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Background: We examined the effects of exercise training on resting metabolic rate (RMR), and whether changes in body composition are associated with changes in RMR in adolescents with overweight and obesity. Methods: One hundred forty adolescents (12–18 years, BMI ≥85th percentile) participated in randomized exercise trials (3–6 months) at UPMC Children's Hospital of Pittsburgh (18 control, 51 aerobic, 50 resistance, and 21 combined aerobic and resistance exercise). All participants had RMR assessments by indirect calorimetry after a 10–12 hour overnight fast, and body composition by magnetic resonance imaging and dual-energy X-ray absorptiometry. Results: There were no significant changes in RMR (kcal/day) between exercise groups vs. controls (p > 0.05). All exercise groups decreased visceral fat (−0.2 ± 0.02 kg; p 0.05), was a significant determinant of changes in RMR, independent of exercise modality (p = 0.04). Conclusion: Although exercise modality was not associated with changes in RMR, change in FFM, but not skeletal muscle or FM, was a significant correlate of changes in RMR in adolescents with overweight and obesity. Clinicaltrials.gov registration numbers: NCT00739180, NCT01323088, NCT01938950.

ObjectiveIt is unclear to what degree acutely violating bioelectrical impedance analysis (BIA) measurement assumptions will alter the predicted percent fat mass (%FM) and whether this differs by sex or body mass index (BMI).Methods%FM was assessed under control, dehydration, exercise, water, food intake and non-voided bladder conditions with three BIA devices (Tanita: BC-418, TBF-314, & Omron HBF-306CN) for men (n = 23, age: 24.0 ± 5.2 years old) and women (n = 17, age: 22.5 ± 3.4 years old) separately.ResultsFor all BIA devices, there were no differences in the %FM values between the control and the other conditions in men or women (− 1.9 to 0.4%,p > 0.05). Across the three devices and five conditions, 97% of %FM tests returned values within 5% of control (2 tests), and 86% of tests were within 2% of control despite violating an assumption. The errors were greatest with dehydration and women were more likely to have a %FM difference greater than 2% than men with dehydration using the hand-to-foot device (Tanita TBF-314: 59% versus 9%). There were no differences in %FM between control and the conditions when examined by BMI (overweight/obesity: − 2.8 to 0.1% and normal weight: − 1.7 to 0.5%; BMI*trial,p = 0.99).Conclusion%FM estimates were similar despite acutely violating the preliminary measurement BIA assumptions across a range of different BMIs. The minor variations in %FM are smaller than what would be expected with day-to-day variability or weight loss intervention but may be larger in women than men.

To examine the utility of changes in cardiorespiratory fitness (CRF) and body composition in response to exercise training in adolescents with obesity beyond simple measures of body weight change. This is a secondary analysis of our previously published randomized trials of aerobic, resistance, and combined training. We included 104 adolescents (body mass index (BMI) ≥85th percentile) who had complete baseline and post-intervention data for CRF, regional body fat, insulin sensitivity, and oral glucose tolerance. Associations between changes in body composition and CRF with cardiometabolic variables were examined adjusted for age, sex, Tanner stage, race, exercise group, and weight loss. At baseline, CRF, visceral fat and liver fat were correlated with insulin sensitivity with and without adjustment for BMI percentile. Training-associated changes in CRF, visceral fat, and liver fat were also correlated with insulin sensitivity changes, but not independent of body weight change. After accounting for body weight change, none of the body composition or CRF were associated with changes in insulin sensitivity, glucose tolerance, systolic blood pressure, or high-density lipoprotein cholesterol. Although CRF and body composition were strong independent correlates of insulin sensitivity at baseline, changes in CRF and visceral fat were not associated with changes in insulin sensitivity after accounting for body weight change. Clinicaltrials.gov registration nos.: NCT00739180, NCT01323088, NCT01938950. Novelty With exercise training, changes in body weight, CRF, visceral fat, and liver fat were correlated with changes in insulin sensitivity. Changes in body composition or CRF generally did not remain significant correlates of changes in insulin sensitivity after adjusting for body weight changes.

POINTS CLES L’obesite est une maladie chronique complexe dans laquelle la graisse corporelle anormale ou excessive (adiposite) nuit a la sante, augmente le risque de complications medicales a long terme et reduit la duree de vie[1][1]. Les etudes epidemiologiques definissent l’obe

KEY POINTS Obesity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan.[1][1] Epidemiologic studies define obesity using the body mass index (BMI; weight/height2), which can stratify

Background We examined the relationship between ratios of select biomarkers of kidney and liver function on all-cause and coronary heart disease (CHD) mortality, both in isolation, and in combination with metabolic syndrome (MetS), among adults (20 + years, n = 10,604). Methods Data was derived from the U.S. National Health and Nutrition Examination Survey (1999–2016) including public-use linked mortality follow-up files through December 31, 2015. Results Select biomarker ratios of kidney (UACR or albuminuria and BUN-CR) and liver (AST-ALT and GGT-ALP) function in isolation and in combination with MetS were associated with all-cause and CHD mortality. Compared to individuals with neither elevated biomarker ratios nor MetS (HR = 1.00, referent), increased risk of all-cause mortality was observed in the following groups: MetS with elevated UACR (HR, 95% CI = 2.57, 1.99–3.33), MetS with elevated AST-ALT (HR = 2.22, 1.61–3.07), elevated UACR without MetS (HR = 2.12, 1.65–2.72), and elevated AST-ALT without MetS (HR = 1.71, 1.35–2.18); no other biomarker ratios were associated with all-cause mortality. For cause-specific deaths, elevated risk of CHD mortality was associated with MetS with elevated UACR (HR = 1.67, 1.05–2.67), MetS with elevated AST-ALT (HR = 2.80, 1.62–4.86), and elevated BUN-CR without MetS (HR = 2.12, 1.12–4.04); no other biomarker ratios were associated with CHD mortality. Conclusion Future longitudinal studies are necessary to examine the utility of these biomarker ratios in risk stratification for chronic disease management.

