Resistance training lowers exercise-induced oxidative stress and homocysteine levels in overweight and obese older adults

Objective: To compare exercise‐induced oxidative stress and levels of homocysteine and cholesterol in normal‐weight and overweight older adults after resistance exercise (RX). Research Methods and Procedures: This interventional study was conducted at a wellness center. Forty‐nine older adults (age range, 60 to 72 years) were stratified by BMI (<25 kg/m² normal weight, ≥25 kg/m² overweight/obese) and then randomly assigned to either a control non‐exercise group or an RX group. The RX group completed a 6‐month training program. Exercise‐induced lipid hydroperoxides (PEROXs) and thiobarbituric‐reactive acid substances, homocysteine, lipoprotein a, cholesterol, and high‐density lipoprotein cholesterol were measured before and after the 6‐month RX program. Results: PEROXs and thiobarbituric‐reactive acid substances were lower in both the overweight/obese and normal‐weight RX‐trained groups compared with control groups (p < 0.05). Homocysteine levels were lower in both overweight/obese and normal‐weight RX groups compared with control groups (p < 0.05). Lipoprotein a, total cholesterol, and high‐density lipoprotein cholesterol were not different in normal‐weight and overweight/obese groups before or after RX. The change in muscle strength was correlated with homocysteine at 6 months (r = ?0.452, p < 0.05), whereas the change in PEROXs was correlated with the change in body fat (r = ?0.329). Discussion: To our knowledge, these data are the first to show that RX reduces exercise‐induced oxidative stress and homocysteine regardless of adiposity, indicating that this protection can be afforded in an older, overweight/obese population as effectively as in healthy older adults. These data suggest that RX may afford some protection against emerging cardiovascular risk factors using a mode of exercise that supports body weight.     

Acquired liver fat is a key determinant of serum lipid alterations in healthy monozygotic twins

Objective: The effects of acquired obesity on lipid profile and lipoprotein composition in rare BMI‐discordant monozygotic (MZ) twin pairs were studied. Design and Methods: Abdominal fat distribution, liver fat (magnetic resonance imaging and spectroscopy), fasting serum lipid profile (ultracentrifugation, gradient gel‐electrophoresis, and colorimetric enzymatic methods), and lifestyle factors (questionnaires and diaries) were assessed in 15 BMI‐discordant (within‐pair difference [Δ] in BMI >3 kg/m²) and nin concordant (ΔBMI <3 kg/m²) MZ twin pairs, identified from two nationwide cohorts of Finnish twins. Results: Despite a strong similarity of MZ twins in lipid parameters (intra‐class correlations 0.42‐0.90, P < 0.05), concentrations of apolipoprotein B (ApoB), intermediate‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein 3a% (HDL3a%), and HDL3c% were higher (P < 0.05) and those of HDL cholesterol, HDL2‐C, and HDL2b% were lower (P < 0.01) in the heavier co‐twins of BMI‐discordant pairs. The composition of lipoprotein particles was similar in the co‐twins. When BMI‐discordant pairs were further divided into liver fat‐discordant and concordant (based on median for Δliver fat, 2.6%), the adverse lipid profile was only seen in those heavy co‐twins who also had high liver fat. Conversely, BMI‐discordant pairs concordant for liver fat did not differ significantly in lipid parameters. In multivariate analyses controlling for Δsubcutaneous, Δintra‐abdominal fat, sex, Δsmoking and Δphysical activity, Δliver fat was the only independent variable explaining the variation in ΔApoB, Δtotal cholesterol, and ΔLDL‐C concentration. Conclusions: Several pro‐atherogenic changes in the amounts of lipids but not in the composition of lipoprotein particles were observed in acquired obesity. In particular, accumulation of liver fat was associated with lipid disturbances, independent of genetic effects.     

