Distriktssköterskans erfarenheter av hälsosamtal avseende levnadsvanor gällande övervikt och fetma : En Fenomenografisk enkätstudie

Syfte: Syftet med studien är att beskriva distriktssköterskans erfarenhet av hälsosamtal avseende levnadsvanor med patienter som lever med övervikt eller fetma. Metod: En empirisk studie med kvalitativ ansats utfördes via enkätfrågor som var beskrivande med öppna svarsalternativ. I studien deltog fem distriktssköterskor som arbetade på vårdcentral i Dalarna eller på Gotland. Genom fenomenografisk design analyserades data. Resultat: Resultatet läggs fram genom två beskrivningskategorier; Evidensbaserade metoder som innehöll uppfattningsgrupperna; Utredning och behandling samt Bejaka patientens resurser. Beskrivningskategorin Omgivnings faktorer, hade uppfattningsgrupperna; Frekvensen av hälsosamtal samt Pedagogiskt förhållningssätt. Användning av evidensbaserade verktyg såsom midjemått och midja/höftkvot var låg bland distriktssköterskorna, men body mass index (BMI) samt motiverande samtal (MI) användes flitigt. Patienter söker ofta för andra besvär (högt blodtryck, ledbesvär) som kan återkopplas till kroppsvikten. Distriktssköterskorna erfarenhet var att det är svårt att komma tillrätta med viktproblem där motivation till viktnedgång var stark i början hos patienten men att den avtar. Dessa svårigheter kan bero på depression, skuld och skam hos patienterna. Slutsats: För att patienter med övervikt och fetma ska få den ultimata behandlingen krävs mer tid och resurser från hälso- och sjukvården då det kan vara en lång process att gå ner i vikt. Motivationen har en avgörande roll samt användning av evidensbaserade verktyg.

Genetic variation and obesity in Australian women: A prospective study.

Objective: A number of candidate genes have been implicated in the pathogenesis of obesity in humans. This study examines associations between longitudinal changes in body mass and composition and the presence of polymorphisms in the ß-3 adrenergic receptor, tumor necrosis factor-α, leptin, and leptin receptor (Lepr) in a cohort of Australian women.

Research Methods and Procedures: Healthy white Australian women (n = 335) were randomly selected from the Barwon region of Victoria and underwent baseline anthropometry and double-energy X-ray absorptiometry for assessment of body mass and adiposity. These measurements were repeated again at 2-year follow-up. Genomic DNA was extracted and used for polymerase chain reaction-based genotyping of all polymorphisms.

Results: The Pro1019Pro Lepr polymorphism was associated with longitudinal increases in body weight (p = 0.02), fat mass (p = 0.05), and body mass index (p = 0.01) in this study, and individuals homozygous for the A allele at this locus had a greater propensity to gain body fat over time. The largest effects on body composition seemed to be in individuals already obese at baseline. Changes in body weight, fat mass, percent body fat, and body mass index over a 2-year period were not associated with genetic variation in the ß-3 adrenergic receptor (Trp64Arg), tumor necrosis factor-α promoter, or leptin genes in non-obese or obese women.

Discussion: These results suggest that a Lepr polymorphism is involved in the regulation of body mass and adiposity in obese Australian white women, which may have implications for the treatment of obesity in this population.

Which aspects of socioeconomic status are related to obesity among men and women?

OBJECTIVE: This study aimed to investigate the relationships between body weight and fat distribution, and four empirically derived domains of socioeconomic status: employment, housing, migration status and family unit.

DESIGN: A population-based study was used.

PARTICIPANTS: A total of 8667 randomly-selected adults (4167 men; 4500 women) who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objective height, weight and body fat distribution, and a range of sociodemographic indicators.

