Dissertations / Theses on the topic 'Social aspects of Obesity'

This study of 449 newspaper articles from South Africa from 1997 provides an analysis of the representations of obesity evinced in the corpus. The research argues that obesity is overwhelmingly framed as being diseased and that there are four main refrains within this frame, namely, statistics on obesity, the naturalisation of negative assumptions about fat, the social dysfunction of fat and the use of crisis metaphors to describe fatness. This framing lends itself to representations of obesity which are raced, gendered and classed. Fat bodies are portrayed as being in deficit and fat people as lacking agency. The disproportional focus on black bodies in the corpus can be attributed to assumptions of ‘incivility’ which are premised on racial stereotypes which construct black people as being unintelligent, irrational, lacking agency and being largely dependent on others to survive. This disproportional focus on black bodies can also be understood in the context of emerging markets. This study argues that the medicalisation of obesity has contributed to many oversimplifications and contradictions in the representation of obesity in the corpus, which seem to go unquestioned, such as the conflation of weight and health, something I argue is one of the main contributors to the negative consequences of the dominant framing of obesity. Framing obesity as medicalised also promotes fat shaming and acts as a form of social control which maintains existing power relations through the use of discursive practices for the identification and control of deviants. These representations are problematic chiefly because they promote the dehumanisation of fat people, but also because that they do not promote good health as they claim to do.

The purpose of this investigation was to identify college students' visual perceptions of obese individuals and to identify any differences that may exist due to gender or body build of the subject. The subjects who participated in this study were students randomly chosen from a beginning counseling psychology course at Ball State University. One hundred subjects volunteered to complete the necessary testing for this thesis. A cross tabulation and Chi Square analysis of gender and somatotype preference found significant differences in that female subjects chose to interact less often with endomorphs than did the male subjects. The differences between the subject's somatotype and somatotype preference were found to be insignificant.
Institute for Wellness

Hypotheses explaining maternal compliance behavior in relation to maternal attitudes and motivations and family and social influences were explored retrospectively in families of 39 obese infants from six to twelve months of age. Maternal social support and infant characteristics were not strongly associated or predictive of maternal compliance behavior. Stressful life changes in the family were negatively associated with maternal compliance to the dietary regimen. Maternal perception of infant fatness was negatively associated with dietary compliance behavior and positively associated with study protocol compliance behavior. Demographic variables were positively associated with compliance to study protocol. Family stress, maternal health beliefs, and demographic variables outweighed social support in their power to predict compliance behaviors. Compliance to study requirements did not necessarily mean compliance to the dietary regimen. Clinical use of assessing family stress, maternal beliefs and demographic variables appears to provide additional understanding of compliance behaviors in mothers with infant feeding recommendations.

Das Krankheitsbild der Adipositas hat sich weltweit zu einem relevanten Gesundheitsproblem entwickelt. Die bariatrische Chirurgie wird zunehmend als wirkungsvolle Behandlung bei schwer ausgeprägter Adipositas eingesetzt. Jedoch ist über die Rolle psychologischer Variablen im bariatrischen Behandlungsverlauf noch wenig bekannt. Die vorliegende Dissertation untersucht Einfluss und Veränderung patientenberichteter Gesundheitsmerkmale in der chirurgischen Adipositastherapie. Dazu werden in einer naturalistischen Beobachtungsstudie Patienten mit schwerer Adipositas vor und im Durchschnitt zwei Jahre nach einer bariatrischen Operation (OP) befragt. Ziele der Arbeit sind 1) die Charakterisierung adipöser Patienten vor OP hinsichtlich bio-psycho-sozialer Variablen; 2) die Identifikation möglicher Einflussvariablen auf den gewichtsbezogenen Behandlungserfolg nach OP; 3) die Untersuchung von Auswirkungen der OP auf das Essverhalten; und 4) die Analyse von Veränderungen in der essstörungsbezogenen Psychopathologie und in der gesundheitsbezogenen Lebensqualität nach OP. Die Ergebnisse der bariatrischen Patienten werden im Vergleich zu denen konservativ behandelter Patienten betrachtet. Die Ergebnisse zeigen, dass Patienten mit bariatrischem Behandlungswunsch eine somatisch und psychisch belastete Patientengruppe darstellen. Die bariatrische OP führt im zweiten postoperativen Jahr zu einer nachhaltigen und klinisch bedeutsamen Gewichtsreduktion. Der präoperative Body-Maß-Index, das Bildungsniveau und aktives Problembewältigungsverhalten sind mit dem Gewichtsverlust nach OP assoziiert. Im Vergleich zur konservativen Behandlung berichten die Patienten, die sich der OP unterziehen, über stärker ausgeprägte Verbesserungen in ihrem Essverhalten und eine Steigerung ihrer Lebensqualität. Auf Basis der Befunde wird ein routinemäßiges Monitoring der somatischen und psychischen Situation der Patienten nach bariatrischer OP empfohlen, um die gezeigten Behandlungserfolge optimal zu sichern.
Obesity has become a relevant global health problem. Bariatric surgery is an effective treatment for severe obesity. However, while the number of operations performed continues to increase, the role of psychological variables throughout the bariatric surgery pathway remains uncertain. The present dissertation investigates the patient-reported health status as it impacts and results from bariatric surgery. In a naturalistic observational study, patients with severe obesity are assessed before and, on average, two years after the surgical treatment. Main aims are 1) to characterize obese patients prior to bariatric surgery in terms of biological, psychological and socio-demographic variables; 2) to identify possible predictors for the postoperative weight-related treatment success after bariatric surgery; 3) to examine changes in eating behaviors; and 4) to analyze changes in eating-related psychopathology and in health-related quality of life (HRQoL). The outcomes of surgical patients are compared with those of conservatively treated patients for the same follow-up period. The findings show that bariatric surgery candidates represent a vulnerable patient group with high physical and psychological burden. In the second postoperative year after bariatric surgery, a sustainable and clinically meaningful weight reduction is achieved. The preoperative body mass index, education level and active coping behavior are associated with weight loss after surgery. Compared with conservative treatment, patients who undergo bariatric surgery report not only greater improvements in their eating behavior and eating-related psychopathology but also an increase in their HRQoL. Based on the results, the provision of a routine monitoring of the somatic and psychological situation of patients following bariatric surgery is recommended to secure longer-term treatment success.

The purpose of this study was to explore the lives of overweight/obese adolescent boys. A qualitative case study focused on depth of understanding. Four boys volunteered to participate in the study. Findings further our understanding of the adolescent boys’ lifescapes; viable and non-viable recruitment strategies among this population; ethical obligations of ending research after establishing trust and rapport; and “Avoidance” as an Idiom of Distress among this sample of boys. Suggestions for future research are addressed in the study.
vi, 102 leaves ; 29 cm

Nos dias de hoje, a obesidade se caracteriza como uma doença de causas múltiplas, sendo uma enfermidade grave e com alta incidência em países desenvolvidos e em desenvolvimento. Dessa maneira, é possível considerar que a obesidade pode ser analisada por vários aspectos multifatoriais como os genéticos, sociais e afetivos. Nesse sentido, esta dissertação aborda alguns aspectos afetivos presentes na problemática da obesidade e sobrepeso em adolescentes mulheres, procurando verificar possíveis falhas na relação afetiva mãe e filha, nos estágios precoces do desenvolvimento da menina. Este estudo está fundamentado em concepções teóricas de Winnicott (1983; 2000; 2005; 2006), Levisky (1995), Barbosa Silva (2005), Bruno (2011) e Cardoso (2008). Foi utilizada como procedimento metodológico a abordagem qualitativa da História Oral de Vida que privilegia as narrativas do sujeito como compreensão de suas vivências afetivas. Desse modo, foram feitas entrevistas gravadas com as adolescentes obesas ou com sobrepeso de 13 a 18 anos que fazem parte da triagem ou estão em tratamento nutricional na Clínica-Escola de Nutrição da Faculdade de Ciências Biológicas e da Saúde do Centro Universitário (Cesmac) em Maceió, Alagoas. Diante disso, as narrativas das adolescentes entrevistadas teceram sua história de vida, apresentando dados significativos como a relação com a mãe, o contexto familiar, o próprio ato de adolescer e o lidar com os conflitos existentes no dia a dia como aspectos importantes e como hipóteses possíveis de ocasionar o aparecimento da obesidade e do sobrepeso nessas adolescentes mulheres. Cada contexto estudado, revela singularidades da relação mãe e filha e se destaca como fundamental para o desenvolvimento e a construção do amadurecimento da menina na infância e, principalmente, na adolescência.
Nowadays, obesity is characterized as a disease of multiple causes, its a serious illness and with high incidence in developed and developing countries. This way, it is possible to consider that obesity can be analyzed by various multifactorial features as genetic, social, and affective. In this sense, this dissertation says some affective aspects in obesity and overweights problematic in adolescent women, seeking to verify possible failures in affective relation mother and daughter, in the early stages of development of the girl. This study, is based on theoretical conceptions of Winnicott (1983, 2000, 2005, 2006), Levinsky (1995), Barbosa Silva (2005), Bruno (2011) and Cardoso (2008). It was used as methodological procedure the qualitative approach of Oral Life History that privileges the narratives of the subject as knowledge their affective experiences. Thus, they have been recorded interviews with obese adolescents or overweight 13 to 18 years who are part of the screening or are in the nutritional treatment Clinic-School of Nutrition of Biological Sciences and Health College (Cesmac) in Maceió, Alagoas. In this way, the narratives of the interviewed adolescents wove their life story, they are presenting significant data such as the relationship with the mother, the family context, the own act of adolescent and the dealing with conflicts in daily life as important aspects and as possible hypotheses to bring on the onset of obesity and overweight in these adolescent women. Each studied context, reveals singularities mother and daughter relationship and it stands as fundamental to the development and the construction girls maturing in childhood, and mainly, in youth.

The primary purpose of this research was to investigate relationships between physical activity participation, weight change, and selfreports of social physique anxiety, physical self-concept and health-related quality of life. A secondary purpose was to investigate personality as a mediator of self-perceptions and quality of life beliefs following obesity surgery. Two studies with differing methodologies were conducted. The first study was a cross-sectional survey of patients who had participated in a multi-component clinical weight-loss program involving a combination of physical activity, diet modification, and drug therapy. The second study was a longitudinal investigation of laparoscopic adjustable gastric banding patients. Amount of weight lost was not found to be related to changes in social physique anxiety, physical self-concept or health-related quality of life. However, physical activity levels were found to be an important predictor of improvements in physical self-concept and health-related quality of life amongst clinical weight loss patients, but not surgical patients. Improvements over time with respect to social physique anxiety, physical self-concept and health-related quality of life were observed amongst all participants who underwent LABG. Personality factors, whilst not predicting changes over time in social physique anxiety, physical self-concept or health-related quality of life, discriminated between two types of obese adults presenting for obesity surgery. Future research could be undertaken to determine if long-term outcomes differ for these two types of patients.