Oxidant Stress in Healthy Normal‐weight,Overweight, and Obese Individuals

This study was undertaken to investigate the association among BMI and lipid hydroperoxide (LH), total antioxidant status (TAS), superoxide dismutase (SOD), and reduced glutathione (GSH). Ninety (n = 90) healthy males and females (n = 23/67) (29 normal weight (BMI: 22.74 ± 0.25 kg/m²), 36 overweight (BMI: 27.18 ± 0.23 kg/m²), and 25 obese (33.78 ± 0.48 kg/m²)) participated in the study. Data collected included anthropometric measures, fasting blood glucose, lipid profile, LH, TAS, and enzymatic antioxidants (SOD, and reduced GSH). The results of the study showed that obese individuals had significantly increased LH levels compared to normal‐weight individuals (obese vs. normal weight (0.88 ± 0.05 vs. 0.67 ± 0.03 µmol/l, P < 0.01)) but the increased levels were not significantly different when compared to the overweight group (obese vs. overweight (0.88 ± 0.05 vs. 0.79 ± 0.05 µmol/l)). No other consistent significant differences in TAS, SOD, and GSH were identified between groups. This study concluded that only obesity and not moderate overweight elevates LH levels. Furthermore, the levels of TAS, SOD, and GSH in obesity do not explain the increased LH levels observed in obesity.     

The Relationship of Health Outcomes to Improvement in BMI in Children and Adolescents

Objective: To evaluate the clinical outcomes of patients participating in an outpatient program for managing childhood and adolescent obesity. Research Methods and Procedures: Based on a retrospective chart review, 394 physician‐referred obese youth (BMI > 95th percentile), 5 to 19 years of age, were treated in an interdisciplinary, family‐centered, behavioral weight management program in a hospital‐based outpatient setting. Treatment included group exercise, parent education, and behavioral intervention therapies to improve diet and physical activity. Results: A total of 177 (45%) completed the initial phase of treatment (mean duration = 5.6 months). For the completion group, there were significant improvements (all p < 0.001) in weight (?2.0 ± 4.9 kg), BMI (?1.7 ± 1.9 kg/m²), and BMI z score (?0.15 ± 0.15), without interfering with growth (height, 2.2 ± 1.3 cm; p < 0.001). Significant improvement was also found for blood pressure, total cholesterol, low‐density lipoprotein (LDL)‐cholesterol, triglycerides, insulin, and aerobic fitness. At onset of treatment, 134 (84%) patients had abnormal fasting insulin concentration, 88 (50%) had abnormal total cholesterol, 14 (8%) had abnormal diastolic blood pressure, and 69 (40%) had abnormal LDL‐cholesterol. At the end of treatment, a significant proportion of patients with baseline abnormal blood pressure, total cholesterol, and LDL‐cholesterol had normal values (p < 0.001). A decrease in BMI z score was associated with significant improvements in insulin and lipid values (all p < 0.05). Discussion: We have demonstrated that a modest decrease in BMI in an ongoing clinical pediatric weight management program is accompanied by significant improvements in related health measures. These results may be helpful in counseling families with overweight children and adolescents.     

Effects of Exercise on Metabolic Risk Variables in Overweight Postmenopausal Women: A Randomized Clinical Trial

Objective: This study examined the effects of exercise on metabolic risk variables insulin, leptin, glucose, and triglycerides in overweight/obese postmenopausal women. Research Methods and Procedures: Sedentary women (n = 173) who were overweight or obese (BMI ≥ 25 kg/m² or ≥24 kg/m² with ≥33% body fat), 50 to 75 years of age, were randomized to 12 months of exercise (≥45 minutes of moderate‐intensity aerobic activity 5 d/wk) or to a stretching control group. Body composition (DXA) and visceral adiposity (computed tomography) were measured at baseline and 12 months. Insulin, glucose, triglycerides, and leptin were measured at baseline and 3 and 12 months. Insulin resistance was evaluated by the homeostasis model assessment formula. Differences from baseline to follow‐up were calculated and compared across groups. Results: Exercisers had a 4% decrease and controls had a 12% increase in insulin concentrations from baseline to 12 months (p = 0.0002). Over the same 12‐month period, leptin concentrations decreased by 7% among exercisers compared with remaining constant among controls (p = 0.03). Homeostasis model assessment scores decreased by 2% among exercisers and increased 14% among controls from baseline to 12 months (p = 0.0005). The exercise effect on insulin was modified by changes in total fat mass (trend, p = 0.03), such that the exercise intervention abolished increases in insulin concentrations associated with gains in total fat mass. Discussion: Regular moderate‐intensity exercise can be used to improve metabolic risk variables such as insulin and leptin in overweight/obese postmenopausal women. These results are promising for health care providers providing advice to postmenopausal women for lifestyle changes to reduce risk of insulin resistance, coronary heart disease, and diabetes.     