RESULTS: Results demonstrated associations for women, after controlling for age, between the employment domain, and body mass index and waist-to-hip ratio. Low status employed women were 1.4 times as likely to be overweight as high status employed women. There were less consistent relationships observed among these factors for men. Relationships between family unit and indicators of body weight and body fat distribution were observed for both men and women, with those who were married, particularly men (OR=1.6, 95% CI 1.4-2.0), at higher risk of overweight. The migration and housing socioeconomic status domains were not consistently associated with body mass index or waist-to-hip ratio.

CONCLUSIONS: These findings indicate that different components of socioeconomic status may be important in predicting obesity, and thus should be examined separately. Future research would benefit from investigating the underlying mechanisms governing the relationships between socioeconomic status domains further, particularly those related to employment and family unit and obesity

Who does not gain weight? Prevalence and predictors of weight maintenance in young women

OBJECTIVE: To investigate the prevalence and predictors of weight maintenance over time in a large sample of young Australian women.

DESIGN: This population study examined baseline and 4 y follow-up data from the cohort of young women participating in the Australian Longitudinal Study on Women's Health.

SUBJECTS: A total of 8726 young women aged 18-23 y at baseline.

MEASURES: Height, weight and body mass index (BMI); physical activity; time spent sitting; selected eating behaviours (eg dieting, disordered eating, takeaway food consumption); cigarette smoking, alcohol consumption; parity; and sociodemographic characteristics.

RESULTS: Only 44% of the women reported their BMI at follow-up to be within 5% of their baseline BMI (maintainers); 41% had gained weight and 15% had lost weight. Weight maintainers were more likely to be in managerial or professional occupations; to have never married; to be currently studying; and not to be mothers. Controlling for sociodemographic factors, weight maintainers were more likely to be in a healthy weight range at baseline, and to report that they spent less time sitting, and consumed less takeaway food, than women who gained weight.

CONCLUSIONS: Fewer than half the young women in this community sample maintained their weight over this 4 y period in their early twenties. Findings of widespread weight gain, particularly among those already overweight, suggest that early adulthood, which is a time of significant life changes for many women, may be an important time for implementing strategies to promote maintenance of healthy weight. Strategies which encourage decreased sitting time and less takeaway food consumption may be effective for encouraging weight maintenance at this life stage.

Exercise training increases lipid metabolism gene expression in human skeletal muscle

The effects of a single bout of exercise and exercise training on the expression of genes necessary for the transport and beta -oxidation of fatty acids (FA), together with the gene expression of transcription factors implicated in the regulation of FA homeostasis were investigated. Seven human subjects (3 male, 4 female, 28.9 ± 3.1 yr of age, range 20-42 yr, body mass index 22.6 kg/m², range 17-26 kg/m²) underwent a 9-day exercise training program of 60 min cycling per day at 63% peak oxygen uptake (V_{O2 peak}; 104 ± 14 W). On days 1 and 9 of the program, muscle biopsies were sampled from the vastus lateralis muscle at rest, at the completion of exercise, and again 3 h postexercise. Gene expression of key components of FA transport [FA translocase (FAT/CD36), plasma membrane-associated FA-binding protein], beta -oxidation [carntine palmitoyltransferase(CPT) I, beta -hydroxyacyl-CoA dehydrogenase] and transcriptional control [peroxisome proliferator-activated receptor (PPAR)alpha , PPARgamma , PPARgamma coactivator 1, sterol regulatory element-binding protein-1c] were unaltered by exercise when measured at the completion and at 3 h postexercise. Training increased total lipid oxidation by 24% (P < 0.05) for the 1-h cycling bout. This increased capacity for lipid oxidation was accompanied by an increased expression of FAT/CD36 and CPT I mRNA. Similarly, FAT/CD36 protein abundance was also upregulated by exercise training. We conclude that enhanced fat oxidation after exercise training is most closely associated with the genes involved in regulating FA uptake across the plasma membrane (FAT/CD36) and across the mitochondrial membrane (CPT I).

