Reduction in Obesity and Related Comorbid Conditions after Diet-Induced Weight Loss or Exercise-Induced Weight Loss in Men Trial of prevention and reduction of obesity through active living in clinical settings: a randomized controlled trial. The Natural History of the Development of Obesity in a Cohort of Young U.S. Adults between 1981 and 1998 Prevention and Reduction of Obesity through Active Living (PROACTIVE): rationale, design and methods Multicenter evaluation of an interdisciplinary 52-week weight loss program for obesity with regard to body weight, comorbidities and quality of life—a prospective study Effects of a community-oriented obesity prevention programme on indicators of body fatness in preschool and primary school children. Main results from the IDEFICS study. Health promotion in individuals with mental disorders: a cluster preference randomized controlled trial Impact of obesity in asthma: evidence from a large prospective disease management study. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. A worksite obesity intervention: results from a group-randomized trial. Primary care physicians' attitudes about obesity and its treatment. The long-term effectiveness of a lifestyle intervention in severely obese individuals. Effectiveness of a Randomized Controlled Lifestyle Intervention to Prevent Obesity among Chinese Primary School Students: CLICK-Obesity Study Effectiveness of a diet and physical activity promotion strategy on the prevention of obesity in Mexican school children The continuing epidemics of obesity and diabetes in the United States. Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity among adults A school-based intervention for diabetes risk reduction.
In 1997 , the World Health Organization published a l and mark document recognizing obesity as a worldwide disease that poses a serious threat to public health ( 1 ) . Persons who are overweight or obese have substantially increased risk for morbidity from numerous chronic disorders , such as diabetes ( 2 , 3 ) , hypertension ( 4 , 5 ) , and cardiovascular disease ( 6 , 7 ) . Obesity-related health risk is greater when excess fat is deposited in the abdomen region because this phenotype is a stronger predictor of cardiovascular disease and type 2 diabetes mellitus than general obesity is ( 8 - 11 ) . This may be partially explained by excess accumulation of visceral fat , an independent correlate of insulin resistance ( 9 - 11 ) and dyslipidemia ( 8 , 9 ) . These observations highlight the need to identify appropriate treatment strategies to prevent and reduce obesity and suggest that the effectiveness of these treatments would be enhanced if abdominal obesity , particularly visceral fat , was substantially reduced . Diet restriction remains the most common method of obesity reduction ( 12 ) . Despite the observation that low levels of physical activity are a major cause of obesity ( 13 ) , increased physical activity alone is not thought to be a useful strategy for obesity reduction . Some reports have suggested that physical activity in obese adults results in only modest weight loss ( approximately 1 to 2 kg ) independent of the effects of diet restriction ( 14 ) . However , these conclusions are drawn from studies in which individual energy intake and expenditure were not rigorously controlled or accurately measured ( 15 - 17 ) . Moreover , in most studies , the negative energy balance induced by exercise was modest enough that substantial weight loss was not expected ( 15 - 17 ) . Currently , no compelling evidence supports the observation that exercise alone is not a useful method for reducing total or abdominal obesity . It is well known that a single exercise session is associated with a significant improvement in insulin-stimulated glucose uptake ( 18 , 19 ) . It is also clear that weight loss is associated with an improvement in insulin action ( 20 - 24 ) . It is unclear , however , whether regular exercise improves glucose metabolism after the short-term effects of exercise and changes in body fat distribution are considered . Segal and colleagues ( 25 ) controlled for the confounding effect of the last exercise session and body composition changes and found that exercise had no independent effect on insulin sensitivity ( 25 ) . Given the established importance of insulin resistance as an antecedent to both cardiovascular disease and type 2 diabetes mellitus ( 26 ) , it is important to clarify whether exercise improves insulin action independent of fat loss . We performed a r and omized , controlled trial to determine the independent effect of diet-induced or exercise-induced weight loss on obesity and insulin resistance in moderately obese men . We also evaluated whether exercise without weight loss was associated with reductions in abdominal obesity and insulin resistance . Methods Participants Participants were recruited from Kingston , Ontario , Canada , a typical suburban region , through the general media . We selected men with a body mass index greater than 27 kg/m2 and a waist circumference greater than 100 cm whose weight had been stable ( 2 kg ) for 6 months before study entry . Participants were nonsmokers who consumed an average of fewer than two alcoholic beverages per day , had a sedentary lifestyle , and took no medications known to affect the principal outcome measures . All participants had a preparticipation medical examination that included screening for normal glucose tolerance and plasma lipid profile . A computer program was used to r and omly assign eligible men to one of the following four groups : control , diet-induced weight loss , exercise-induced weight loss , and exercise without weight loss ( Figure 1 ) . Of the 101 participants who were r and omly assigned to groups , 34 chose not to participate because they were dissatisfied with their assigned group , 5 were diabetic or dyslipidemic , and 3 were relocated because of job transfers . Those who chose not to participate and those who completed the trial were similar with regard to anthropometric variables . In addition , those who completed the trial were similar to those who did not in each group ( P > 0.10 ) . Baseline characteristics among groups were similar for all participants ( Table 1 ) . All participants gave fully informed written consent . The study was conducted