This systematic review examined the shifts in undernutrition and overnutrition in Nepal during the past two decades. We searched PubMed for studies and reports published between January 1, 2000, and June 30, 2018. Publications with a sample size greater than or equal to 500 that reported prevalence of nutritional status were included. Six large national reports and 36 studies met study inclusion criteria and were included. Overall, available nationally representative data remained limited. The Nepal Demographic and Health Survey 2001 to 2016 showed that underweight prevalence decreased from 26.7% to 17.2% and prevalence of overweight/obesity increased from 6.5% to 22.1% among women of reproductive age (15-49 years). In preschool children, prevalence of stunting, wasting, and underweight decreased from 57.2% to 35.8%, 11.2% to 9.7%, and 42.7% to 27.0%, respectively. Prevalence of overweight/obesity was low among children and was higher in higher socio-economic status (SES) groups. The overweight-obesity/underweight ratios indicate a shift from undernutrition to overnutrition problem; it was more evident in urban areas and higher SES groups. In conclusion, Nepal is experiencing a nutrition transition. More research is warranted to address this shift, and well-tailored public health efforts need to combat the double burden of overweight/obesity and undernutrition.

Background: The present study examined the effects of breastfeeding and its duration on the development of childhood obesity from 24 months through grade 6. Methods: U.S. longitudinal data collected from 1234 children were analyzed using logistic regression models and generalized estimating equation (GEE). Child height and weight were measured six times at ages of 24 months, 36 months, 54 months, grade 1, grade 3, and grade 6. Results: During the early 1990s, prevalence of breastfeeding was low in the United States, 60% and 48% at 1 and 6 months, respectively. Nonsmoking, white, married mothers with both parents in the household, and with income above the poverty line, were more likely to breastfeed at 1 month of age of their babies. Obesity rate of the children increased with age from 24 months to grade 6. Logistic regression showed that breastfeeding at month 1 was associated with 53% (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.30-0.73) and 47% (OR: 0.53, 95% CI: 0.36-0.78) decreased risks for childhood obesity at grades 1 and 6, respectively. GEE analysis showed that breastfeeding at 1 month reduced risk for childhood obesity by 36% (95% CI: 0.47-0.88) from ages 24 months through grade 6. Regarding breastfeeding duration, more than 6 months (vs. never) was associated with a decreased risk for childhood obesity by 42% (OR: 0.58, 95% CI: 0.36-0.94). Conclusions: Breastfeeding at 1 month and more than 6 months reduced the risk of childhood obesity. Rate of breastfeeding was low in the United States in the 1990s, which may have had long-term implications on children.

The primary objective of this study was to evaluate the relationship between milk-fat intake and obesity, particularly abdominal obesity, in 13,544 U.S. adults. A secondary objective was to determine the extent to which the association was influenced by multiple potential confounding variables. This cross-sectional study used data from the 2011–2016 National Health and Nutrition Examination Survey (NHANES). Level of milk-fat content regularly consumed was the exposure variable. Body mass index (BMI) and sagittal abdominal diameter (SAD), a measure of abdominal obesity, were the outcome variables. SAD correlates strongly with visceral fat, when measured by computed tomography, and has been shown to predict cardiometabolic disorders better than BMI. After controlling for age, gender, race, physical activity, sedentary behavior, alcohol habits, and cigarette use, significantly lower BMIs were associated with regular nonfat and full-fat milk consumption (F = 4.1, P = 0.0063). A significantly lower SAD was associated only with regular consumption of nonfat milk (F = 5.0, P = 0.0019). No significant differences were found between the other milk-fat groups or milk abstainers. In this nationally representative sample, only 19.6% of adults regularly consumed low-fat milk. In conclusion, regular nonfat milk intake was associated with lower levels of abdominal adiposity compared to consumption of higher levels of milk-fat.