OBJECTIVE: To examine sex and ethnic differences in how baseline and changes in anthropometric measures relate with change in visceral fat with interventions in adolescents. STUDY DESIGN: Black and white adolescents (n = 143: BMI≥85(th) percentile, 12–18 years) who participated in intervention studies (3–6 months) were included and had assessments of anthropometric measures [weight, BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-thigh ratio (WTR)] and visceral fat at L4-L5 by magnetic resonance imaging before and after interventions. RESULTS: At baseline, all of the anthropometric measures were positively associated with visceral fat (P < .05), with weight, WC and WHR having the largest variance explained (Model Adj R(2) =0.35 to 0.47 versus 0.32 to 0.35). Blacks had 11.5 to 23.3 cm(2) less visceral fat as compared with whites for a given anthropometric value. Girls tended to have less visceral fat for a given anthropometric value, but the sex differences were not consistently significant (range: 0.7 to 12.9 cm(2)). Changes in WC, BMI and weight, but not WHR, remained significantly associated with changes in visceral fat. There were no sex differences, and much more minimal ethnic differences (

Objective This study aimed to compare weight loss (WL) outcomes for patients taking antidepressants and/or antipsychotics with those not taking psychiatric medication. Methods A total of 17,519 adults enrolled in a lifestyle WL intervention at the Wharton Medical Clinics in Ontario, Canada, were analyzed. Sex-stratified multivariable linear regression analysis was used to examine the association of taking antidepressants, antipsychotics, both, or neither with WL when adjusting for age, initial weight, and treatment time. Results Twenty-three percent of patients were taking at least one psychiatric medication. Patients lost a significant amount of weight (P 0.05). Conversely, men taking antidepressants lost only slightly less weight than men taking both classes or neither class of psychiatric medication (3.2 ± 0.3 kg vs. 5.6 ± 0.9 kg and 4.3 ± 0.1 kg; P 0.05). Conclusions Results of this study suggest that those who participate in a weight management program can lose significant amounts of weight regardless of psychiatric medication use.

Traditionally, individuals with obesity have been encouraged to participate in aerobic exercise for long-term weight management and improved obesity-related health outcomes. Recently, resistance exercise has become a popular mode of exercise among youth with obesity. However, to date, the literature is mixed as to whether resistance exercise training alone improves body weight, fat free mass, body composition, cardiovascular risk factors, or atherogenic lipoprotein profiles. The limited research in this area suggests potential sex differences in response to resistance training in youth. The literature is more consistent in demonstrating improvements in muscular fitness and insulin resistance independent of caloric restriction and weight loss. Although major health organizations recommend combining aerobic and resistance training, little research has examined the effects of their combination versus their individual effects, thus it is unclear whether their combination is associated with benefits that extend beyond those of either exercise modality alone. The purpose of this review is to examine the effects of resistance exercise on body composition and the health risk factors associated with cardiovascular disease and type 2 diabetes in youth with obesity.

We aimed to predict % maximal oxygen consumption at absolute accelerometer thresholds and to estimate and compare durations of objective physical activity (PA) among body mass index (BMI) categories using thresholds that account for cardiorespiratory fitness. Eight hundred twenty-eight adults (53.5% male; age, 33.9 ± 0.3 years) from the National Health and Nutrition Examination Survey 2003–2004 were analyzed. Metabolic equivalent values at absolute thresholds were converted to percentage of maximal oxygen consumption, and accelerometer counts corresponding to 40% or 60% maximal oxygen consumption were determined using 4 energy expenditure prediction equations. Absolute thresholds underestimated PA intensity for all adults; however, because of lower fitness, individuals with overweight and obesity work at significantly higher percentage of maximal oxygen consumption at the absolute thresholds and require significantly lower accelerometer counts to reach relative moderate and vigorous PA intensities compared with those with normal weight (P < 0.05). However, moderate-to-vigorous physical activity (MVPA) durations were shorter when using relative thresholds compared with absolute thresholds (in all BMI groups, P < 0.05), and they were shorter among individuals with obesity compared with those with normal weight when using relative thresholds (P < 0.05). Regardless of the thresholds used, a greater proportion of individuals with normal weight met the PA guideline of 150 min·week–1 of MVPA compared with individuals with obesity (absolute: 21.3% vs 6.7%; Yngve: 4.0% vs 0.2%; Swartz: 10.7% vs 3.9%; Hendelman: 4.7% vs 0.2%; Freedson: 6.4% vs 0.5%; P < 0.05). Current absolute thresholds of accelerometry-derived PA may overestimate MVPA for all BMI categories when compared with relative thresholds that account for cardiorespiratory fitness. Given the large variability in our results, more work is needed to better understand how to use accelerometers for evaluating PA at the population level.

Objective. To determine if the rate of weight loss (WL) is associated with metabolic changes independent of the absolute WL. Methods. WL and health changes were assessed in 11,281 patients attending a publicly funded clinical weight management program over a treatment period of 12.7 months. Early weight loss rate (WLR) in the first 3–6 months and overall WLR were categorized as Fast WLR (≥1 kg/wk), Recommended WLR (0.5 to 0.9 kg/wk), or Slow WLR (Results. On average, patients attained a 6.6 ± 7.3 kg (5.8 ± 5.7%) WL over 12.8 ± 13.1 months. Prior to adjusting for covariates, patients with Fast WLR (−24.7 ± 13.4 kg) at 3–6 months had a greater overall WL as compared to those with Recommended WLR (−13.3 ± 8.7 kg) and Slow WLR (−5.0 ± 5.4 kg). Fast WLR also had greater improvements in the overall waist circumference and blood pressure than patients with Slow or Recommended WLR. However, after adjustment for absolute WL, Early and overall Recommended and Fast WLR did not differ in the changes in any of the health markers (P>0.05). Conversely, the absolute WL sustained is significantly associated with changes in metabolic health independent of WLR (P<0.001). Similar results were observed with WLR over the entire treatment period. Conclusions. Faster rates of WL are associated with a greater absolute WL and larger improvements in waist circumference and blood pressure. However, after adjusting for the larger absolute WL sustained, early and overall faster WLR do not appear to have advantages for improving metabolic health markers. Thus, the absolute WL attained may be the most important factor for improving metabolic health.

Objective To assess changes in weight by calendar month and sex in patients enrolled in a weight loss intervention. Methods Adults participating in a lifestyle weight loss intervention at the Wharton Medical Clinic from January 1st, 2007 to July 4th, 2019 were examined (N = 19,153). A linear generalized estimating equation was used to examine the association between weight change (baseline, month 1, month 2) and calendar month with adjustment for age, sex and baseline body mass index. A first order interaction between sex and calendar was included to assess if the association between calendar month and weight loss differs by sex. Results Patients lost 1.3 ± 2.0 kg (1.2 ± 1.8%) of their body weight per month. As compared to the mean monthly weight loss, patients lost slightly less weight in September (mean, 95% confidence interval (CI): −0.3, −0.4 to −0.2 kg) and slightly more weight in October (0.2, 0.1–0.3 kg). With adjustment for age, body mass index and calendar month, men lost 0.4 kg/month (95% CI: 0.3, 0.5 kg/month) than women. There were no other significant differences in the monthly weight change between men and women (sex*calendar month P-value = 0.24). Conclusion While there were slight differences in the amount of weight change achieved by patients in September, and October, it was not of a magnitude that is likely clinically relevant. In addition, men consistently lost more weight than women across all calendar months. Taken together, this suggest that calendar month is not associated with differences in weight loss for men and women enrolled in a structured weight management program.