in accordance with the ethical guidelines of Queen 's University . The participants did not receive monetary compensation . Figure 1 . Flow of participants through the study . Table 1 . Selected Anthropometric , Magnetic Resonance Imaging , and Metabolic Variables before Treatment and 3 Months after Treatment Diet and Exercise Regimen During the baseline period , daily energy requirements for all participants were determined by estimating resting energy expenditure and multiplying the obtained value by a factor of 1.5 ( 27 ) . All participants followed a weight maintenance diet ( 55 % to 60 % carbohydrate , 15 % to 20 % protein , and 20 % to 25 % fat ) for a 4- to 5-week baseline period . During this period , body weight was monitored to determine the accuracy of the prescribed energy requirement , which was adjusted accordingly to maintain body weight . Controls were asked to maintain body weight throughout the 12-week treatment period . Participants in the diet-induced weight loss group were asked to reduce the isocaloric diet by 700 kcal/d during the treatment period to achieve a weekly weight loss of approximately 0.6 kg . To lose the same amount of weight , participants in the exercise-induced weight loss group were asked to maintain the isocaloric diet for the duration of the treatment period and to perform exercise that expended 700 kcal/d . Participants assigned to exercise without weight loss were asked to maintain body weight . Therefore , they consumed enough calories to compensate for the energy expended during the daily exercise sessions ( approximately 700 kcal ) . At the end of the treatment period , isocaloric requirements were determined and prescribed for a 2-week weight stabilization period . All participants were free-living and consumed self-selected foods .  No vitamins or other nutritional supplements were prescribed . Each person participated in a series of weekly 1-hour seminars in which a dietitian taught proper food selection and preparation . Participants were told that the composition of the maintenance and energy-reduced diets should be approximately 55 % to 60 % carbohydrate , 15 % to 20 % protein , and 20 % to 25 % fat . Participants kept and analyzed daily , detailed food records for the duration of the study period ( approximately 20 weeks ) ; the study dietitian also review ed these records . For the 2-week period during which doubly labeled water measurements were acquired ( weeks 6 and 7 ) , the diet records were analyzed by using a computerized program ( Food Processor , Esha Research , Salem , Oregon ) . Participants in both exercise groups performed daily exercise ( brisk walking or light jogging ) on a motorized treadmill for the duration of the 12-week trial . The length of each exercise session was determined by the time required to expend 700 kcal . Participants were asked to exercise at an intensity not greater than 70 % of their peak oxygen uptake ( Vo 2 ) ( approximately 80 % of maximal heart rate ) . Energy expenditure was determined by using the heart rate and oxygen consumption data that were obtained from the pretreatment grade d exercise test and were adjusted according to the results of two subsequent tests performed at weeks 4 and 8 . During each session , heart rate was monitored every 5 minutes by using an automated heart rate monitor ( Polar Oy , Kempele , Finl and ) . All exercise sessions were by appointment and were supervised . Peak Vo 2 was determined by using a grade d treadmill test and st and ard open-circuit spirometry techniques ( SensorMedics , Yorba Linda , California ) . Energy Expenditure Total energy expenditure for 14 days was measured by using a two-point doubly labeled water method ( 28 ) . Deuterium enrichment was analyzed by using a 903 deuterium dual-inlet isotope ratio mass spectrometer ( VG Isogas , Cheshire , United Kingdom ) . Oxygen-18 was determined by using a SIRA 12 isotope ratio mass spectrometer ( VG Isogas ) . Total energy expenditure was calculated by using the DeWeir formula ( 29 ) . After an overnight stay in the hospital , resting metabolic rate was measured at 7:00 a.m. by using indirect calorimetry with a modified mask system ( Teem 100 , Aerosport , Inc. , Ann Arbor , Michigan ) . Values were obtained for 30 minutes , and the last 25 minutes were used to determine resting metabolic rate . Resting systolic and diastolic blood pressure were measured when the participant was supine . Magnetic Resonance Imaging and Anthropometric Measurements Whole-body data from magnetic resonance imaging ( approximately 45 equidistant images ) were obtained with a General Electric 1.5-Tesla magnet ( Milwaukee , Wisconsin ) by using an established protocol described in detail elsewhere ( 30 ) . Once acquired , the data were transferred to a st and -alone work station ( Silicon Graphics , Mountain View , California ) for analysis with specially design ed computer software ( Tomovision , Inc. , Montreal , Canada ) , the procedures for which are described elsewhere ( 31 ) . For adipose tissue ( fat ) and skeletal muscle , volume units ( L ) were converted to mass units ( kg ) by multiplying the volumes by the assumed constant density for fat ( 0.92 kg/L ) and fat-free skeletal muscle ( 1.04 kg/L ) ( 32 ) . All anthropometric circumference measurements were obtained by using st and ard procedures described elsewhere ( 30 ) . Insulin Sensitivity and Glucose Tolerance Participants consumed a weight-maintenance diet consisting of at least 200 g of carbohydrate for a minimum of 4 days and were asked to avoid strenuous physical activity for 3 days before insulin BACKGROUND The efficacy of physical activity with a healthful diet to reduce obesity is established ; however , little is known about the translation of effective lifestyle strategies for obesity reduction in primary care setting s. METHODS We assessed the effectiveness of a 2-year behaviorally based physical activity and diet program implemented entirely within clinical practice s to reduce obesity . A total of 490 sedentary , obese adults were r and omized to usual care ( n = 241 ) or to the behavioral intervention ( n = 249 ) . The usual care group received advice from their physicians about lifestyle as a strategy for obesity reduction . The behavioral intervention included individual counseling from health educators to