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Despite the high prevalence of overweight and obesity in the human and companion animal populations, and the global trends for increasing numbers of affected people and pets, there are few successful interventions that are proven to combat this complex multifactorial problem. One key strategy involves effective communication between human and veterinary healthcare professionals with patients and clients about obesity. In human healthcare, the focus of communication should be on physical activity as part of overall health and wellbeing, rather than assessment of the body mass index; clinical examination of patients should record levels of physical activity as a key 'vital sign' as part of their assessment. Successful weight loss programmes for companion animals also involves strategic communication with the entire healthcare team leading clients through the 'stages of change'. There is great potential in employing a 'One Health' framework to provide novel solutions for the prevention and treatment of this condition in people and their pets. Comparative clinical research into the biology of obesity and its comorbidities in dogs and cats is likely to lead to knowledge relevant to the equivalent human conditions. The advantages of companion animal clinical research over traditional rodent models include the outbred genetic background and relatively long lifespan of pets and the fact that they share the human domestic environment. The human-companion animal bond can be leveraged to create successful programmes that promote physical activity in people and their pets with obesity. Dog walking is a proven motivator for human physical activity, with health benefits to both the owner and the dog. Realizing the potential of a One Health approach will require the efforts and leadership of a committed group of like-minded individuals representing a range of scientific and medical disciplines. Interested parties will need the means and opportunities to communicate and to collaborate, including having the resources and funding for research. One Health proponents must have a role in forming public policy related to the prevention and management of overweight and obesity., (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The evaluation process for obesity uses the same framework of a history, physical examination and interpretation of selected laboratory and diagnostic tests that are used for other chronic care patient encounters. What makes this evaluation process different is knowing how to take an obesity focused history, what to examine, and which tests to order. An assessment of risk status is then determined based on the National Heart, Lung, and Blood Institute Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Other important aspects of the evaluation process include determining the patient's goals, expectations, and motivation for weight loss along with support systems and/or barriers to behavior change.

Exercise is frequently identified as a predictor of weight maintenance after elective weight loss in retrospective studies of treatments for obesity. We conducted a prospective study to test whether physical activity measured soon after weight loss predicted weight maintenance and to determine how much physical activity was required to optimize maintenance. Thirty-two women [mean (+/- SD) age, 38 +/- 7 y; body mass index (in kg/m2), 24 +/- 3] were recruited through local advertising within 3 mo of reaching their target for weight loss (23 +/- 9 kg). Total energy expenditure (TEE) was measured by the doubly labeled water method. Postabsorptive resting metabolic rate (RMR) and postprandial RMR [expressed as thermic effect of a meal (TEM)] were measured by respiratory gas exchange. Women in the physically active group (ratio of TEE to RMR = 1.89 +/- 0.08) gained 2.5 +/- 3.1 kg during the 12 mo after reaching their target for weight loss, moderately active women (TEE:RMR = 1.64 +/- 0.05) gained 9.9 +/- 10.5 kg, and sedentary women (TEE:RMR = 1.44 +/- 0.08) gained 7.0 +/- 5.9 kg (P < 0.01). Retrospective analyses of weight regain as a function of energy expended in physical activity indicated a threshold for weight maintenance of 47 kJ x kg body wt(-1) x d(-1). This corresponds to an average of 80 min/d of moderate activity or 35 min/d of vigorous activity added to a sedentary lifestyle.

Standardization of measurement conditions is essential for obtaining accurate, precise, and reproducible bioelectrical impedance analysis (BIA) data. Errors due to lack of measurement control are propagated in subsequent calculations of body composition and contribute to differences in predictive equations among investigators. Various individual and environmental factors have been shown to influence BIA. We review the factors that have been identified from the literature as being conditions requiring standardization both for healthy subjects and for those in a medical setting.

The use of bioelectrical impedance analysis (BIA) in patients with end-stage renal disease who are receiving dialysis provides researchers with two important applications: 1) a biological model in which the underlying assumptions of BIA can be tested, and 2) if valid, a tool that can be used to improve the clinical management of patients receiving dialysis. We review the rationale of and purpose for using BIA in the dialysis population, the physiologic changes that occur during dialysis that influence BIA measurements, and last, conclusions reached from the current scientific literature.