Social comparisons and negative affect as indicators of problem eating and muscle preoccupation among children

The present study examined the utilization of social comparison practices and the role of negative affect in predicting body dissatisfaction, problem eating, and muscle preoccupation among young children. Participants were 236 children aged between 8 and 10 years. Children's eating, exercising, and muscle concerns were examined using a modified version of the Children's Eating Attitudes Test (ChEAT), which included additional items pertaining to muscle bulk and exercising. Consistent with past findings, body mass index (BMI) was found to be the sole unique indicator of body dissatisfaction for both boys and girls. Utilization of social comparison practices with adults was the main unique indicator of the modified ChEAT factors for boys, while BMI was the main unique indicator of the modified ChEAT factors for girls. In addition, negative affect was associated with binging, food preoccupation, and social pressure to eat for boys and dieting and muscle preoccupation for girls. Findings are discussed in relation to previous studies with adolescents and adults.

The taq IA and Ser311Cys polymorphisms in the dopamine D2 receptor gene and obesity

Dopamine D2 receptors (DRD2) in the central nervous system are involved in the regulation of feeding. It remains to be elucidated if mutations in the DRD2 gene contribute to the development of obesity. The aim of the present study was to investigate whether the Taq IA and Ser311Cys polymorphisms in the DRD2 gene are associated with obesity in Nauruan and Australian subjects. Subjects were selected based on extremes of the body mass index (BMI) distribution. Two groups of Australian women were selected. The leanest group had a mean BMI of 22.5 kg/m2 (range: 20.3-24.3) and the heaviest group had a mean of 36.1 kg/m2 (32.5-44.1). Four groups of Nauruan subjects were selected. Leanest men had a mean BMI of 33.0 kg/m2 (28.4-36.9), heaviest men had a mean of 52.8 kg/m2 (46.5-69.2), leanest women had a mean of 34.8 kg/m2 (28.2-41.8) and heaviest women had a mean of 55.1 kg/m2 (49.3-73.8). Subjects were genotyped for the Taq IA and Ser311Cys polymorphisms using polymerase chain reaction (PCR) restriction fragment length polymorphism analysis and allelic discrimination TaqmanTM PCR respectively. Leanest and heaviest groups were examined for differences in genotype frequency. Taq IA and Ser311Cys genotype frequencies did not differ significantly between leanest and heaviest Nauruan groups, or between leanest and heaviest Australians. Haplotype frequencies of these polymorphisms did not differ between leanest and heaviest groups. The Taq IA and Ser311Cys polymorphisms in the DRD2 gene are unlikely to be common causes of obesity in these populations.

Social factors and obesity: an investigation of the role of health behaviours

OBJECTIVES: This study evaluated a behavioural model of the relation between social factors and obesity, in which differences in body mass index (BMI) across sociodemographic groups were hypothesized to be attributable to social group differences in health behaviours affecting energy expenditure (physical activity, diet and alcohol consumption and weight control).

METHODS: A total of 8667 adults who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objectively measured height and weight, health behaviours, and social factors including family status, employment status, housing situation and migration status.

RESULTS: Social factors remained significant predictors of BMI after controlling for all health behaviours. Neither social factors alone, nor health behaviours alone, adequately explained the variance in BMI. Gender-specific interactions were found between social factors and individual health behaviours.

CONCLUSIONS: These results suggest that social factors moderate the relation between BMI and weight-related behaviours, and that the mechanisms underlying sociodemographic group differences in obesity may vary among men and women. Additional factors are likely to act in conjunction with current health behaviours to explain variation in obesity prevalence across sociodemographic groups.

