Tourism has social and economic benefits. Economic benefits are received through tourists visiting tourist attractions. Social benefits related to benefits tourists receive personally when visiting tourist attractions. The number of individuals that are obese are constantly increasing and leads to hazardous medical conditions. The aim of this research study was to determine the extent to which geocaching can be used to increase tourism and decrease obesity. Geocaching is similar to a treasure hunt where participant use clues and a Global Positioning System device to find a treasure that are called a cache. The cache is filled with trinkets that are exchanged by participants that find the cache. Students of the second avenue campus of the Nelson Mandela Metropolitan University were used as respondents and given information on what geocaching involve. Three geocaches were hidden in The Boardwalk Casino and Entertainment World in Summerstrand, Port Elizabeth. The respondents met at The Boardwalk Casino and Entertainment World where a clue and map was provided. After finding the cache the respondents was asked to complete an anonymous questionnaire. The results were calculated and conclusions and recommendations were made. The primary research process was conducted over too short a period of time to conclude whether it can lead to a reduction in obesity. However geocaching experience by respondents did show that the process of geocaching involves physical exercise, which is needed for losing weight. Research also indicated that respondents would like to geocache with family and friends. Geocaching with family and friends involves support which secondary research have also proven is important to losing weight and decreasing obesity. Respondents indicated that they enjoyed geocaching and would like to geocache in their free time. The indication of enjoying geocaching, participating in geocaching during free time allows travelling for leisure purposes as to geocache travelling is necessary and the majority of geocaches is hidden at tourist attractions. The combination of travelling to tourist attractions, enjoying the experience and partaking in physical exercise with family and friends involve two of the three main aspects seen as helping to reduce obesity: enjoyable physical activity and support from family and friends. The conclusion is therefore that geocaching can be utilised to increase tourism and reduce obesity.

