Self-reported substantial 1-year weight change among men and women in the United States

The Association between Marital Status and Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity was included in the International Classification of Diseases in 1990 as a chronic disease characterized by the excessive accumulation of body fat and a body mass index (BMI) greater than 30 kg/m2.

AIM

This systematic review was aimed to examine the role of marital status in determining body mass index and the risk of obesity.

METHODS

We performed a systematic literature search using three databases (PubMed (Medline), Embase, and Google Scholar) with the search query.

RESULTS

Of the 105 studies included in the systematic review, 76 studies (72%) reported a greater risk of obesity in married individuals compared to unmarried individuals. A meta-analysis of 24 studies included a total population of 369,499 participants: 257,257 married individuals (40,896 of whom had obesity) and 112,242 comparison subjects (single, divorced, or widowed individuals, 15,084 of whom had obesity). Odds ratios for obesity found a significant pooled odds ratio for obesity in married individuals compared with controls (OR 1.70; 95% CI 1.38-2.10). The socioeconomic environment was not the same throughout the period of studies analyzed. The odds of obesity in married individuals during economic crises was greater than during the period between crises: OR 2.56 (95% CI 2.09-3.13) during crises vs. OR 1.55 (95% CI 1.24-1.95) between crises.

CONCLUSION

The results of this review confirm the importance of considering marital status in determining the risk of obesity.

Changes in weight, physical and psychosocial patient-reported outcomes among obese women receiving treatment for early-stage breast cancer: A nationwide clinical study

BACKGROUND

Evidence on how weight loss correlates to health-related quality-of-life (HRQOL) among obese breast cancer (BC) patients is limited. We aimed to evaluate associations between weight changes and HRQOL.

METHODS

We included 993 obese women with stage I-II-III BC from CANTO, a multicenter, prospective cohort collecting longitudinal, objectively-assessed anthropometric measures and HRQOL data (NCT01993498). Associations between weight changes (±5% between diagnosis and post-treatment [shortly after completion of surgery, adjuvant chemo- or radiation-therapy]) and patient-reported HRQOL (EORTC QLQ-C30/B23) were comprehensively evaluated. Changes in HRQOL and odds of severely impaired HRQOL were assessed using multivariable generalized estimating equations and logistic regression, respectively.

RESULTS

14.1% women gained weight, 67.3% remained stable and 18.6% lost weight. Significant decreases in functional status and exacerbation of symptoms were observed overall post-treatment. Compared to gaining weight or remaining stable, obese women who lost weight experienced less of a decline in HRQOL, reporting better physical function (mean change [95%CI] for gain, stability and loss: -12.9 [-16.5,-9.3], -6.9 [-8.2,-5.5] and -6.2 [-8.7,-3.7]; pinteraction[weight-change-by-time] = 0.006), less dyspnea (+18.9 [+12.3,+25.6], +9.2 [+6.5,+11.9] and +3.2 [-1.0,+7.3]; pinteraction = 0.0003), and fewer breast symptoms (+22.1 [+16.8,+27.3], +18.0 [+15.7,+20.3] and +13.4 [+9.0,+17.2]; pinteraction = 0.044). Weight loss was also significantly associated with reduced odds of severe pain compared with weight gain (OR [95%CI] = 0.51 [0.31-0.86], p = 0.011) or stability (OR [95%CI] = 0.62 [0.41-0.95], p = 0.029). No associations between weight loss and worsening of other physical or psychosocial parameters were found.

CONCLUSIONS

This large contemporary study suggests that weight loss among obese BC patients during early survivorship was associated with better patient-reported outcomes, without evidence of worsened functionality or symptomatology in any domain of HRQOL.

Associations between family factors and body weight gain from 20 years old

BACKGROUND

Although family factors can greatly impact adult health, little is known about the extent to which family factors are related to body weight gain (BWG) in adulthood. This study aimed to examine the associations between family factors and BWG from 20 years old.

METHODS

Among the 6395 possible participants aged 35 to 79 years, 2884 men and 2171 women were eligible for the study. Present body mass indexes (BMI) were measured, and family factors and body weight from 20 years old (i.e., BMI_20yr) were collected using a self-administered questionnaire. The differences between BMI and BMI_20yr were calculated, and those with increases of BMI ≥2.5 kg/m² (i.e., ≥7.5 and 6.0 kg in men and women, respectively) were defined as 'cases' of BWG. Using a multiple logistic regression analysis, the odds ratios (ORs, 95% confidence intervals [CIs] and p for trend) were estimated.