Public definitions of success in weight management

Objective: To examine perceptions of success in weight control and future weight-control intentions in a community sample. Design: Cross-sectional postal survey. Subjects: There were 1500 adults randomly selected from the Electoral Roll of Victoria (47% response). Setting: Community. Main outcome measures: Retrospective weight change over previous 12 months; perceived weight-control success; future weight-control intentions. Statistical analyses: Pearson's χ² tests were used to compare perceived weight-control success by sex, and by age, education level, initial BMI, amount of weight change and weight-loss behaviour within sex. ANOVA was used to compare mean weight change associated with perceived weight control success within sex, and within age, education, body mass index and weight-loss behaviour by sex. The distribution (frequency) of weight-control intentions are reported within perceived weight-control success and amount of weight change. Results: One in two (53%) reported maintaining their weight within 1kg in the preceding 12 months, 26% of men and 21% of women reported weight gain and 20% of men and 26% of women reported weight loss. Almost one-third (30%) of those who maintained their weight considered themselves unsuccessful. A majority of those who lost weight considered themselves successful at controlling their weight. However, more than 45% of men who gained weight also considered themselves successful. Those who considered themselves unsuccessful experienced less weight loss (1.1 ± 3.9kg) than those who considered themselves quite successful (-1.4 ± 4.5 kg, P < 0.001) or very successful (-1.3 ± 7.8 kg, P < 0.001). Conclusion: Public views of what constitutes successful weight control may need to be reoriented to be consistent with public health goals.

A biopsychosocial model of disordered eating and the pursuit of muscularity in adolescent boys

This review provides an evaluation of the correlates and/or risk factors associated with disordered eating and the pursuit of muscularity among adolescent boys. One of the main conclusions is that similar factors and processes are associated with both behavioral problems. Several factors found to be consistently associated with disordered eating among boys are also similar to those found with girls. These include body mass index, negative affect, self-esteem, perfectionism, drug use, perceived pressure to lose weight from parents and peers, and participation in sports that focus on leanness. However, as many of the findings have only been verified using cross-sectional designs, prospective studies are now needed. (PsycINFO Database Record (c) 2008 APA, all rights reserve

An investigation into the incidence of obesity and underweight among adults with an intellectual disability in an Australian sample

Reports suggest that 7% to 18% of Australian adults are obese and a further 16% to 55% are overweight. Studies from other countries have indicated that obesity among people with an intellectual disability may be at least, or even more, prevalent. Prevalence rates range from 28% to 59%. The aim of the current study was to investigate the weight distribution of an Australian sample of people with an intellectual disability using Body Mass Index (BMI) to classify males and females, and Kelly and Rimmer's (1987) Percentage of Body Fat (PBF) formula to also classify males. Forty-one females and 52 males with a mild to severe intellectual disability were assessed. The correlation between BMI and PBF for males was r=.89. BMI classifications revealed a higher percentage of females as overweight (41.4%) and obese (36.6%) compared to overweight males (30.8%) and obese males (30.8%). There were more underweight males (7.6%) than females (4.9%). There was no relationship between living environment and weight classifications on the BMI. The PBF formula indicated that 73% of the males were classified as obese. The possibility of misclassification using the BMI and the need for weight interventions are discussed.

Effect of orlistat on cardiovascular disease risk in obese adults

Aim: The aim of this study is to compare the effect of orlistat vs. placebo on the predicted 10-year cardiovascular disease (CVD) risk in obese people with one or more cardiovascular risk factors treated for 12 months, in conjunction with a fat-reduced, but otherwise ad libitum, diet.

Methods: A double-blind, randomized, placebo-controlled, parallel study was performed in conjunction with a fat-reduced diet and physical activity advice for 1 year. Participants (n = 339) from eight centres in Australia and New Zealand were randomized to either orlistat (120 mg) three times daily (n = 104 women, 66 men; mean ± s.d. age = 52.0 ± 7.5 years, body mass index (BMI) = 37.6 ± 5.1 kg/m2) or placebo three times daily (n = 89 women, 80 men; age = 52.5 ± 7.4 years, BMI = 38.0 ± 4.9 kg/m2). The primary efficacy criterion was the 10-year risk of developing CVD calculated from the Framingham equation. Secondary efficacy criteria were body weight, waist circumference, blood pressure and serum concentrations of triglycerides, cholesterol (total, LDL and HDL), glucose, insulin and glycated haemoglobin and quality of life.