The weight loss history and weight loss goals were examined in 4108 patients referred to a publicly funded evidence-based clinical weight management program using a retrospective chart review. The majority of patients were white females, aged of 50.1 ± 13.7 years and a BMI of 39.0 ± 7.5 kg/m2 . Pregnancy was the most common reason for weight gain in women (17.7%) and while the reasons in men are more varied (injury, stress and medication: all ~5%). Over 50% of patients cited no specific reason for their weight gain. Self-directed diet and exercise were the most commonly used self-reported weight loss methods. Women were more likely to report using medication and bariatric surgical weight loss methods than men (P

We examined the separate and combined associations for cardiorespiratory fitness (CRF) and muscular strength (MS) with total and regional fat, and insulin sensitivity (IS) in 204 adolescents (BMI ≥85th percentile, 12–18 years) at UPMC Children’s Hospital of Pittsburgh. CRF was measured by maximum oxygen consumption during a graded treadmill test. MS was quantified by combining 1-repetition maximum test for the leg and bench press. Participants were stratified as having either high or low CRF and MS based on sex-specific median split. Both high CRF and high MS groups had lower (P < 0.05) total fat after adjustment for sex, Tanner stage and ethnicity than the low CRF and MS groups (Difference: 6.6, 2.6–9.6% and 5.4, 2.4–8.3%, respectively). High CRF, but not high MS, had lower visceral (67.5 versus 77.9 cm2, P < 0.01) and intermuscular fat (3.6 versus 4.0 kg, P = 0.01) than the low CRF groups. Differences by CRF remained significant after adjustment for MS. High CRF, but not high MS, was associated (P < 0.05) with lower fasting glucose and higher IS after accounting for sex, Tanner stage and ethnicity than the low CRF group, and high CRF remained associated with these markers after adjustment for MS. High CRF is associated with lower total and regional fat, and higher IS after adjustment for MS. Novelty: CRF is associated with lower total fat, visceral and intermuscular fat, and higher insulin sensitivity adjusting for muscular strength. Muscular strength is not associated with regional body fat and insulin sensitivity after accounting for CRF.

Objective To examine the combined association between metformin use and physical activity on HbA1c in adults with type 2 diabetes. Research Design and Methods Adults with type 2 diabetes from NHANES continuous survey (1999‐2018, n = 6447) were classified as active and inactive based on self‐reported engagement in moderate‐to‐vigorous or vigorous physical activity (MVPA or VigPA) and metformin use over the last month. Results There was a significant negative main effect of metformin usage on HbA1c levels, independent of whether individuals engaged in modest levels of MVPA or VigPA. Moreover, there was a higher prevalence of metformin users with a HbA1c .05). Conclusions There appears to be independent benefits of metformin and regular physical activity on glucose control, but the impact of these two treatments are not necessarily additive. Based on this analyses, the benefit of physical activity on HbA1c levels in type 2 diabetes is likely more apparent in those not taking metformin, as compared to those who are., There appears to be independent benefits of metformin and regular physical activity on glucose control, but the impact of these two treatments are not necessarily additive. Based on these analyses, the benefit of physical activity on HbA1c levels in type 2 diabetes is likely more apparent in those not taking metformin, as compared to those who are.

We compared the effects of aerobic exercise, resistance exercise, and combined aerobic and resistance exercise on total, regional subcutaneous adipose tissue (SAT) and visceral AT (VAT), skeletal muscle (SM), and biomarkers of cardiovascular disease in adolescents. Adolescents with overweight/obesity (N = 118; body mass index ≥ 85th percentile; age, 12–17 years) were randomized to 1 of the following groups for 6 months (3 days/week, 180 min/week): aerobic exercise (n = 38), resistance exercise (n = 40), or combined aerobic and resistance exercise (n = 40). After accounting for age, sex, and baseline value, there was a greater (P < 0.05) reduction in body weight in the aerobic exercise group compared with the resistance exercise group and the combined groups. There were reductions (P < 0.05) in total and regional SAT within the aerobic exercise group only, and the reductions in lower-body SAT were greater (P = 0.02) than the combined group. All groups had reductions (P < 0.01) in VAT, with no group differences. There were significant increases in total and regional SM mass in the resistance exercise and combined group, and not in the aerobic exercise group. Although all exercise modalities are effective in reducing VAT, aerobic exercise is superior at reducing total and regional SAT, but inferior for increasing SM in adolescents with obesity. Despite reductions in VAT, carotid-femoral pulse wave velocity and carotid intima-media thickness did not improve with either exercise. Clinicaltrials.gov identifier: NCT01938950. Novelty Regular exercise (180 min/week) is associated with reductions in visceral fat independent of exercise modality. Resistance exercise alone and combined resistance and aerobic exercise are similarly effective in increasing SM mass.

The aims of this study were to assess the effectiveness of a low-carbohydrate high-fat (LCHF) diet with and without a time-restricted feeding (TRF) protocol on weight loss and participating in three sequential dietary interventions (standard calorie-deficit diet, LCHF, and LCHF + TRF) on weight loss outcomes.Data from 227 adults from the Wharton Medical Clinic (WMC) were analyzed using a unidirectional case crossover design. Data was imputed for 154 patients to create a pseudo-sample in which everyone participated in three dietary interventions: standard calorie restriction, LCHF, and LCHF + TRF.Patients lost an average of 11.1 ± 1.3 kg (9.8 ± 1.1%) after three sequential dietary interventions (P0.0001). Patients lost a statistically significant amount of weight from the standard WMC, LCHF, and LCHF+TRF diets (P0.05). With and without adjustment for age, sex, body mass index at the start of the dietary protocol, and treatment time, patients lost a similar amount of weight regardless of the dietary intervention (P0.05). Approximately 78.6% of patients achieved ≥5% weight loss with at least one of the diets.Patients can lose a similar amount of weight regardless of the diet they are following. Approximately 78.9% of patients achieved 5% weight loss with at least one of the diets and lost an average 11.1 kg (or 9.8%). This is nearly double what has been previously reported for one dietary intervention. Thus, participating in sequential diets may be associated with greater absolute weight loss, and likelihood of achieving a clinically significant weight loss.

Studies have examined mortality risk for metabolically healthy obesity, defined as zero or one metabolic risk factors but not as zero risk factors. Thus, we sought to determine the independent mortality risk associated with obesity or elevated glucose, blood pressure or lipids in isolation or clustered together. The sample included 54 089 men and women from five cohort studies (follow-up = 12.8 ± 7.2 years and 4864 [9.0%] deaths). Individuals were categorized as having obesity or elevated glucose, blood pressure or lipids alone or clustered with obesity or another metabolic factor. In our study sample, 6% of individuals presented with obesity but no other metabolic abnormalities. General obesity (hazard ratios [HR], 95% CI = 1.10, 0.8-1.6) and abdominal obesity (HR = 1.24, 0.9-1.7) in the absence of metabolic risk factors were not associated with mortality risk compared to lean individuals. Conversely, diabetes, hypertension and dyslipidaemia in isolation were significantly associated with mortality risk (HR range = 1.17-1.94, P