Esta dissertação tem como objetivo compreender o funcionamento das famílias com crianças acometidas pela obesidade na instalação e manutenção da doença, na perspectiva dos pais. Nesta circunstância, foram considerados os sentimentos e dificuldades expressos pelas mães frente à obesidade dos filhos; estratégias utilizadas para enfrentar o problema e indicadores no contexto familiar que pudessem estar contribuindo para a manutenção do quadro de obesidade infantil. O trabalho está dividido em três artigos, sendo um teórico e dois empíricos. O primeiro apresenta um breve histórico da necessidade humana de alimentação que mostrou as mudanças ocorridas que culminaram na proliferação da obesidade e, nesse cenário, as transformações que a família enfrenta para adaptar-se ao meio permeado de tantas ofertas e constantes modificações, em articulação com a Teoria Sistêmica. O segundo artigo identifica no contexto familiar à luz da Teoria Sistêmica, os indicadores da dinâmica familiar que podem estar contribuindo para a instalação e a manutenção da obesidade na infância. O terceiro artigo considera elementos presentes na história familiar das crianças com obesidade, os sentimentos expressos pelas famílias e as consequências físicas e psíquicas da evolução da doença. A pesquisa é de natureza qualitativa levando em consideração a experiência dos participantes em relação ao tema. Foram entrevistadas seis mães e uma avó de crianças, na faixa etária entre 8 a 10 anos incompletos, que se encontravam em atendimento no ambulatório de Obesidade Infantil do Instituto de Medicina Integral Professor Fernando Figueira (IMIP), na cidade do Recife. Utilizamos uma entrevista com roteiro previamente estabelecido e, posteriormente, os resultados foram discutidos com base na análise de conteúdo temática. Os resultados indicaram que todos os membros do sistema estão implicados na instalação da obesidade, através da rejeição materna, compensada por superproteção alimentar, conflitos conjugais, interferência das avós na alimentação dos netos, o que demonstra confusão na hierarquia. As dificuldades de intercâmbio com o meio demonstraram que as famílias consomem alimentos com alto teor de gordura; a falta de coesão acerca das normas alimentares e de limites à criança são elementos que podem estar contribuindo para a manutenção da obesidade na infância
This dissertation aims to understand the functioning of families with children affected by obesity in the installation and maintenance of the disease from the perspective of parents. In this circumstance, we considered the feelings expressed by mothers and difficulties facing the obesity of children, strategies used to address the problem in the family context and indicators that could be contributing to the maintenance of the obese children. The work is divided in three articles, one theoretical and two empirical. The first presents a brief history of the human need to feed that showed the changes that led to the proliferation of obesity and, in this scenario, the changes that the family faces in adapting to the environment permeated with so many offers and constant changes, in conjunction with Systemic Theory. The second article identifies the family context under the light of the Systemic Theory, indicators of family dynamics that may be contributing to the installation and maintenance of obesity in childhood. The third article considers elements in the family history of children with obesity, the sentiments expressed by the families and the physical and psychological consequences of disease progression. The research is qualitative in nature, taking into account the experience of participating in the issue. Six mothers were interviewed and a grandmother of children, aged between 8-10 years old, who were in the outpatient clinic of Childhood Obesity Institute of Medicine Professor Fernando Figueira (IMIP) in the city of Recife. We used an interview with previously established questions, and subsequently the results were discussed based on thematic content analysis. The results indicated that all members of the system are involved in the installation of obesity, through the maternal rejection, overprotection offset by food, marital conflicts, and interference from the grandparents in the feeding of grandchildren, which shows confusion in the hierarchy. The difficulties of exchange with the environment showed that families consume of food with high contents of fat, lack of cohesion about food standards and limits are the child elements that may be contributing to the maintenance of childhood obesity

Thesis (PhD)--Stellenbosch University, 2012.
Includes bibliography
ENGLISH ABSTRACT: Background/Aims: Obesity has increased rapidly in South African children and adolescents with significant variability observed among racial groups. Genes that regulate appetite have been studied in different populations worldwide, but their role in obesity among South African adolescents is unknown. The present study aimed at investigating the role of these genes, and their combined effect with physical activity in the development of obesity among South African adolescents. Methods: A total of 1564 South African school learners of Caucasian (n= 146), Mixed Ancestry (n= 872) and Black African (n= 537) ethnic groups were recruited for a research project that aimed to elucidate diabetes and the metabolic syndrome in children and adolescents attending schools in periurban areas of the Western Cape. The present case-control study included 227 obese-overweight (115 Black Africans and 112 Mixed Ancestry), and 204 normal weight (94 Black Africans and 110 Mixed Ancestry) adolescents learners. The learners were genotyped for nine polymorphisms (LEP: 19G>A, Lys36Arg, Val94Met; LEPR: Lys109Arg; Gln223Arg, Lys656Asn; CART: c.160-33G>A, c.499delA, and c.517A>G; GHRL: Leu72Met; and MC3R: Thr6Lys, Val81Ile) using allele-specific restriction enzyme analysis and automated sequencing. Genotype and haplotype associations with anthropometric variables such as body mass index (BMI), waist, hip, and mid-upper-arm circumferences (WC, HC, MUAC), and metabolic traits (fasting blood glucose, high density lipoproteincholesterol, total cholesterol), and blood pressure were further conducted. Furthermore, the type and frequency of physical activity was assessed by means of structured questionnaires; and its effect on obesity-related variables investigated in learners that were genotyped for the MC3R Thr6Lys and Val81Ile polymorphisms. Results: In a stepwise backward logistic regression analysis (containing age, gender, and LEP, LEPR, CART and GHRL polymorphisms), CART c.517A>G was independently significantly associated with obesity (OR= 5.98; 95%CI= 2.02, 21.27). CART c.517G carriers had higher MUAC (b coefficient= 1.88; 95%CI= 0.31, 3.44) while the LEPR 109Arg allele was significantly associated with decreased BMI (b coefficient = -2.36; 95%CI= -4.24, -0.47), WC (b coefficient = -5.66; 95%CI= -9.89, -1.44) and MUAC (b coefficient = -1.61; 95%CI= -3.00, -0.22); after adjusting for age, gender, and ethnicity. The haplotype containing the three LEP polymorphisms (A-A-A compared to the reference G-A-G haplotype) increased BMI (p= 0.0155), MUAC (p= 0.0146), and HC (p= 0.0128). The minor alleles of the MC3R polymorphisms decreased BMI, HC, WC, MUAC and TC; whilst only the Thr6Lys was associated with systolic and diastolic blood pressure (p= 0.0047 and 0.0027, respectively) in Mixed Ancestry learners. Doing house chores was associated with lower total cholesterol, independently and in the presence of the 81Ile allele (b coefficient = -0.355; 95%CI= 0.148, 0.561). Conclusion: To our knowledge, this is the first study that reports CART c.517A>G polymorphism as a risk factor for obesity in adolescents. Furthermore, the present study demonstrated that the MC3R polymorphisms had a positive effect on total cholesterol, which was further enhanced in physically active individuals. Similar to other studies, LEPR Lys109Arg and LEP polymorphisms were associated with variations in obesity-related variables among Black African and Mixed Ancestry South African learners.
AFRIKAANSE OPSOMMING: Agtergrond/Doelwitte: Vetsug het drasties toegeneem in Suid-Afrikaanse kinders en adelossente met ‘n beduidende variasie opgemerk tussen verskillende rassegroepe. Gene verantwoordelik vir regulering van eetlus is reeds wêreldwyd in verskillende bevolkingsgroepe bestudeer, maar hul rol in oorgewig Suid-Afrikaanse adolessente is onbekend. Die huidige studie was daarop gerig om ondersoek in te stel na die rol van hierdie gene en hul gekombineerde effek met fisiese aktiwiteit in die ontwikkeling van vetsug onder Suid-Afrikaanse adolessente. Metodes: ‘n Totaal van 1564 Suid-Afrikaanse leerders van Kaukasiese Afkoms (n=146), Gemengde Afkoms (n=872) en Swart Afkoms (n= 537) was gewerf in die navorsingsprojek wat ten doel gehad het om kinders en adolosente met diabetes en die metaboliese sindroom te identifiseer wat skole bygewoon het in semi-voorstedelike gebiede van die Wes-Kaap. Die huidige gevalle studie het 227 vetsugtige-oorgewig (115 Swart Afkoms en 110 Gemengde Afkoms) en 204 normale gewig (94 Swart Afkoms en 110 Gemengde Afkoms) leerders ingesluit. Die leerders was gegenotipeer vir nege polimorfismes (LEP: 19G>A, Lys36Arg, Val94Met; LEPR: Lys109Arg; Gln223Arg, Lys656Asn; CART: c.160-33G>A, c.499delA, and c.517A>G; GHRL: Leu72Met; and MC3R: Thr6Lys, Val81Ile) met die gebruik van alleel-spesifieke restriksie ensiem analises en geoutomatiseerde DNA volgorde bepalings tegnieke. Genotipiese en haplotipiese assosiasies met antropometriese veranderlikes soos liggaamsmassa indeks (BMI), middel-, heup- en mid-boarm omtrek (WC, HC, MUAC), metaboliese tendense (vastende bloed glukose, hoë-digtheid lipoproteïen-cholesterol, totale cholesterol) en bloeddruk was ook uitgevoer. Die tipe en frekwensie fisiese aktiwiteit was geassesseer deur middel van gestruktureerde vraelyste; en die uitwerking daarvan op vetsugverwante veranderlikes ondersoek in leerders wat vir die MC3R Thr6Lys en Val81Ile polimorfismes gegenotipeer was. Resultate: Statistiese ontleding (‘‘stepwise backward logistic regression analysis”), wat ouderdom, geslag en polimorfismes (LEP, LEPR, CART GHRL) ingesluit het, het getoon dat CART c.517A>G betekenisvol onafhanklik geassosiasieer was met vetsug (OR= 5.98; 95% CI= 2.02, 21.27). CART c.517G draers het ‘n hoër MUAC waarde gehad (b koeffisient = 1.88; 95%CI= 0.31, 3.44), terwyl die LEPR 109Arg alleel betekenisvol geassosieer was met verlaagde BMI ((b koeffisient = -2.36; 95%CI= -4.24, -0.47), WC (b koeffisient = -5.66; 95%CI= -9.89, -1.44) en MUAC (b koeffisient = -1.61; 95%CI= -3.00, -0.22) na die aanpassing van ouderdom, geslag en etnisiteit. Die haplotipe met die drie LEP polimorfismes (A-A-A teenoor die G-A-G verwysingshaplotipe) het die BMI (p= 0.0155), MUAC (p= 0.0146) en HC (p= 0.0128) verhoog. Die mindere allele van die MC3R polimorfismes het die BMI, HC, WC, MUAC en TC verlaag; terwyl slegs die Thr6Lys polymorfisme met sistolies en diastolies bloeddruk (p= 0.0047 en p= 0.0027, onderskeidelik) geassosieer was in Gemengde Afkoms leerders. Die verrigting van algemene huistake was geassosieer met laer totale kolesterol vlakke, onafhanklik en in die teenwoordigheid van die 81lle alleel (b koeffisient= -0.355; 95%CI= 0.148, 0.561). Gevolgtrekking: Na ons wete is hierdie die eerste studie wat die CART c.517A>G polimorfisme as ‘n risikofaktor vir vetsug in adolessente aantoon. Die huidige studie toon ook dat die MC3R polimorfisme ‘n positiewe effek op totale kolesterol gehad het, wat ook verder versterk was in fisiese aktiewe individue. Soortgelyk aan ander studies, was die LEPR Lys109Arg en LEP polimorfismes geassosieer met variasies in vetsug-verwante veranderlikes onder Suid-Afrikaanse Swart en Gemengde Afkoms leerders.
This research was supported by a grant from the University Research Fund of the Cape Peninsula University of Technology, Harry Crossley, University of Stellenbosch, Faculty of Health Sciences, Medical Research Council, and the National Health Laboratory Services, South Africa.