Because there can be serious health and social consequences to obesity, the need for effective treatment programs is great. So far researchers in the field have been more successful in improving the short-term effectiveness of treatment programs for weight loss than the likelihood of long-term maintenance. This study investigated the effects of a 4-week non-diet maintenance intervention program for 59 female participants who had successfully reached a target goal weight, maintained their loss for at least six months, and had moderately high levels of concern about future maintenance. Two treatment conditions were compared, a maintenance intervention (MI) and a relapse prevention intervention (RPI) with a waiting list serving as a control group. Measures of self-efficacy and coping were taken before and after treatment, and by mail at a 6-week follow-up for the 2 treatment conditions; the waiting list was tested at corresponding time intervals without intervening treatment. It was expected that levels of self-efficacy and the relative use of problem-focused coping would increase from pretest to posttest for both treatment conditions compared with the waiting list and that only the relapse prevention intervention group would maintain these increases from posttest to follow-up. No such significant differences were found among the groups on the dependent measures, however, as hypothesized, problem-focused coping at posttest was positively correlated with levels of self-efficacy at follow-up. When clinical significance was assessed, individual participants in both treatment conditions showed improvement in self-efficacy (MI, 36%; RPI, 28%), and relative use of problem-focused coping (MI, 22%; RPI, 33%). In addition, correlational findings were similar to those of other maintenance studies (i.e., smaller weight regains were associated with higher levels of exercise and regular monitoring of weight). It was concluded that the relapse prevention treatment had not produced the desired effect of raising levels of self-efficacy and increasing the relative use of problem-focused coping, but also that the program's objectives had been too ambitious for a 4-week program. The relationship between self-efficacy and problem-focused coping found in this study indicates that this is a fruitful area for further investigation in the development of effective intervention programs for successful dieters at risk of relapse. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Background: Malnutrition, manifesting as obesity in women and under-nutrition in children, is a major public health problem in South Africa. There is a multitude of epidemiological evidence reflecting the extent and health effects of these problems, specifically among the African communities. However, at a family level, there is a paucity of information regarding the relationship between obesity in mothers and under-nutrition in children. Studies set to explore this relationship and determinants of body size and nutrition from a cultural perspective are long overdue. Such studies would assist in identifying intervention strategies that are appropriate and effective for the population at risk. Objective: This study, therefore, investigated the relationship between the child's nutritional status and that of the mother in a peri-urban African community. It further explored knowledge, attitudes and perceptions of body size as possible determinants of obesity and under-nutrition. This will make information available for further screening and planning of culturally sensitive nutrition interventions for the population under study. Methods: The study was conducted in two phases. The first phase was an exploratory qualitative design used mainly to develop a questionnaire for the second phase. In-depth interviews were conducted with 10 obese African mothers, whose children were categorised on the 'Road-to-Health' card, as underweight. The interviews provided an understanding of the African women's' perceptions of their body sizes and nutrition regarding the child. The second phase utilised a cross-sectional analytic study design to investigate the relationship between the mother's weight and the child's weight. It further investigated the knowledge, attitudes and perceptions found in the first phase in a larger sample using appropriate statistical techniques. A systematic sample of 365 mother-child pairs attending a child health clinic over a two-month period, starting from August 1997, was selected. The sample included women between the ages of 16 and 49 years old and their children between the ages of 2 and 5 years old attending a child health clinic in Khayelitsha, a peri-urban area outside Cape Town. Anthropometric measurements of children and mothers were taken and a structured questionnaire was administered to the mothers. Findings: The qualitative study showed attitudes and perceptions of body size that were tolerant of a 'big' body image. There was a lack of knowledge regarding causes of obesity and effective ways of reducing weight, preventing chronic diseases of lifestyle and what constitutes 'good' nutrition for the child. All these findings were confirmed in the second phase of the study. The main study showed that less than half (42%) of the mothers were able to estimate their body weights. These mothers underestimated their weights, on average, by 5 kg (p=0.0001 CI: 3.5-6.8). In the total sample, 37.3% of the mothers were obese (BMI> 30kg/m2) and 33.4 % were overweight (25 <BMI < 30 kg/m 2). Sixty-eight (18.6%) children were stunted in terms of the NCHS reference values (z-score<-2 height-for-age), 13.2% underweight (z-score<-2 weight-forage) and 7.1 % were wasted (z-score<-2 weight-for-height). Only a small proportion (6.3%) were obese, z-score >2 weight-for-height. The main finding is that, overall, no relationship was found between the mother's weight and that of the child. The mother's BMI showed a weak positive correlation with the weight-for-age zscore. The relationship between BMI and height-for-age z-score or weight-for-height was not statistically significant. However, most importantly, subgroup analysis showed that mothers' perceptions of their own body size and that of the child were significantly related to BMI and weight-for-age z-scores. Furthermore, a higher proportion of obese mothers (47.1 %) were unhappy about their body size than non-obese mothers (35.4 %). Consequently, a lesser proportion of obese mothers (36%) chose an overweight body image as 'attractive' compared with non-obese mothers (40.2%). Conclusions: Although there was no relationship found between obesity in mothers and under-nutrition in children, this study confirmed the high prevalence of both problems in the study group. Furthermore, it provided new evidence on the relationship between nutritional status of mothers and the resultant attitudes and perceptions to body size. This crucial information could be used in planning appropriate intervention strategies for the study population. More studies of this nature are needed for specific target populations in order to direct effective interventions.