Effect of obesity on inpatient rehabilitation outcomes after total hip arthroplasty

Objective: This study examined whether obesity affected inpatient rehabilitation outcomes after total hip arthroplasty (THA). Research Methods and Procedures: This was a retrospective, comparative study conducted using a computerized medical database derived from THA patients at a university‐affiliated rehabilitation hospital (data from 2002 to 2005). Patients were divided into four brackets based on BMI: non‐obese (<25 kg/m²), overweight (25 to 29.9 kg/m²), moderate obesity (30 to 39.9 kg/m²), and severe obesity (≥40 kg/m²). All patients completed an interdisciplinary inpatient rehabilitation program after THA. Functional independence measure (FIM) scores, length of stay (LOS), FIM efficiency scores (FIM/LOS), hospital charges, and discharge disposition location were collected. Results: FIM scores improved from admission to discharge similarly in all groups (25 to 29.5 points). However, FIM efficiency, LOS, and total charges were curvilinearly related with BMI (all p < 0.05). Total hospital charges were highest in the severely obese group compared with the overweight group (p < 0.05). Non‐homebound discharge disposition rates were lower in non‐obese (13.1%) and severely obese groups (10.5%). Discussion: Elevated BMI does not prevent FIM gains in THA patients during inpatient rehabilitation. However, BMI is related with FIM efficiency, LOS, and hospital charges in a curvilinear fashion. Severely obese patients can achieve physical improvements but at a lower efficiency and greater cost.     

Morbidity and mortality risk associated with an overweight BMI in older men and women

Background: There is controversy as to whether older adults with a BMI in the overweight range (25 to 29.9 kg/m²) are at increased health risk and whether they should be encouraged to lose weight. The purpose of this study was to determine whether older adults with a BMI in the overweight range are at increased morbidity and mortality risk. Methods: Participants consisted of 4968 older (≥65 years) men and women from the Cardiovascular Health Study limited access dataset. Based on BMI (kg/m²), participants were grouped into normal‐weight (20 to 24.9 kg/m²), overweight (25 to 29.9 kg/m²), and obese (≥30 kg/m²) categories. Participants were followed for up to 9 years to determine if they developed 10 weight‐related health outcomes that are pertinent to older adults. Cox proportional hazards models were used to estimate the hazards ratios of morbidity and mortality after adjusting for age, sex, income, smoking, and physical activity. Results: Compared with the normal‐weight group, the risks of myocardial infarction, stroke, sleep apnea, urinary incontinence, cancer, and osteoporosis were not different in the overweight group (p > 0.05). The risks for arthritis and physical disability were modestly increased in the overweight group (p < 0.05), whereas the risk for type 2 diabetes was increased by 78% in the overweight group (p < 0.01). After adjusting for all relevant covariates, all‐cause mortality risk was 11% lower in the overweight group (p < 0.05). Conclusions: A BMI in the overweight range was associated with some modest disease risks but a slightly lower overall mortality rate. These findings suggest that a BMI cut‐off point of 25 kg/m² may be overly restrictive for the elderly.     

Evaluation of Oxidative Stress in Overweight Subjects With or Without Metabolic Syndrome