The present study employed a quantitative, non-experimental, multivariate correlational research design to test a hypothesized model examining associative paths of influence between ecological factors and weight status of urban, African-American adolescent females. Anthropometric and self-report survey data of 182 urban, African- American adolescent females were collected during after-school programs, health and physical education classes, and community events in an urban area in northeast Florida. Descriptive analyses were conducted to characterize the study participants based upon their age, study setting, and weight status. A scale reliability analysis was conducted to assess the internal consistency reliability of the sample data using selected measures within the context of the study’s specific population and subsequently guided the structural equation model (SEM) analyses. The SEM path analysis was used to develop two measurement models to control for observed error variance for variables demonstrating poor internal consistency reliability (diet behaviors and nutrition selfefficacy) and a final structural model to test the associative paths of influence between latent (diet behaviors and nutrition self-efficacy) and manifest variables (teacher social support and friend social support) on weight status. The results of the path analysis indicated that both teacher social support and friend social support demonstrated a positive, indirect influence on child weight status through nutrition self-efficacy and diet behaviors following two different and specific paths of influence. Diet behaviors, in turn, demonstrated a positive, direct effect on child weight status. These findings provide clear implications for educational leaders that call for the integration of health behavior change theory into traditional education and leadership practice and actively addressing the childhood obesity epidemic in the school environment by implementing health behavior change strategies at various ecological environmental levels.

There is often an assumption that there is a right and a wrong way for consumers to behave. For example, with regard to eating, people should make food choices based on maximizing vitamins and minerals and not consuming more calories than one expends in a day. Likewise, it is assumed that buying products to conspicuously signal a message to another is wasteful and maladaptive. The research in this thesis challenges these assumptions and argues that these behaviours can be both adaptive and maladaptive depending on one’s environmental conditions. In this thesis, I describe three experiments that examine how perception of environmental harshness affects appetite for different types of foods. The data shows that food desirability in adulthood varies depending on early childhood socio-economic status, the type of environmental stressor (harsh social, harsh economic and harsh physical safety) and the intensity of the stressors within each of these environments. It was also found that different types of environmental harshness differentially affects food desire based on energy density and food category type. In addition to the experiments on harshness and food desirability, I have examined how environmental harshness affects desire for products that are used to conspicuously signal information to others. For example, under conditions of environmental stress, products may be used to advertise that a male possesses financial or physical power which is desirable to a potential mate. Likewise, a women may buy products to display she possess financial power or she may purchase products that augment her beauty and sexual attractiveness. These studies reveal that product desire is also affected by different types of environmental harshness and the intensity of the stress generated by these environmental conditions. Through the research described in this thesis, we gain a more comprehensive understanding of the proximate variables that influence two subsets of consumer behaviour, namely food desire and product signalling, and how these behaviours may have been selected for due to their adaptive value.

This study aims to analyze the obesity and its more extreme classification, morbid obesity, and also its forms of treatment, with emphasis on bariatric surgery, procedure that appears to solve the obesity problem, assuming often a magical character. Nowadays, the body plays a central role in life of the subject and it is the stage for changes that aim a perfect and healthy body. The medical discourse underlies this context when points out that the ideal body is healthy, providing higher quality of life and longevity to the subject. In this scenario, the obese is a deviant because it doesn´t have control over your body to achieve the healthy, it is far from the threshold of normality that medicine postulates. Treatments are attempting to program such body, through diet, exercise and, in more severe cases, drugs. Bariatric surgery is indicated when conventional treatment was unsuccessful and promises to reduce the IMC range for normal, improve comorbidities and consequently the quality of life of the subject. The main question of this work is what causes the subject to look for bariatric surgery. We got in the bariatric surgery program at the University Hospital of UFS to analyze the processes that occur in practice. Under the theoretical and methodological framework of psychoanalysis and focused on listening, we explored the field in the waiting room. The speeches of patients that were waiting consultation with the preparing team of the program, and others who already passed by, enriched this work. We concluded that the medical discourse can ignore the subject, their expectations and fears in this process, taking from him his involvement in the decision to perform surgery, and it ends up suggesting to the subject a form of treatment outwardly magical that cures obesity.
Esse trabalho se propõe a analisar o tema obesidade e sua classificação mais extrema, a obesidade mórbida, além de suas formas de tratamento, com ênfase na cirurgia bariátrica, intervenção cirúrgica que surge para solucionar o problema da obesidade, assumindo, muitas vezes, um caráter mágico. Na contemporaneidade, o corpo assume papel central na vida do sujeito e é palco para modificações que visam um corpo saudável e perfeito. O discurso médico embasa esse contexto ao pontuar que o corpo ideal é o saudável, por proporcionar maior qualidade de vida ao sujeito e maior longevidade. Nesse cenário, o indivíduo obeso é um desviante, pois por não ter domínio sobre seu corpo para o alcance do saudável, ele se situa longe do limiar de normalidade que a medicina postula. Os tratamentos são a tentativa de reprogramar tal corpo, através de dietas, de exercícios físicos e, em casos mais graves, de medicamentos. A cirurgia bariátrica é indicada quando o tratamento convencional não teve sucesso e promete reduzir o IMC para uma faixa dentro da normalidade, melhorar as comorbidades e, consequentemente, a qualidade de vida do sujeito. A grande questão desse é o que leva o sujeito a procurar a cirurgia bariátrica. Inserimo-nos no programa de cirurgia bariátrica do Hospital Universitário da UFS para analisar na prática os processos ocorridos. Sob o referencial teórico-metodológico da Psicanálise e dispostos a escutar, exploramos o campo na sala de espera. As falas dos pacientes que aguardavam consultas com a equipe de preparação do programa, além de outros que por ali passavam, enriqueceram o trabalho. Chegamos à conclusão que o discurso médico pode desconsiderar o sujeito, suas expectativas e medos nesse processo, retirando dele sua implicação na decisão de realizar a cirurgia, à medida que acaba sugerindo ao sujeito uma forma de tratamento aparentemente mágica que cura a obesidade.

Indiana University-Purdue University Indianapolis (IUPUI)
Research indicates that negative affective traits (e.g., depression) are predictors and consequences of excess adiposity. Given that racial minorities and positive affective traits have been underrepresented in past investigations, more prospective studies are needed which examine multiple affective traits in relation to obesity in these populations. The objective of the current study was to investigate the prospective, bidirectional associations between multiple affective traits and multiple adiposity indicators in African Americans using data from the African American Health (AAH) study. The AAH study is a prospective cohort study of African Americans aged 49-65 years at baseline (N = 998). The longest follow-up period in the current study was 9 years (N = 579). Self-reported and measured body mass index (BMI; kg/m2) and body fat percent (BF%) were used as adiposity indicators. Depressive symptoms were assessed with the 11-item Center for Epidemiologic Studies-Depression Scale (CES-D), and anxiety was assessed using the Generalized Anxiety Disorder-2 (GAD-2) scale. Positive affective traits were assessed with the Vitality subscale of the Short Form-36 and Positive Affect subscale from the CES-D. Latent variable path analysis, a structural equation modeling technique, was conducted. Although fit statistics indicated that the models fit the data (RMSEA < .06), examination of the structural paths revealed that the CES-D and GAD-2 were not predictors or consequences of self-reported BMI, measured BMI, or BF% (ps > .05). Likewise, Vitality and CES-D Positive Affect were not related to any adiposity indicator (ps > .05). The results of this prospective cohort study suggest that affective traits are not predictors or consequences of adiposity in middle-aged African Americans and that this group may require obesity prevention or intervention programs with little to no emphasis on affective traits. Possible explanations for the current results include ethnic differences in the mechanistic pathways between affective traits and adiposity.

Obesity continues to be a major cause of morbidity and mortality and worldwide prevalence rates continue to rise. The cornerstone for treating obesity remains diet and lifestyle, with the ultimate goal being normalising those parameters that are associated with ill health, for example hyperinsulinaemia and insulin resistance. Because obesity predominantly develops due to a mismatch between energy intake and utilisation, this thesis looked at the effects of dietary interventions upon Resting Energy Expenditure (REE) and substrate oxidation. In addition, the impact of popular dietary interventions upon body composition and insulin resistance was examined. When phenotypic characteristics were investigated before and after weight loss by using hypocaloric diets, which differed in fat and carbohydrate content, Fat-Free Mass (FFM) and Fat Mass (FM), were strong predictors of REE before and after the intervention and weight loss rather than the specific dietary intervention, significantly predicted post intervention REE. Fasting fat oxidation was found to be lower in obese subjects and they had a lower postprandial response to a high fat challenge. This implied that a diet high in fat is more likely to promote a positive energy balance an ultimate weight gain. The final study compared 4 popular dietary interventions. Each was equally effective at achieving clinically significant weight loss and improvements in insulin sensitivity. Although none was significantly more superior, there was a trend supporting three of the diets (Atkins’, Weight Watchers and Rosemary Conley) above the other (Slim-Fast) and it was the pattern of weight loss, i.e. mainly loss of FM, which proved beneficial with regards to improving insulin sensitivity. In summary, this thesis confirms that REE is mainly predicted by FFM and FM and that there is diminished fat oxidation on obese subjects. What this thesis also adds to previous research that it if a specific diet can improve the pattern of weight loss, this can be clinically beneficial.

Obesity is a complex disorder which has reached epidemic proportions in many parts of the world. Twin studies have demonstrated a high heritability for obesity. The subsequent appli-cation of genome wide association studies (GWAS) in the last decade have identified at least 32 genetic loci associated with body mass and obesity. Despite these great advances, these loci are almost exclusively completely naïve in a functional context. Genetic variations within the gene encoding the fat mass and obesity associated gene (FTO) are the strongest and most consistently observed genetic variants associated with obesity and body mass throughout various studied populations from all parts of the world. The identification of association of FTO with obesity has spurred immense interest in the function of the FTO protein and the functional consequences of its variants. However, the implications of genetic variants at other genetic loci on protein molecular function and body mass development remain undetermined. This thesis aims to examine more closely four of the genetic loci associated with obesity; in proximity of, or associated with: FTO, TMEM18, MAP2K5 and STK33, in two cohorts of children of European descent: a case-control of clinically obese children and normal weight controls from the Stockholm area; and a cross sectional cohort of Greek children. These smaller cohorts allow for studies of more specific effects of genetic variants as individuals in these cohorts can be more carefully studied. TMEM18 gene expression was also studied in the rat-brain where a positive correlation was observed between the body weight of the animal and TMEM18 expression. We also employed next generation sequencing to more carefully study obesity-associated genetic loci related to FTO and TMEM18. We utilized a novel strategy in this project to study genetic variation in the entire FTO- and TMEM18 genes, as well as in the GWAS-identified BMI-associated loci located downstream from TMEM18. This analysis was performed on a case-control cohort of Swedish children (n = ~1000). Through this analysis, we were able to observe genetic variants within intron 1 of the FTO gene to be the main genetic variants asso-ciated with obesity at this locus. We also observed, for the first time, obesity-associated genetic variants within the gene encoding TMEM18. To analyze the potential functional context of FTO we used an in silico approach, utilizing public information databases on mRNA co-expression and protein-protein interaction. Based on our findings, we speculate on a wider functional role of FTO in extracellular ligand-induced neuronal plasticity, possibly via interaction or modulation of the BDNF/NTRK2 signaling pathway.