BACKGROUND: Among patients with obstructive sleep apnea (OSA) a higher number of medical morbidities are known to be associated with those that have obesity hypoventilation syndrome (OHS) compared to OSA alone. OHS can therefore pose a higher risk of postoperative complications after elective non-cardiac surgery (NCS) and is often unrecognized at the time of surgery. The objective of this study was to retrospectively identify patients with OHS and compare their postoperative outcomes with those who have OSA alone. METHODS: Patients meeting criteria for OHS were identified within a large cohort of patients with OSA who underwent elective NCS at a major tertiary care center. We identified postoperative outcomes associated with OSA and OHS as well as the clinical determinants of OHS (BMI, AHI). Multivariable logistic or linear regression models were used for dichotomous or continuous outcomes, respectively. RESULTS: Patients with hypercapnia from definite or possible OHS, and overlap syndrome are more likely to develop postoperative respiratory failure [OR: 10.9 (95% CI 3.7-32.3), p<0.0001], postoperative heart failure (p<0.0001), prolonged intubation [OR: 5.4 (95% CI 1.9-15.7), p=0.002), postoperative ICU transfer (OR: 3.8 (95% CI 1.7-8.6), p=0.002]; longer ICU (beta coefficient: 0.86; SE: 0.32, p=0.009) and hospital length of stay (beta coefficient: 2.94; SE: 0.87, p=0.0008) when compared to patients with OSA. Among the clinical determinants of OHS, neither BMI nor AHI showed associations with any postoperative outcomes in univariable or multivariable regression. CONCLUSIONS: Better emphasis is needed on preoperative recognition of hypercapnia among patients with OSA or overlap syndrome undergoing elective NCS / Revisión por pares

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MSc (Med), School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Excess adiposity may increase the risk of heart failure through interactions with conventional risk factors. As cardiomyocyte apoptosis may be an important mechanism responsible for the development of heart failure the aim of the present study was to determine whether obesity enhances a) the increased cardiomyocyte apoptosis that accompanies pressure-overload hypertrophy and b) sympathetic-induced cardiomyocyte apoptosis. The impact of dietary-induced obesity on cardiomyocyte apoptosis was studied in elderly spontaneously hypertensive rats (SHR) and age-matched (8-9 months of age at the beginning of the study) Wistar Kyoto rats (WKY) after a 5 month feeding period and in young WKY rats (1 month of age at the beginning of the study) receiving either isoproterenol (ISO) or the vehicle (saline) for 5 days at the end of the feeding period. To induce obesity rats were fed a diet that promotes hyperphagia. At the end of the feeding period echocardiography was performed. Cardiac myocyte apoptosis was assessed using a TUNEL staining technique. Rats receiving the obesity-inducing diet had increases in body weight and visceral fat content. No further changes in systolic blood pressure were observed in rats during the feeding period. SHRs on the obesity-inducing diet had an increased left ventricular end-diastolic diameter and a decreased endocardial fractional shortening. As compared to lean rats, dietary-induced obesity resulted in an increase in the percentage of cardiomyocytes that were apoptotic in SHRs (3.4±0.5%, p<0.005 vs all other groups) and in WKYs receiving ISO (0.35±0.05%, p<0.05 vs Control-ISO and p<0.01 vs Control-saline and Diet-saline groups). In conclusion, obesity was associated with cardiomyocyte apoptosis through an interaction with pressure-overload hypertrophy v and excessive sympathetic activation. These findings provide insights into the potential mechanisms through which obesity may promote the development of heart failure.

A thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Community Psychology), Department of Psychology in the Faculty of Arts at the University of Zululand, South Africa, 2013. / In recent years, significant attention has been given in the popular and academic press to an ‘obesity crisis’ that supposedly, is both ever increasing and sweeping across the world. The study was undertaken to explore the influence of wellness in weight loss. Although it is not known why the prevalence of obesity has increased so suddenly and markedly specifically in the past twenty years, experts agree that the rise is unlikely to be related to a sudden shift in genetic or biological factors within the individual. The causes are largely environmental or a consequence of the mismatch between our physiology and an environment where food is abundant and physical activity unnecessary. Moreover, there seems to be an increasing belief that psychological instability and childhood experiences play a great role in this epidemic. The present study focused on the influence of wellness in weight loss. The holistic approach to deal with this study was undertaken looking at mental, physical and spiritual wellness. Specifically the study looked at food or diet (healthy food and nutrition as important in promotion of good health), fitness or exercise, meditation (helps reduce stress), mental or emotional health and community (social isolation leads to severe stress, which in turn may result in unhealthy behaviour). The results were interesting in that, there was a significant loss of weight amongst the participants at the end of the study; participants demonstrated a positive change and displayed willingness to take better care of their selves to stay well. Qualitatively, participants reported an increase in daily physical activities, healthier dietary choices, feelings of optimism and greater self acceptance. Thus wellness shows promise as a weight loss intervention.