RESULTS

In the men, no association was found. In the women, the ORs were 0.31, 1.00 and 0.77 (0.17-0.58, [reference], and (0.52-1.29), p < 0.001) as per their marital status: unmarried, married, and bereaved/divorced, respectively. Although no association was found with family structure (i.e., single, couple, and two and three generations living together), for familial relationships, the ORs were 1.00, 1.11 and 1.86 ([reference], 0.85-1.46, and 1.25-2.79, p < 0.01) for 'good', 'somewhat good', and 'not so good/not good', respectively. Even if a 'case' of BWG was ≥3.5 kg/m², nearly the same risks remained.

CONCLUSION

Marital status and family relationships were associated with decreased and increased risks of BWG only in the female participants. Family factors should be considered when advising women on body weight control.

Food insecurity and adult weight abnormality risk: a systematic review and meta-analysis

PURPOSE

Research into the relationship between food insecurity and weight abnormality has yielded varied and contradictory results. Therefore, a systematic review and meta-analysis were carried out to examine the association between food insecurity and weight abnormality in adults.

METHODS

Pertinent studies were identified by searching PubMed and Scopus databases, up to February 2018. Data were available from 31 studies. These studies were conducted in 14 different countries. The odds ratio of 115,993 individuals in these studies was pooled for the meta-analysis.

RESULTS

The present meta-analysis showed that adults in food-insecure households are more at risk of obesity (OR 1.15, 95% CI 1.06-1.23). Subgroup analysis by gender also revealed that women had a higher risk of obesity compared to men in food-insecure households (OR 1.26, 95% CI 1.05-1.46). Furthermore, subgroup analysis by food insecurity level implied that a severe level of household food insecurity may be associated with a higher risk of underweight (49%) than overweight (37%) or obesity (29%) among adults. In addition, subgroup analysis revealed that with lower levels of national economic development, the risk of weight abnormality shifted from obesity to underweight.

CONCLUSION

It seems that adults in food-insecure households, especially women, are at higher risk of obesity. The weight abnormality risk may increase with the intensification of the level of food insecurity. Also, the level of economic development is an important factor in the effects of food insecurity on weight status. However, due to the high heterogeneity among studies, the results should be interpreted with caution.

One-year weight change and long-term sickness absence in professional firefighters

BACKGROUND

Little is known about the association between weight change (particularly moderate weight loss, 5-10% in initial weight) and long-term sickness absence (LSA) in working populations.

METHODS

Three hundred and forty professional firefighters reported their current and past (1 year ago) weights in a cross-sectional survey, along with their LSA experience due to a severe accident, injury, or illness during the previous 12 months.

RESULTS

The prevalence of LSA was 14.7%. In the non-smoking male firefighters, the prevalence of LSA was 3.4% in those with moderate weight loss over the past year; 13.3% in those who maintained their weight; and 21.7% in those who gained their weight moderately: gamma coefficient, 0.44 (95%CI: 0.05, 0.66). The linear association remained significant after further controlling for age and alcohol consumption. And it was similar across the adiposity strata (normal weight, overweight, and obesity) of the firefighters 1 year ago.

CONCLUSIONS

One-year weight loss was associated with decreased risk of LSA in professional firefighters.

Body Weight, Marital Status, and Changes in Marital Status

In this article, I use 20 years of data taken from the 1979 National Longitudinal Study of Youth to examine the relationship between body weight and both marital status and changes in marital status. I use a latent growth curve model that allows both fixed and random effects. The results show that living without a partner, either being divorced or never married, is associated with lower body weight. Cohabitors and married respondents tend to weigh more. Marital transitions also matter but only for divorce. Gender does not appear to moderate these results.

Overweight and obesity among adults in Serbia: results from the National Health Survey

INTRODUCTION

The purpose of the study was to evaluate the prevalence of overweight and obesity in Serbian adults. The impact of socioeconomic and lifestyle factors on weight was explored.

MATERIALS AND METHODS

A cross-sectional study representative of the adult population in Serbia was carried out in 2006. The study involved 13,796 people aged 20 years and over (6551 men and 7245 women). Individuals were interviewed and underwent anthropometric examination (overweight and obesity defined by body mass index--BMI).

RESULTS

In 2006 in Serbia, 55.7% of adult population was overweight (19.0% of examinees were obese). Among men (body mass index ≥ 25 kg/m²) 26.4% considered themselves as above ideal weight (overweight and obese), while 70.9% classified themselves in an ideal body weight (normal weight). Among women (body mass index ≥ 25 kg/m²) 41.7% classified themselves as above ideal body weight while 56.0% as ideal body weight. Lower educational status, marriage status, rural area of settlement, third and fourth level of household income and irregular main meals were all strongly associated with overweight and obesity.