Ce travail de thèse vise la compréhension des processus d’auto-dépréciation et d'auto-affirmation chez les personnes obèses. 209 personnes obèses et 920 personnes normo-pondérées ont participé à ce travail composé de six expérimentations. Pour ce faire, nous nous sommes d’abord penchés sur les représentations sociales liées à l'obésité et à la personne obèse, en fonction du contact intergroupe. Ensuite, nous avons construit et validé un outil de mesure du sentiment de rejet lié au poids (sentiment de stigmatisation). Pour finir, nous avons testé les effets de l'auto-affirmation, sur des mesures d'image de soi, chez une population normo-pondérée et obèse. Dans un premier temps, il a été montré que lorsqu’il y a contact entre une personne obèse et non obèse, la représentation sociale est plus empathique, qu’en absence de contact. Dans un deuxième temps, nous avons éprouvé la validité du questionnaire d’auto-stigmatisation (sensibilité, validité de contenu, fiabilité). Celui-ci permet de déterminer la fréquence de situations stigmatisantes vécues par l’individu, associée aux émotions ressenties lors de ces situations. Pour finir, nous mettons en évidence que la technique d'auto-affirmation, via le protocole de Napper, Harris et Epton, (2009), entraine des effets d’auto-centration et de comparaison sociale, susceptibles d’interférer dans le processus de valorisation de l'image de soi des personnes obèses. Ce travail permet de montrer les processus identitaires personnels et sociaux engagés dans le traitement de la question de l’image des individus obèses. Nous proposons un cadre d'analyse des processus identitaires en jeu dans le cas du sentiment de rejet lié au poids
The aims of this thesis are to understand the processes of self-depreciation and self-affirmation in obese people. 209 obese and 920 normal-weight people took part in this six experiment thesis. We first examined social representations related to obesity and obese people, according to intergroup contact. Then we developed and validated a weight related stigma feeling questionnaire. Finally, we tested coping strategies and self-affirmation effects (ie, protocol Napper, Epton and Harris, 2009), on self-image measures, in normal-weight and obese people.Firstly, results show that when there is contact between an obese and a non-obese person, their social representation is more empathetic than without contact. Secondly, we tested the validity of the weight related stigma feeling questionnaire (sensitivity, content validity, reliability). This questionnaire determines individual stigmatizing experiences frequency associated with emotions experienced in those situations. Finally, we highlight that self-affirmation technique, through Napper, Harris and Epton's protocol (2009), causes self-centering and social comparison effects that could interfere in obese people's self-image enhancement process. Our work helps to emphasize the personal and social identity processes involved in treating obese people’s image question. We propose an analysis framework of identity processes involved in weight related rejection feeling

This project investigates the many influences throughout the life span that interact to cause obesity. Heredity factors, overfeeding in infancy and childhood, repeated dieting, inactivity, lifestyle and psychosocial conditions all contribute to the incidence of obesity.

Thesis (Ph.D.) -- University of Glasgow, 2004.
Ph.D. thesis submitted to the Department of General Practice & Primary Care, Division of Community Based Sciences, University of Glasgow, 2004. Includes bibliographical references. Print version also available.

The current epidemic of obesity poses a substantial threat to public health worldwide. Obesity is associated with many deleterious health conditions, including type 2 diabetes, hypertension, dyslipidaemia, respiratory conditions, arthritis, and some forms of cancer. Moreover, the rising prevalence of obesity has been accompanied by a substantial increase in the cost of treating these conditions. Obesity results from a complex interaction between behavioural, environmental, and genetic factors. While the recent increase in the prevalence of obesity is largely due to behavioural factors (for example, physical inactivity); it has also been observed that genetic factors make a large contribution to individual susceptibility. In fact, studies indicate that as much as 50 - 80% of the variation in measures of obesity can be attributed to the effects of genes. Furthermore, closer examination of this genetic component using segregation analysis has indicated the presence of common genes for obesity, with large effects on the phenotype. However, these putative major genes for obesity have not yet been identified. The aim of this thesis was to investigate the role of three distinct genetic loci in obesity and related cardiovascular factors, including type 2 diabetes and dyslipidaemia. The aim of the first investigation was to test whether a common polymorphism (Pro12Ala) in the gene encoding peroxisome proliferator-activated receptor gamma 2 (PPAR-γ2) was associated with obesity and other cardiovascular risk factors in a large group of Caucasian subjects. PPAR-γ2 is an adipogenic transcription factor, which also regulates insulin sensitivity in adipose tissue. No association was observed between the Pro12Ala polymorphism and obesity in Caucasians, but obese subjects carrying the Ala allele displayed an altered blood lipid profile compared with obese Pro/Pro subjects. As the Pro12Ala polymorphism may exacerbate the risk of cardiovascular disease by modifying blood lipid profile in obesity, this relationship was examined further in a separate population. The aim of the second investigation was to determine whether the Pro12Ala polymorphism was associated with obesity, dyslipidaemia, diabetes and carotid intima-medial wall thickening in a population at high risk of developing cardiovascular disease. Australian Aboriginal people display high rates of mortality from cardiovascular disease, and it is possible that their increased susceptibility is due to genetic factors. However, the results from the Aboriginal population confirmed the results of the first study: there was no intrinsic association between the Pro12Ala variant and obesity. In addition, the Ala allele was not associated with deleterious changes in blood lipid profile, as it was in Caucasians. The aim of the third investigation was to confirm the presence of a quantitative trait locus (QTL) for obesity on chromosome 20q13. Highly polymorphic genetic markers in this region were tested for linkage and association with several measures of obesity in a Caucasian population. None of the measures of obesity were linked to or associated with markers spanning 20q13, suggesting that this chromosomal region does not contain a major locus for obesity in this Caucasian population. In the fourth investigation, the 5' sequence of Agouti Signalling Protein (ASIP) was identified. ASIP is a candidate gene for obesity, as it is expressed at high levels in adipocytes, and may participate in several obesity-related processes. Three new exons and two alternative promoters were identified for the ASIP gene. These results may lead to greater understanding of the role of ASIP in obesity and adipocyte metabolism; and may also be used to direct further research into genetic variation within this candidate gene. In conclusion, extensive study of two established candidate genetic loci revealed no association with measures of obesity. Therefore, it is likely that loci other than these make significant contributions to obesity in humans. Further investigation of novel candidate genes, such as ASIP, may allow the identification of novel genetic polymorphisms and new pathways important for the genetic basis of obesity.

This study hypothesized body weight and eating patterns to be important discriminators of psychological characteristics among eating disordered groups. A total of 146 bulimic and non-bulimic women from underweight (anorexic), normal weight, and overweight (obese) categories were examined. Based upon the theoretical and research literature reviewed, this study hypothesized locus of control, personal potency, self-esteem, and psychopathology to be central psychological characteristics in anorexia nervosa, bulimia, and obesity. These variables were measured by Rotter's Internal-External Locus of Control Scale, the Semantic Differential Potency Scale, Rosenberg's Self-Esteem Scale, and the Minnesota Multiphasic Personality Inventory, respectively. The relative importance of these variables in the disorders was also addressed. Results showed women in the eating disordered groups examined to demonstrate the following psychological characteristics: (1) Non-bulimic anorexics--an external locus of control, low self-esteem, and hysteria; (2) Bulimic anorexics--the greatest external locus of control, the lowest self-esteem, psychopathic deviance, hysteria, thought disorder, depression, a preoccupation with somatic concerns, and hypofemininity; (3) Normal weight bulimics--an external locus of control, low self-esteem, psychopathic deviance, hysteria, thought disorder, and depression; (4) Non-bulimic obese--low self-esteem; and (5) Bulimic obese--low self-esteem, an external locus of control, thought disorder and depression. The primary conclusion drawn from this study is that bulimia is a better predictor of the psychological characteristics than body weight. Bulimia, across all weight categories, was associated with an external locus of control, low self-esteem, psychopathic deviance, hysteria, thought disorder, and depression. That there was little variability in personality characteristics associated with bulimia across weight categories emphasized the stability of the symptom constellation associated with this disorder. This study supported the view of the normal weight bulimic as psychologically similar to the bulimic anorexic. This study also supported the stance that simple obesity does not represent a unitary psychological disorder.

Background: Childhood obesity remains a major public health concern. While preventing childhood obesity is important, the effectiveness of existing prevention strategies is indefinite. Important obesity contributors are speculated to be overlooked while the role of well-studied obesity-related factors has been questioned. Objectives: 1) Although the association between lifestyle and obesity is seemingly well-established, how an overlooked dietary factor, breakfast location, associates with obesity was investigated 2) At a time where inconsistencies in findings for the frequently studied association between TV viewing and obesity still exist, this thesis tested for the existence of the said association in the understudied Chinese population 3) The effect of mental health on childhood obesity is understudied. Using self-esteem as a mental health indicator, the effect of self-esteem on childhood obesity was investigated To understand the role of lifestyle factors in the association between self-esteem and obesity, how 4) breakfast habit and 5) TV viewing habit associates with self-esteem was explored Methods: A cohort of 83405 primary 4 (P4) Department of Health Student Health Service participants (49.7% male, mean age 9.9 years) in 1998-2000 were successfully tracked for 2 years into primary 6 (P6). A self-administered health questionnaire collected information on the breakfast and TV habits of participants alongside other lifestyle characteristics. Self-esteem was assessed using the four Culture Free Self-Esteem Inventories for Children (SEI) subscales. Body mass index (BMI) was derived using objectively measured weight and height. Weight status was classified in accordance to International Obesity Task Force standards. Logistic, multinomial logistic and linear regression were used to yield adjusted odds ratios (AOR) and β-coefficients for becoming overweight/obese in P6 (among P4 normal weight children), breakfast skipping/location, TV viewing habit and SEI subscale scores. Breakfast skipping behaviour was tested as a mediator in the association between self-esteem and obesity using standard mediation procedures. Breakfast and TV viewing habits were tested as effect modifiers in the same association by inclusion of interaction terms in models. Results: Among normal weight P4 children, those who skipped breakfast (AOR: 1.24; 95% CI: 1.02 to 1.51) or ate away from home (1.39; 1.20 to 1.60) were more likely to become overweight/obese in P6. Poor self-esteem was also associated with higher AORs for becoming overweight/obese, particularly among girls. While TV viewing in P4 did not predict overweight/obesity in P6, those who increased TV watching hours (≤2h/day to 2h/day) during the two follow-up years were 32% more likely to become overweight/obese in P6 than their counterparts who maintained watching ≤2h/day. Breakfast habit and self-esteem was bi-directionally associated. Although a curvilinear inverted J-shaped relation between P4 TV viewing and P6 self-esteem was observed, self-esteem did not predict TV viewing habit. While neither breakfast nor TV viewing habit significantly interacted with self-esteem to predict obesity, breakfast skipping was found to be a potential partial mediator in the association between self-esteem and obesity. Conclusion: Breakfast location, self-esteem and TV viewing patterns over time are important to consider in relation to childhood obesity. Additionally, the association between self-esteem and obesity could be mediated by lifestyle factors.
published_or_final_version
Community Medicine
Doctoral
Doctor of Philosophy