As childhood obesity continues to increase, so do the comorbidities and related health issues, putting youth at a greater risk of developing adult-related diseases such as hypertension, Type 2 diabetes, and cardiovascular diseases. Current literature indicates that healthcare organizations have a significant role in the fight against this epidemic, yet most children's hospitals have no policy to accomplish this task. The purpose of this project was to develop a program proposal for a hospital-based, sustainable obesity program that will aid in improving patient and family awareness of the importance of maintaining an ideal body weight to decrease the incidences of obesity-related comorbidities in pediatric patients ages 2-19 with a Body Mass Index (BMI) greater than or equal to 30. Lewin's theory of planned change and the logic model were used as the theoretical framework to guide the change process for this project through its development. To that end, the proposal was accepted at the site by the executive leadership in consideration for full implementation and evaluation. Key stakeholders and content experts were brought together to create the proposal for the program which includes an algorithm to guide care. The results of this project, once adopted will promote positive change in the quality of life, decrease BMI to a healthy limit, improve overall population health, and reduce healthcare expenditure. Additionally, dissemination of results of the project may stimulate changes in other children's hospitals to adopt the measures of care in the fight against childhood obesity, and contribute to social change. .

Dans le champ de l'obésité massive, le corps est otage, l'individu est victime et agresseur. Le regard stigmatisant de l'Autre induit une souffrance psychique indicible par ceux dont le corps est différent de celui attendu dans une conformité imposée par des normes. L'individu, dans une présentification corporelle singulière, est déchiré entre le principe de plaisir offrant la satisfaction pulsionnelle, et le principe de réalité organisant l'indépassable culpabilité. Elle est renforcée par l’atteinte narcissique, majorée par le regard de l’autre, induit la haine de l'image, favorise le silence des affects. Que signifie : fabriquer plus de corps qui se traduit par plus de poids ? Quelle disjonction traverse Ie sujet entre son vouloir et son pouvoir, son savoir conscient et son désir inconscient ? L'étude des rapports ambivalents médecine/culture/norme/oralité aide à entrevoir des hypothèses différentes de celles des TCA classiques. A partir de la clinique, on peut envisager celle d'un état psychique entre deuil et mélancolie. A partir de la pratique en entretien apparait l'opportunité pour le sujet obèse d'engager un mouvement du regard à la parole afin de le dégager de l'entremêlement honte/rejet, et lui rendre une dignité. / In the field of massive obesity the body is the hostage and the dictator, the subject beingsimultaneously the victim and the assailant. The stigmatizing look of the other implies anunspeakable psychic pain for those whose body is different from the one expected to be conform to the present norms. The obese subject in a singular corporal presentification is torn between the principle of pleasure which gives him an urge-driven satisfaction and the principle of reality which organizes the impassable guilt. This culpability is strengthened by a narcissistic infringement and increased the other's look. This guilt also implies the hate of the image and furthers the silence of affects. What does it mean to produce more of body which manifests as more weight? Which disjunction goes through the subjects, between their will and their capacities, between what they consciously know and what they unconsciously desire? The study of the ambivalent relationships between medicine/culture/norm/orality helps us to foresee hypotheses which are different from those of the eating disorders 'classic theories. Through a clinical work, one can consider the hypothesis of a psychic state between loss and melancholy. Starting from the practice of interviews the obese subjects has an to start a motion from the look to the speech in order to free him from his mixed up state between shame and rejection, and to give him back dignity.

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