promote physical activity with a healthful diet . The primary outcome was change in waist circumference ( WC ) . RESULTS A total of 396 participants completed the trial ( 80.8 % ) . A significant main effect was observed for WC change within the intervention compared with usual care ( P < .001 ) that was sustained at 24 months ( mean [ SE ] , -0.9 [ 0.4 ] vs 0.2 [ 0.4 ] cm ; P = .05 ) . Secondary analyses revealed significant main effects for change in WC in men ( P = .009 ) and women ( P = .02 ) . In men , the mean ( SE ) reduction in WC at 24 months was greater with behavioral intervention compared with usual care ( -1.6 [ 0.6 ] vs 0.1 [ 0.6 ] cm ; P = .049 ) . In women , the behavioral intervention was associated with differences in WC compared with usual care at 6 and 12 months ( P ≤ .01 ) but not at 24 months ( P = .10 ) . CONCLUSIONS Behavioral intervention in clinical setting s is associated with modest reductions in WC during a 2-year study in obese patients . However , the effectiveness of the intervention is restricted to men . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00665158 Context Studies of the natural history of obesity have had limitations , such as cross-sectional design , short follow-up , or narrowly defined population s. Contribution Using data from a national study of Americans born between 1957 and 1964 and followed for nearly two decades , these investigators found that more than 25 % were obese by age 35 years . Obesity developed most quickly in black women , with moderate rapidity in Hispanic women , and most slowly in white women . Hispanic men developed obesity more quickly than other men . More recent birth cohorts became obese faster than earlier cohorts . Implication s Underst and ing ethnic differences in the age of onset and rate of progression of obesity may help efforts to prevent obesity . The Editors The proportion of Americans who are overweight or obese is increasing at an alarming rate . From 1960 to 1999 , the prevalence of excess weight ( body mass index [ BMI ] 25 kg/m2 ) increased from 44 % to 61 % of the adult population ( persons aged 20 to 74 years ) and the prevalence of obesity ( BMI 30 kg/m2 ) doubled from 13 % to 27 % ( 1 , 2 ) . Obesity has been linked to increased mortality and chronic morbidity from such diverse causes as hypertension , diabetes , sleep apnea , certain types of cancer , and depression . In the context of this rising prevalence , obesity is increasingly being recognized as an important medical and public health problem ( 3 - 6 ) . Treatment options are available for obesity . However , they can be expensive , often involve difficult lifestyle modifications , and pose adherence problems for many patients . In addition , weight loss , once achieved , is difficult to sustain . Because the health consequences are often long term , the costbenefit ratio of treatment may be more favorable if people who have recently become obese are targeted . Similarly , prevention should focus on those at immediate risk for becoming obese or overweight . Such approaches require a clear underst and ing of who is at highest risk for obesity , when this risk is greatest , and how excess weight develops over time . Although inactivity and high caloric intake are the primary risk factors for obesity , other risk factors have been established . Three of the most influential are age , sex , and race or ethnicity ( 1 , 7 - 9 ) . To better identify people at risk for obesity and those who might benefit from early intervention , we assessed the relationship between weight development and these influential factors . Despite the morbidity and mortality burden of obesity , its natural history has not been well characterized . Current knowledge is based largely on cross-sectional data . Although several large studies have examined weight development in adults , they have important limitations . Only a few tracked weight long enough to detect age-based trends . The first National Health and Nutrition Examination Survey ( NHANES I ) Epidemiologic Follow-up Study examined a representative group of U.S. residents but sample d only two time points , spaced 10 years apart , and had insufficient follow-up to track weight patterns in most minority groups ( 10 ) . The Coronary Artery Risk Development in Young Adults study followed weight development in a large cohort of young black and white Americans but did not provide data for other population s and was geographically restricted ( 8) . Other studies have been performed outside of the United States , but the results may not apply here ( 10 , 11 ) . We design ed our study to address the limitations described earlier . We examined data from the National Longitudinal Survey of Youth 1979 ( NLSY79 ) . This large , prospect i ve cohort study allowed longitudinal examination of weight trends over a time frame sufficient to capture the dynamics of such a slowly changing problem and of an age range during which obesity becomes prevalent . Because not all weight gain has been documented to be harmful , our analysis focused on obesity onset ( defined as the time at which a person reaches obesity ) rather than weight gain . We used the clinical definition of obesity ( BMI 30 kg/m2 ) as our end point because it reflects a point at which mortality risk increases substantially ( 12 ) . Underst and ing how obesity develops over time , who is at greatest risk , and when that risk is highest may be essential in reversing the population trend toward excess weight . Methods Study Group and Obesity Measurement We analyzed data from the NLSY79 , which was initiated by the U.S. Department of Labor , Bureau of Labor Statistics . This survey was design ed to gather information about the labor market activities and other life events of young U.S. citizens . It has been used extensively in economic and sociologic analyses , and the sample design is described elsewhere ( 13 - 16 ) . The cohort of men and women , born between 1957 and 1964 , has been followed for more than two decades . It consists of a nationally representative group , with supplemental sample s overrepresenting minority racial and ethnic groups and poor persons . We excluded a sample of military personnel because this population was removed from the study in 1985 and because physical activity requirements for these individuals