Results: There was no difference in the change in 10-year CVD risk between orlistat and placebo groups over 1 year. The orlistat group, however, had significant favourable changes in many of the individual CVD risk factors (total cholesterol, LDL-cholesterol, glucose, glycated haemoglobin, insulin, body weight and waist circumference) and one of the domains of quality of life measured by means of the SF-36 questionnaire (vitality), compared to the placebo group. Significant reductions in medication use for hypertension and diabetes were observed in the orlistat group, compared to those in placebo, but there were no significant differences in medication use for blood lipids.

Conclusions: Orlistat may have reduced CVD risk, as judged by the favourable changes in individual risk factors and reductions in medication use, but the method used in order to measure absolute CVD risk in this study (Framingham CVD equation) was not sensitive enough to detect the changes in this relatively low-risk group (approximately 10% of risk of a CVD event over 10 years).

Palatability and glucose, insulin and satiety responses of chickpea flour and extruded chickpea flour bread eaten as part of a breakfast

Objective: To determine the effect of adding chickpea flour or extruded chickpea flour to white bread on palatability and postprandial glycaemia, insulinaemia and satiety.

Design: A randomised, single-blind, cross-over study of four 50 g available carbohydrate breakfasts.

Setting: School of Exercise and Nutrition Sciences, Deakin University.

Subjects: In all, 12 healthy subjects were recruited through posted notices. Totally, 11 (nine male, two female) completed the study (meanplusminuss.e.m.; age 32±2 y; body mass index, 24.7±0.8 kg/m²).

Intervention: After overnight fasting, subjects consumed a control (white) bread (WB) breakfast twice, a chickpea bread (CHB) breakfast once and an extruded chickpea bread (EXB) breakfast once. Palatability and postprandial blood glucose, insulin and satiety responses were determined. Following this, food intakes from an ad libitum buffet and for the remainder of the day were assessed.

Results: A trend towards a lower incremental area under the curve (IAUC) of glucose for the CHB breakfast compared to the WB breakfast was observed (P=0.087). The IAUC of insulin and insulinaemic index (II) of the CHB breakfast were higher (P<0.05) than for the WB breakfast. No differences in glycaemic index (GI), satiety response, food intake or palatability were observed.

Conclusions: CHB and EXB demonstrated acceptable palatability. CHB demonstrated some hypoglycaemic effect compared to WB, but neither CHB nor EXB demonstrated effects on satiety or food intake. The hyperinsulinaemic effect of CHB observed in this study requires further investigation.

Whose socioeconomic status influences a women's obesity risk: her mother's, her father's, or her own?

Background Evidence on the relative influence of childhood vs adulthood socioeconomic conditions on obesity risk is limited and equivocal. The objective of this study was to investigate associations of several indicators of mothers', fathers', and own socioeconomic status, and intergenerational social mobility, with body mass index (BMI) and weight change in young women.

Methods This population-based cohort study used survey data provided by 8756 women in the young cohort (aged 18–23 years at baseline) of the Australian Longitudinal Study on Women's Health. In 1996 and 2000, women completed mailed surveys in which they reported their height and weight, and their own, mother's, and father's education and occupation.

Results Multiple linear regression models showed that both childhood and adulthood socioeconomic status were associated with women's BMI and weight change, generally in the hypothesized (inverse) direction, but the associations varied according to socioeconomic status and weight indicator. Social mobility was associated with BMI (based on father's socioeconomic status) and weight change (based on mother's socioeconomic status), but results were slightly less consistent.

Conclusions Results suggest lasting effects of childhood socioeconomic status on young women's weight status, independent of adult socioeconomic status, although the effect may be attenuated among those who are upwardly socially mobile. While the mechanisms underlying these associations require further investigation, public health strategies aimed at preventing obesity may need to target families of low socioeconomic status early in children's lives.