Objective We examined whether racial differences in liver fat are associated with the differences in abdominal fat distribution or cardiorespiratory fitness (CRF). Methods Participants included 57 black and white obese boys (12-18 years). Total and abdominal fat was measured by dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging, respectively. CRF was measured using a maximal graded treadmill test with the use of standard open-circuit spirometry techniques until volitional fatigue. Liver fat was measured using a 3T proton magnetic resonance spectroscopy. Fatty liver was defined as having liver fat ≥5%. Results In the sample, 16.1% of black boys and 30.8% of white boys had fatty liver. Liver fat was associated (P ≤ .05) with body mass index (BMI) percentile (r = 0.28), total fat (r = 0.31), waist circumference (r = 0.38), visceral fat (r = 0.62), abdominal subcutaneous adipose tissue (r = 0.30), and CRF (r = −0.27) adjusting for age and race. White boys had greater liver fat than black boys with adjustment for age and differences in BMI percentile or CRF, but not with waist circumference or visceral fat (P > .05). In a model with age, ethnicity, total body fat, fat-free mass, visceral fat, abdominal subcutaneous fat, and CRF, visceral fat was the only factor to be independently associated with increased odds of having fatty liver (OR = 1.12; 95% CI: 1.04-1.21; P = .003). Conclusion The racial disparities in liver fat between obese black vs white adolescents are explained, in part, by differences in visceral fat.

The aim of this study was to examine the associations between baseline and changes in resting metabolic rate (RMR) with chronic condition(s) and weight loss (WL). Sex stratified analysis was undertaken on 393 adults from the Wharton Weight Management Clinics. The association between baseline RMR and WL was examined adjusting for age, BMI, ethnicity and treatment time. The association between changes in RMR (ΔRMR) and WL was also examined adjusting for baseline RMR and above covariates. Models were further adjusted for high glucose, triglycerides, blood pressure, low-density lipoprotein (LDL) and low high-density lipoprotein (HDL). While men (6.0 ± 8.6 kg) and women (5.6 ± 8.3 kg) had significant WL throughout the intervention, their measured decreases in RMR (-48 ± 322 kcal and -5 ± 322 kcal, respectively) were non-significant (P > 0.05). Individuals with a high blood pressure had a higher baseline RMR and women with a high LDL had a lower baseline RMR than those without the chronic condition (P 0.05) in both models. Participants with a low baseline RMR do not appear to be at a disadvantage for WL. Further, WL can occur without decreases in RMR in populations with high levels of obesity and obesity-related comorbidities.

To examine the trends in chronic conditions after accounting for temporal differences in body mass index (BMI) and waist circumference (WC). Pooled cycles (1999-2014) of the U.S. National Health and Nutrition Examination Survey (NHANES) were analysed (n = 36 959). The models were adjusted for caloric intake, smoking, medications use and physical activity. The prevalence of diabetes increased in women with general or abdominal obesity (BMI*time; WC*time, P .05), but there were no differences in men. For hypertension, independent of BMI, the prevalence was not different over time in both sexes (P .05), whereas for a given WC, there was a decrease in the prevalence over time in women (WC*time, P = .05). For dyslipidemia, independent of BMI, the prevalence decreased in men, whereas for a given WC, there was a decrease in the prevalence in both sexes (P .05). Over the same time frame, blood pressure, low-density lipoprotein and triglycerides decreased, while plasma glucose increased independent of general and abdominal obesity (P .001). The relationship between obesity and chronic conditions has changed over time. There may be other changes that have altered how obesity is related with metabolic health markers over time. Further investigation is needed to better understand the current causes of chronic conditions.

BackgroundThe association between metabolic syndrome (MetS) and all-cause mortality is well established but it is unclear if there are differences in mortality risk among the 32 possible MetS combinations. Hence, the purpose of this study is to evaluate the associations between different MetS combinations and its individual components with all-cause mortality, and to examine differences in the association by age and sex.MethodsA merged sample of 82,717 adults from 7 U.S. cohorts was used.ResultsIn our sample, MetS was present in 32% of men, 34% of women, 28% of younger adults (18-65 years) and 62% of older adults (>65 years) with 14,989 deaths over 14.6 ± 7.4 years of follow-up. Risk of all-cause mortality was higher in younger individuals with a greater number of MetS factors present, but in older adults having all 5 MetS factors was the only combination significantly associated with mortality. Regardless of age or sex, elevated blood pressure was the MetS factor most consistently present in MetS combinations that were significantly and most strongly associated with mortality. In fact, elevated blood pressure in the absence of other risk factors was significantly associated with mortality in men (HR, 95% CI = 1.56, 1.33-1.84), women (HR = 1.62, 1.44-1.81) and younger adults (HR = 1.61, 1.45-1.79). Conversely, waist circumference, glucose and triglycerides in isolation were not associated with mortality (p>0.05).ConclusionIn a large U.S. population, different combinations of MetS components vary substantially in their associations with all-cause mortality. Men, women and younger individuals with MetS combinations including elevated blood pressure had stronger associations with greater mortality risk, with minimal associations between MetS and mortality risk in older adults. Thus, we suggest that future algorithms may wish to consider differential weighting of these common metabolic risk factors, particularly in younger populations.

Summary To assess the effectiveness of liraglutide 3.0 mg in post‐bariatric surgery patients, and to determine whether this would differ based on the type of bariatric surgery. One hundred seventeen post‐bariatric surgery patients from the Wharton Medical Clinic were analysed. Changes in weight while taking liraglutide 3.0 mg were examined for all patients, and by three types of bariatric surgery—Roux‐en‐Y gastric bypass, gastric banding and gastric sleeve. Patients primarily underwent Roux‐en‐Y gastric bypass (n = 53, 45.3%) or gastric banding (n = 50, 42.7%). Over 7.6 ± 7.1 months taking liraglutide 3.0 mg, patients lost a statistically significant amount of weight (−6.3 ± 7.7 kg, P .05). This decrease in weight remained significant after 1‐year of taking liraglutide 3.0 mg (P

Background: We retrospectively examined the sex differences in the changes in (1) total fat, total and regional subcutaneous adipose tissue (SAT), visceral fat, and intermuscular fat and (2) total and regional skeletal muscle distribution in response to aerobic exercise (AE) or resistance exercise (RE) in adolescents with obesity. Methods: Twenty-eight boys and 27 girls with obesity (BMI ≥95th percentile, 12–18 years) were randomly assigned to 3-month interventions (180 minutes per week) of AE or RE. Changes in total and regional fat and skeletal muscle distribution were assessed by a whole-body magnetic resonance imaging. Results: After controlling for corresponding baseline values, age, and race, changes in body weight, BMI, BMI z-score, and waist circumference were similar between exercise groups (p > 0.05) and sexes (p > 0.05). There were no sex or exercise group differences in the reductions in total fat, total SAT, visceral fat, or intermuscular fat. With AE, boys had greater (p

Summary The aim of this article was to examine the associations between having had a sinus infection (SI) and BMI and physical activity (PA), diet quality, stress and/or sleep. A total of 2915 adults from the National Health and Nutrition Examination Survey 2005–2006 were examined. Logistic regression analysis was used to examine the association between having had an SI with BMI and PA, diet quality, stress or sleep. As these factors are known to influence one another, a fully adjusted model with PA, diet quality, stress and sleep was also constructed to examine their independent associations with having had an SI. Overall, 15.5 ± 1.2% of the population report having had an SI in the past year. In all models, individuals with obesity were approximately twice as likely to have had an SI compared to those of normal weight (P 0.05), individuals with stress and sleep troubles were also twice as likely to have had an SI (P

This study examined whether sucrose, fructose, aspartame, and saccharin influences the association between obesity and glucose tolerance in 2856 adults from the NHANES III survey. Aspartame intake significantly influenced the association between body mass index (BMI) and glucose tolerance (interaction: P = 0.004), wherein only those reporting aspartame intake had a steeper positive association between BMI and glucose tolerance than those reporting no aspartame intake. Therefore, consumption of aspartame is associated with greater obesity-related impairments in glucose tolerance.