could lead to atypical weight patterns . We included only persons who reported that the ethnicity with which they most closely identified was Hispanic , black , or white ( or European origin ) . Height and weight data were self-reported ; height was reported in 1981 and 1985 , and weight was reported 12 times between 1981 and 1998 . Examination of Age-Specific Body Mass Index Patterns Age-specific BMI was calculated for all participants . Height was assumed to remain constant after age 21 years . St and ard clinical definitions were used for overweight ( BMI 25 to 29.9 kg/m2 ) and obesity ( BMI 30 kg/m2 ) . Trends in age-specific BMI were examined by race or ethnicity and birth year . Cohort Differences We examined whether rates of obesity onset differed for people maturing at different times in our sample . Birth cohorts were grouped by 2-year increments . To st and ardize relative rates to age rather than calendar year , time was expressed as the number of years until a person reached obesity , starting from a st and ard age . In the cohort analysis , obesity onset was evaluated from age 24 years ( the baseline age of the oldest participants ) . The outcome of interest was obesity , and the time variable was years from age 24 years to obesity . People who were already obese at age 24 years were excluded . KaplanMeier plots visually demonstrated differences in rates of obesity onset . Cox proportional-hazards modeling estimated the ratio of rates ( hazard ratio ) between groups . For this method to be correct , the ratio of rates must be constant over time ( proportional ) . To assess this assumption , we used two methods : a statistical test of the scaled Schoenfeld residuals , with a P value greater than 0.05 implying that the rates were proportional and a visual method with parallel lines implying proportional rates . In all our analyses , results of proportional hazards testing were reported whenever the assumption was violated . Timing of Obesity Onset by Race or Ethnicity and Sex We evaluated relative rates of obesity onset in 17- and 18-year-old persons of different race or ethnicity who were not obese at the start of the study ; different models were used for men and women . Time was expressed as the number of years from age 17 years until reaching obesity . To control for birth cohort differences , models were adjusted for birth year . As before , KaplanMeier plots were examined and hazard ratios were estimated by using Cox proportional-hazards modeling . To determine relative importance of weight gain during childhood compared with adulthood in terms of the timing of obesity onset , we adjusted the models for baseline BMI at 17 or 18 years of age and examined the effect on hazard ratio estimation . Prevalence and Incidence of Obesity in Early Adulthood For this analysis , we defined early adulthood as the period from 20 to 22 years of age to 35 to 37 years of age . Persons born between 1959 and 1963 were queried about their weight one to two times during each of these age intervals . We calculated the prevalence and incidence of obesity across the early adulthood range . Logistic regression modeling predicted obesity status at age 35 to 37 years from an individual 's race or ethnicity , sex , and BMI at age 20 to 22 years . The model was adjusted in 2-year increments for year of birth . Its predictive ability was quantified by using receiver-operating characteristic ( ROC ) curves . This study was evaluated and exempted from review by the Institutional Review Board of the University of North Carolina at Chapel Hill . Role of the Funding Sources Primary funding was through the Robert Wood Johnson Clinical Scholars Program , with additional support from the National Institute of Child Health and Human Development . Neither entity had a role in the design , conduct , or reporting of this study . Results Description of the Study Sample The total sample included 9179 people : 19 % Hispanic , 31 % black , and 50 % white ( Table ) . People who did not report ethnicity ( n = 106 ) were not included . Age ( sample year minus birth year ) ranged from 17 to 24 years in 1981 to 34 to 41 years in 1998 , and participants were equally distributed across 8 years of birth . Baseline weight was 31.7 to 136.1 kg , and baseline BMI was 11.3 to 51.5 kg/m2 . Table . Sample Characteristics in 1981 Relationship of Body Mass Index to Time Mean age-specific BMI increased with time . This relationship between weight and time has two components , illustrated with data from the oldest and youngest birth cohorts of our sample ( Figure 1 ) . The first is the natural history of body weight : Average BMI increased with age throughout early adulthood . The second is a secular weight trend : Persons born in later calendar years tended to have larger age-specific BMI values . In every case in which the same age was sample d for both birth cohorts , the group born in 1957 had a lower mean BMI than the group born The Prevention and Reduction of Obesity through Active Living ( PROACTIVE ) is a r and omised controlled trial to evaluate the effectiveness of a behaviourally based physical activity and diet composition programme to prevent and reduce obesity and related comorbidities in a primary healthcare setting . 491 abdominally obese men and women 25–75 years of age who were patients of primary care physicians were r and omly assigned to either a usual care group ( N = 242 ) or a behavioural intervention group ( N = 249 ) . Those in usual care received general advice from the physician regarding the merits of physical activity and a healthy diet as a strategy for obesity reduction . Those in the behavioural intervention group received an individually design ed counselling programme from a specially trained health educator , with respect to physical activity , diet and obesity reduction . The study was design ed to provide 95 % power in both men and women to detect a 2 % ( 2 cm ) difference in waist circumference and 80 % power to identify a 15 % reduction in the prevalence of the metabolic syndrome , the two primary outcomes . PROACTIVE is the first behavioural intervention study to assess the effects of physical activity and diet on abdominal obesity and associated metabolic risk factors in a primary healthcare setting , include a generalised sample of men and women and