Obesity is a multi-factorial metabolic disease, resulting in increased adipose tissue acquisition by the host. This disease increases the risk for developing co-morbidities, including Metabolic Syndrome and other disorders such as breast cancer. Obesity, and particularly abdominal obesity, is characterised by metabolic changes, including chronically elevated insulin concentrations and aberrant secretion of cytokines released from fat tissue, called adipokines. Epidemiologically, the risk of developing postmenopausal breast cancer is increased in obese individuals. The molecular link between obesity and breast cancer however is not well understood. The study presented here aimed at identifying the molecular mechanisms involved in this link, by testing the hypothesis that high insulin concentration and certain adipokines may promote breast cancer progression and/or breast cancer aetiology. A cell culture system of breast cancer cells and breast epithelial cells was employed to investigate changes in cell proliferation, activation of cell signalling pathways, cell cycle progression and apoptosis after treatment with insulin, leptin, TNF-α, adiponectin and IL-6. In MDA-MB-231 breast cancer cells, insulin treatment did not affect cell proliferation, cell cycle or apoptosis. Conversely, IR-phosphorylation, AKT-phosphorylation and ERK1/2-phosphorylation were all significantly increased. Microarray analysis indicated several important changes in gene expression with insulin treatment. Leptin treatment increased proliferation by 21%. Additional analyses of the effect of leptin indicated that neither the PI3-kinase pathway nor the MAP-kinase pathway was involved in mediating this effect. Treatment with TNF-α increased apoptosis, but did not affect cell proliferation or activation of cell signalling pathways. In MCF-10A breast epithelial cells, cell proliferation increased after insulin treatment by 180%. IR-phosphorylation, AKT-phosphorylation and ERK1/2 phosphorylation were all significantly increased while early apoptosis decreased after insulin treatment. Analysis of cell cycle however did not indicate a change in progression. Microarray analysis indicated that insulin treatment may increase expression of genes related to cancer growth. Leptin treatment increased cell proliferation and also increased ERK1/2-phosphorylation, while AKT-phosphorylation was not affected. Leptin did not change cell cycle progression. TNF-α treatment increased cell proliferation and also increased ERK1/2 phosphorylation, while AKT-phosphorylation was not changed. TNF-α treatment tended to increase apoptosis, the change however was not statistically significant. In SK-BR-3 breast cancer cells, cell proliferation did not change after insulin treatment. IR-phosphorylation and AKT-phosphorylation increased after insulin treatment, while ERK1/2-phosphorylation decreased. Gene expression of cyclin D and cyclin E increased with insulin treatment, while apoptotic rate and cell cycle profile were also not affected. Cell proliferation increased by 115% after treatment with 100 ng/ml leptin. ERK1/2-phosphorylation however decreased, while AKT-phosphorylation tended to increase, but the change was not statistically significant. Cell cycle profile was not affected by leptin treatment, G1-phase however tended to increase, but the change was again not statistically significant. Cell proliferation increased by 59% after 48 h treatment with 10 ng/ml TNF-α. AKT-phosphorylation and ERK1/2-phosphorylation increased with TNF-α treatment. Cell cycle analysis showed a decrease in S-phase and G2-phase, indicative of a decrease in cell cycle progression. These results indicate that none of the examined obesity-related factors is convincingly identified as the main molecular link between obesity and postmenopausal breast cancer. Conversely, all treatments affected each of the cell lines in, at least, one of the examined aspects. This indicates that many of the obesity-related factors may affect breast cancer and that a single breast tumour may utilise a unique combination of those factors to promote growth. All treatments increased proliferation in MCF-10A breast epithelial cells, with additional analysis generally supporting growth promotion. Insulin treatment particularly increased cell proliferation, while leptin and TNF-α increased MAP-kinase signalling. This may indicate that insulin and adipokines may have a higher impact on breast cancer aetiology than on breast cancer progression.

Background: Obesity is a global problem that resulted from excessive positive energy balance. Decreased physical activity and other dietary, environmental and genetic factors all contribute to its development (Han et al., 2010). On a larger scope, social, economic and cultural factors also predisposed to its occurrence globally (WHO, 2000). Of particular concern is the rise in paediatric obesity with subsequent rise in morbidity during childhood, adolescence and young adulthood, and rise in morbidity in adulthood, including adult obesity, as well as increased risk of premature mortality in adulthood (Reilly and Kelly, 2011, Reilly, 2006). In Kuwait, paediatric obesity prevalence is high and may be continuing to rise in all age groups (Mirmiran et al., 2010, Al-Isa and Thalib, 2008, Al-Isa and Thalib, 2006). Affluence and rapid transformation of Kuwaiti society after the discovery of oil is one theory behind the changes that took place in the dietary and physical activity patterns which could be the main mediators for the obesity epidemic in Kuwait (Ng et al., 2011). However, despite the paediatric obesity problem in Kuwait there is not a widely available treatment solution or attempts to find obesity treatment solutions locally (Al-Isa et al., 2010b). At an international level, effective treatment strategies were traditionally confined to the Western world, particularly the Epstein group in the USA (Epstein et al., 2012, Oude Luttikhuis et al., 2009, Epstein, 1996), though other successful treatment programmes have been published since the early pioneering work of Epstein (Ho et al., 2012). The aim of the thesis was to: a) test the hypothesis that obesity impairs health related quality of life in Kuwaiti adolescents and test the differences in health related quality of life assessed by self-report and parent-proxy report, b) determine the prevalence of cardiometabolic risk factor abnormalities and metabolic syndrome in a sample of obese Kuwaiti adolescents, and c) test the effectiveness of a treatment intervention for adolescent obesity and compare it to a primary care control. Methodology: Chapter 4 describes the health related quality of life study (HRQL) that was conducted at baseline comparing the HRQL between obese and healthy-weight Kuwaiti adolescents (aged 10 to 14 years). Five hundred eligible consenting participants were assessed using the Peds QL™ self-reports as well as 374 parent-proxy reports. From the obese group (n= 224), 82 participants agreed to participate in the National Adolescent Treatment Trial for obesity (NATTO) (chapter 6), an assessor-blinded randomised controlled trial, and were randomised to the intervention programme or primary care control over 6 months. The intervention programme aimed to change sedentary behaviour, diet and physical activity in low intensity doses through 6 hours contact over 24 weeks. At baseline, 80 blood samples were collected from 80 out of the 82 participants from the NATTO study, for the assessment of cardiometabolic risk factors namely C-reactive protein, intracellular adhesion molecules, interleukin-6, fasting blood glucose, fasting insulin, alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and adiponectin. Metabolic syndrome was assessed using two criteria modified for use in younger individuals. Results: From the health related quality of life study, obesity was not associated with impaired health related quality of life in regression analysis. In a structured paired comparison of 98 pairs of obese adolescents vs healthy weight peers, impaired health related quality of life reached significance only for the physical quality of life domain (obese group score = 87.5, healthy weight group score = 93.7, 95% CI for quality of life score = -1.5, -9.4, p 0.007). In a paired comparison between parent-proxy vs self-reports for the obese adolescents, physical quality of life score (parent-proxy score 81.3, self-report score 87.5, 95% CI = -3.2, -11.0, p < 0.001), psychosocial score (parent-proxy score 76.7, self-report score 85.0, 95% CI = -4.2, -10.8, p < 0.001) and total score (parent-proxy score 78.8, self-report score 84.8, 95% CI = -4.9, -10.9, p < 0.001) were all significantly lower in the parent reports. The cardiometabolic risk factors with highest prevalence of abnormal values in the sample (n = 80), described in chapter 5, were; aspartate aminotransferase (89% of samples abnormal), insulin resistance by homeostasis model assessment (HOMA) (67% abnormal ), intracellular adhesion molecule (ICAM) (67% abnormal), fasting insulin (43.5%), C-reactive protein (42.5%), low density lipoprotein (LDL) (35%), total cholesterol (34% abnormal), and systolic blood pressure (30% abnormal). Of all participants (n=80), 77 had at least one impaired cardiometabolic risk factor besides their obesity. Prevalence of Metabolic syndrome was 21.3% using the International Diabetes Federation definition and 30% using the Third Adult Treatment Panel definition. At 6 months outcome in the treatment intervention NATTO, the trial had acceptable retention (n =31 from the intervention group and n =32 from the control group), but engagement with both the intervention and control treatment (as measured by attendance at treatment sessions) was poor. The intervention had no significant effect on BMI Z score relative to control, and no other significant effects of the intervention were observed. Conclusion: In a sample of obese Kuwaiti adolescents, obesity was not associated with marked impairment of health related quality of life; however, marked impairment in multiple cardiometabolic risk factors was present. Conducting the National Adolescent Treatment Trial for Obesity in Kuwait was feasible but not efficacious, and future obesity treatment trials should incorporate a qualitative assessment for better participants’ engagement.

Thesis (MBA)--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: The prevalence of overweight and obesity escalated over the past 30 years worldwide in adults, children, and adolescents. Estimates are that 26% of the global adult population is either overweight or obese. However, the most alarming fact is the increase in obesity in children and adolescents. In South Africa, the estimated overweight and obesity prevalence in adults is 45% and 20% in children below 6 years of age. The World Heath Organisation acknowledges obesity as an unforgiving, formidable chronic disease, an eminent global epidemic, and the most significant independent risk factor to chronic disease. There are about 30 different diseases associated with obesity of which cardiovascular disease, metabolic syndrome, lifestyle cancers, depression, and diabetes are the most prominent. The current rising obesity trends increase the prevalence of these obesity-associated diseases, as well as a wide range of psychosocial problems. Global expectations are that weight-related chronic disease will develop into the most significant healthcare problem in the 21st century. The overarching trend of globalisation has transformed the global landscape into a more obesogenic environment with resultant changes in behavioural lifestyles of increased caloric consumption and less physical activity at home and at work. However, genetic, social, and cultural determinants enhance weight gain, which contributes largely to current obesity trends. Obesity is a major public healthcare problem in South Africa, with African women and Caucasian men most at risk. However, the competing priorities of unemployment, poverty, and HIV/AIDS place high demands on the South African economy, with resultant neglect of obesity. Obesity has the potential to incur a large impact on the South African economy through the reduction in labour productivity, corporate profitability, and national output, especially in combination with HIV/AIDS.
AFRIKAANSE OPSOMMING: Die insidensie van oorgewig en obesiteit het toegeneem oor die afgelope 30 jaar wereldwyd in volwassenes, tieners, en kinders. Omtrent 26% van die globale populasie is of oorgewig of vetsugtig. Die erns van die huidige situasie is egter die toenemende voorkoms van obesiteit in kinders en tieners. Die voorkoms van oorgewig en obesiteit in Suid-Afrika word geskat op 45% in volwassenes en 20% in kinders jonger as 6 jaar. Die Wereld Gesondheid Organisasie het in 1997 obesiteit geklassifiseer as 'n chroniese siekte en hul kommer uitgespreek oor die feit dat obesiteit epidemiese proporsies bereik het. Obesiteit word ook nou erken as die belangrikste, onafhanklike risiko faktor vir chroniese siekte. Obesiteit word geassosieer met omtrent 30 verskillende siektetoestande waarvan kardiovaskulere siekte, metaboliese sindroom, lewensstyl kankers, depressie, en diabetes die belangrikste is. Stygende obesiteit syfers verhoog ook die voorkoms van hierdie siektes asook verskeie psigososiale probleme. Verwagtings is dat gewig verwante siektes die belangrikste gesondheid probleme sal wees gedurende die 21 ste eeu. Die proses van globalisasie het die wereld landskap verander in 'n omgewing wat meer obesogenies is, wat gelei het tot veranderings in leefstyle in die rigting van 'n hoër inname van kaloriee en minder aktiewe leefstyle. Genetiese, sosiale, en kulturele faktore verhoog ook die vatbaarheid van die individu tot gewig toename en speel 'n groot rol in die huidige obesiteit status. Obesiteit is tans 'n geweldige gesondheidprobleem in Suid-Afrika met Swart vrouens en Blanke mans die populasiegroepe wat die hoogste risiko dra. Die probleem is egter dat die kompeterende prioriteite van werkloosheid, armoede, en MIV/VIGS alreeds hoe eise stel aan die Suid-Afrikaans ekonomie met gevolglike verwaarlosing van obesiteit. Obesiteit het die potensiaal om 'n groot effek uit te oefen op die Suid-Afrikaanse ekonomie deur middel van 'n verlies in produktiwiteit, verminderde korporatiewe wins, en ekonomiese groei, veral in kombinasie met MIV/VIGS.