CONCLUSIONS

High prevalence of overweight and obesity is a significant public health problem among Serbian adults. Efforts are needed to effectively promote daily physical activity and healthy eating through progressive modifications in lifestyle and the creation of supportive environments.

Posttransplant metabolic syndrome: an epidemic waiting to happen

With increasing survival after orthotopic liver transplantation (OLT), metabolic syndrome and its individual components, including diabetes mellitus, hypertension, dyslipidemia, and obesity, are increasingly being identified and contributing to cardiovascular complications and late morbidity and mortality. The prevalence of posttransplant metabolic syndrome (PTMS) and its individual components has been found to be higher post-OLT versus a comparable population without OLT. The development of nonalcoholic fatty liver disease (NAFLD) after liver transplantation for non-NAFLD cirrhosis is also being increasingly recognized. A number of predictors have been identified as potential risk factors related to these complications. The pretransplant risk factors include immunosuppression, a higher age at transplant, male gender, a history of smoking, the pretransplant body mass index, pre-OLT diabetes, the etiology of the underlying liver disease that resulted in OLT (hepatitis C, cryptogenic cirrhosis, or alcohol), an increased donor body mass index, and marital status. Although there is an increased risk of cardiovascular events, rejection, and infection among patients with PTMS, the overall impact on long-term survival and mortality remains inconclusive. Strategies to reduce the development of metabolic syndrome after transplantation should include lifestyle modifications involving alterations in diet and increased physical activity. Additional measures that may be potentially beneficial include the use of lipid-lowering agents, the optimal control of blood glucose, and the use of tacrolimus instead of cyclosporine.

The impact of a long-term reduction in dietary energy density on body weight within a randomized diet trial

We examined the effect of dietary energy density change on body weight in participants of a randomized trial. Intervention participants markedly increased fruit and vegetable intake while reducing energy intake from fat. Participants were 2,718 breast cancer survivors, aged 26-74 yr, with baseline mean body mass index of 27.3 kg/m(2) (SD = 6.3). We assessed dietary intake by sets of four 24-h dietary recalls and validated with plasma carotenoid concentrations. Weight and height were measured at baseline, 1 yr, and 4 yr. Dietary energy density was calculated using food but excluding beverages. Intervention participants significantly reduced dietary energy density compared to controls and maintained it over 4 yr -- both in cross-sectional (P < 0.0001) and longitudinal (Group x Time interaction, P < 0.0001) analyses. Total energy intake or physical activity did not vary between groups. The intervention group had a small but significant weight loss at 1 yr (Group x Time interaction, P < 0.0001), but no between-group weight difference was observed at 4 yr. Our study showed that reducing dietary energy density did not result in a reduction in total energy intake and suggests that this strategy alone is not sufficient to promote long-term weight loss in a free-living population.

Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women's healthy eating and living (WHEL) study

PURPOSE

To examine predictors of weight gain following breast cancer diagnosis and subsequent return to pre-cancer weight.

OBJECTIVES

To determine (1) the associations of anti-neoplastic chemotherapy and/or, Tamoxifen((R)) therapy on weight change following breast cancer diagnosis, (2) whether chemotherapy modified the effect of specific demographic and tumor characteristics on weight gain, (3) the proportion and characteristics of women who gained significant weight on chemotherapy and returned to their pre-cancer weight during follow-up.

SUBJECTS AND METHODS

Participants were 3088 breast cancer survivors, aged 27-74 years. Weight was measured at baseline and years 1 through 6; pre-cancer weight was self-reported. Cancer stage and treatment modalities were obtained by medical record review; demographic and physical activity data were obtained from questionnaires. Weight gain of >/=5% body weight following cancer diagnosis was considered significant.

RESULTS

Chemotherapy was significantly associated with weight gain (OR = 1.65, 95% CI = 1.12, 2.43) and Tamoxifen((R)) was not (OR = 1.03, 95% CI = 0.71, 1.51). Tamoxifen((R)) did not modify the effect of either chemotherapy or its different regimens on weight gain. Both types (anthracycline: OR = 1.63, p-value = 0.01, non-anthracycline: OR = 1.79, p = 0.003) and all regimens of chemotherapy (AC: OR = 1.55, p-value = 0.01, CAF: OR = 1.83, p = 0.003, CMF: OR = 1.76, p = 0.004) were associated with weight gain but the associations were not different from one another. Only 10% of participants returned to their pre-cancer diagnosis weight at the follow-up visits; the degree of initial gain (p for trend <0.0001) predicted that return.