examine long-term ( 24 months ) effects . PROACTIVE has the potential to provide the basis for changing clinical practice ( primary care ) with respect to the prevention and reduction of obesity and related health risks . The purpose of this report is to present and discuss the rationale , design and methods of PROACTIVE Objectives : To determine the effectiveness of a structured multidisciplinary non-surgical obesity therapy program on the basis of a temporary low-calorie-diet for 12 weeks , and additional intervention modules to enhance nutritional education , to increase physical activity and to modify eating behavior . Design : Prospect i ve multicenter observational study in obese individuals undergoing a medically supervised outpatient-based 52-week treatment in 37 centers in Germany . Subjects : A total of 8296 participants with a body mass index ( BMI ) of > 30 kg m−2 included within 8.5 years . Measurements : Main outcome measures were body weight loss , waist circumference ( WC ) , blood pressure , quality of life and adverse events . Results : In females , initial body weight was reduced after the 1-year-intervention by 19.6 kg ( 95 % confidence intervals 19.2–19.9 kg ) and in males by 26.0 kg ( 25.2–26.8 ) according to per protocol analysis of 4850 individuals . Intention-to-treat ( ITT ) analysis revealed a weight reduction of 15.2 kg ( 14.9–15.6 ) in females and 19.4 kg ( 18.7–20.1 ) in males . Overall , the intervention result ed in mean reduction in WC of 11 cm ; it reduced the prevalence of the metabolic syndrome by 50 % and the frequency of hypertension from 47 to 29 % of all participants ( ITT , all P<0.001 ) . The beneficial effects could be documented for up to 3 years and comprised significant improvement of health-related quality of life . The incidence of adverse effects was low ; the only event repeatedly observed and possibly related to either the intervention or the underlying disease was biliary disorders . Conclusion : The present non-surgical intervention program is a highly effective treatment of obesity grade s I – III and obesity-related diseases , and therefore , could be a valuable basis for future weight maintenance strategies required for sustained success BACKGROUND / OBJECTIVES Childhood obesity is a major public health concern but evidence -based approaches to tackle this epidemic sustainably are still lacking . The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS ( IDEFICS ) study investigated the aetiology of childhood obesity and developed a primary prevention programme . Here , we report on the effects of the IDEFICS intervention on indicators of body fatness . SUBJECTS/ METHODS The intervention modules addressed the community , school and parental level , focusing on diet , physical activity and stress-related lifestyle factors .  A cohort of 16,228 children aged 2 - 9.9 years - about 2000 per country - was equally divided over intervention and control regions . ( Participating countries were Sweden , Germany , Estonia , Hungary , Cyprus , Italy , Spain and Belgium . ) We compared the prevalence of overweight/obesity and mean values of body mass index z-score , per cent body fat and waist-to-height ratio over 2 years of follow-up . Mixed models adjusting for age and socioeconomic status of the parents and with an additional r and om effect for country accounted for the clustered study design . RESULTS The prevalence of overweight and obesity increased in both the intervention and control group from 18.0 % at baseline to 22.9 % at follow-up in the control group and from 19.0 % to 23.6 % in the intervention group . The difference in changes between control and intervention was not statistically significant . For the cohort as a whole , the changes in indicators of body fatness did not show any clinical ly relevant differences between the intervention and control groups . Changes in favour of intervention treatment in some indicators were counterbalanced by changes in favour of the control group in some other indicators . CONCLUSIONS Over the 2-year-observation period , the IDEFICS primary prevention programme for childhood obesity has not been successful in reducing the prevalence of overweight and obesity nor in improving indicators of body fatness in the target population as a whole Background The existing literature on weight management interventions targeting physical activity and healthy eating in mental health care appears to provide only limited evidence . The aim of the study was to examine the effectiveness of a 10-week health promotion intervention , followed by a 6-month follow-up period in individuals with mental disorders living in sheltered housing in the Fl and ers region ( Belgium ) . Methods The study had a cluster preference r and omized controlled design . Twenty-five sheltered housing organisations agreed to participate ( 16 in the intervention group , nine in the control group ) . In the intervention group , 225 individuals agreed to participate , while in the control group 99 individuals entered into the study . The main outcomes were changes in body weight , Body Mass Index , waist circumference and fat mass . Secondary outcomes consisted of changes in physical activity levels , eating habits , health-related quality of life and psychiatric symptom severity . Results A significant difference was found between the intervention group and the control group regarding body weight ( −0.35 vs. + 0.22 kg ; p=0.04 ) , Body Mass Index ( −0.12 vs. + 0.08 kg/m2 ; p=0.04 ) , waist circumference ( −0.29 vs. + 0.55 cm ; p<0.01 ) , and fat mass ( −0.99 vs. −0.12 % ; p<0.01 ) . The decrease in these outcomes in the intervention group disappeared during the follow up period , except for fat mass . Within the intervention group , a larger decrease in the primary outcomes was found in the participants who completed the intervention . No significant differences between the two groups in changes in the secondary outcomes were found , except for the pedometer-determined steps/day . In the intervention group , the mean number of daily steps increased , while it decreased in the control group . Conclusions The study demonstrated that small significant improvements in the primary outcomes are possible in individuals with mental disorders .  