Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-06, page: 3259. Adviser: Charles E. Ford. Includes bibliographical references.

Thesis (Masters)--College of Saint Elizabeth, 2010. / Typescript. Available at The College of Saint Elizabeth - Office of Graduate Programs. "March 2010."

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0911. Includes bibliographical references.

The Three-Factor-Eating-Questionnaire (TFEQ) is an established instrument to assess eating behaviour. Analysis of the TFEQ-factor structure was based on selected, convenient and clinical samples so far. Aims of this study were (I) to analyse the factor structure of the German version of the TFEQ and (II)—based on the refined factor structure—to examine the association between eating behaviour and the body mass index (BMI) in a general population sample of 3,144 middle-aged and older participants (40–79 years) of the ongoing population based cohort study of the Leipzig Research Center for Civilization Diseases (LIFE Health Study). The factor structure was examined in a split-half analysis with both explorative and confirmatory factor analysis. Associations between TFEQ-scores and BMI values were tested with multiple regression analyses controlled for age, gender, and education. We found a three factor solution for the TFEQ with an ‘uncontrolled eating’, a ‘cognitive restraint’ and an ‘emotional eating’ domain including 29 of the original 51 TFEQ-items. Scores of the ‘uncontrolled eating domain’ showed the strongest correlation with BMI values (partial r = 0.26). Subjects with scores above the median in both ‘uncontrolled eating’ and ‘emotional eating’ showed the highest BMI values (mean = 29.41 kg/m²), subjects with scores below the median in all three domains showed the lowest BMI values (mean = 25.68 kg/m²; F = 72.074, p<0.001). Our findings suggest that the TFEQ is suitable to identify subjects with specific patterns of eating behaviour that are associated with higher BMI values.

Fetma är en av världens snabbast växande sjukdomar och karies är fortfarande en vanlig sjukdom hos barn och ungdomar. Syftet med denna licentiatavhandling har varit att: beskriva frekvensen av övervikt och fetma från födseln till tjugo års ålder. analysera vikt och viktutvecklingen från födseln till vuxen ålder. undersöka prevalens av approximal karies hos femtonåringar i förhållande till deras åldersspecifika BMI (isoBMI). undersöka tidiga mellanmålsvanor och karies vid femton års ålder. I studien ingick 671 barn följda från 1 till 20 års ålder. Studien har en populationsbaserad longitudinell design och analyserna baserar sig på uppgifter från barnhälsovårds (BHV) -, skolhälsovårds (SHV)- och folktandvårdsjournaler (FTV) från fyra distrikt i Jönköpings kommun. Längd, vikt och födelsediagnoser är inhämtade från BHV- journaler. Från SHV journaler inhämtades längd och viktuppgifter vid 15 år och från FTV journaler inhämtades uppgifter om kariesförekomst vid 15 och 20 års ålder. Dessutom inhämtades data från intervjuer och frågeformulär, som samlats in då barnen var 1 och 3 år gamla. Studien visade att det finns ett samband mellan övervikt/fetma vid 20 års ålder och övervikt/fetma vid 5½ och 15 års ålder. Emellertid var 70 % av dem som hade övervikt/fetma vid 20 år normalviktiga vid 5½ år och 47 % av dem med övervikt/fetma var normalviktiga vid 15 års ålder. Studien visade också att tonåringar med övervikt och fetma hade en signifikant högre prevalens av approximal karies än de som var normalviktiga. Vidare påvisades ett samband mellan förtäring av kariesriskprodukter vid 1 och 3 år och kariesförekomst vid 15 år. Det framkom inget samband mellan födelsevikt och senare övervikt/fetma vid 20 års ålder. Studien visade inte heller något tydligt mönster av viktutvecklingen från tidig barndom till ung vuxen. Ett barn kunde t ex ha övervikt vid ett mättillfälle för att vid nästa mättillfälle vara normalviktig och sedan överviktig igen. Framtida preventionsprogram för att förebygga både fetma och karies bör samordnas mellan de olika hälsoprofessionerna. Med tanke på att minst hälften av individer som utvecklar övervikt/ fetma till 20 års ålder rekryterades efter 15 års ålder bör denna tonårsgrupp ges särskild uppmärksamhet och nya former för prevention och behandling behöver utvecklas. För barn i förskoleåldern bör primär prevention riktas till hela populationen. / Obesity is one of the most rapid growing illnesses and dental caries is still a common illness by children and youth. The aims of this licentiate thesis were: describe frequency of overweight and obesity from birth to twenty years of age. analyze weight and weight development from birth to adult age. examine prevalence of approximal dental caries by teenagers fifteen years of age comparing to their age-specific BMI (isoBMI). examine early snacking habits and dental caries at the age of fifteen. The investigations have a population based longitudinal design and the analyses are based on data from 671 children followed from birth to 20 years of age. Information about weight and height were collected from health records at child health centers and school health care. At 20 years of age, weight and height measurements were performed by one of the authors. Data were also selected from caries examinations, interviews and questionnaires when the children were 1 and 3 years of age and from the children’s bitewing radiographs at 15 years of age. The result showed an association between overweight/obesity at 20 years and overweight/obesity at 5½ and 15 years. However, 70% of those who were overweight/obese at 20 years were of normal weight at 5½ years and 47% at 15 years. The majority of those who were overweight/obese at 20 years of age were recruited after 5.5 years of age and half of them in their late teens. Another finding was that overweight and obese adolescents had more approximal caries than normal-weight adolescents. Furthermore, consumption of snacking products and soft drinks at an early age appears to be associated with caries at 15 years of age. There was no connection found between birth weight and later overweight/obesity at 20 years of age. The study could not demonstrate any distinct patterns of the weight development from early childhood to young adult. A child could, for example, have overweight/obesity at one measurement, have normal weight at the next and then again have overweight/obesity at the third measurement. Because dental caries and overweight/obesity have common determinants further prevention measures should include strategies to prevent and reduce both overweight/obesity and dental caries in the young population. During the preschool period, the entire population should be the target of primary prevention from overweight/obesity, while, in the case of teenagers, prevention strategies should be developed for the whole population and treatment strategies for teenagers with established overweight/obesity.