Although oxidative stress is considered the underlying mechanism by which dysfunctional metabolism occurs in obese subjects, there are few studies on oxidative stress in overweight subjects. The objective of this study was to verify the influence of metabolic syndrome (MetS) on oxidative stress and antioxidant defense in overweight subjects. There were 123 subjects (50 in the control group and 73 in the overweight group) chosen to participate in this cross‐sectional study. The control group included 50 healthy individuals with a BMI between 20 and 24.9 kg/m² and without MetS. The overweight group included 73 subjects with a BMI between 25 and 29.9 kg/m². Overweight subjects were divided into two groups: with MetS (29 subjects) and without MetS (44 subjects). Control group and overweight group subjects without MetS showed no differences in oxidative stress parameters and total antioxidant capacity (TRAP). Overweight subjects with MetS had higher hydroperoxide concentrations measured by chemiluminescence compared to the control group (P < 0.05), higher hydroperoxide and hydrogen peroxide concentrations determined by ferrous oxidation‐xylenol orange assay compared to overweight subjects without MetS (P < 0.001), and higher advanced oxidation protein product (AOPP) concentrations (P < 0.001) compared to the other groups. AOPP was directly correlated with uric acid concentrations. Overweight subjects with MetS had lower TRAP concentrations compared to the control group (P < 0.001). In conclusion, this study showed that overweight subjects with MetS, in contrast to overweight subjects without MetS, have a redox imbalance characterized by increased plasma oxidation and reduced antioxidant capacity.     

Obesity and Quality of Life: Mediating Effects of Pain and Comorbidities

Objective: To estimate the association between body mass index (BMI) and health‐related quality of life (HRQL) and examine whether joint pain and obesity‐related comorbidities mediate the BMI‐HRQL association. Research Methods and Procedures: Population‐based survey data from the 1999 Behavioral Risk Factor Surveillance Survey. Adults (N = 155, 989) were classified according to BMI as underweight (<18.5 kg/m²), desirable weight (18.5 to 24.9 kg/m²), overweight (25 to 29.9 kg/m²), obese class I (30 to 34.9 kg/m²), obese class II (35 to 39.9 kg/m²), and obese class III (≥40 kg/m²). Data including general health status, unhealthy days in the past 30 caused by physical problems and mental problems, and total unhealthy days in the past 30 were collected. Results: After adjusting for age, sex, race, smoking, education, and income, we observed J‐shaped associations between BMI and HRQL. Compared with desirable weight adults, underweight, overweight, and obesity classes I, II, and III adults [odds ratio (OR) = 1.57, 1.19, 1.95, 2.72, and 4.36, respectively] were significantly (p < 0.001) more likely to report fair/poor general health status. For unhealthy days caused by physical problems, the corresponding ORs were 1.51, 1.15, 1.66, 2.27, and 3.61 (p < 0.001). For unhealthy days caused by mental problems, the ORs were 1.35, 1.14 1.43, 1.57, and 2.25 (p < 0.001). For total unhealthy days, the corresponding ORs were 1.27, 1.09, 1.37, 1.73, and 2.46 (p < 0.01). Adding joint pain and obesity‐related comorbidities into models attenuated BMI‐HRQL associations. Discussion: Associations between BMI and HRQL indices were J‐shaped. Joint pain and comorbidities may mediate BMI‐HRQL associations.     

Selenium supplementation and exercise: effect on oxidant stress in overweight adults

Both obesity and acute high‐intensity exercise increase oxidant stress levels. This study investigates whether selenium (Se) supplementation could be a potential effective therapy to reduce obesity‐associated oxidant stress and exercise‐induced oxidant stress. Ten normal‐weight (NW) (22.80 ± 0.41 kg/m²) and ten overweight (OW) healthy subjects (28.00 ± 0.81 kg/m²) were assessed during a randomized double‐blind Se supplementation study (200 µg sodium selenite/day for 3 weeks) with a 3‐week placebo control and inversion of treatment periods. Blood levels of lipid hydroperoxide (LH), superoxide dismutase (SOD), erythrocyte glutathione (GSH), and total antioxidant status (TAS), were measured at rest, pre‐, and postexercise (30 min 70% VO₂ max before and after treatment (pretreatment (week 0 and 12) and post‐treatment (week 3 or 15)). At rest, compared to placebo, Se supplementation had no significant effect on LH, SOD, GSH, and TAS levels. However, Se supplementation decreased LH levels in the OW group, immediately postexercise (?0.25 ± 0.12 µmol/l, P = 0.05) compared to placebo treatment. Postexercise, with or without Se supplementation, no changes in TAS, SOD, and GSH levels were observed in both the NW and OW group. This study has highlighted a potential benefit of Se in reducing LH levels postexercise in OW individuals. Given that oxidant stress is a predictor of coronary events, it is imperative to better understand oxidant stress‐related responses to lifestyle factors (in particular “high‐risk” population groups) and potential antioxidant therapy.     