Background: Previous surveys have shown that there is a disparity between physicians' beliefs about the importance of diet and nutrition in health maintenance and disease prevention and the actual delivery of nutrition counseling. The primary objective of this study was to assess the current attitudes, practice behavior, and barriers to the delivery of nutrition counseling by primary care physicians., Methods: A random-sample-mailed questionnaire was sent to 2,250 primary care physicians selected from the AMA masterfile from general practice, internal medicine, and pediatrics, representing self-employed, group, hospital, and HMO practices. Participants were stratified by age, gender, geographical region, and present employment. The main outcome measures were to determine time spent by physicians providing and percentage of patients receiving dietary counseling and to identify barriers to the delivery of nutrition counseling., Results: A 49% response rate (n = 1,103) was obtained. Results are presented for the 1,030 physicians (70% private practice) with complete data. Over two-thirds of physicians provide dietary counseling to 40% or less of patients and spend 5 or fewer min discussing dietary changes. Despite this pattern, nearly three-quarters of respondents feel that dietary counseling is important and is the responsibility of the physician. Ranking of perceived barriers to delivery of dietary counseling were lack of time, patient noncompliance, inadequate teaching materials, lack of counseling, training, lack of knowledge, inadequate reimbursement, and low physician confidence., Conclusions: This survey suggests that multiple barriers exist that prevent the primary care practitioner from providing dietary counseling. A multifaceted approach will be needed to change physician counseling behavior.

Several recent self-reported surveys have suggested that African-American women may engage in less leisure-time physical activity (PA) than whites. Objective measurements of PA have not been performed, however. Therefore, the purpose of this study was to compare the components of energy expenditure, including PA, between black and white obese women. Using the doubly labeled water method, total daily energy expenditure (TDEE), basal metabolic rate (BMR), thermic effect of a meal (TEM), and PA were measured in 14 black and 15 white moderately obese women over 2 weeks. No statistically significant differences were seen between the 2 groups in BMR, TEM or TDEE. Mean PA was significantly (p = 0.05) lower among black women compared to whites when expressed as MJ. d-1 (3.49 vs. 4.30) or kJ.kg-1.d-1 (37.6 vs. 47.7). Our study supports the survey differences seen in PA among black and white women.

The effect of aerobic exercise on dietary compliance was assessed in 13 obese women (44 +/- 3% fat) during a 12-wk weight-reduction program (EX group). Seventeen obese women (45 +/- 5% fat) not engaged in aerobic exercise (NX group) served as control subjects. The reducing diets were designed to promote a weight loss of 1 kg/wk, with energy intakes individually prescribed (mean +/- SD: 4.9 +/- 0.6 MJ/d) to approximate 75% of each subject's measured basal metabolic rate. The EX group completed of three 45-min sessions/wk of supervised aerobic exercise at 65% of maximal oxygen consumption (VO2max). Daily energy intakes were calculated by summing changes in body stores, measured by total body water isotope dilution, and total daily energy expenditure, measured by doubly labeled water (DLW). Dietary compliance was assessed by comparing calculated intakes with prescribed intakes. Both the EX and NX groups reported consuming close to their prescribed daily intakes, with differences of -0.08 +/- 0.28 (EX group) and +0.03 +/- 0.57 (NX group) MJ/d, respectively. However, expenditure/balance data determined by the DLW method indicated that the EX subjects exhibited better dietary compliance than the NX subjects, with intakes exceeding those prescribed by only 0.7 +/- 1.5 compared with 2.3 +/- 1.6 MJ/d for the NX subjects (P = 0.01). Therefore, an additional benefit of aerobic exercise during energy restriction is enhanced dietary compliance, which has important implications for the treatment of moderate obesity.

