Body mass index and neurocognitive functioning across the adult lifespan. Obesity, Abdominal Obesity and Alzheimer Disease Association between weight perception and psychological distress The effect of family-based multidisciplinary cognitive behavioral treatment in children with obesity: study protocol for a randomized controlled trial Reverse causality and confounding and the associations of overweight and obesity with mortality. Beyond personal responsibility: Effects of causal attributions for overweight and obesity on weight-related beliefs, stigma, and policy support A cross-sectional examination of school characteristics associated with overweight and obesity among grade 1 to 4 students The Natural History of the Development of Obesity in a Cohort of Young U.S. Adults between 1981 and 1998 Reduction in Obesity and Related Comorbid Conditions after Diet-Induced Weight Loss or Exercise-Induced Weight Loss in Men Emotional Health Predicts Changes in Body Mass Index (BMI-z) Among Black and Latino Youth Variables predictive of adherence to diet and physical activity recommendations in the treatment of obesity and overweight, in a group of Spanish subjects Obesity is associated with reduced white matter integrity in otherwise healthy adults. Intentional weight loss and 13-year diabetes incidence in overweight adults. A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics A three-dimensional program for the treatment of obesity. Cognitively challenging physical activity benefits executive function in overweight children Systematic review of interventions in the management of overweight and obese children which include a dietary component.
OBJECTIVE Cognitive dysfunction and structural brain abnormalities have been observed in obese versus lean individuals , but with variability across age and weight groups . The current study was design ed to clarify the cognitive profile of obesity by examining performance across multiple cognitive domains in adults with wide-ranging age and weight status . METHOD Participants ( N = 732 ; 61 % women ; ages 18 - 88 ; BMI range 19 - 75 ) underwent assessment of cognitive functioning and relevant medical/demographic covariates .  Neuropsychological tests  were grouped by cognitive domain ( via confirmatory factor analysis ) , and st and ardized scores were averaged into composite variables . RESULTS Hierarchical linear regression analyses revealed main effects for BMI on motor ( ΔR2 = .02 , β = -.15 ) and attention/processing speed ( ΔR2 = .01 , β = -.07 ) , whereas a significant interaction between BMI and age was observed ( ΔR2 = .01 , β = -.08 ) for predicting executive functioning ( p < .05 ) . BMI was not independently associated with memory or language functioning and no interaction effects were observed for these variables . Although BMI was not independently related to executive dysfunction , a significant age × BMI interaction suggests that obesity-related executive deficits may increase with age . CONCLUSIONS Overall , these findings may support an independent association between obesity and a frontal-subcortical pathology , though prospect i ve studies are needed to further clarify this possibility Background / Aims : Obesity has a strong association with vascular and metabolic diseases , which have been linked with Alzheimer disease ( AD ) . While recent studies have reported an association between mid-life obesity and dementia , the role of later-life obesity is less clear . This study investigated the relation between AD , obesity and abdominal obesity at later-life in a case-control study . Methods : Participants were 50 consecutive patients with probable AD from memory disorders clinics in Launceston , Australia , and Bristol , Engl and , and 75 cognitively normal controls .  Height and weight [ from which body mass index ( BMI ) was calculated ] and hip and waist circumferences ( from which waist-hip ratio was calculated ) were measured . Participants were classified according to their BMI as : underweight ( BMI < 20.0 kg/m2 ) ; normal weight ( BMI 20.0–24.9 kg/m2 ) ; overweight ( BMI 25–29.9 kg/m2 ) , or obese ( BMI ≧30 kg/m2 ) . They were classified as abdominally obese if their waist-hip ratio was > 0.9 ( men ) or > 0.8 ( women ) . Results : AD was associated with obesity [ OR 9.5 , 95 % CI 2.4–37.3 , p = 0.001 ] , underweight ( OR 5.4 , CI 0.9–33.7 , p = 0.07 ) and abdominal obesity ( OR 2.5 , CI 1.1–5.7 , p = 0.027 ) using logistic regression analyses adjusted for age , sex and location . The inclusion of metabolic risk factors in the model increased the ORs for obesity ( OR 12.6 , CI 2.8–56.5 , p = 0.001 ) and underweight ( OR 7.9 , CI 1.0–66.3 , p = 0.056 ) . Conclusion : AD may be associated with obesity , underweight and abdominal obesity at later life . Larger prospect i ve studies are required to investigate this further Background : Obesity is a well-known cause of cardiovascular disease burden and premature death , but effects on depressive symptoms remain equivocal . Depressive symptoms may be more common among the obese individuals who perceive themselves as overweight , rather than those who perceive themselves as having an acceptable weight . Our aim was to determine whether weight status and weight perceptions are independently associated with psychological distress . Methods : We conducted a cross-sectional