Heat production and body temperature during cooling and rewarming in overweight and lean men

Objective: To compare overweight and lean subjects with respect to thermogenesis and physiological insulation in response to mild cold and rewarming. Research Methods and Procedures: Ten overweight men (mean BMI, 29.2 ± 2.8 kg/m²) and 10 lean men (mean BMI, 21.1 ± 2.0 kg/m²) were exposed to cold air for 1 hour, followed by 1 hour of rewarming. Body composition was determined by hydrodensitometry and deuterium dilution. Heat production and body temperatures were measured continuously by indirect calorimetry and thermistors, respectively. Muscle activity was recorded using electromyography. Results: In both groups, heat production increased significantly during cooling (lean, p = 0.004; overweight, p = 0.006). The increase was larger in the lean group compared with the overweight group (p = 0.04). During rewarming, heat production returned to baseline in the overweight group and stayed higher compared with baseline in the lean group (p = 0.003). The difference in heat production between rewarming and baseline was larger in the lean (p = 0.01) than in the overweight subjects. Weighted body temperature of both groups decreased during cold exposure (lean, p = 0.002; overweight, p < 0.001) and did not return to baseline during rewarming. Discussion: Overweight subjects showed a blunted mild cold‐induced thermogenesis. The insulative cold response was not different among the groups. The energy‐efficient response of the overweight subjects can have consequences for energy balance in the long term. The results support the concept of a dynamic heat regulation model instead of temperature regulation around a fixed set point.     

Metabolic Syndrome and Changes in Body Fat From a Low‐fat Diet and/or Exercise Randomized Controlled Trial

It is difficult to identify the successful component(s) related to changes in metabolic syndrome (MetS) from lifestyle interventions: the weight loss, the behavior change, or the combination. The purpose of this study is to determine the effects of a weight‐stable randomized controlled trial of low‐fat diet and exercise, alone and in combination, on MetS. Men (n = 179) and postmenopausal women (n = 149) with elevated low‐density lipoprotein cholesterol (LDL‐C) and low high‐density lipoprotein cholesterol (HDL‐C) were randomized into a 1‐year, weight‐stable trial with four treatment groups: control (C), diet (D), exercise (E), or diet plus exercise (D+E). MetS was defined using a continuous score. Changes in MetS score (ΔMetS) were compared between groups using analysis of covariance, stratified by gender and using two models, with and without baseline and change in percent body fat (ΔBF) as a covariate. In men, ΔMetS was higher for D vs. C (P = 0.04), D+E vs. C (P = 0.0002), and D+E vs. E (P = 0.02). For women, ΔMetS was greater for D vs. C (P = 0.045), E vs. C (P = 0.02), and D+E vs. C (P = 0.004). After adjusting for ΔBF, all differences between groups were attenuated and no longer significant. ΔMetS were associated with ΔBF for both men (P < 0.0001) and women (P = 0.004). After adjustment for ΔBF, low‐fat diet alone and in combination with exercise had no effect on MetS. The key component for MetS from low‐fat diet and/or increased physical activity appears to be body fat loss.     

Additive Interactions of Maternal Prepregnancy BMI and Breast‐feeding on Childhood Overweight