Fragestellung: Sowohl die Childhood Group der International Obesity Task Force (IOTF) als auch die European Childhood Obesity Group (ECOG) empfehlen den Body-mass-Index als Beurteilungskriterium für Übergewicht und Adipositas bei Kindern und Jugendlichen. Im Erwachsenenalter erfolgt die Definition von Übergewicht und Adipositas anhand fester Grenzwerte, bei der Beurteilung von Kindern und Jugendlichen müssen die alters- und geschlechtsspezifischen Veränderungen des BMI berücksichtigt werden. Methode: Unter Heranziehung von 17 bereits durchgeführten Untersuchungen aus verschiedenen Regionen Deutschlands wurden BMI-Perzentile für Kinder und Jugendliche erstellt. Die Berechnung der Perzentile basiert auf den Körperhöhen- und Körpergewichtsdaten von 17.147 Jungen und 17.275 Mädchen im Alter von 0–18 Jahren. Ergebnisse und Schlussfolgerung: Die vorgestellten Perzentile sollten als Referenz für deutsche Kinder und Jugendliche angewendet werden. Die Arbeitsgemeinschaft „Adipositas im Kindes- und Jugendalter“ (AGA) hat in ihren Leitlinien die Anwendung der hier vorgestellten 90. und 97. Perzentile zur Definition von Übergewicht und Adipositas empfohlen. / Objectives: Both the Childhood Group of the International Obesity Task Force (IOTF) and the European Childhood Obesity Group (ECOG) recommend to use the body mass index (BMI = weight in kilograms/height in meter2) to evaluate overweight and obesity in children and adolescents. Whereas it is customary with adults to use fixed cut off points to define overweight and obesity, in children and adolescents age and sex specific developmental changes in BMI need to be addressed, which are due to physiological alterations of fat mass. Method: Because a national reference population for children and adolescents does not exist in Germany, a BMI reference data set was compiled. Therefore measurements of height and weight from 17 different regional studies including 17147 boys and 17275 girls aged 0 to 18 years were used. Results and conclusions: We recommend the use of the presented percentiles as reference to asses under- and overweight (obesity) in German children and adolescents. In the guidelines of the “Arbeitsgruppe Adipositas im Kindes- und Jugendalter”(AGA) the 90th and 97th BMI percentiles as calculated in this reference population are proposed as cut-off points for the definition of overweight and obesity in German children and adolescents.