Introduktion: Livskvalitén och välbefinnandet hos ungdomar med övervikt kan vara nedsatt men vissa menar att det är synen på sig själv som kan vara den avgörande faktorn för måendet. Självkonceptet är ett begrepp som omfattar individens uppfattning om sig själv. Personens självvärde och ideala själv ingår samt upplevelsen av personligheten och kroppen och synen på sig själv utifrån ett sammanhang. För att kunna stötta ungdomar med övervikt till en livsstilsförändring behöver distriktsköterskan ha en god kunskap om ungdomarnas situation och syn på sig själva. Syfte: Belysa självkoncept hos överviktiga ungdomar Metod: En litteraturstudie utfördes där nio artiklar valdes och granskades enligt Polit & Becks niostegsmodell. Innehållsanalys gjordes enligt Graneheim och Lundman. Resultat: Resultatet redovisas i fem kategorier: Självkoncept i relation till den egna kroppen, Självkoncept i relation till prestationer, Yttre faktorer påverkar självkonceptet, Copingstrategier används för att bevara självkonceptet och Det finns skillnader mellan kön. Konklusion: Många faktorer påverkar självkonceptet hos ungdomarna med övervikt och att ha kunskap om dessa gör att distriktsköterskan kan arbeta för att förbättra ungdomarnas bild av dom själva vilket leder till bättre mående.

Background: Gestational Diabetes Mellitus (GDM) has been linked with later metabolic abnormalities in offspring due to subsequent overweight and obesity. In Sub-Saharan Africa, there is a paucity of data on the outcomes of children exposed to GDM in utero. Aims: The primary aim of this sub-study was to investigate the prevalence of overweight and obesity in 5 and 6-year-old children from GDM complicated pregnancies and macrosomia at birth in the same cohort. The secondary aim was to identify risk factors associated with overweight and obesity in these 5 and 6-year-old children. Outcome measures: The main outcome was the prevalence of overweight and obesity in these children as measured by their age-specific body mass index (BMI) and Z-scores. Additionally, the association between other risk factors, overweight and obesity was investigated. Methods: A cross-sectional sub-study design was employed nested within a larger study that is investigating the progression to type 2 diabetes in women managed for GDM during 2010 and 2011. Mothers who participated in the larger study were informed about the sub-study and invited to allow their children to participate in the sub-study. Written informed consent was obtained from the mothers for the sub-study. The following data were collected: anthropometric data at birth and pregnancy related information from the mothers’ hospital record, additional demographic, social and medical information by questionnaire from the mother and at the research center. In addition, the children were weighed and had their height measured using standardized methods. Anthropometry was standardized using WHO standards. Risk factors for overweight and obesity were tested using a BMI>1 Z-score cut-off, (as a binary variable) in a manual multivariate logistic regression model. Results: The sub-study recruited 176 participants; 78 boys (44.3%) and 98 girls (55.7%). The mean (SD) Z-scores for the children’s anthropometry at ages 5 to 6 years were 0.28 (1.40) for weight, 0.01 (1.07) for height and 0.37 (1.63) for BMI. The overall prevalence of macrosomia at birth (birth weight>4000 gm) was 12.3 % (95% CI 8.2-9.1). The overall prevalence of overweight in the 5 and 6-year-old children was 13.4% (95% CI 8.6-20.4), while the prevalence of obesity was 14.2% (95% CI 9.2-21.2). The combined prevalence of overweight and obesity was 27.6% (95% CI 20.6-35.9). The prevalence of macrosomia (P=0.53) or overweight/obesity proportions (P=0.37) at ages 5 to 6 years did not differ by gender. In multivariate logistic regression analysis, factors independently associated with the risk of overweight and obesity were: mothers’ oral glucose tolerance test 2-hour blood glucose level during pregnancy (AOR=2.06, 95% CI 1.14-3.74, P=0.02), birth weight (AOR=1.00, 95% CI 1.00-1.00, P=0.01), child’s age in years (AOR=0.03, 95% CI 0.002-0.29, P=0.004) and number of adults in the house (AOR=0.38, 95% CI 0.17-0.86, P=0.02). Conclusion: This is the first study to report the prevalence of overweight and obesity in children born from GDM complicated pregnancies, in the Western Cape, South Africa. The combined prevalence of overweight and obesity found in 5 and 6-year-old children exposed to GDM in the Western Cape is higher than overweight and obesity in children reported in other South African studies. This can imply a higher tendency towards overweight and obesity in children exposed to GDM which needs further exploration.