Objective: To examine the interactions of maternal prepregnancy BMI and breast‐feeding on the risk of overweight among children 2 to 14 years of age. Research Methods and Procedures: The 1996 National Longitudinal Survey of Youth, Child and Young Adult data in the United States were analyzed (n = 2636). The weighted sample represented 51.3% boys, 78.0% whites, 15.0% blacks, and 7.0% Hispanics. Childhood overweight was defined as BMI ≥95th percentile for age and sex. Maternal prepregnancy obesity was determined as BMI ≥30 kg/m². The duration of breast‐feeding was measured as the weeks of age from birth when breast‐feeding ended. Results: After adjusting for potential confounders, children whose mothers were obese before pregnancy were at a greater risk of becoming overweight [adjusted odds ratio (OR), 4.1; 95% confidence interval (CI), 2.6, 6.4] than children whose mothers had normal BMI (<25 kg/m²; p < 0.001 for linear trend). Breast‐feeding for ≥4 months was associated with a lower risk of childhood overweight (OR, 0.6; 95% CI, 0.4, 1.0; p = 0.06 for linear trend). The additive interaction between maternal prepregnancy obesity and lack of breast‐feeding was detected (p < 0.05), such that children whose mothers were obese and who were never breast‐fed had the greatest risk of becoming overweight (OR, 6.1; 95% CI, 2.9, 13.1). Discussion: The combination of maternal prepregnancy obesity and lack of breast‐feeding may be associated with a greater risk of childhood overweight. Special attention may be needed for children with obese mothers and lack of breast‐feeding in developing childhood obesity intervention programs.     

The Effect of CYP19 and COMT Polymorphisms on Exercise‐Induced Fat Loss in Postmenopausal Women

Objective:To examine whether genetic polymorphisms in CYP19 [intron 4 (TTTA)_n; n = 7 to 13 and a 3‐base pair deletion, which is in strong linkage disequilibrium with the seven repeat] and COMT (Val^108/158Met) modified the change in BMI, total and percentage body fat, or subcutaneous and intra‐abdominal fat during a year‐long exercise intervention trial. These genes metabolize estrogens and androgens, which are important in body fat regulation. Research Methods and Procedures: A randomized intervention trial was used, with an intervention goal of 225 min/wk of moderate‐intensity exercise for one year. Participants (n = 173) were postmenopausal, 50 to 75 years old, sedentary, overweight or obese, and not taking hormone therapy at baseline. Results: Exercisers with two vs. no CYP19 11‐repeat alleles had a larger decrease in total fat (?3.1 kg vs. ?0.5 kg, respectively, p = 0.01) and percentage body fat (?2.4% vs. ?0.6%, respectively, p = 0.001). Exercisers with the COMT Met/Met vs. Val/Val genotype had a smaller decrease in percentage fat (?0.7% vs. ?1.9%, respectively, p = 0.05). Among exercisers, women with the COMT Val/Val genotype and at least one copy of the CYP19 11‐repeat allele vs. those with neither genotype/allele had a significantly larger decrease in BMI (?1.0 vs. +0.1 kg/m², respectively, p = 0.009), total fat (?2.9 vs. ?0.5 kg, respectively, p = 0.004), and percentage body fat (?2.6% vs. ?0.4%, respectively, p < 0.001). Discussion: Genetic polymorphisms in CYP19 and COMT may be important for body fat regulation and possibly modify the effect of exercise on fat loss in postmenopausal women.     

Association Between Body Fat Response to Exercise Training and Multilocus ADR Genotypes

Objectives : To examine the contribution of adrenergic receptor (ADR) gene polymorphisms and their gene‐gene interactions to the variability of exercise training‐induced body fat response. Research Methods and Procedures : This was an intervention study that used a volunteer sample of 70 healthy, sedentary men (n = 29) and postmenopausal women (n = 41) 50 to 75 years of age, with a BMI ≤37 kg/m², from the Washington, DC, metropolitan area. Participants completed 6 weeks of dietary stabilization (American Heart Association diet) before 24 weeks of supervised aerobic exercise training. Diet was maintained throughout the intervention. Change in percent total body fat, percent trunk fat, and fat mass by DXA in ADR genotype groups (Glu¹²/Glu⁹ α2b‐ADR, Trp64Arg β3‐ADR, and Gln27Glu β2‐ADR) at baseline and after 24 weeks of aerobic exercise training was measured. Results : In multivariate analysis (covariates: age, gender, and baseline value of phenotype), best fit models for percent total body and trunk fat response to exercise training retained main effects of all three ADR gene loci and the effects of each gene‐gene interaction (p = 0.009 and 0.003, respectively). Similarly, there was a trend for the fat mass response model (p = 0.03). The combined genetic factors explained 17.5% of the overall model variability for percent total body fat, 22% for percent trunk fat, and 10% for fat mass. Discussion : The body fat response to exercise training in older adults is associated with the combined effects of the Glu¹²/Glu⁹ α2b‐, Trp64Arg β3‐, and Gln27Glu β2‐ADR gene variants and their gene‐gene interactions.     