study  using data from the Australian National Health Survey 2004–2005 ( N=17 253 ) . All variables were collected by self-report . Adjusted multinomial logistic regression analysis was conducted to generate prevalence odds ratios with 95 % confidence intervals ( 95 % CI ) for medium ( Kessler Psychological Distress Scale ( K10 ) scores of 20–29 ) and high ( K10 scores of 30–50 ) psychological distress ( compared with K10 scores of 10–19 as the reference ) associated with weight status ( st and ard body mass index ( BMI ) cutoffs for underweight , overweight and obesity vs normal weight ) , weight perception ( perceived underweight and overweight vs acceptable weight ) and weight misperception ( incorrect with BMI vs correct with BMI ) adjusting for numerous important covariates . Results : Overweight and underweight perception increased the odds of medium ( 40 and 50 % ) and high ( 50 and 120 % ) psychological distress , whereas weight status and weight misperception were not associated with psychological distress in adjusted analysis . Gender , alcohol consumed per week and post-school education were not significant covariates ( at P<0.10 level ) . Conclusions : Overweight and underweight perception rather than weight status or weight misperception are significant risk factors associated with medium and high psychological distress prevalence and effects appear to be uniform for men and women . Well- design ed prospect i ve studies are still needed to determine whether weight perceptions cause psychological distress , and if so , whether symptoms are significantly reduced following effective intervention Background The prevalence of childhood obesity has increased rapidly during the last three decades in the Netherl and s. It is assumed that mainly environmental factors have contributed to this trend . Parental overweight and low social economic status are risk factors for childhood obesity . Childhood obesity affects self-esteem and has negative consequences on cognitive and social development . Obese children tend to become obese adults , which increases the risk for developing cardiovascular complications , type 2 diabetes mellitus , and psychosocial problems . Additionally , the secretion of several gastrointestinal hormones , responsible for appetite and food intake , is impaired in obese subjects . Weight reduction through lifestyle changes in order to change health risks is , until now , suggested as the preferred treatment for childhood obesity . The objective of this study is the effect evaluation of a family-based cognitive behavioral multidisciplinary lifestyle treatment . The intervention aims to establish long-term weight reduction and stabilization , reduction of obesity-related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques . Study design / Methods In this r and omized clinical trial newly presented children with obesity ( 8 - 17 years old ) are divided , by r and omization , in an intervention and  control  group , both consisting of 40 obese children . The intervention is carried out in groups of 8 - 11 children , and consists of respectively 7 and 5 separate group meetings for the children and their parents and 1 joint group meeting of 2 ½ hours . Main topics are education on nutrition , self-control techniques , social skills , physical activity and improvement of self-esteem . The control group is given advice on physical activity and nutrition . For normal data comparison , data were collected of 40 normal-weight children , 8 - 17 years old . Discussion Because of the increasing prevalence of childhood obesity and the impact on the individual as well as on society , prevention and treatment of obesity in children is of great importance . For evaluation of short- and long-term effects of the treatment , measurements are taken before and after 3 months of treatment , and after 12 and 24 months follow-up . During these visits clinical and biochemical data are determined , cardiovascular fitness tests are performed and quality of life question naires are completed . Trial registration International St and ard R and omised Controlled Trial Number Register IS RCT OBJECTIVE To examine the effect of reverse causality and confounding on the association of BMI with all-cause and cause-specific mortality . RESEARCH METHODS AND PROCEDURES Data from two large prospect i ve studies were used . One ( a community-based cohort ) included 8327 women and 7017 men who resided in two Scottish towns at the time of the baseline assessment in 1972 - 1976 ; the other ( an occupational cohort ) included 4016 men working in the central belt of Scotl and at the time of the baseline assessment in 1970 - 1973 . Participants in both cohorts were ages 45 to 64 years at baseline ; the follow-up period was 28 to 34 years . RESULTS In age-adjusted analyses that did not take account of reverse causality or smoking , there was no association between being overweight ( BMI 25 to < 30 kg/m(2 ) ) and mortality , and weak to modest associations between obesity ( BMI > or = 30 kg/m(2 ) ) and mortality . There was a strong association between smoking and lower BMI in women and men in both cohorts ( all p < 0.0001 ) . Among never-smokers and with the first 5 years of deaths removed , overweight was associated with an increase in all-cause mortality ( relative risk ranging from 1.12 to 1.38 ) , and obesity was associated with a doubling of risk in men in both cohorts ( relative risk , 2.10 and 1.96 , respectively ) and a 60 % increase in women ( relative risk , 1.56 ) . In both never-smokers and current smokers , being overweight or obese was associated with important increases in the risk of cardiovascular disease . DISCUSSION These findings demonstrate that with appropriate control for smoking and reverse causality , both overweight and obesity are associated with important increases in all-cause and cause-specific mortality , and in particular with cardiovascular disease mortality Objective : The objective of this research was to compare the effects of different causal attributions for overweight and obesity , among individuals with overweight and obesity , on weight-related beliefs , stigmatising attitudes and policy support . Design : In Study 1 , an online sample of 95 US adults rated the extent to which they believed various factors caused their own weight status . In Study 2 , 125 US adults  read one of three r and omly assigned online passages attributing obesity to personal responsibility , biology , or the ‘ food environment . ’  All participants in both studies were overweight or obese . Main outcome measures : All participants reported beliefs about weight loss , weight-stigmatising attitudes , and support for obesity-related policies . Results : In Study 1 , biological attributions were associated with low weight-malleability beliefs and blame , high policy support , but high internalised weight bias . ‘ Food environment ’ attributions were not associated with any outcomes , while ‘ personal responsibility ’ attributions were associated with high prejudice and blame . In Study 2 , participants who received information about the food environment reported greater support for food-related policies and greater self-efficacy to lose weight . Conclusion : Emphasising the role of the food environment in causing obesity may promote food policy support and health behaviours without imposing the negative consequences associated with other attributions Background Excessive weight gain among youth is an ongoing public health concern . Despite evidence linking both policies and the built environment to adolescent and adult overweight , the association between health policies or the built environment and overweight are often overlooked in research with children . The purpose of this study was to examine if school-based physical activity policies and the built environment surrounding a school are associated with  weight status among children . Methods Objective ly measured height and weight data were available for 2,331 grade 1 to 4 students ( aged 6 to 9 years ) attending 30 elementary schools in Ontario , Canada . Student-level data were collected using parent reports and the PLAY-On question naire administered to students by study nurses . School-level policy data were collected from school administrators using the Physical Activity Module of the Healthy School Planner tool , and built environment data were provided by the Enhanced Points of Interest data re source . Multi-level logistic regression models were used to examine the school- and student-level characteristics associated with the odds of a student being overweight or obese . Results There was significant between-school r and om variation in the odds of a student being overweight [ σ2μ0 = 0.274(0.106 ) , p < 0.001 ] , but not for being obese [ σ2μ0 = 0.115(0.089 ) ] . If a student attended a school that provided student access to a variety of facilities on and off school grounds during school hours or supported active transportation to and from school , he/she was less likely to overweight than a similar student attending a school without these policies . Characteristics of the built environment were not associated with overweight or obesity among this large cross-sectional sample of children . Conclusions This new evidence suggests that it may be wise to target obesity prevention efforts to schools that do not provide student access to recreation facilities during school hours or schools that do not support active transportation for students . Future research should evaluate if school-based overweight and obesity prevention programming might be improved if interventions selectively targeted the school characteristics that are putting students at the greatest risk 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 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 Childhood obesity is a complex and multifaceted health problem linked to elevated risk for chronic diseases , such as diabetes , cancer , hypertension , and cardiovascular disease.1,2 Although research has increased dramatically in the past 2 decades , questions regarding factors driving overweight and obesity remain , particularly among youth of color who experience disproportionate rates of obesity and comorbid health conditions.3 Adolescence is a critical period in the developmental trajectory,4 in part because overweight and obese adolescents are more likely to remain overweight and /or obese in adulthood.3 Overweight and obesity have been associated with adverse symptoms and intra- and interpersonal psychological , social , and emotional issues that continue into adulthood , including depression and anxiety , social withdrawal , feeling