Methadone is a mu-opioid agonist used in the treatment of patients with an opioid use disorder in an outpatient addiction treatment clinic. A recognized knowledge gap exists among nurses managing overweight and obese patients in an outpatient methadone treatment center in the northeastern United States. The goal of this project was to develop a weight management toolkit to assist nurses in the identification, evaluation, and management of overweight and obese patients receiving methadone treatment at the center. The evidence-based weight management toolkit incorporated practice guidelines from the American Heart Association, American Association of Clinical Endocrinologists, America College of Cardiology, and the Obesity Medical Association. The project was evaluated by 8 content experts in primary care and addiction medicine. A 5-point Likert-scale survey was used to measure experts' responses. The survey evaluated the relevance of the weight management educational toolkit in relation to nurses' preparedness to assess, identify, and manage patients on methadone treatment with negative weight gain. Results indicated that toolkit content was beneficial in guiding nurses on the use of evidence-based guidelines to promote weight management treatment for patients on methadone. The toolkit supports social change by providing nurses with the tools necessary to increase their knowledge and skills to manage patients' weight gain on methadone, thus promoting improved patient outcomes.

Childhood obesity has increased due to factors such as more television time, less outside play, parents' lack of education about nutritious meals, and eating more fast food versus home cooked meals. Research has been performed on many school-aged children; however, there is a gap in research as it pertains to preschool children. Preschool age learning is when children are most receptive to habit-forming activities. The purpose of this transcendental phenomenological study was to assess the parental perceptions of 11 preschool parents in rural Northeastern North Carolina of 4-year-old children who have been told by a health care professional that their children are overweight or obese. This qualitative study used the health belief model as its theoretical foundation. Responses were manually transcribed and uploaded into NVivo 10 software. The researcher performed horizonalization of the data to determine the themes and subthemes used for data analysis. Participants revealed that they recognized childhood obesity and overweight as an issue in their child and were knowledgeable on how to combat their child's diagnosis. As a result of this research, parents revealed that working and a lack of affordable resources played viable roles in why childhood obesity and overweight exists in their children. Parents shared that they felt safe in their neighborhoods, but acknowledged that affordability of healthy foods and other family members' impact on their child's eating habits play a role in their child's weight concerns. This study will lead to positive social change by providing local public health workers with an increased understanding of the experiences of parents of overweight and obese preschool-aged children, which may assist in stronger program development for the targeted population.

Veterans with post-traumatic stress disorder (PTSD) have increased rates of overweight/obesity, higher prevalence of obesity-related medical conditions, and greater morbidity and mortality compared to their peers without PTSD. The aim of this study was to assess the impact of PTSD on weight and metabolic parameters as well as the effect of weight change on metabolic indices. In a case-control cohort, we compared PTSD patients (n=364) with those without mental health disorders (NoMH, n=1,008) at baseline (i.e., eight years prior to enrollment) and on the trajectory of changes before the enrollment in the Miami VA MOVE!® (Weight Management for Veterans) program. Multilevel modeling for change was used to investigate changes in weight and physiological markers over time. The sample consisted of 1,372 veterans (1,208 men and 164 women). Mental health status, weight and metabolic parameters were obtained from medical record. The PTSD group was significantly younger, had lower average BMI at baseline, and higher prevalence of weight-related medical conditions. Groups did not differ by gender, race/ethnicity, or Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) status. At baseline, the PTSD group had significantly lower weight, lower HDL-cholesterol, and higher values for glucose and triglycerides than the NoMH group. The PTSD group had a significantly greater slope than NoMH group for HDL-cholesterol (p¬=.011). The difference in rate of change between groups for weight, glucose, and triglycerides was not significant. The sample as a whole showed a significant increase for weight and glucose while total cholesterol, blood pressure, and triglycerides decreased over time. Despite lower weight, veterans with PTSD had greater prevalence of weight related-medical conditions while rate of change in metabolic parameters over time was comparable to NoMH peers. Exploratory analyses showed that weight had a significant negative effect on total cholesterol and blood pressure. PTSD appears to be a significant risk factor for diabetes and overall metabolic dysfunction. The lack of results with regards to the effect of weight on HDL cholesterol, triglycerides, glucose and hemoglobin A1c are not surprising given the complex relationships among weight and these metabolic indices.

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