Quality of life in Mexican-American children following a weight management program

Objective: The objective was to evaluate quality of life (QOL) in at‐risk‐for‐overweight and overweight Mexican‐American children after participating in 6 months of intensive weight management or self‐help. Research Methods and Procedures: Eighty sixth‐ and seventh‐grade at‐risk‐for‐overweight (BMI ≥85th to <95th percentile) and overweight (BMI ≥95th percentile) Mexican‐American children were randomly assigned to either intensive instructor‐led intervention (ILI) or self‐help (SH). The ILI condition included daily participation for 12 weeks in a school‐based program comprised of nutrition education, physical activity, and behavior modification, followed by ongoing monthly maintenance. QOL was assessed at baseline and 6 months via child self‐report PedsQL. QOL outcomes were compared across treatment groups, and the impact of change in zBMI on change in QOL was evaluated. Results: Children in the ILI condition not only achieved significantly greater weight loss (zBMI, ?0.13 ± 0.14; p < 0.001) but also significantly greater physical QOL improvements than those in the SH condition at 6 months (p < 0.05). Furthermore, physical QOL increases were associated with zBMI reduction (p < 0.05). However, neither psychosocial nor total QOL was significantly impacted by intervention or zBMI change. Discussion: These findings show that even modest decreases in zBMI after weight management result in improved physical QOL in Mexican‐American children. These results illustrate the clear need to include evaluation of QOL in the process of identifying effective weight management programs.     

Obesity Increases the Risk of Spontaneous Abortion during Infertility Treatment

Objective: This study examines the relationship between body mass and the risk of spontaneous abortion in a large cohort of patients who received infertility treatment. Research Methods and Procedures: This is a retrospective study using data on pregnancies (n = 2349) achieved after treatment in a tertiary medical center from 1987 to 1999. One pregnancy per subject was included, and the subjects were stratified into five body mass groups based on body mass index (BMI): underweight, <18.5 kg/m²; normal, 18.5 to 24.9 kg/m²; overweight, 25 to 29.9 kg/m²; obese, 30 to 34.9 kg/m²; and very obese, ≥35 kg/m². Logistical regression analysis was used. Results: The overall incidence of spontaneous abortion was 20% (476 of 2349). The effect of BMI on the risk of spontaneous abortion was significant after adjusting for several independent risk factors. Compared with the reference group (BMI 18.5 to 24.9 kg/m²), underweight women had a similar risk of spontaneous abortion, whereas there was progressive increase of risk in overweight, obese, and very obese groups (p < 0.05, p < 0.01, and p < 0.001, respectively). Discussion: Of all known risk factors for spontaneous abortion, the control of obesity has great significance because it is noninvasive, potentially modifiable, possibly amenable to low cost, and self‐manageable by patients. This study established a positive relationship between BMI and the risk of spontaneous abortion in women who became pregnant after assisted reproductive technology treatment.     

Exercise‐Induced Reduction in Obesity and Insulin Resistance in Women: a Randomized Controlled Trial

Objectives : To determine the effects of equivalent diet‐ or exercise‐induced weight loss and exercise without weight loss on subcutaneous fat, visceral fat, and insulin sensitivity in obese women. Research Methods and Procedures : Fifty‐four premenopausal women with abdominal obesity [waist circumference 110.1 ± 5.8 cm (mean ± SD)] (BMI 31.3 ± 2.0 kg/m²) were randomly assigned to one of four groups: diet weight loss (n = 15), exercise weight loss (n = 17), exercise without weight loss (n = 12), and a weight‐stable control group (n = 10). All groups underwent a 14‐week intervention. Results : Body weight decreased by ～6.5% within both weight loss groups and was unchanged in the exercise without weight loss and control groups. In comparison with controls, cardiorespiratory fitness improved within the exercise groups only (p < 0.01). Reduction in total, abdominal, and abdominal subcutaneous fat within the exercise weight loss group was greater (p < 0.001) than within all other groups. The reduction in total and abdominal fat within the diet weight loss and exercise without weight loss groups was greater than within controls (p < 0.001) but not different from each other (p > 0.05). Visceral fat decreased within all treatment groups (p < 0.008), and these changes were not different from each other. In comparison with the control group, insulin sensitivity improved within the exercise weight loss group alone (p < 0.001). Discussion : Daily exercise without caloric restriction was associated with substantial reductions in total fat, abdominal fat, visceral fat, and insulin resistance in women. Exercise without weight loss was also associated with a substantial reduction in total and abdominal obesity.     