This study sought to examine whether participation in physical activity affects the ability to correctly classify body size, based on body mass index classifications. Secondarily, this study determined whether adolescents who incorrectly classified their body size overestimated or underestimated their size. Self-report data from the Youth Risk Behavior Surveillance Survey collected by the Centers for Disease Control and Prevention were analyzed. Logistic regression was performed to examine relationships between self-perception of body size and physical activity, television viewing time, computer/video game use, physical education class time, and extracurricular sports activities. Significance was set to p<0.05. Physical activity was the only statistically significant independent variable (p=0.058, OR = 1.060). Although physical activity was shown to be statistically significant, it did not appear to meaningfully increase the ability of youth to correctly classify body size. Secondary analysis showed that adolescents who incorrectly classified their body size were more likely to underestimate their body size. Females more frequently underestimated their body size (females=673; males=384).

Social phobia is a disabling, lifelong disorder characterised by fear in social settings.

The aim of the present study was to gain more knowledge about diagnostic, neurobiologic and epidemiologic aspects of social phobia.

Thirty-two individuals were assessed by the Structured Clinical Interview for DSM-IV Axis I and II psychiatric disorders, the Karolinska Scales of Personality and the Temperament and Character Inventory. Social phobia was accompanied by concurrent axis I disorders in about 28% of individuals, lifetime axis I disorders in 54%, personality disorders in 60%, and avoidant personality disorder (APD) in 47%. This suggests that there is a high comorbidity between social phobia and APD according to the DSM-IV criteria. The personality profiles associated with social phobia were dominated by anxiety-related traits that were primarily related to social phobia itself and not to the presence of concurrent personality disorders.

Eighteen subjects with social phobia and eighteen controls were investigated with positron emission tomography and the radiolabeled serotonin precursor, [3 -11C]–5-HTP (5-HTP). Individuals with social phobia demonstrated proportionally lower regional relative whole brain accumulation of 5-HTP in areas of the frontal and temporal cortices as well as the striatum, but higher accumulation in the cerebellum. This suggests that there are imbalances in presynaptic serotonin function in individuals with social phobia, although this could only be confirmed in men, and not in women.

By means of a postal survey, distributed to 2000 randomly selected individuals, social phobia in Sweden was found to be common, with a point prevalence of 15.6%.

Introduction: The long-term success of non-surgical weight loss treatment in adults with obesity is limite by substantial relapse, and only a few evidence-based weight loss maintenance treatments exist. This clinical trial investigates the feasibility and efficacy of a social facilitation maintenance programme for weight loss maintenance, tailored to meet the needs of obese adults who have undergone a lifestyle weight loss intervention. Methods and analysis: In a single-centre, open feasibility trial, 72 adults currently or previously obese or overweight who have undergone a lifestyle weight loss intervention are centrally randomised to 4 months of social facilitation maintenance treatment or treatment as a usual control condition. In 16 outpatient group sessions, the social facilitation maintenance treatment, based on a socioecological model and on evidence supporting social facilitation as a key process in maintaining weight loss, focuses on promoting interpersonal relationships to build up a healthy lifestyle for long-term weight loss maintenance. Primary outcome is the amount of weight regain at 6-month follow-up, compared with pre-treatment weight, derived from measured body weight. Secondary outcomes address feasibility, including recruitment, attrition, assessment non-completion, compliance and patients’ programme evaluation; and in comparison with pre-weight loss maintenance, social and interpersonal functioning, eating behaviour and physical activity, psychological and physical symptoms, body composition and risk of comorbidity, and quality of life at post-treatment and follow-up assessments. Ethics and dissemination: The study was approved by the Ethical Committee at the University of Leipzig (165-13-15072013). The study results will be disseminated through peer-reviewed publications. Trial registration number: DRKS00005182

Objective The prevalence of obesity and related diseases such as type 2 diabetes mellitus (T2DM) is increasing worldwide, and the Asian Indian population seems to be particularly susceptible to developing T2DM, even at a low body mass index (BMI). In Sweden, the age-adjusted prevalence of diabetes has not increased despite increasing self-reported obesity. However, modern data on the prevalence of obesity and T2DM in Scandinavia are absent.The biochemical links between obesity and subsequent T2DM are unknown, but the adipocyte-derived hormones leptin and adiponectin (adipokines) have been suggested as potential links because they both are related to insulin and glucose physiology. Some studies have found leptin to be an independent predictor of T2DM in men but not in women, although these results are inconsistent. In contrast, adiponectin has more consistently been linked to development of T2DM in both men and women. Furthermore, the leptin–adiponectin ratio may predict incident T2DM better than either of the two hormones separately.The aims of this thesis were to describe time trends in obesity and T2DM in northern Sweden, to evaluate leptin and adiponectin as predictors of deterioration in glucose metabolism including T2DM, and to evaluate leptin as a risk marker regarding ethnic differences, circ-annual variation, and intra-individual stability. Materials and methods Three large population surveys were used, the Northern Sweden MONICA (MONitoring of Trends and Determinants in CArdiovascular Disease) study, the Västerbotten Intervention Programme (VIP), and the Mauritius Non-Communicable Disease Study. Within the MONICA study, six cross-sectional surveys were performed in Sweden’s two northernmost counties, Norrbotten and Västerbotten, between 1986 and 2009. A total of 1000 men and 1000 women ages 25–64 years, also including from 1994 250 men and 250 women ages 65–74 years, were independently chosen for each survey. The overall participation rate was 75%. In 1999, a reinvestigation was performed in 74% of all participants from the three first surveys. Data from the MONICA surveys were used in papers I and IV and data from the reinvestigation survey in paper II. VIP is an ongoing population intervention program that started in the mid-eighties targeting cardiovascular risk factors and has covered the whole county of Västerbotten since 1991. Inhabitants are invited the years they turn 40, 50, and 60 years old, and the annual participation rate has varied between 48% and 67%. A subset (n=1780) from VIP was used in paper II for the circ-annual leptin analysis, and VIP data linked to the diabetes register in Västerbotten (DiabNorr) were used in a case referent study (640 patients with T2DM) in paper III. The Mauritius Non-Communicable Disease Study was performed in 1987 in 10 randomly selected (with probability proportional to size) population clusters. All eligible adults ages 25–74 years were invited, and the participation rate was 86% (n=5083). In 1992, a follow-up survey was performed in 49% of the initial participants. The Mauritius survey data were used in paper II. Results I. BMI increased in men ages 25–74 years and in women ages 25–44 years in northern Sweden between 1986 and 2004. The prevalence of obesity (BMI 30) increased in men ages 25–44 and 55–74 years and in women ages 25–44 years. The prevalence of obesity increased from 10.4% to 19.1% in men and from 12.9% to 17.9% in women ages 25–64 years. Waist circumference (WC) decreased in women of all ages and in men ages 55–64 years between 1986 and 1990. After 1990, WC increased again, and the prevalence of abdominal obesity rose markedly in women ages 25–64 years. II. Differences in circulating levels of leptin, leptin per BMI unit (leptin/BMI), and leptin per cm in WC (leptin/waist) were tested in men and women of Asian Indian, Creole (African), and Caucasian ethnicity. Asian Indian men and women had the highest leptin concentrations and Caucasian men and women the lowest while Creole men and women had intermediate values for leptin, leptin/BMI, and leptin/waist. No circ-annual variation in leptin concentrations was seen in Caucasians. The intra-individual test– retest stability for leptin was equal in men and women of different ethnicities, over 5–13 years, with an intra-class correlation of 0.65–0.82. III. High adiponectin concentrations predicted decreased risk of T2DM in both insulin-sensitive and insulin-resistant men and women, whereas high leptin levels predicted increased risk for T2DM only in insulinsensitive men. A high leptin–adiponectin ratio predicted T2DM in both men and women, and men with a high ratio had a shorter time to diagnosis than those with a low ratio. IV. In northern Sweden, fasting and post-load glucose increased in women ages 24–65 years with 0.2 mmol/l and 0.7 mmol/l, respectively, between 1990 and 2009. Consequently, the prevalence of impaired fasting glucose and impaired glucose tolerance (IGT) rose from 4.5% to 7.7%, and from 7.8% to 14.5%, respectively. In men, post-load glucose increased at 0.5 mmol/l, and the prevalence of IGT rose from 3.5% to 10.1%. The prevalence of diabetes did not increase. An independent relationship between leptin and changes in fasting and post-load glucose was seen in men but not in women. Conclusion An increasing obesity and concomitant deterioration in glucose metabolism was seen in northern Sweden in the period studied. High adiponectin concentrations predicted a decreased risk of T2DM in both men and women, whereas high leptin concentrations predicted an increase in fasting and post-load glucose as well as an increased risk of T2DM in men but not in women. Individual insulin resistance status modified the association between leptin and T2DM, and the leptin–adiponectin ratio may add further predictive information beyond the measures of the separate hormones. In relation to traditional anthropometric measures of obesity, Asian Indian men and women had the highest and Caucasians the lowest concentrations of leptin while Creole (African) men and women had intermediate levels. As a risk marker, leptin has a high intra-individual stability, equal in men and women and among different ethnicities over 5–13 years with no circ-annual variation.

According to the U.S. Department of Health and Human Services, Office of Minority Health and the Center for Disease Control (CDC), individuals who identified themselves as African-American or Black have the highest rate of obesity in the United States. The higher prevalence of overweight and obesity among the African-American population correlates to an increased risk for a number of diseases (including heart disease, diabetes, and several cancers) and an increased mortality rate for the African American population. Through focus groups and interviews, the research I will present focuses on perceptions of overweight and obesity among African-Americans, including any cultural beliefs associated with overweight, obesity and African-Americans. I examined cultural norms of body image, food preference (including "soul food" and other foods traditionally associated with African-American culture), and access to healthy foods and how the familial unit deals with issues of overweight and obesity. I also explored popular explanatory models surrounding the cultural acceptance of overweight and obesity in the African-American culture. Finally, I attempted to uncover the role that socioeconomic status plays in the acceptance, belief and/or knowledge of these models. A total of 80 participants who identify as African-American or Black were chosen using non-probability sampling techniques to participate in this research. I conducted 3 focus groups and 60 one on one interviews. Each participant in the focus group and one on one interview filled out a brief questionnaire about their perceptions of their own body image in conjunction with their interview. Varying socioeconomic status was sought amongst interview participants while similar socioeconomic status and education level were sought among focus group participants so that each person within the group felt as comfortable as possible sharing their experiences with weight and food. In my paper, I will discuss common themes that emerged in focus groups and interviews regarding perceptions of obesity among my participants.