To test the benefits of aerobic exercise and dietary carbohydrate during reduced-energy feeding, 23 obese women (44 +/- 4% fat) were randomly assigned to either aerobic exercise (Ex) or no exercise (Nx), and to a low-fat (LF) or low-carbohydrate (LC) reducing diet (5.00 +/- 0.56 MJ/d) for 12 wk. Changes in body composition, postabsorptive resting metabolic rate (RMR), thermic effect of a meal (TEM), and total daily energy expenditure (TDEE) were measured by respiratory gas exchange and doubly labeled water. Significant effects of Ex included a greater loss of fat mass (Ex: -8.8 +/- 2.1 vs Nx: -6.1 +/- 2.3 kg, P = 0.008) and maintenance of TDEE (Ex: +0.07 +/- 1.23 vs Nx: -1.46 +/- 1.04 MJ/d, P = 0.004), due to a difference in physical activity (Ex: +0.75 +/- 1.06 vs Nx: -0.61 +/- 1.03 MJ/d, P = 0.006), which was not attributable solely to the Ex sessions. RMR in both groups decreased comparably (-0.54 MJ/d), and TEM (% of meal) did not change. Diet composition did not significantly influence body composition or energy expenditure changes, but a greater weight loss was observed after the LC than after the LF (-10.6 +/- 2.0 vs -8.1 +/- 3.0 kg, P = 0.037) diet. The addition of aerobic exercise to a low-energy diet was beneficial in the treatment of moderate obesity because of its favorable effects on body composition, physical activity, and TDEE.

Comparison of heart rate and physical activity recall with doubly labeled water in obese women. Med. Sci. Sports Exerc., Vol. 27, No. 1, pp. 126-133, 1995. Accurate methods of estimating total daily energy expenditure (TDEE) that are inexpensive and differentiate activities of varying intensities are needed in obesity research. We compared minute-by-minute heart rate (HR) monitoring and the 7-d physical activity recall (PAR) questionnaire with doubly labeled water (DLW) for the measurement of TDEE and physical activity in 14 obese women (45% +/- 4% fat, mean +/- SD) before and during 12 wk of weight reduction. TDEE was measured over 2 wk by DLW. HR monitoring was conducted for 3 d, with individual VO2/HR calibrations applied to HR data above 3 METs. PAR revealed the amount of time spent in sleep, moderate, hard, and very hard activities during 1 wk, with time spent in light activities determined by difference. Mean TDEE values, expressed as the % difference from DLW, prior to weight loss were -5.2 +/- 10.8% by HR and 3.4 +/- 14.4 by PAR, and during the diet were + 0.9 +/- 14.1% by HR and + 0.9 +/- 14.7% by PAR. Individual variability was high for both HR (-24.0 to + 25.6%) and PAR (-27.4 to + 36.2%). Energy expended in physical activity prior to weight loss were 3.97 +/- 1.23 MJ.d-1 by DLW, 3.91 +/- 0.90 by HR, and 4.79 +/- 0.95 by PAR. During weight loss, physical activity values by DLW, HR, and PAR were 4.31 +/- 1.18, 4.84 +/- 2.22, and 4.64 +/- 1.06 MJ.d-1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Over the years ideal or desirable weights have been associated with the lowest mortality and defined in a number of ways. The widely used height-weight tables of the Metropolitan Life Insurance Company, developed in the 1940s, have been supplanted in the last decade by new weight standards based on findings of several population-based studies that compared body weight to mortality. The Quetelet or body mass index (BMI), now used as the de facto criterion for defining a desirable weight index, indicates relative fatness and is only minimally correlated with height. However, the optimal BMI or weight for longevity remains to be defined for a number of methodological reasons. This article reviews the strength of the evidence for increased mortality in adults who are overweight or underweight based on standard BMI ranges and in those who reported a change in body weight. Epidemiological studies show that excess body weight is associated with increased mortality, depending on fat patterning, gender, and age. A similar increase is shown for subjects with body weight below the relative weight range, although here associated life-style factors are greater contributors. Preliminary data suggest that change in body weight may also be associated with increased mortality. Overall, carefully measured weight and height remain the most easily performed and useful determinants of nutritional status and predictors of mortality for the general population.

"I can't lose weight" is a frequent refrain among obese patients. Even though a patient desires to lose extra pounds and apparently is complying with his or her physician's recommendations, the expected weight loss often does not occur. To achieve a more successful outcome in obese patients, the authors suggest that physicians become active rather than passive participants in the weight loss regimen.

Compliance with a lipid-lowering diet was sustained in only 30% of patients following an initial three-month intervention. Additional strategies are required to support long-term adherence.

We compared two bioelectrical impedance analysis models, the right-sided tetrapolar method and an experimental cylindrical method, to total body water (TBW) determined by isotopic dilution in 37 prepubertal children aged 5-9 years, who were divided into development and cross-validation groups. Despite its theoretical advantage, no improvement in predicted TBW was seen with the experimental method. The best predictive equation, using the tetrapolar method, was TBW (kg) = 1.84 + 0.45 (height square/resistance) +0.11(weight); r2 = 0.98; SEE = 0.62 kg.