Ability to accurately estimate calories is important for weight management, yet few studies have investigated whether individuals can accurately estimate calories during exercise or in a meal. The objective of this study was to determine if accuracy of estimation of moderate or vigorous exercise energy expenditure and calories in food is associated with body weight class or weight loss status.Fifty-eight adults who were either normal weight (NW) or overweight (OW), and either attempting (WL) or not attempting weight loss (noWL), exercised on a treadmill at a moderate (60% HRmax) and a vigorous intensity (75% HRmax) for 25 min. Subsequently, participants estimated the number of calories they expended through exercise and created a meal that they believed to be calorically equivalent to the exercise energy expenditure.The mean difference between estimated and measured calories in exercise and food did not differ within or between groups after moderate exercise. After vigorous exercise, OW-noWL overestimated energy expenditure by 72% and overestimated the calories in their food by 37% (P0.05). OW-noWL also significantly overestimated exercise energy expenditure compared with all other groups (P0.05) and significantly overestimated calories in food compared with both WL groups (P0.05). However, among all groups, there was a considerable range of overestimation and underestimation (-280 to +702 kcal), as reflected by the large and statistically significant absolute error in calorie estimation of exercise and food.There was a wide range of underestimation and overestimation of calories during exercise and in a meal. Error in calorie estimation may be greater in overweight adults who are not attempting weight loss.

Summary The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m−2 or BMI > 35 kg m−2 with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m−2. Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P

To examine whether a combined aerobic exercise and resistance exercise is more effective than either aerobic exercise or resistance exercise alone in improving insulin sensitivity and reducing total adiposity and ectopic fat in adolescents.A total of 118 sedentary adolescents with overweight/obesity (body mass index85th percentile, 12-17 years) were recruited from October 2013 through April 2017 at Children's Hospital of Pittsburgh. Participants were randomized to 1 of the following 6-month exercise groups (3 d/wk, 180 min/wk): aerobic exercise (n = 38), resistance exercise (n = 40), and combined aerobic exercise and resistance exercise (n = 40). The primary outcome was the change in insulin-stimulated glucose disposal by a 3-hour hyperinsulinemic-euglycemic clamp. The secondary outcomes were changes in liver fat by proton magnetic resonance spectroscopy and intermuscular adipose tissue by computed tomography.Of the 118 participants randomized, 85 participants (72%) completed the study with 90% exercise attendance. Total adiposity reduced similarly in all groups (-2%, P .05). After adjusting for age and sex, insulin-stimulated glucose disposal increased (P .05) in all groups, with the increase in the aerobic exercise group being greater than the resistance exercise group (1.7 ± 0.1 vs 0.7 ± 0.1 mg/kg/min, P .05) but not different from the combined group (1.2 ± 0.1 mg/kg/min). Liver fat was reduced (P .05) in the aerobic exercise (-0.6%) and combined (-0.6%) groups but not in the resistance exercise group (-0.3%, P .05). Intermuscular adipose tissue decreased (P .05) similarly in all groups.Combined aerobic exercise and resistance exercise and aerobic exercise alone are similarly beneficial in improving insulin sensitivity and reducing ectopic fat in adolescents with obesity.ClinicalTrials.gov: NCT01938950.

Introduction. One in three US adults is living with obesity or hypertension, and more than 75% of hypertensive individuals are using antihypertensive medications. Therefore, it is important to examine blood pressure (BP) differences in populations that are using these medications with differing obesity status. Aim. We examined whether BP attained when using various antihypertensive medications varies amongst different body mass index (BMI) categories and whether antihypertensive medication use is associated with differences in other metabolic risk factors, independent of BMI. Methods. Adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 were used (n=15,285). Linear regression analyses were used to examine the main effects and interaction between antihypertensive use and BMI. Results. In general, users of antihypertensive medications had lower BP than those not taking BP medications (NoBPMed) (P<0.05), whereby in women, the differences in systolic BP between angiotensin-converting-enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) users and NoBPMed were greater in those with obesity (ACE inhibitors: −14 ± 1 mmHg; ARB: −16 ± 1 mmHg) compared to normal weight individuals (ACE inhibitors: −9 ± 1 mmHg; ARB: −11 ± 1 mmHg) (P<0.05). Diastolic BP differences between women ARB users and NoBPMed were also greatest in obesity (−5 ± 1 mmHg) (P<0.05) whilst there were no differences in normal weight individuals (−1 ± 1 mmHg) (P>0.05). Furthermore, glucose levels and waist circumference in women were higher in those using ACE inhibitors compared to diuretics (P<0.05). Conclusion. ACE inhibitors and ARBs may be associated with more beneficial BP profiles in women with obesity, with no obesity-related BP differences for antihypertensive medication in men. However, there could be potential cardiometabolic effects for some antihypertensive medications that should be explored further.

The predictive value of total 25-hydroxyvitamin D (25(OH)D, a biomarker of vitamin D status) in relation to lifetime risk of cardiometabolic mortality is not known. The purpose of this study was to determine the association between standardized and annualized total 25(OH)D levels and lifetime risk for cardiometabolic mortality in middle- to older-aged adults. In this study, we followed up 7958 participants in the Third National Health and Nutrition Examination Survey from 1988 to 1994 (NHANES III) until the occurrence of cardiometabolic death or attainment of 95 years of age (median follow-up 17.9 years, 1371 cardiometabolic-deaths). Lifetime risks were estimated according to recommended total 25(OH)D cutoffs by national guidelines, and a combination of total 25(OH)D status and traditional risk factor burden. We also explored variation in lifetime risk estimates by levels of body mass index (BMI). The results of this study showed that annualized total 25(OH)D30 nmol/L was associated with high lifetime risk of cardiometabolic mortality (40%). Lifetime risks of cardiometabolic mortality were similar for annualized levels between 30-50 nmol/L, 50-75 nmol/L and ≥75 nmol/L (31-33%). Lifetime risk was highest among participants with annualized total 25(OH)D30 nmol/L and ≥2 major traditional risk factors (45%), whereas lifetime risk was lowest among participants with annualized 25(OH)D ≥30 nmol/L and low-intermediate risk factors (28%). Lifetime risk estimates were similar across BMI categories. In conclusion, a single measurement of vitamin D deficiency (annualized levels30 nmol/L) in middle- to older-aged adults is a strong predictor of high lifetime risk for cardiometabolic mortality, particularly among those with high burden of traditional risk factors.