In der Literatur wird von einem kontinuierlichen, weltweiten Anstieg der Inzidenz des Typ 1 Diabetes mellitus unter Kindern und jungen Erwachsenen, insbesondere in der Altersgruppe der unter 20-Jährigen, berichtet. Die multizentrische Studie EURODIAB untersuchte in den Jahren 1989-2003 die Inzidenz des Typ 1 Diabetes in 17 europäischen Ländern und bestätigte mit deren Ergebnissen diese weltweite Tendenz. Die Akzelerator Hypothese von Wilkin aus dem Jahr 2001 sieht die Ursache hierfür durch einen übermäßigen Gewichtsanstieg bedingt, da auch die Inzidenz übergewichtiger Kinder innerhalb der letzten Jahre zugenommen hat. Demnach sei die Anzahl Betroffener insgesamt gleich, jedoch in jungen Jahren (bis 15 Jahre) erhöht. Folglich sei Übergewicht mit Insulinresistenz ein Triggerfaktor für eine raschere Progression der Erkrankung und würde zu einem vorzeitigen klinischen Ausbruch des Typ-1-Diabetes beitragen. Im Rahmen dieser Dissertation verglichen wir anthropometrische Geburtsdaten von 1.117 Kindern mit Typ 1 Diabetes mellitus, deren Erstmanifestation zwischen 1988 und April 2013 lag, mit einer Kontrollgruppe, die bezüglich Geschlecht, Alter und Schwangerschaftswoche angepasst wurde (n=54.344). Des Weiteren wurden die Kinder mit Diabetes entsprechend ihres Alters bei Manifestation bestimmten Gruppen zugeordnet: G1:0-4,9 Jahre; G2:5 9,9 Jahre; G3:10-20 Jahre. Diese Unterteilung wurde vorgenommen, um festzustellen, ob Kinder, bei denen eine Diabetes Erkrankung früher klinisch manifest wird, zur Geburt bzw. zum Zeitpunkt der Diagnosestellung einen höheren Gewichts SDS aufweisen als Kinder, welche erst in späteren Jahren betroffen sind. Zusätzlich wurden Verlaufsdaten des BMI SDS von 540 Studienkindern vor, zu und nach Manifestation ermittelt und mit einer gesunden Kontrollpopulation (n=134.249) verglichen. Hierbei zeigten Kinder und Jugendliche mit Typ 1 Diabetes im Vergleich zu Stoffwechselgesunden signifikant erhöhte Geburtsgewicht SDS Werte. Es konnte jedoch keine signifikante Abhängigkeit zwischen einer vorzeitigen Diabetes-Manifestation und einem erhöhten Geburtsgewichts bzw. einem erhöhten BMI SDS zum Zeitpunkt der Manifestation gezeigt werden. Ebenso blieb der laut Wilkin zu erwartende Gewichtsanstieg 4 Jahre vor Ausbruch der Erkrankung aus. Kinder mit Diabetes verlieren, wie erwartet, zur Manifestation an Gewicht und erreichen nach ungefähr einem Jahr ihr Ausgangsgewicht. In den Folgejahren sind Kinder mit Typ 1 Diabetes signifikant schwerer als die Kontrollgruppe. Aufgrund dieser Ergebnisse müssen wir die von Wilkin postulierte „Akzelerator Hypothese“ widerlegen.

Syftet med studien var att beskriva prevalens av övervikt, fetma och undervikt hos 10-11-åriga barn under en fyraårsperiod. Detta gjordes genom att jämföra två födelsekohorter, 1989 och 1993 med fokus på könsskillnader och skillnader i socioekonomi (SES) definierat utifrån inkomst i fyra olika typområden. Studien utfördes i Stockholms län 2005 där SES-områden och skolor inom dessa områden valdes slumpmässigt. Antropometriska data från skolhälsovårdsjournaler insamlades från barn i skolår fyra. Vikt, längd och födelsedata erhölls från 2416 10-11-åringar födda 1989 och från 2183 barn födda 1993. Övervikt och fetma definierades enligt Cole ́s ålders- och könsspecifika BMI-gränser. Undervikt definierades som – 2 SD enligt referenskurvor från Karlberg 2001. En tydlig könsskillnad kan ses vad gäller prevalens av övervikt och fetma. Hos pojkarna var 21,3 % överviktiga både i kohort 1989 och 1993 medan fetma ökade ickesignifikant från 3,1 % till 4,0 %. Hos flickorna minskade övervikten från 22,9 % till 19,7 % (ns) och fetma minskade från 4,6 % till 2,9 % (RR= 0,62 95 % CI:0,41-0,98). Undervikten tenderade att minska både hos flickor och hos pojkar. Vid jämförelse av de olika SES-områdena var den sociala gradienten mer tydlig i födelsekohort 1993 jämfört med 1989. I födelsekohort 1993 var 17,1 % av pojkarna överviktiga i det mest resursstarka området jämfört med 29,0 % i det mest resurssvaga området. För fetma var motsvarande siffror 1,9 % och 6,0 %. Flickorna uppvisade ett helt annat mönster; hos flickor i det mest resurssvaga området var överviktsprevalensen nästan identisk vid de två studerade tidpunkterna; 28,4 % och 28,3 %. I de övriga SES-områdena var övervikten lägre hos flickor i födelsekohort 1993 jämfört med födelsekohort 1989. Studien visar att trenden av övervikt och fetma delvis ändrat riktning med en minskning av fetma hos flickorna medan pojkarna fortsätter att öka särskilt i resursfattiga områden. Det finns en tendens till att den sociala gradienten har ökat under den studerade fyraårsperioden vilket understryker vikten av förebyggande åtgärder för barn och deras familjer i särskilt resursfattiga områden / The objective of the study was to describe prevalence of overweight, obesity, and underweight among 10-11 year old children during a four year period. This was done by comparing 1989 and 1993 birth cohorts, with focus on gender and socioeconomic (SES) using data from small geographical areas. The study was performed 2005 in Stockholm county where SES areas and schools within SES areas were randomly sampled. In selected schools, anthropometric data from routine assessments of 4thgraders were abstracted from school records. Weights, heights and birthdates were retrieved from 2416 10-11 year olds born in 1989 and 2183 born in 1993. Overweight and obesity were defined according to Cole’s age- and sex-specific BMI cut-off points. Underweight was defined as -2 SD according to the national growth reference curves established by Karlberg and coworkers 2001. Secular trends in prevalence between 1989 and 1993 seemed to vary by sex. In boys, the prevalence of overweight was 21.3 % in both birth cohorts, while obesity increased non-significantly from 3.1 to 4.0 %. In girls overweight decreased non-significantly from 22.9 to 19.7 and obesity decreased from 4.6 to 2.9 % (RR= 0.62 95 % CI: 0.41-0.98). The prevalence of underweight decreased non-significantly both in boys and in girls. When comparing the different SES-areas the social gradient was more obvious in birth cohort 1993 than cohort 1989. In birth cohort 1993 17.1 % of the boys were overweight in the most affluent area compared to 29.0 % in the low SES area. For obesity the prevalences were 1.9 % and 6.0 % respectively. In girls there is a slightly different pattern; among girls in the low SES areas the prevalence of overweight are almost identical 28.4 and 28.3. In the other areas the 1993 cohort shows a lower overweight prevalence compared to girls born 1989. In summary decreases in obesity occurred in girls from the two respective birth cohorts; at the same time both overweight and underweight tended to decrease. In contrast, among boys, there were no significant differences over time, although increases in obesity were detected among boys in less advantaged socioeconomic areas.This underlines the need for computer based monitoring of routine height and weight measurements in schools and preventive efforts which target children and their families in areas of low-socioeconomic status in early childhood. / <p>ISBN 91-7997-158-x</p>