Integration of health promotion activities targeting physical activity and healthy eating into daily care are , however , necessary to maintain the promising results .Trial registration This study is registered at Clinical Trials.gov BACKGROUND asthma and obesity continue to have a significant effect on public health . It is widely accepted that obesity may be an independent risk factor for asthma and affect asthma severity and quality of life ( QOL ) . OBJECTIVE to examine the relationship between body mass index ( BMI [ calculated as weight in kilograms divided by height in meters squared ] ) and asthma severity , spirometry findings , health care utilization ( HCU ) , and QOL . METHODS this 12-month prospect i ve r and omized controlled trial comparing disease management with traditional care enrolled 902 patients ( 473 pediatric and 429 adults ) representing an underserved population . Data collected at baseline and at 6-month intervals included demographics , asthma severity , medication use , spirometry findings , and HCU . The QOL was assessed using the pediatric and adult versions of the Asthma Quality of Life Question naire and the 36-Item Short Form Health Survey .  All HCU was determined by means of patient interview and extensive medical record review . Data were analyzed using negative binomial regression and analysis of variance . RESULTS in children , 45 % were overweight/obese ( 17 % with BMI s > 85th percentile ; 28 % with BMI s ≥ 95th percentile ) . In adults , 58 % were obese ( BMI s ≥ 30 ) . There was no relationship in children between BMI and severity of asthma , spirometry findings , QOL , or HCU . In adults , there was no relationship between BMI and asthma severity or HCU . Higher BMI was associated with a significant reduction in QOL ( P < .001 ) . The BMI had an inverse relationship with forced vital capacity but with no other spirometric values . CONCLUSIONS obesity was not associated with worse asthma severity , spirometry findings , QOL , or HCU in children . In adults with asthma , obesity was associated with lower forced vital capacity and QOL but not with severity or HCU BACKGROUND Few evidence -based weight loss treatment options exist for medically vulnerable patients in the primary care setting . METHODS We conducted a 2-arm , 24-month r and omized effectiveness trial in 3 Boston community health centers ( from February 1 , 2008 , through May 2 , 2011 ) . Participants were 365 obese patients receiving hypertension treatment ( 71.2 % black , 13.1 % Hispanic , 68.5 % female , and 32.9 % with less than a high school educational level ) . We r and omized participants to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components . The intervention included tailored behavior change goals , self-monitoring , and skills training , available via a website or interactive voice response ; 18 telephone counseling calls ; primary care provider endorsement ; 12 optional group support sessions ; and links with community re sources . RESULTS At 24 months , weight change in the intervention group compared with that in the usual care group was -1.03 kg ( 95 % CI , -2.03 to -0.03 kg ) . Twenty-four-month change in body mass index ( calculated as weight in kilograms divided by height in meters squared ) in the intervention group compared with that in the usual care group was -0.38 ( 95 % CI , -0.75 to -0.004 ) . Intervention participants had larger mean weight losses during the 24 months compared with that in the usual care group ( area under the receiver operating characteristic curve , -1.07 kg ; 95 % CI , -1.94 to -0.22 ) . Mean systolic blood pressure was not significantly lower in the intervention arm compared with the usual care arm . CONCLUSION The intervention produced modest weight losses , improved blood pressure control , and slowed systolic blood pressure increases in this high-risk , socioeconomically disadvantaged patient population . Trial Registration clinical trials.gov Identifier : NCT00661817 OBJECTIVES We used a participatory process to develop an obesity intervention appropriate for elementary school personnel . METHODS A r and omized controlled trial included 16 school worksites ( 8 intervention , 8 control ) .  Intervention schools formed committees to develop and implement health promotion activities for employees .  Anthropometric and self-report data were collected at baseline and postintervention ( 2 years later ) . The primary outcome measures were body mass index ( BMI ) , waist-hip ratio , physical activity , and fruit and vegetable consumption . RESULTS After adjustment for age , ethnicity , and job classification , employees in intervention schools reduced their BMI by an average of 0.04 kg/m2 , and those in control schools increased their BMI by an average of 0.37 kg/m2 . Comparisons for waist-hip ratio , weekly physical activity minutes , and fruit and vegetable consumption were not significant . CONCLUSIONS The participatory process appeared to be an effective means for stimulating change . The intervention may have slowed and perhaps reversed the tendency of adults to gain weight progressively with age OBJECTIVE This study was design ed to assess physicians ' attitudes toward obese patients and the causes and treatment of obesity . RESEARCH METHODS AND PROCEDURES A question naire assessed attitudes in 2 geographically representative national r and om sample s of 5000 primary care physicians . In one sample ( N = 2500 ) , obesity was defined as a BMI of 30 to 40 kg/m(2 ) , and in the other ( N = 2500 ) , obesity was defined as a BMI > 40 . RESULTS Six hundred twenty physicians responded . They rated physical inactivity as significantly more important than any other cause of obesity ( p < 0.0009 ) . Two other behavioral factors-overeating and a high-fat diet-received the next highest mean ratings . More than 50 % of physicians viewed obese patients as awkward , unattractive , ugly , and noncompliant . The treatment of obesity was rated as significantly less effective ( p < 0.001 ) than therapies for 9 of 10 chronic conditions . Most respondents ( 75 % ) , however , agreed with the consensus recommendations that a 10 % reduction in weight is sufficient to improve obesity-related health complications and viewed a 14 % weight loss ( i.e. , 78 + /- 5 kg from an initial weight of 91 kg ) as an acceptable treatment outcome . More than one-half ( 54 % ) would spend more