Purpose: Canada’s Food Guide (CFG) defines food serving sizes and recommends a specific number of servings from each of the 4 food groups. However, there is no differentiation in serving sizes for different versions of foods that may differ in nutritional value.Methods: Participants (n = 20) estimated serving sizes of “healthier” and “unhealthier” versions of milk, bread, cereal, potatoes, chicken, fish, and juice and reported the amount normally consumed in 1 sitting.Results: Participants estimated unhealthier servings of cereal and juice to be smaller than healthier servings, but estimated unhealthier servings of chicken to be larger than healthier versions (P < 0.05). There were no differences for bread, milk, potatoes, and fish. Accordingly, estimated servings of juice (P < 0.01) had more calories than the unhealthier orange drink. There were no caloric differences for cereal (P = 0.12), but an estimated serving of bran flakes had more fat and fibre than frosted flakes cereal.Conclusions: In contrast with CFG, which does not account for different versions of food, certain unhealthier foods were estimated to be smaller or larger than the healthier versions. However, both healthy and unhealthy serving sizes still tended to be larger than what is prescribed in CFG. Thus, better education or revision of serving sizes in future editions of CFG may warrant consideration.

We examined the joint and independent associations between VAT and LF with insulin sensitivity (IS) and lipids in seventy-one obese adolescents (BMI ≥ 95th, 14.9 ± 1.8 years). VAT was assessed by magnetic resonance imaging, and LF was quantified by proton magnetic resonance spectroscopy. IS was evaluated by a 3 -h hyperinsulinemic (80 mU·m−2·min−1) euglycemic clamp. Independent associations between VAT and LF on metabolic variables were assessed in mutually adjusted multivariate models. The joint association between VAT and LF on metabolic variables was assessed by categorizing participants into a low VAT + low LF group (n = 35), high VAT + low LF group (n = 26), or high VAT + high LF group (n = 10), based on a VAT median split (1.17 kg) and high (≥5%) and low (

Objective To examine whether changes in modifiable risk factors [physical activity, cardiorespiratory fitness (CRF), body weight, and diet composition] are associated with the transition to metabolically healthy overweight/obese (MHOW) versus metabolically abnormal overweight/obese. Methods Analysis included 1,358 adults [aged 25.0 (3.5) years] from the CARDIA study who were healthy at baseline and had overweight/obesity at follow-up. Participants with zero or one of the following six risk factors were classified as MHOW: elevated triglycerides, LDL, blood pressure, fasting glucose, and HOMA-insulin resistance and low HDL. Results Over the 20-year follow-up, the sample gained weight (BMI 24.5 to 31.1 kg/m2), and the prevalence of MHOW was 47% at follow-up. After adjusting for changes in CRF, diet, and weight change, physical activity and macronutrient intake were not independently associated with MHOW (P > 0.05), while changes in CRF [fit–unfit: RR (95%) = 0.58, 0.52-0.66; unfit–unfit: RR = 0.67, 0.58-0.76, versus fit–fit] and weight [gain: RR (95%) = 0.54, 0.43-0.67; cycle: RR = 0.74, 0.57-0.94, versus stable] were independently associated with MHOW. Conclusions Focusing on high CRF and strategies to limit weight gain may be important for individuals with overweight and obesity in early to mid-adulthood to maintain a metabolically healthy profile.

Recent literature has suggested that bicycling may be associated with increases in serum PSA levels, a diagnostic and prognostic marker for prostate cancer. To further investigate this relationship, we conducted a systematic review and meta-analysis of current literature in this field.MEDLINE, CENTRAL, CINAHL and SPORTDiscus were searched using MeSH terms and keywords for English publications related to bicycle riding and PSA. Studies were included if PSA was measured relative to cycling activity in healthy men who were free of any prostatic condition. Case studies were excluded.Eight studies met our inclusion criteria, comprising 912 participants that engaged in, or self-reported, bicycling activity. Six studies investigated the acute pre-post change in PSA following bicycling activity that ranged from a single cycling bout of 15 min to a 4-day cycling event. Following cycling activity, two studies reported total PSA increased from baseline by up to 3.3-fold, free PSA increased in one study by 0.08±0.18 ng ml(-)(1) and did not change in four studies. One study compared PSA in elite/professional cyclists versus non-cyclists and demonstrated no significant difference in PSA measurements between groups. Data from six studies were meta-analyzed and demonstrated no significant increase in PSA associated with cycling from pre to post (mean change +0.027 ng ml(-)(1), s.e.m.=0.08, P=0.74, 95% confidence interval (CI)=-0.17-0.23).Our findings suggest that there is no effect of cycling on PSA; however, the limited number of trials and the absence of randomized controlled trials limit the interpretation of our results. Additionally, the median sample size only consisted of 42 subjects. Therefore, our study may have low statistical power to detect a difference in PSA. Although, a higher sample size may demonstrate statistical significance, it may not be clinically significant. Studies of higher empirical quality are needed.

The objective was to determine whether detectable levels of OP metabolites influence the relationship between BMI and cardiometabolic health. This cross-sectional study was conducted using 2227 adults from the 1999–2008 NHANES datasets. Urinary concentrations of six dialkyl phosphate metabolites were dichotomized to above and below the detection limit. Weighted multiple regression analysis was performed adjusting for confounding variables. Independent of BMI, individuals with detectable metabolites had higher diastolic blood pressure (for dimethylphosphate, diethylphosphate, and diethyldithiophosphate;P<0.05), lower HDL (for diethyldithiophosphate;P=0.02), and higher triglyceride (for dimethyldithiophosphate;P=0.05) than those below detection. Contrarily, those with detectable dimethylthiophosphate had better LDL, HDL, and total cholesterol, independent of BMI. Individuals at a higher BMI range who had detectable diethylphosphate (interaction:P=0.03) and diethylthiophosphate (interaction:P=0.02) exhibited lower HDL, while little difference existed between OP metabolite detection statuses at lower BMIs. Similarly, individuals with high BMIs and detectable diethylphosphate had higher triglyceride than those without detectable levels, while minimal differences between diethylphosphate detection statuses were observed at lower BMIs (interaction:P=0.02). Thus, cardiometabolic health outcome differs depending on the specific OP metabolite being examined, with higher BMIs amplifying health risk.