Objective: Internalizing the pervasive weight bias commonly directed towards individuals with overweight and obesity, cooccurs with increased psychopathology and impaired quality of life. This study sought to establish population norms and psychometric properties of the most widely used self-report questionnaire, the Weight Bias Internalization Scale (WBIS), in a representative community sample. Design and Methods: In a survey of the German population, N = 1158 individuals with overweight and obesity were assessed with the WBIS and self-report measures for convergent validation. Results: Item analysis revealed favorable item-total correlation of all but one WBIS item. With this item removed, item homogeneity and internal consistency were excellent. The one-factor structure of the WBIS was confirmed using confirmatory factor analysis. Convergent validity was shown through significant associations with measures of depressive and somatoform symptoms. The WBIS contributed to the explanation of variance in depressive and somatoform symptoms over and above body mass index. Higher WBIS scores were found in women than in men, in individuals with obesity than in individuals with overweight, and in those with lower education or income than those with higher education or income. Sex specific norms were provided. Conclusions: The results showed good psychometric properties of the WBIS after removal of one item. Future research is warranted on further indicators of reliability and validity, for example, retest reliability, sensitivity to change, and prognostic validity.

Background: Obesity and the accompanying increased morbidity and mortality risk is highly prevalent among older adults. As obese elderly might benefit from intentional weight reduction, it is necessary to determine associated and potentially modifiable factors on senior obesity. This cross-sectional study focuses on multi-morbid patients which make up the majority in primary care. It reports on the prevalence of senior obesity and its associations with lifestyle behaviors. Methods: A total of 3,189 non-demented, multi-morbid participants aged 65–85 years were recruited in primary care within the German MultiCare-study. Physical activity, smoking, alcohol consumption and quantity and quality of nutritional intake were classified as relevant lifestyle factors. Body Mass Index (BMI, general obesity) and waist circumference (WC, abdominal obesity) were used as outcome measures and regression analyses were conducted. Results: About one third of all patients were classified as obese according to BMI. The prevalence of abdominal obesity was 73.5%. Adjusted for socio-demographic variables and objective and subjective disease burden, participants with low physical activity had a 1.6 kg/m2 higher BMI as well as a higher WC (4.9 cm, p<0.001). Current smoking and high alcohol consumption were associated with a lower BMI and WC. In multivariate logistic regression, using elevated WC and BMI as categorical outcomes, the same pattern in lifestyle factors was observed. Only for WC, not current but former smoking was associated with a higher probability for elevated WC. Dietary intake in quantity and quality was not associated with BMI or WC in either model. Conclusions: Further research is needed to clarify if the huge prevalence discrepancy between BMI and WC also reflects a difference in obesity-related morbidity and mortality. Yet, age-specific thresholds for the BMI are needed likewise. Encouraging and promoting physical activity in older adults might a starting point for weight reduction efforts.