worthless , lower self-esteem , and behavioral problems.5–7 Poor mental health may lead to increases in weight due to fluctuations in appetite , obesogenic behaviors ( eg , overeating ) to cope with negative mood , sedentary behavior , and increased isolation.8 Chronic stress or experiences of discrimination may also influence physiology and behaviors that affect weight gain.9 On the other h and , increased body mass index ( BMI ) could result in adverse emotional outcomes over time due to weight-based stigma , bullying , or poor self-esteem.5,6 The few longitudinal studies that have examined the association between emotional health and physical health outcomes have primarily taken a narrow focus of mental health symptoms ( e.g. , only examining depression)10 or behavioral concerns ( e.g. , conduct).11 Physical outcomes , including BMI , were often collected by self-report12 and /or retrospectively.13 Furthermore , they have been limited to predominantly White sample s of older adolescents or adults.12,13 Persistent racial and ethnic disparities in overweight and obesity further complicate research as well as clinical prevention and intervention efforts . Black and Latino youth experience disproportionate levels of overweight and obesity beginning as early as preschool and are more likely to remain obese as adults compared with Whites.14 Blacks and Latinos also are at disproportionate risk for multiple negative health conditions associated with overweight and obesity , such as diabetes.14,15 Reasons for such disparities remain poorly understood and understudied . Although emotional health has been associated with weight in both adults and youth,16 prior research has been limited to cross-sectional studies .17 Longitudinal , prospect i ve design s are critical to explicate the association between emotional health and BMI among Black and Latino youth . The primary objective of this study is to examine whether negative emotional symptoms prospect ively predict increases in BMI z-scores ( BMI -z ) across 2 years among a sample of predominantly Black and Latino , urban youth . We hypothesize that more negative emotional symptoms measured at baseline ( grade s 5 and 6 ) would predict increases in BMI -z scores 2 years later . Results can inform programs and interventions aim ed at reducing obesity in youth of color OBJECTIVE : To assess the factors that could predict a successful completion of a weight loss program . STUDY DESIGN : A single-centered , cross-sectional , prospect i ve study conducted over 4 y . SUBJECTS : Data were obtained on 1018 overweight subjects ( 788 women , 230 men ) aged 14.8–76.3 y ( mean 38.4 ) and body mass index ( BMI ) of 31.7 ( range 25.03–57.1 ) seeking help to lose weight at a specialist obesity clinic . MATERIAL S AND METHODS : A program involving a hypocaloric , Mediterranean diet was prescribed plus recommendations for free-time exercise and day-to-day activity . Follow-up was weekly until the desired weight loss was achieved ( ‘ successful completion ’ ) or the patient dropped-out of the program ( ‘ failure ’ ) . Cox 's regression analysis was used to evaluate success and the variables included were compliance with the program , age , gender , initial BMI , physical activity , alcohol consumption , smoking habit , hypertension , diabetes , hypercholesterolemia , cardiovascular disease , previous dietary programs , cause of obesity , age at which excessive weight was first noted and parental obesity . RESULTS : Factors predictive of completion were : gender ( males responded better ) , previous dietary programs  ( predictive of dropout ) , initial BMI ( higher index , lower completion ) , and age ( younger age , poorer outcome ) . There was an interaction between parental obesity and offspring childhood obesity . Absence of parental obesity and adult-onset obesity had a higher probability of program completion . CONCLUSIONS : In a st and ard weight reduction program the recommendations of dietary restriction and moderate exercise seems less effective for women , persons with high BMI , younger age groups and those who have had other attempts at weight loss . Poorest outcomes applied to those subjects with childhood obesity and who had obese parents Existing work demonstrates that obesity is independently associated with cognitive dysfunction and macrostructural brain changes ; however , little is known about the association between obesity and white matter ( WM ) integrity . We explore this relationship in a large cohort of otherwise healthy subjects . The present study classified 103 adult participants from the Brain Re source International Data base between 21 and 86 years of age without history of neurological , medical , or psychiatric illness according to BMI ( normal weight , overweight , obese ) and subjected them to diffusion tensor imaging ( DTI ) .  