time working on weight management issues if their time was reimbursed appropriately . DISCUSSION Primary care physicians view obesity as largely a behavioral problem and share our broader society 's negative stereotypes about the personal attributes of obese persons . Practitioners are realistic about treatment outcomes but view obesity treatment as less effective than treatment of most other chronic conditions OBJECTIVE Severe obesity ( body mass index [ BMI ] ≥40 kg/m(2 ) ) is a serious public health concern . Although bariatric surgery is an efficacious treatment approach , it is limited in reach ; thus , nonsurgical treatment alternatives are needed . We examined the 4-year effects of an intensive lifestyle intervention  on body weight and cardiovascular disease risk factors among severely obese , compared with overweight ( 25 ≤ BMI < 30 ) , class I ( 30 ≤ BMI < 35 ) , and class II obese ( 35 ≤ BMI < 40 ) participants . METHODS There were 5145 individuals with type 2 diabetes ( 45 - 76 years , BMI ≥25 kg/m(2 ) ) r and omized to an intensive lifestyle intervention or diabetes support and education .  The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings , a ≥10 % weight loss goal , calorie restriction , and increased physical activity . Diabetes support and education received a less intense educational intervention . Four-year changes in body weight and cardiovascular disease risk factors were assessed . RESULTS Across BMI categories , 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education ( Ps < .05 ) . At year 4 , severely obese lifestyle participants lost 4.9%±8.5 % , which was similar to class I ( 4.8%±7.2 % ) and class II obese participants ( 4.4%±7.6 % ) , and significantly greater than overweight participants ( 3.4%±7.0 % ; P < .05 ) . Four-year changes in low-density-lipoprotein cholesterol , triglycerides , diastolic blood pressure , HbA(1c ) , and blood glucose were similar across BMI categories in lifestyle participants ; however , the severely obese had less favorable improvements in high-density-lipoprotein cholesterol ( 3.1±0.4 mg/dL ) and systolic blood pressure ( -1.4±0.7 mm Hg ) compared with the less obese ( Ps < .05 ) . CONCLUSION Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals Background Childhood obesity has been increasing rapidly worldwide . There is limited evidence for effective lifestyle interventions to prevent childhood obesity worldwide , especially in developing countries like China . The objective of this study was to assess the effectiveness of a school-based multi-component lifestyle childhood obesity prevention program ( the CLICK-Obesity study ) in Mainl and China . Methods A cluster r and omized controlled trial was developed among grade 4 students from 8 urban primary schools ( 638 students in intervention , 544 as control ) in Nanjing City , China . Students were r and omly allocated to the control or intervention group at school-level . A one-year multi-component intervention program ( classroom curriculum , school environment support , family involvement and fun programs/events ) together with routine health education was provided to the intervention group , while the control group received routine health education only . The main outcome variables assessed were changes in body mass index , obesity occurrence , obesity-related lifestyle behaviors and knowledge . Results Overall , 1108 ( 93.7 % ) of the 1182 enrolled students completed the intervention study . The intervention group had a larger marginal reduction than did the control group in overall mean BMI value ( -0.32±1.36 vs. -0.29±1.40 , p = 0.09 ) , although this was not significant . Compared with the control group , the intervention group was more likely to decrease their BMI ( OR = 1.44 , 95%CI = 1.10 , 1.87 ) by 0.5 kg/m2 or above , increase the frequency of jogging/running ( OR = 1.55 , 95%CI = 1.18 , 2.02 ) , decrease the frequency of TV/computer use ( OR = 1.41 , 95%CI = 1.09 , 1.84 ) and of red meat consumption ( OR = 1.50 , 95%CI = 1.15 , 1.95 ) , change commuting mode to/from school from sedentary to active mode ( OR = 2.24 , 95%CI = 1.47 , 3.40 ) , and be aware of the harm of selected obesity risk factors . Conclusions The school-based lifestyle intervention program was practical and effective in improving health behaviors and obesity-related knowledge for children in China . This study provides important policy implication s on school-based intervention programs for modifications of obesity-related lifestyles . Trial Registration Chinese Clinical Trial Registry Background  Overweight and obesity in children in Mexico was among the countries with the highest prevalence 's in the world . Mexico currently has few innovative and comprehensive experiences to help curb the growth of this serious public health problem . Therefore , the aim of this study is to assess the effectiveness of a nutrition and physical activity strategy , called " Nutrition on the Go " ( " nutrición en movimiento " ) in maintaining the BMI values of school children in the State of Mexico . Methods A two-stage cluster trial was carried out . Sixty schools were selected in the State of Mexico , of which 30 were r and omly assigned to the intervention group ( IG ) and 30 to the control group ( CG ) . A total of 1020 fifth grade school children participated . The intervention strategy aim ed to decrease the energy content of school breakfasts and include fruits and vegetables , as well as increase physical activity and the consumption of water during the time spent at school . The strategy was implemented over a 6-month period . Results The estimated probability ( EP ) of obesity between baseline and the final stage for the IG decreased 1 % ( Initial EP = 11.8 % , 95%CI 9.0 , 15.2 , final EP = 10.8 , 95%CI 8.4 , 13 . ) For the CG , the probability increased 0.9 % ( baseline EP = 10.6 % ; 95%CI 8.1 , 13.7 ; final EP = 11.5 , 95%CI 9.0 , 14.6 ) . The interaction between the intervention and the stage is the average odd time corrected treatment effect , which is statistically significant ( p = 0.01 ) ( OR = 0.68 , 95%CI 0.52 , 091).This represents the interaction between intervention and stage , which is highly significant ( p = 0.01 ) ( OR = 0.68 ; 95%CI 0.52 , 091 ) . In addition , girls had a protective effect on obesity ( OR = 0.56 ; 95%CI 0.39 , 0.80 ) . Conclusions The intervention strategy is effective in maintaining the BMI of school children CONTEXT Recent reports show that obesity and diabetes have increased in the United States in the past decade . OBJECTIVE To estimate the prevalence of obesity , diabetes , and use of weight control strategies among US adults in 2000 . DESIGN , SETTING , AND PARTICIPANTS The Behavioral Risk Factor Surveillance System , a r and om-digit telephone survey conducted in all states in 2000 , with 184 450 adults aged 18 years or older . MAIN OUTCOME MEASURES Body mass index ( BMI ) , calculated from self-reported weight and height ; self-reported diabetes ; prevalence of weight loss or maintenance attempts ; and weight control strategies used . RESULTS In 2000 , the prevalence of obesity ( BMI > /=30 kg/m(2 ) ) was 19.8 % , the prevalence of diabetes was 7.3 % , and the prevalence of both combined was 2.9 % . Mississippi had the highest rates of obesity ( 24.3 % ) and of diabetes ( 8.8 % ) ; Colorado had the lowest rate of obesity ( 13.8 % ) ; and Alaska had the lowest rate of diabetes ( 4.4 % ) . Twenty-seven percent of US adults did not engage in any physical activity , and another 28.2 % were not regularly active . Only 24.4 % of US adults consumed  fruits and vegetables 5 or more times daily . Among obese participants who had had a routine checkup during the past year , 42.8 % had been advised by a health care professional to lose weight . Among participants trying to lose or maintain weight , 17.5 % were following recommendations to eat fewer calories and increase  physical activity to more than 150 min/wk . CONCLUSIONS The prevalence of obesity and diabetes continues to increase among US adults . Interventions are needed to improve physical activity and diet in communities nationwide Background Socioeconomic inequalities in obesity and associated risk factors for obesity are widening throughout developed countries worldwide . Tackling obesity is high on the public health agenda both in the United Kingdom and internationally . However , what works in terms of interventions that are able to reduce inequalities in obesity is lacking . Methods / Design The review will examine public health interventions at the individual , community and societal level that might reduce inequalities in  obesity among adults aged 18 years and over , in any setting and in any country . The following electronic data bases will be search ed : MEDLINE , EMBASE , CINAHL , PsycINFO , Social Science Citation Index , ASSIA , IBSS , Sociological Abstract s , and the NHS Economic Evaluation Data base . Data base search es will be supplemented with website and gray literature search es . No studies will be excluded based on language , country or publication date . R and omized and non-r and omized controlled trials , prospect i ve and retrospective cohort studies ( with/without control groups ) and prospect i ve repeat cross-sectional studies ( with/without control groups ) that have a primary outcome that is a proxy for body fatness and have examined differential effects with regard to socioeconomic status ( education , income , occupation , social class , deprivation , poverty ) or where the intervention has been targeted specifically at disadvantaged groups or deprived areas will be included . Study inclusion , data extraction and quality appraisal will be conducted by two review ers . Meta- analysis and narrative synthesis will be conducted . The main analysis will examine the effects of 1 ) individual , 2 ) community and 3 ) societal level public health interventions on socioeconomic inequalities in adult obesity . Interventions will be characterized by their level of action and their approach to tackling inequalities . Context ual information on how such public health interventions are organized , implemented and delivered will also be examined . Discussion The review will provide evidence , and reveal any gaps in the evidence base , of public health strategies which reduce and prevent inequalities in the prevalence of obesity in adults and provide information on the organization , implementation and delivery of such interventions . Systematic review registration PROSPERO registration number : BACKGROUND We examined the effects of a multicomponent , school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes . METHODS Using a cluster design , we r and omly assigned 42 schools to either a multicomponent school-based intervention ( 21 schools ) or assessment only ( control , 21 schools ) . A total of 4603 students participated ( mean [ + /- SD ] age , 11.3 [ + /- 0.6 years ; 54.2 % Hispanic and 18.0 % black ; 52.7 % girls ) . At the beginning of 6th grade and the end of 8th grade , students underwent measurements of  body-mass index ( BMI ) , waist circumference , and fasting glucose and insulin levels .  RESULTS There was a decrease in the primary outcome --the combined prevalence of overweight and obesity -- in both the intervention and control schools , with no significant difference between the school groups . The intervention schools had greater reductions in the secondary outcomes of BMI z score , percentage of students with waist circumference at or above the 90th percentile , fasting insulin levels ( P=0.04 for all comparisons ) , and prevalence of obesity ( P=0.05 ) . Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline . Less than 3 % of the students who were screened had an adverse event ; the proportions were nearly equivalent in the intervention and control schools . CONCLUSIONS Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools . However , the intervention did result in significantly greater reductions in various indexes of adiposity . These changes may reduce the risk of childhood-onset type 2 diabetes . ( Funded by the National Institutes of Health and the American Diabetes Association ; Clinical Trials.gov number , NCT00458029 .
We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk .
Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .
INTRODUCTION Obesity is a top public health priority but interventions to reverse the condition have had limited success .
About one-in-three obese adults are free of metabolic risk factor clustering and are considered ' healthy ' , and much attention has focused on the implication s of this state for obesity management .