weekly mailed newsletters and supportive telephone calls were used as assistive tools to remind pregnant women of limiting excessive GWG. Seven studies showed less weight gain in pregnant women receiving the intervention, of which four studies demonstrated a reduction in excessive GWG in women with varying body mass index (BMI) spanning the normal, overweight and obese categories, while three studies reported a reduction of excessive GWG only in normal weight women and obese women need to be paid attention in the future. Conclusions The effectiveness of diet and physical interventions to limit excessive GWG may not be confirmed because of limited quality or sample size of intervention studies. However, studies have demonstrated reduction of excessive GWG during pregnancy, in addition to persistent healthy behaviours following such interventions during pregnancy. Further meta-analyses of RCTs studies should be done to confirm the effectiveness of such interventions among Chinese women. / published_or_final_version / Public Health / Master / Master of Public Health

Övervikt och fetma är ett stort problem världen över. Varje år dör 2,8 miljoner vuxna människor av sjukdomen. För att kunna arbeta preventivt mot övervikt och fetma och hjälpa de patienter som lider av sjukdomen bör sjuksköterskan ha mer kunskap och utbildning om de bakomliggande faktorerna. Syftet med denna litteraturstudie var att belysa bakomliggande faktorer för övervikt och fetma. 12 vetenskapliga artiklar valdes ut och granskades och resultatet framkom i form av fyra kategorier; livsstilsfaktorer, känslor och relationer, socioekonomiska faktorer och genetiska faktorer.  I ett flertal studier framkom det att brist på fysisk aktivitet var en starkt bidragande faktor till viktuppgång. Stress och tidsbrist var de utlösande faktorerna till att den fysiska aktiviteten uteblev. Graviditet och moderskap sågs som en bakomliggande faktor till viktuppgång hos kvinnor. Relationer och en svår barndom kunde också bidra till viktuppgång hos både män och kvinnor. Arbetsmiljö, utbildningsnivå och socioekonomisk status hade en betydelse relaterat till högt BMI, dock visade dessa faktorer skillnader gällande genus. Det framkom att det finns ett könsideal och att det framförallt har betydelse gällande männens viktuppgång. Vidare kvalitativ forskning med fokus på patienternas upplevelser är av betydelse. Likaså sjuksköterskans preventiva arbete som bör uppmärksammas redan under sjuksköterskeutbildningen. / Overweight and obesity is a major problem worldwide. Every year 2.8 million adult dies in the disease. In order to work preventively against overweight and obesity and to help patients who suffer from the disease, nurses need more knowledge and education about the underlying factors. The purpose of this study was to illustrate the underlying factors for overweight and obesity. 12 scientific papers were selected and examined and the result emerged in four categories; lifestyle factors, feelings and relationships, socioeconomic factors and genetic factors. Several studies showed that the lack of physical activity was a major contributing factor to gaining weight. Stress and lack of time were the triggering factors that physical activity did not occurred. Pregnancy and motherhood was seen as an underlying factor to why women gained weight. Relationships and a difficult childhood could also contribute to weight gain in both men and woman. Work environment, education and socioeconomic status had a role related to high BMI, however, those factors showed differences regarding gender. It was found that there are gender ideals and that they are primarily of importance regarding the men’s weight gain. Further qualitative researches focusing on patients’ experiences are relevant. Similarly, the nurse’s preventive work should be addressed during nursing school.