Result ing fractional anisotropy ( FA ) indexes for the corpus callosum and fornix were examined in relation to BMI and age in a multiple regression framework . Results indicated that increasing BMI was independently associated with lower FA in the genu , splenium , and fornix , and a BMI × age interaction emerged for FA in the splenium and body of the corpus callosum . When categorized , obese persons demonstrated lower FA than normal and overweight persons for all WM indexes , but no FA differences emerged between overweight and normal persons . Results indicate both a direct association between obesity and reduced WM tract integrity and an interaction between obesity and aging processes on certain WM tracts in otherwise healthy adults . While such findings suggest a possible role for adiposity in WM dysfunction and associated cognitive deficits , prospect i ve studies are needed to clarify the nature of these relationships and eluci date underlying mechanisms Observational studies have established that obesity is associated with a substantially increased risk of developing type 2 diabetes.1 Whether intentional weight loss reduces the risk of obese persons ’ developing diabetes remains unclear , however . Two r and omized controlled trials for the primary prevention of type 2 diabetes in adults have included lifestyle intervention arms emphasizing modest weight loss.2,3 Relatively few observational studies have examined the association of weight loss with diabetes risk,4 and no published observational study has differentiated the effects of intentional weight loss from those of unintentional weight loss . This is important because unintentional weight loss may be associated with the clinical onset of diabetes.5 This is the first observational study to use data on weight-loss intention in examining the prospect i ve relationship between weight change and the incidence of diabetes in overweight adults Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents . The prevalence of obesity , insulin resistance , impaired glucose tolerance , type 2 diabetes mellitus , dyslipidemia , and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population . Risk reduction studies for persons with obesity , diabetes , and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction . In the l and mark multi-center r and omized-controlled trial study , the Diabetes Prevention Project ( DPP ) , a cognitive/behavioral intervention , was more successful in producing weight loss and preventing diabetes than the drugs metformin , troglitazone or placebo . This pilot study examined the effectiveness of a cognitive/behavioral group intervention , modified after the DPP program , in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system . Outcome measures included body weight , body mass index , waist-hip ratios , and fasting glucose levels . Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33 . The group that received the cognitive/behavioral group intervention  lost more weight than the treatment as usual group . The CB group participants lost an average of 5.4 lb or 2.9 % of body weight , and those in the control group lost 1.3 lb or 0.6 % body weight . The range of weight loss for the treatment group was from 1 to 20 lb . This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder Summary -Obesity is seen as a consequence of a positive balance of energy consumed over energy expended . The reduction of obesity is accordingly sought through the reduction in the amount of food eaten coupled with an increase in the rate at which energy is expended . Both the reduction in the rate of eating  and the increase in the rate of exercise  are sought through management of critical aspects of the environment . Specific recommendations are made for the behavioral treatment of obesity , with the success of the treatment seeming to depend upon the effectiveness with which environmental stimuli are brought under control rather than depending upon motivational or other personal characteristics of the overeater . Pre-test data generated by the use of this procedure , coupled with the results of several recent studies appear to indicate uniquely positive results for the behavior & control of overeating . WHETHER overweight is determined by gross body weight ( Metropolitan Life Insurance Company , 1969 ) or skin-fold measurement ( Seltzer and Mayer , 1965 ) even when differences in fat as a proportion of body weight are controlled ( Durnin and Passmore , un date d , p. 137 ) , at least one in five Americans is found to be overweight ( United States Public Health Service , un date d ) . The social and economic costs of being overwieght are staggering and are complicated by greatly increased vulnerability to a broad range of physical diseases , including cardiovascular and renal diseases , maturity-onset diabetes , cirrhosis of the liver , and gall bladder diseases , among many others ( Mayer , 1968).+ + Despite the history of concern with obesity and the magnitude of the problem , little uncontested knowledge has been accumulated with respect to its etiology and treatment . Mayer ( 1968 ) has suggested that genetic factors may contribute to the onset of a smal1 number of cases , while an additional small number of cases can be explained on the basis of injury to the hypothalamus , hormonal imbalance and other threats to normal metabolism . The exact role of genetic and physiological factors has , however , remained a mystery , and there has been little evidence to counterm and an early observation by Newburgh and Johnston ( 1930 ) that most cases of obesity are Abstract This study tested the association between aerobic fitness and executive function and the impact of enhanced , cognitively challenging physical activity on executive function in overweight and lean children . Seventy children aged 9–10 