Thesis (MA)--University of Stellenbosch, 2007.
ENGLISH ABSTRACT: This case-based research of Mrs K, a 39 year old, white woman who has been facing weight problems since the age of six sheds light on the effectiveness of a Cognitive-behavioural hypnotherapy intervention as an aid to weight loss and the enhancement of body image and satisfaction. Literature is provided to contextualise the research question and both a quantitative and phenomenological approach to conducting the research is employed in this case study. The results are also discussed from both these perspectives. The subject’s body image improved over the eight session period and she was better able to understand and challenge her food cravings. At the start of the program she experienced thirty two cravings a week and by session eight they had reduced to 10. It was also found that the frequency of her five main self defeating cognitions (monitored and reported weekly on a cumulative basis) decreased from one hundred and twenty-one to eighty-two. While her actual weight-loss was not significant, the intervention assisted in her overall sense of well being facilitating self acceptance. The phenomenological section of this paper partially follows a model conceptualised by Fishman (2005), one of the leading founders of the journal Pragmatic Case Studies in Psychotherapy (PCSP). He advocates that as part of the study a clinical assessment and formulation be included so as to elucidate the subject’s context. It was found that Mrs K had experiences in life relating to themes of unworthiness and inadequacy. These experiences could have thus impacted on her eating behaviours resulting in negative and self defeating diet patterns to develop.
AFRIKAANSE OPSOMMING: In die enkelgevalstudie met Mev. K., ̛n 39 jarige blanke vrou wat sedert sesjarige ouderdom ̛n gewigsprobleem het, word die effektiwiteit van ̛n kognitiewe gedragshipnoterapeutiese intervensie, met betrekking tot gewigsverlies, liggaamlike selfbeeld en satisfaksie ondersoek. Kwantitatiewe sowel as ̛n kwalitatief fenomenologiese metode is gebruik om die navorsingsdata te ontleed. Tydens die agt sessies van die program het die persoon se liggaamlike selfbeeld verbeter en was daar ̛n verbeterende ingesteldheid teenoor voedsel – eetlus en kon sy dit beter verstaan en beheer. Aan die begin van die intervensie het sy 32 eetbegeertes ervaar wat afgeneem het na 10 aan die einde van die program. Die frekwensie van haar vyf hoof negatiewe gedagte-patrone (weekliks gerapporteer op ̛n kumulatiewe basis) het van 121 na 82 verminder. Terwyl haar fisiese gewigsverlies nie statisties noemenswaardig was nie, het haar oorkoepelende gevoel van algemene gesondheid haar selfaanvaarding gefasiliteer. Die fenomenologies-kwalitatiewe navorsingsgedeelte is gebaseer op die model van Fishman (2005), een van die stigterslede van die Pragmatic Case Studies in Psychotherapy (PCSP) Journal. Hy voer aan dat ‘n kliniese ondersoek en formulering in die intervensie ingesluit word om sodoende die persoon se konteks beter te skets. Die volgende temas, naamlik minderwaardigheid en ontoereikendheid, is fenomenologies geïdentifiseer. Laasgenoemde belewinge (temas) het ̛n negatiewe invloed op haar dieetpatroon gehad.

Background The consumption of sugar-sweetened beverage (SSBs) among children and adolescents, particularly carbonated soft drinks, are always blamed to be the contributor to the epidemic of overweight and obesity. With the number of obese population increased, people become increasingly more focus on the relationship between SSB and the weight gain problems. However, because there are some characteristics of these beverages that people can get energy and happiness, so that people enjoy drinking sugar-sweetened beverage especially children who like sugar and sweet. So, people are still wondering the association between SSB and obesity. Methods A literature search was performed using Google scholar and Pubmed to locate all relevant articles in English that study the impacts of SSB on the weight gain and obesity on children and adolescent up to December 2013. Findings Eleven core references were found to study the association between SSB and the weight gain among children and adolescent including 4 randomized trial studies, 6 cross-sectional studies and 1 case-control study. Conclusions The data collected from large cross-sectional studies, especially the long-term studies shows that there is a positive association between the intake of SSB and the weight gain and obesity in children and adolescent. A case control study based on hospital shows that the children who with less soft-drink consumptions have lower prevalence of obesity and overweight. In addition, the randomized control trials indicate that the greater consumption of SSB, the easier to gain weights among children and adolescents. Although more evidence are needed, the sufficient evidence exists now are not encouraging the public to intake too many sugar-sweetened beverage as a healthy behavior.
published_or_final_version
Public Health
Master
Master of Public Health

This thesis comprises five chapters in total, starting with a general introduction that raises the issue of obesity as well as a brief description of the basic research questions of the dissertation, three main chapters involving the analysis of the Body Mass Index (BMI) with a view to investigate the social, economic, cultural and environmental factors driving and sustaining health disparities in obesity in Spain and a chapter of concluding remarks stemming from the analysis made. In particular, the second chapter examines the evolution of obesity as well as the incomerelated inequality in obesity over the past two decades in Spain, splitting by gender. It also evaluates income inequality in obesity (measured by distribution sensitive measures) by breaking it down to its main contributors. The results indicate that obesity prevalence rates have been increasing over the last twenty years among the Spanish population, as in most developed countries, however income-related inequality in obesity status, depth and severity has a declining trend mainly among women. These findings may imply a switch in the basic determinants of obesity across the income distribution; that is, BMI status might not be linked only to individual attributes, but changes in environmental influences across income groups may be important as well. This is inextricably linked to the third chapter, where we seek to understand the basic determinants of individual body weight and obesity risk, by concurrently examining individual and regional characteristics within a multilevel approach, to conclude that not only personal attributes but also environmental characteristics (i.e., criminality and lack of green spaces) affect positively individual and women s BMI and obesity. Driven by the spatial pattern of BMI that is observed in this third chapter, according to which southern regions of Spain tend to exhibit higher BMI levels than the northern ones, we proceed with chapter four. In this fourth chapter we aim to contribute to the North to South health divide in Spain, using decomposition techniques to analyse the main contributors of the BMI gap between the North and the South of Spain. Our findings indicate that North to South differences are significant only for women and that the largest share of this gap is attributed to differences in endowments (mainly education) to the detriment of women living in the South.