Physical activity-related energy expenditure with the RT3 and TriTrac accelerometers in overweight adults

Objective: The objective was to evaluate two accelerometers, the RT3 and the TriTrac‐R3D for their ability to produce estimates of physical activity‐related energy expenditure (PAEE) in overweight/obese adults. Research Methods and Procedures: PAEE estimates from both accelerometers were obtained in two experiments. In Experiment 1, 13 overweight/obese subjects (BMI 34.2 ± 6.4 kg/m²) were monitored over 2 weeks in everyday life, PAEE being simultaneously measured by the doubly labeled water method (DLW). In Experiment 2, 8 overweight/obese subjects (BMI 34.3 ± 5.0 kg/m²) and 10 normal‐weight subjects (BMI 20.8 ± 2.1 kg/m²) were monitored during a treadmill walking protocol, PAEE being simultaneously measured by indirect calorimetry. Results: In Experiment 1, there was no significant difference between methods in mean PAEE (DLW: 704 ± 223 kcal/d, RT3: 656 ± 140 kcal/d, TriTrac‐R3D 624 ± 419 kcal/d). The relative difference between methods (accelerometer vs. DLW) was ?17.1% ± 16.7% for the RT3 and ?20.0 ± 44.6% for the TriTrac‐R3D. Correlation for PAEE between RT3 and DLW was higher than between TriTrac‐R3D and DLW (r = 0.67, p < 0.05 and r = 0.36, p = 0.25, respectively). The 95% confidence interval (CI) (kcal/d) of the mean difference between methods was large, amounting to ?385 to 145 for the RT3 and ?887 to 590 for the TriTrac‐R3D. In Experiment 2, both accelerometers were sensitive to the changes in treadmill speed, with no significant difference in mean PAEE between methods in overweight/obese subjects. Conclusions: Although both accelerometers did not provide accurate estimates of PAEE at individual levels, the data suggest that RT3 has the potential to assess PAEE at group levels in overweight/obese subjects.     

Lifetime Overweight Status in Relation to Serial Changes in Body Composition and Risk Factors for Cardiovascular Disease: The Fels Longitudinal Study

Objective: The aims were to determine if 1) individuals who became and maintained overweight during their entire lifetime differ from those who were never‐overweight in terms of annual changes in adiposity and concurrent changes in cardiovascular disease (CVD) risk factors; 2) the changes and their relationships to each other varied between these groups or by sex within the groups; and 3) alcohol usage, smoking habits, and level of physical activity differed between groups. Research Methods and Procedures: Data from 16,315 examinations of 414 individuals were utilized to assess lifetime overweight (body mass index [BMI] > 25 kg/m²) status. A regressive analytic approach was used to determine the average annual changes for each individual over an adult serial interval ranging from 4 to 20 years. Results: Men and women who have become and maintained overweight have higher blood pressure and a poorer lipid/lipoprotein risk profile than those who have never been overweight. There is an accelerated deterioration in the atherogenic profile of overweight men and women as indicated by annual changes in CVD risk factors about double that of their never‐overweight counterparts. In women, increased risk is derived from increasing systolic and diastolic blood pressure, whereas in men the increased risk comes not only from increasing diastolic blood pressure but also cholesterol, triglycerides, and low‐density lipoprotein cholesterol levels and, to a lesser extent, decreasing high‐density lipoprotein cholesterol. Discussion: The reduced physical activity observed in the overweight adults may be related to their accumulation of adipose tissue at a rate about double their never‐overweight counterparts, and this may be driving the higher rate of increase of CVD risk factors in the overweight groups.