years were assigned to either a 6-month enhanced physical education programme including cognitively dem and ing ( open skill ) activities or curricular physical education only . Pre- and post-intervention tests assessed aerobic capacity ( Leger test ) and two components of executive function : inhibition and working memory updating ( r and om number generation task ) . Indices of inhibition and memory updating were compared in higher- and lower-fit children and intervention effects were evaluated as a function of physical activity programme ( enhanced vs. curricular ) and weight status ( lean vs. overweight ) . Results showed better inhibition in higher- than lower-fit children , extending the existing evidence of the association between aerobic fitness and executive function to new aspects of children ’s inhibitory ability . Overweight children had more pronounced pre- to post-intervention improvements in inhibition than lean children only if involved in enhanced physical education . Such intervention effects were not mediated by aerobic fitness gains . Therefore , the cognitive and social interaction challenges inherent in open skill tasks , even though embedded in a low-dose physical activity programme , may represent an effective means to promote cognitive efficiency , especially in overweight children Background The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective . Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness , if the risk of obesity-related morbidity and mortality is yet be reduced . Diet plays a pivotal role in successful treatment of obesity but to date , there is limited evidence on which to base practice . Objectives To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese . Search strategy Published English language literature was search ed using the electronic data bases CINAHL , MEDLINE , PRE- MEDLINE , DARE , COCHRANE , EMBASE , AUSTROM , Current Concepts and Dissertation Abstract s. The data bases were limited to English Language from 1975 until 2003 . Government reports from the UK , USA and Australian were also search ed and a h and search performed for the Journal of the Dietitians Association of Australia , International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles . Selection criteria ( i ) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity ; ( ii ) Children aged less than 18 years ; and ( iii ) Participants were defined as overweight or obese by relative weight or a measure of body weight status , studies that reported body weight per se were excluded . Data collection and analysis An experienced professional librarian search ed the data bases , and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion . The included studies were critically appraised for method ological quality by two people independently . Data were extracted from the appropriate articles and when a discrepancy arose , a third party would arbitrate . Main results There were 116 articles that met the inclusion criteria . While 49 articles described r and omised controlled trials , they arose from 37 separate studies . There were 67 non-r and omised trials . Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data . There was a high degree of heterogeneity between studies and this made comparisons between studies problematic . Interventions that include diet therapy generally result in significant weight loss , at least in the short term . Many studies were poorly design ed and had no or only minimal follow up . The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported , making repetition of the studies difficult . Review ers ' conclusions There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity . These studies require adequate follow up to ascertain if weight loss can be sustained in the long term . Details of the dietary prescription , adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice
The results confirmed the presence of a relation between executive functions and overweight/obesity , although the directionality of this relation was not clear ; nor did any single executive function emerge as being more involved than others in this relation .
Despite this , there was evidence of a reciprocal influence between executive functions and overweight/obesity .
Conclusions : This systematic review underlines the presence of a relationship between executive functions and overweight/obesity .
Moreover , it seems to suggest a bidirectional trend in this relationship that could be the cause of the failure of interventions for weight reduction .
Background : The increasing incidence of people affected by overweight or obesity is a significant health problem .
The knowledge of the factors which influences the inappropriate eating behaviors causing excessive body fat is an essential goal for the research .
Overweight and obesity are significant risk factors for many health diseases , such as cardiovascular problems , diabetes .
Recently , many studies have focused on the relationship between body weight and cognitive processes .
Objectives : This systematic review is aim ed to investigate the existence and the nature of the relationship between excessive body weight ( overweight/obesity ) and executive functions , analyzing cross-sectional , and longitudinal studies in order to verify the evidence of a possible causality between these variables .