We investigated the general utility of bioelectrical impedance analysis (BIA) and the implications of BIA theory in populations of various ages from infancy to adulthood by developing a single impedance equation. Four subject data sets representing 62 adults, 37 prepubertal children, 44 preschool children, and 32 premature low-birth-weight neonates were combined. Subjects were randomly divided into a development group (n = 116) and a cross-validation group (n = 59). The single best predictor of total body water (TBW) was height2/resistance (ht2/R), which explained 99% of the variation in TBW (SEE = 1.67 kg). The addition of weight reduced the SEE to 1.41 kg. A significant bias was only seen in the preschool children. These results were confirmed in the cross-validation group and the best prediction formula was TBW = 0.59 ht2/R + 0.065 wt + 0.04. We conclude that the impedance index (ht2/R) is a significant predictor of TBW and that there is some improvement in prediction of TBW by inclusion of a weight term.

Clinical trials indicate that elemental enteral diets are equally as effective as corticosteroid treatment for acute Crohn's disease; however, a clear efficacy of polymeric formulas has yet to be demonstrated. Moreover, the mechanism of action of enteral nutrition remains uncertain, and further study is needed to define the precise role of specialized enteral formulas in the long-term management of this disease.

Whole-body bioelectrical impedance analysis (BIA) is widely used by researchers and clinicians as a noninvasive and safe method to estimate body composition and body water volume in children and adults. Development of new approaches, such as segmental and multifrequency analyzers, should greatly expand the utility of this electrical technique. This article reviews the principles, underlying assumptions, clinical applications and future directions of the BIA method.

Because limited information exists about nutrition training of residents, we studied the teaching practices of nationally recognized nutrition programs. Two hundred thirty-eight nutrition educators and 787 residency-program directors identified 160 institutions with strong nutrition training. The 23 highest-ranked programs were surveyed and 7 were visited. The results showed that 1) clinically active physician-nutritionist role models are the key elements in teaching residents clinical nutrition; 2) multidisciplinary nutrition support teams are valuable learning resources unless they function primarily as technical support services; 3) nutrition elective rotations, although highly effective, are taken by a minority of residents; 4) the nutrition curriculum should include practical learning materials and conferences; and 5) a research environment is important to attract qualified physician-nutritionist role models. A major deficit is teaching nutritionally based approaches to disease prevention in the ambulatory setting. Finally, a shortage of nutrition-oriented physician role models is probably the major constraint in teaching nutrition to residents.

A moderately obese 49-year-old woman who was enrolled in a nutrition and weight control clinic quickly attained her target weight through an individualized program of balanced deficit diet, routine exercise, and weekly counseling. Weight loss continued until she was 15% below Metropolitan Relative Weight, when family members grew concerned that she had developed an eating disorder. Despite nutritional and behavioral counseling, she has rigorously maintained her exaggerated weight loss. This case report illustrates a potentially serious but often overlooked reason for careful monitoring of patients undergoing treatment for obesity. Health professionals involved in weight control programs should routinely assess patients for potential eating disorders.

Patients with inflammatory bowel disease often present with weight loss. Among possible causes, an elevated energy expenditure has frequently been suggested but is the least documented. In this study resting metabolic rate (RMR) and total daily energy expenditure (TDEE) were measured in 15 outpatients with inflammatory bowel diseases and in eight healthy control subjects. Measured RMR as a percentage of that predicted from fat-free mass was not significantly different for control subjects (102 +/- 9.8%, mean +/- SD) and patients (100 +/- 13.3%). TDEE, expressed as a multiple of RMR, was 1.70 +/- 0.31 for control subjects and 1.78 +/- 0.24 for patients. When patients were subgrouped as greater than or equal to 90% or less than 90% desirable body weight, a mean increase over RMR predicted from fat-free mass was seen in the underweight patients (106 +/- 9.3%) but not in normal-weight patients (99.0 +/- 15.6%). Mean TDEE/RMR values for the patient subgroups were 1.70 +/- 0.30 and 1.88 +/- 0.08, respectively. We conclude that stable outpatients with inflammatory bowel disease have only a minimal increase in energy needs.