The a of TNFa in title is the Greek alpha.
Thesis (MSc)--University of Stellenbosch, 2002.
ENGLISH ABSTRACT: Background: Cardiac hypertrophy is an adaptive process occurring in response to mechanical overload or tissue injury. The stimuli for cardiac hypertrophy are diverse and vary from increased afterload on the heart to cardiac remodeling in response to cytokines. Amongst others, obesity is characterized by excessive body weight resulting in metabolic disorders. This excess body weight necessitates an increased blood and oxygen delivery to the peripheral tissues, which is achieved by an elevated cardiac output. Total blood volume is also increased in the obese due to the increased tissue volume and vascularity. With time, the obesity induced increase in cardiac preload results in left ventricular hypertrophy and dilatation. Obesity is also associated with complications such as hypertension, insulin resistance and impaired glucose metabolism. In addition, adipose tissue has been implicated to contribute to elevated circulating TNFa levels in obesity and may contribute to the pathophysiology of the heart in obese individuals. The heart is a major cytokine-producing organ that generates amongst others tumor necrosis factor a (TNFa). TNFa is a proinflammatory cytokine, which acts to increase its own production, has cytotoxic and cytostatic effects on certain tumor cells and influences growth and differentiation in virtually all cell types including cardiomyocytes. Elevated levels of TNFa are detected peripherally in almost all forms of cardiac injury and in hypertrophic cardiomyopathy. These elevations are proposed to be deleterious to the heart, although an adaptive role for low levels of TNFa has been proposed. Aim: The aim of the study was to determine whether there is a correlation between obesity and serum, myocardial, and adipose tissue TNFa levels and cardiac hypertrophy. We also wished to determine whether the hearts from the obese animals functioned normally under normoxic conditions and whether they responded differently to ischaemia/reperfusion when compared with their concurrent controls. Materials and Methods: Male Sprague-Dawley rats (n=100) were fed a high caloric diet (HCD) containing 33% rat chow, 33% condensed milk, 7% sucrose and 27% water, or standard laboratory rat chow for 6-12 weeks. Food consumption, body weight gain, heart weight and tibia length were measured. Serum glucose, insulin and lipid levels were also determined. Hearts were excised and perfused on the isolated Working Heart perfusion apparatus and cardiac function was monitored and documented. Hearts were then subjected to 15 minutes of total global ischaemia at 370C, and reperfused for 30 minutes. Cardiac function was again documented. A separate series of hearts were freeze-clamped at different time points during the experimental protocol and stored in liquid nitrogen for the determination of myocardial TNFa and cGMP levels. Serum TNFa levels were determined after 12 weeks on the high caloric or normal/control diet. After 12 weeks on the diet myocardial TNFa levels of the HCD fed animals and their concurrent controls were determined before and during ischaemia. Adipose tissue and myocardial tissue TNFa levels were also determined after 6, 9 and 12 weeks on the respective diets. Myocardial cGMP levels were measured in the HCD fed rats and the control rats after 6, 9, and 12 weeks. These data were used as an indirect index to determine whether the myocardial NOcGMP pathway was activated in the normoxic hearts on the respective diets. Results: The body weight of the HCO fed animals was significantly higher compared with their respective controls after 12 weeks on the diet (459.9 ± 173.8 g and 271.5 ± 102.6 g respectively (p<0.05». The HCO fed animals also had heart weight to body weight ratios that were significantly greater compared with the controls (4.2 ± 0.1 mglg and 3.7 ± 0.1 mglg respectively (p<0.05». The plasma glucose levels of the HCO fed animals were higher than their respective controls (9.2 ± 0.3 mmoiII and 7.8 ± 0.3 mmoiII respectively (p<0.05)), but their insulin levels were similar (12.87 ± 1.02 IlIUlml and 12.42 ± 5.06 IlIU/ml). Plasma lipid profiles (plasma cholesterol, high density lipoprotein (HOL) cholesterol and plasma triacylglyceride (TAG)) were abnormal in the HCO fed animals compared with the control rats. Plasma TAG levels in the HCO fed animals were significantly higher compared with the control rats (0.664 ± 0.062 mmoiII and 0.503 ± 0.043 (p<0.05», while plasma cholesterol levels (1.794 ± 0.058 mmoIII and 2.082 ± 0.062 mmoiII (p<0.05» and HOL cholesterol levels were significantly lower (1.207 ± 0.031 mmoiII and 1.451 ± 0.050 mmoiII (p<0.05». Cardiac mechanical function was similar for both groups before ischaemia, but the percentage aortic output recovery was lower for the hearts from the HCO fed animals when compared with their controls (47.86 ± 7.87% and 66.67 ± 3.76 % respectively (p<0.05». Serum TNFa levels of the HCO fed animals were higher compared with the control animals (51.04 ± 5.14 AU and 31.46 ± 3.72 AU respectively (p<0.05», but myocardial TNFa levels remained lower in these animals (312.0 ± 44.7 pglgram ww and 571.4 ± 132.9 pg/gram ww respectively (p<0.05)). During ischaemia these myocardial TNFa levels increased above those of the controls (442.9 ± 12.4 pg/gram ww and 410.0 ± 12.5 pg/gram ww respectively (p<0.05)). The adipose tissue TNFa levels were significantly increased after 12 weeks on the high caloric diet compared with the control animals (4.4 ± 0.4 pg/gram ww and 2.5 ± 0.3 pg/gram ww respectively (p<0.05)). There was no significant difference in the myocardial cGMP levels of the HCD rats compared with the conrol rats after 6, 9 and 12 weeks. Conclusion: 1) The high caloric diet induced obesity, which lead to cardiac hypertrophy in this study. 2) There was a strong correlation between elevated adipose tissue and serum TNFa levels, and cardiac hypertrophy. 3) Elevated serum TNFa levels did not lead to activation of the myocardial NO-cGMP pathway in the normoxic hearts in this model. 4) The hypertrophied hearts from the HCD fed animals had poorer post-ischaemie myocardial functions than their concurrent controls.
AFRIKAANSE OPSOMMING: Agtergrond: Miokardiale hipertrofie is In aanpassing wat gebeur as In gevolg van meganiese oorbelading of weefsel beskadiging. Verskillende stimuli kan tot miokardiale hipertrofie aanleiding gee soos byvoorbeeld In verhoging in nalading, of miokardiale hermodellering in respons op sitokiene. Verhoging van voorbelading in vetsug mag ook tot hipertrofie aanleiding gee. Vetsug word gekenmerk deur In oormatige liggaamsmassa wat tot metaboliese versteurings lei. Die oormatige liggaamsmassa vereis In verhoging in bloed- en suurstofverskaffing aan die perifere weefsel wat deur In verhoging in die kardiale uitset vermag kan word. Die bloed volume van In vetsugtige individu word ook verhoog as gevolg van In verhoging in weefselvolume en vaskulariteit en met verloop van tyd induseer die verhoogde kardiale voorbelading linker ventrikulêre hipertrofie en dilatasie. Vetsug word ook met verskeie ander siekte toestande soos hipertensie, insulien weerstandigheid en versteurde glukose metabolisme, geassosieer. Vetweefsel dra ook by tot verhoging van tumor nekrose faktor alfa (TNFa) vlakke in die bloed, wat op sy beurt tot miokardiale hipertrofie mag bydra. TNFa is In proinflammatoriese sitokien wat sy eie produksie kan stimuleer. Dit het ook sitotoksiese en sitostatiese effekte op sekere tumor selle en kan groei en differensiasie in bykans alle seltipes, insluitende kardiomiosiete, stimuleer. Die hart kan ook TNFa produseer en verhoogde TNFa vlakke word feitlik in alle vorms van miokardiale besering en hipertrofiese kardiomiopatie waargeneem. Daar word voorgestel dat verhoogde TNFa vlakke vir die hart nadelig is, ten spyte van die vermoeding dat die sitokien In potensiële aanpassings rol by laer vlakke het. Doelstelling: Die doel van hierdie studie was om vas te stelof daar 'n verband tussen vetsug en serum, miokardiale en vetweefsel TNFa vlakke en miokardiale hipertrofie, bestaan. Ons het ook gepoog om te bepaal of harte van vetsugtige diere normaal funksioneer en of die response van sulke harte op isgemie-herperfusie van die van ooreenstemmende kontroles verskil. Materiaal en tegnieke: Manlike Sprague-Dawley rotte (n=100) is vir 6-12 weke op 'n hoë kalorie dieët (HKD) geplaas. Die HKD het uit 33% rotkos, 33% gekondenseerde melk, 7% sukrose en 27% water bestaan. Kontrole diere het standaard laboratorium rotkos ontvang. Voedselinname, liggaamsmassa toename, serum insulien, glukose en lipied vlakke is ook bepaal. Harte is geïsoleer en geperfuseer volgens die Werk Hart perfusie metode en hart funksie is gemonitor en gedokumenteer. Harte is vervolgens aan 15 minute globale isgemie by 3rC blootgestel en daarna weer vir 30 minute geherperfuseer waartydens hartfunksie weer gedokumenteer is. 'n Aparte groep harte is op spesifieke tydsintervalle gedurende die eksperimentele protokol gevriesklamp en in vloeibare stikstof gestoor vir die bepaling van miokardiale TNFa en sGMP vlakke. Serum TNFa vlakke is bepaal na 12 weke op die dieët. Na die diere 12 weke op die HKD was, is hierdie diere en hulooreenstemmende kontroles se miokardiale TNFa vlakke voor en na isgemie bepaal. Vetweefsel en miokardiale TNFa vlakke is ook onderskeidelik na 6, 9 en 12 weke bepaal. Miokardiale sGMP vlakke is in die HKD diere en in die kontrole diere na 6, 9 en 12 weke bepaal. sGMP vlakke is gebruik as 'n indirekte indeks van aktivering van die miokardiale NO-sGMP boodskapper pad. Resultate: Na 12 weke op die dieët was die liggaamsmassa van die HKD diere beduidend hoër in vergeleke met hulooreenstemmende kontroles (459.9 ± 173.8 g en 271.5 ± 102.6 g (p<0.05)). Die HKD diere se hart massa tot liggaam massa verhouding was ook beduidend hoër in vergelyking met die van kontroles (4.2 ± 0.1 mglg en 3.7 ± 0.1 mglg (p<0.05)). Alhoewel insulien vlakke dieselfde was (12.42 ± 5.06 j.lIU/ml en 12.87 ± 1.02 j.lIU/ml), was serum glukose vlakke van die HKD diere hoër as die van die ooreenstemmende kontroles (9.2 ± 0.3 mmoiii en 7.8 ± 0.3 mmoiii (p<0.05)). Plasma lipied profiele (HOL cholesterol, plasma cholesterol en trigliseriede) was abnormaal in die HKD diere. Plasma TAG vlakke in die HKD diere was beduidend hoër as die van die kontroles (0.664 ± 0.062 mmoiii en 0.503 ± 0.043 (p<0.05)), terwyl plasma cholesterol vlakke (1.794 ± 0.058 mmoiii en 2.082 ± 0.062 mmoiii (p<0.05)) en HOL cholesterol vlakke beduidend laer was (1.207 ± 0.031 mmoiii en 1.451 ± 0.050 mmoiii (p<0.05)). Miokardiale meganiese funksie was dieselfde vir beide groepe voor isgemie, maar die persentasie aorta omset herstel tydens herperfusie was laer in die HKD diere in vergelyking met die van kontrole diere (47.86 ±. 7.87% en 66.67 ± 3.76% (p<0.05)). Serum TNFa vlakke van die HKD diere was beduidend hoër as die van kontrole diere (51.04 ± 5.14 AU en 31.46 ± 3.72 AU (p<0.05)), maar miokardiale TNFa vlakke was laer (312.0 ± 44.7 pglgram nat gewig en 571.4 ± 132.9 pglgram nat gewig (p<0.05)). Die vetweefsel TNFa vlakke was ook beduidend verhoog na 12 weke op "n hoë kalorie dieët wanneer dit vergelyk word met die van kontrole diere (4.4 ± 0.4 pglgram nat gewig en 2.5 ± 0.3 pglgram nat gewig respektiewelik (p<0.05)). Daar was geenbeduidende verskille in die miocardiale vlakke van sGMP in die HKD diere in vergelyking met die kontroles na 6, 9 en 12 weke. Gevolgtrekkings: 1) "n Hoë kalorie dieët het in dié studie vetsug geïnduseer en tot miokardiale hipertrofie gelei. 2) Daar was "n positiewe korrelasie tussen verhoogde vetweefsel en serum TNFa vlakke, en miokardiale hipertrofie. 3) Verhoogde serum TNFa vlakke het nie tot die aktivering van die miokardiale NO-sGMP pad in hierdie model gelei nie. 4) Die hipertrofiese harte het tydens herperfusie ná isgemie swakker as hulooreenstemmende kontroles gefunksioneer.

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Universidade Estadual Paulista (UNESP)
A obesidade é um distúrbio complexo, com origens ambientais, genéticas e de desenvolvimento e com conseqüências médicas, psicossociais e econômicas. As conseqüências da obesidade, quanto às questões emocionais e de identidade, principalmente em crianças e adolescentes, dependerá, em partes, de suas habilidades sociais, do montante de stress gerado por cobranças sociais, preconceitos e experiências de bullying que sofrem, bem como da maneira como fazem o enfrentamento destas experiências. O presente trabalho teve como objetivos conhecer aspectos nutricionais e psicossociais da vida da criança em condição de sobrepeso e obesidade e contribuir para a garantia da qualidade de vida das mesmas e para a (re)construção de recursos psicológicos para o enfrentamento das implicações de sua condição. Participaram do estudo quinze crianças de sete a onze anos em condição de sobrepeso/obesidade, sendo nove meninas e seis meninos. Inicialmente, foram conduzidas entrevistas com as crianças e com os pais e aplicados o Sistema Multimídia de Habilidades Sociais de Crianças e a Escola de Stress Infantil, visando levantar dados acerca da vida das crianças referentes a: hábitos alimentares, prática de atividades físicas, aspectos sócio-emocionais, habilidades sociais, nível de stress e convivência escolar. Após esse processo de avaliação inicial, foi criado e realizado o PACEP (Programa de Atenção a Crianças com Excesso de Peso) onde foram abordados, no geral: hábitos alimentares saudáveis; importância da prática de atividades físicas; discussão sobre aspectos estressogênicos vivenciados no cotidiano e enfrentamento dos mesmos através de técnicas de habilidades sociais; favorecimento à auto-aceitação e à auto-estima. Concluíndo o PACEP, as crianças e os pais passaram por nova entrevista, com a finalidade de avaliar as mudanças de vida infantis...
The obesity is a complex disturb of environmental, genetic and development origins, with medical psychosocial and economical consequences. The consequences of obesity, in regard to the emotional and self identity issues, mainly on children and teenagers, depend, in part, on their social abilities and skllis, of the amount od stress generated by charging of the society, prejudice and bullying experiences they've passed through, as well the quality of life of children in condition of overweight and help them in the (re)construction of psychological resources important to the way they face the psychosocial implications of its condition. Took part in this study fifteen children from 7 to 11 years old in overweight condition, being 9 gilrs and 6 boys. There was a initial interview with children and their parents and applied the Multimedia System of Children Social Abilities and the Scale of Childish Stress in order to collect data about the children's life referred to: healthy feeding habits, practice of physical exercises, socio-economical aspects, social aabilities, stress level and school life. After this initial trial, an interventive program took place, PACEP (Program of Attention to Overweight Children), and the main issue was whether they have healthy feeding habits, the importance of doing gym, discussion on the stressing aspects lives day by day and the way they face it through social abilities techniques improving self love. As the program was in new interview, with the purpose of evaluating the children's lives changes occurred after the program conclusion. The results of the initial trial revealed that most of the participants displayed wrong feeding habits (involving, for example, candies and fatty food); sedentary life; victimization by bullyng at school context; irritation and no-skilled social reactions when victims of bullying; negative self-image... (Complete abstract click electronic access below)