Summary Background & Aims Previous studies assessing the prognosis of metabolically healthy obesity (MHO) have been limited by a lack of a harmonized definition of MHO phenotype. Furthermore, obesity is a risk factor for vitamin D deficiency and low vitamin D status has been associated with a higher risk of mortality; however, few studies have evaluated the joint association between vitamin D, metabolic health phenotype, and mortality risk. Using a harmonized definition, we investigated whether MHO is associated with subsequent all-cause and cardiometabolic mortality, and whether serum 25-hydroxyvitamin D [25(OH)D] modifies these associations. Methods This study included participants aged ≥20 years from the Third National Health and Nutrition Examination Survey (NHANES III). MHO phenotype was defined as a combination of obesity (≥30 kg/m2) and zero component of metabolic syndrome. Multivariable Cox regression was used to assess the risk of mortality across metabolic phenotypes, and the joint association between metabolic phenotype and 25(OH)D. Fine and Gray regression was performed to account for competing risk events. Results Among 11,333 participants, a total of 2980 deaths (937 cardiometabolic death outcomes) occurred during a median follow-up of 19.1 years. In the absence of any metabolic abnormality, obesity (MHO) was not associated with a higher risk of all-cause (hazard ratio [HR], 0.89 [95% CI, 0.52–1.51]) or cardiometabolic mortality (cause-specific HR, 1.21 [95% CI 0.33–4.46]). Similar results were obtained from competing risk analysis. No significant differences in average 25(OH)D levels were observed between MHO and non-MHO participants; however, there was a significant interaction between metabolic health phenotype and serum 25(OH)D in relation to cardiometabolic mortality such that levels of serum 25(OH)D Conclusions Our results support the hypothesis that MHO phenotype is a benign health condition. Vitamin D deficiency may exacerbate the risk of cardiometabolic death outcomes associated with metabolic dysfunction in normal weight and obese individuals. Further research is warranted to validate our findings.

Background Previous literature suggests the beneficial effects of fitness on abdominal obesity may be attenuated in obesity and abolished in severe obesity. It is unclear whether the beneficial association between fitness and health is similarly present in those with mild and severe obesity. Methods Patients from the Wharton Medical Clinic (n = 853) completed a clinical examination and maximal treadmill test. Patients were categorized into fit and unfit based on age- and sex-categories and body mass index (BMI) class (mild: ≤ 34.9 kg/m2, moderate: 35–39.9 kg/m2 or severe obesity: ≥ 40 kg/m2). Results Within the sample, 41% of participants with mild obesity had high fitness whereas only 25% and 11% of the participants with moderate and severe obesity, respectively, had high fitness. BMI category was independently associated with most of the metabolic risk factors, while fitness was only independently associated with systolic blood pressure and triglycerides (P

Background Experts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth. Methods From 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13–17 years old; n = 250) and their parents (n = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children’s hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined. Discussion As a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families’ needs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2201-8) contains supplementary material, which is available to authorized users.

The aim of this study was to determine (i) if adults would measure their own waist circumference (WC), (ii) which WC site(s) are the most intuitive and easy to measure and (iii) if measurement accuracy and association between WC and blood pressure differs across five measurement sites. Participants (n = 198) measured their WC first with no instruction and then using visual instructions for the iliac crest, last rib, midpoint, minimal waist and umbilicus. Without instruction, men most commonly measured their WC at the umbilicus and iliac crest, while women measured their WC at the umbilicus and minimal WC. Both men and women reported the minimal waist and umbilicus to be moderately easier to self-measure compared to the other sites (P 0.05). Prevalence of abdominal obesity varied significantly by gender and measurement site, especially for females (normal weight: 0-18%; overweight: 51-79%). Measurement site did not influence accuracy of WC self-measurement or the association between WC and blood pressure (P 0.05). A universal WC landmark is needed. From these results, there does not appear to be a clear clinical advantage in terms of blood pressure or practical advantage of measuring one WC site over another. However, the umbilicus may be the most intuitive and easy to measure.

We examined whether waist circumference (WC) is associated with liver fat in black and white adolescents. Liver fat was measured using a 3T proton magnetic resonance spectroscopy (1H-MRS) in 152 overweight/obese adolescents (94 black and 58 white, body mass index (BMI) ≥85th percentile, aged 12–18 years) without liver diseases or diabetes. WC was measured at the last rib. Total and visceral adipose tissue (VAT) were measured by dual-energy X-ray absorptiometry and magnetic resonance imaging, respectively. The proportion of fatty liver (defined as liver fat ≥5.0% by 1H-MRS) was lower (P < 0.01) in black adolescents (5.3%) compared with their white peers (24.1%). Despite similar age, BMI, WC, and total adiposity (%), black adolescents had lower (P < 0.01) VAT (59.0% vs. 81.3 cm2), liver fat (1.6% vs. 3.5%), and alanine aminotransferase (17.2 vs. 22.0 IU/L) compared with their white peers. Independent of race, WC was associated with liver fat (black, r = 0.43; white, r = 0.64) in a similar magnitude to the association between VAT and liver fat (black, r = 0.44; white, r = 0.51) and these findings remained significant after controlling for age, sex, Tanner stage, and total adiposity. In blacks, WC and sex (male) were independent (P < 0.01) predictors of liver fat, explaining 17.1% and 5.6% of the variance, respectively, while in whites WC was the single best predictor, explaining 40.8% of the variance in liver fat. These findings suggest that enlarged WC is a marker of increased liver fat in overweight/obese white and black adolescents.

Higher body mass index (BMI) increases the risk of cardiometabolic diseases, but nearly a third of the people living with obesity (BMI: ≥30 kg/m2) are metabolically healthy (MHO). Extreme sleep durations and poor sleep quality are associated with higher bodyweight and cardiometabolic dysfunction, but the full extent to which sleep habits may help differentiate those with MHO versus metabolically abnormal obesity (MAO) is not yet known. Data from the U.S. National Health and Nutritional Examination Survey 2005–08 was used (BMI: ≥30 kg/m2; ≥20 y;N=1,777). The absence of metabolic syndrome was used to define MHO. Those with MHO tended to be younger, female, Non-Hispanic Black, never smokers, more physically active, and with less physician diagnosed sleep disorders than MAO. Neither sleep duration nor overall sleep quality was related to MHO in crude or multivariable adjusted analyses; however, reporting “almost always” to having trouble falling asleep (OR (95% CI): 0.40 (0.20–0.78)), waking up during the night (0.38 (0.17–0.85)), feeling unrested during the day (0.35 (0.18–0.70)), and feeling overly sleepy during the day (0.35 (0.17–0.75)) was related to lower odds of MHO. Selected sleep quality factors, but not sleep quantity or overall sleep quality, are associated with the MHO phenotype.

Objective Whether the increase in prescription medication use over time differs by age and obesity status is unclear. Method National Health and Nutrition Examination Survey (NHANES) between 1988 and 2012 was analyzed (n = 57,543). Findings Increased medication use over time was seen in older individuals of all body mass index (BMI) classes, with the most prominent increase in those with obesity (p0.05). Conclusion Older individuals of all BMI classes may be driving the increase in medication use over time. However, the rise in the likelihood of taking cardiometabolic medications over time was generally not different between those with or without obesity in men with some increases seen in older women. Further research may be required to assess accessibility and barriers to medication use among certain demographics.

Summary Background/Objectives The objective of this study was to determine if abdominal adipose tissue (AT) measurement site influences the association between baseline and change in abdominal subcutaneous (ASAT) and visceral AT (VAT), and metabolic risk factors in obese adolescents. Methods Fifty-five obese adolescents (14.9 ± 1.7 years; 51% male; 42% white) participated in an aerobic or resistance exercise intervention three times/week for 3 months. We compared the association between changes in abdominal AT area (spanning 5 cm below to 15 cm above L4–L5) and volume measured by magnetic resonance imaging with concomitant changes in metabolic risk. Results All AT areas were significantly (p

OBJECTIVE To determine the prevalence of metabolically healthy obesity (MHO) in children and examine the demographic, adiposity, and lifestyle predictors of MHO status. RESEARCH DESIGN AND METHODS This cross-sectional study included 8–17 year olds with a BMI ≥85th percentile who were enrolled in a multidisciplinary pediatric weight management clinic from 2005–2010. Demographic, anthropometric, lifestyle, and cardiometabolic data were retrieved by retrospective medical record review. Participants were dichotomized as either MHO or metabolically unhealthy obese (MUO) according to two separate classification systems based on: 1) insulin resistance (IR) and 2) cardiometabolic risk (CR) factors (blood pressure, serum lipids, and glucose). Multivariable logistic regression was used to determine predictors of MHO using odds ratios (ORs) with 95% CIs. RESULTS The prevalence of MHO-IR was 31.5% (n = 57 of 181) and MHO-CR was 21.5% (n = 39 of 181). Waist circumference (OR 0.33 [95% CI 0.18–0.59]; P = 0.0002) and dietary fat intake (OR 0.56 [95% CI 0.31–0.95]; P = 0.04) were independent predictors of MHO-IR; moderate-to-vigorous physical activity (OR 1.80 [95% CI 1.24–2.62]; P = 0.002) was the strongest independent predictor of MHO-CR. CONCLUSIONS Up to one in three children with obesity can be classified as MHO. Depending on the definition, adiposity and lifestyle behaviors both play important roles in predicting MHO status. These findings can inform for whom health services for managing pediatric obesity should be prioritized, especially in circumstances when boys and girls present with CR factors.

The purpose of this review was to describe the health consequences of obesity in older adults. Although obesity is associated with risk of cardiovascular disease, type 2 diabetes, hypertension, and dyslipidemia in the elderly, the association appears to be weaker in older compared to younger adults. Obesity in older adults is also associated with significantly higher risk of osteoarthritis, postmenopausal breast cancer, and impairments in physical function. However, the influence of obesity on mortality risk, osteoporosis, fracture risk, and cognitive function in older adults is not well understood. Intentional weight loss in obese older adults may be beneficial for metabolic health and physical function, but more long-term studies are needed. When examining the influence of obesity on different health parameters, future studies should consider using alternative measures of obesity beyond body mass index (BMI), such as waist circumference, and also investigate how body weight changes across the lifespan may influence health. The association between obesity and different health parameters in older adults appears to be more complex than in younger adults, and thus requires further investigation.

Objectives: To determine if the association between frequency of leisure-time physical activity and mortality risk differs across adulthood. Method: 9,249 adults from the NHANES III (1988-1994) were categorized as middle-aged (40-64 years), old (65-79 years) or very old (≥80 years), and as inactive (0 bouts of physical activity/week), lightly active (1-2 bouts/week), moderately active (3-4 bouts/week) or very active (5+ bouts/week). Results: In all age categories, lightly, moderately, and very active adults had a lower mortality risk compared to inactive adults ( p < .001). In very old adults only, being very active was associated with a lower mortality risk compared to being lightly active (HR 0.80, 95% CI 0.64-0.98; p = .03) and moderately active (HR 0.80, 95% CI 0.65-0.98; ( p = .03). Discussion: The association between physical activity frequency and mortality risk is strongest in very old adults. All adults and particularly very old adults may benefit from participating in physical activity five or more times a week.

Objective We examined skeletal muscle (SM) and fat distribution using whole-body MRI in response to aerobic (AE) versus resistance exercise (RE) training in obese adolescents and whether DXA provides similar estimates of fat and SM change as MRI. Design and Methods Thirty-nine obese boys (12-18 years) were randomly assigned to one of three 3-month interventions: AE (n = 14), RE (n = 14), or a control (n = 11). Results At baseline, MRI-measured total fat was significantly greater than DXA-measured total fat [△ = 3.1 kg (95% CI: −0.4 to 7.4 kg, P 0.05)], but DXA tended to overestimate MRI fat losses in those with larger fat losses. MRI-measured SM and DXA-measured lean body mass were significantly correlated, but as expected the absolute values were different at baseline [△ = −28.4 kg (95% CI: −35.4 to −21.3 kg, P < 0.05)]. Further, DXA overestimated MRI gains in SM in those with larger SM gains. Conclusions Although DXA and MRI-measured total and regional measures tended to be correlated at baseline and changes with exercise, there were substantial differences in the absolute values derived using DXA versus MRI. Further, there were systemic biases in the estimation between the methods wherein DXA tended to overestimate fat losses and SM gains compared to MRI. Thus, the changes in body composition observed are influenced by the method employed.

Objective It is unclear whether all obese individuals should be prescribed weight loss (WL) treatment. The effect of a clinically significant WL of 5% on metabolic factors among metabolically normal and abnormal overweight and obese (MNO and MAO) individuals was examined. Design and Methods The sample included 392 overweight and obese adults from the Wharton Medical Clinic. MAO was defined as having one or more clinically relevant aberrations in glucose, triglycerides, blood pressure (BP), high-density lipoprotein-C, low-density lipoprotein-C, preexisting, or current medication use for metabolic conditions. Results Of the 392 patients, 21.2% of the sample was MNO at baseline and 41.3% of the sample attained a 5% WL. Regardless of initial metabolic health status, improvements in most risk factors were observed with a 5% WL in comparison with those who did not lose weight. Even MAO patients who did not achieve a 5% WL still significantly improved BP and cholesterol over the treatment period. Conclusions A clinically significant WL is beneficial for the cardiometabolic risk profile of both MNO and MAO. However, a 5% WL is not necessarily required to improve the cardiometabolic risk profile of MAO. Thus, lifestyle-based WL provides beneficial metabolic effects for all overweight and obese individuals, particularly those with significant metabolic aberrations.

background We conducted a study to determine the joint association of physical activity, pharmacologic treatment for hypertension, and the control of blood pressure (BP) on all-cause mortality risk. methods The study subjects were 10,665 adults from the Third National Health and Nutrition Examination Survey (NHANES III) and the Continuous NHANES survey (1999–2000 and 2000–2001). Cox proportional hazards analyses were used to estimate differences in mortality risk according to physical activity, pharmacologic treatment for hypertension, and BP control, with physically active, treated, and controlled as the referent category. results The average follow-up time in the study was 8.6 ± 4.8 years. The main effect of physical activity was significant independently of pharmaco logic treatment and BP control (P