CONCLUSION

Chemotherapy was associated with clinically meaningful weight gain, and a return to initial weight following weight gain was unlikely.

Intentional weight loss in young adults: sex-specific genetic and environmental effects

OBJECTIVE

To explore eating styles associated with intentional weight loss (IWL) and to determine whether the genetic liability in IWL is entirely shared with genetic liability affecting BMI.

RESEARCH METHODS AND PROCEDURES

As part of a longitudinal assessment of various health-related behaviors in a large population-based sample of twins, eating styles, BMI, and the number of times the study participants had intentionally lost > or = 5 kg were assessed by questionnaire from 4667 male and female twins (22 to 27 years of age). Associations of eating styles and IWL were explored using polytomous logistic regression models adjusted for BMI. Sex-specific bivariate structural equation modeling was used to explore genetic and environmental correlations of BMI and IWL.

RESULTS

Individuals who had engaged in IWL exhibited markedly more restricting, overeating, and alternating restricting/overeating than those in the no-IWL group. Snacking and eating in the evening were characteristic of women with at least two IWL attempts. Eating in response to visual and emotional cues was very pronounced in women who had engaged in IWL but much less so in men. IWL was estimated to have a heritability of 38% [95% confidence interval (CI), 19% to 55%] in men and 66% (95% CI, 55% to 75%) in women. The genetic covariance of BMI and IWL was 0.38 (95% CI, 0.28 to 0.47) for men and 0.45 (95% CI, 0.41 to 0.52) for women.

DISCUSSION

Distinct sex differences exist in eating styles associated with IWL and in the heritability of IWL. Most genetic factors affecting BMI are different from those affecting IWL.

Socioeconomic status and weight change in adults: a review

In developed countries, obesity is inversely associated with socioeconomic status (SES) among women, and less consistently among men; whereas, in developing countries, the association is direct. However, the relationship of SES to weight change over time is unknown. This relationship was the focus of the present literature review. It was hypothesized that, compared with persons of higher SES, persons of low SES would show greater weight gain or risk of weight gain over time. A search of electronic databases identified 34 relevant articles from developed countries reporting on studies that assessed the relationship of various measures of SES with weight change over time in adults (there were too few papers from developing countries (n = 1) to include). Results of the methodologically strongest studies (those which obtained objectively measured adiposity data and used a follow-up period of 4 years or more) showed that, among non-black samples, there were relatively consistent inverse associations between occupation and weight gain for men and women. When SES was assessed using education, evidence was slightly less consistent, but still provided some support for the hypothesized relationship. However, when income was used as the indicator of SES, findings were inconsistent, although there were fewer studies available. There was little support for a relationship between SES and weight gain for black samples. In the context of the worldwide epidemic of obesity, these findings suggest that in developed countries, weight gain prevention efforts might best be focused on those who are most socioeconomically disadvantaged, particularly those in lower status occupations.

Intentional weight loss and incidence of obesity-related cancers: the Iowa Women's Health Study

OBJECTIVE

To examine the association of voluntary vs involuntary weight loss with incidence of cancer in older women.

DESIGN

Prospective cohort study from 1993 to 2000, with cancer incidence identified through record linkage to a cancer registry.

SUBJECTS

A total of 21,707 postmenopausal women initially free of cancer.

MEASUREMENTS

Women completed a questionnaire about intentional and unintentional weight loss episodes of > or =20 pounds during adulthood.

RESULTS

Compared with women who never had any > or =20 pounds weight loss episode, women who ever experienced intentional weight loss > or =20 pounds but no unintentional weight loss had incidence rates lower by 11% for any cancer (RR=0.89, 95% CI 0.79-1.00), by 19% for breast cancer (RR=0.81, 95% CI 0.66-1.00), by 9% for colon cancer (RR=0.91, 95% CI 0.66-1.24), by 4% for endometrial cancer (RR=0.96, 95% CI 0.61-1.52), and by 14% for all obesity-related cancer (RR=0.86, 95% CI 0.74-1.01) after adjusting for age, body mass index, waist-to-hip ratio, physical activity, education, marital status, smoking status, pack-years of cigarettes, current estrogen use, alcohol use, parity, and multivitamin use. Furthermore, although overweight women were at increased risk of several cancers, women who experienced intentional weight loss episodes of 20 or more pounds and were not currently overweight were observed to have an incidence of cancer similar to nonoverweight women who never lost weight. Unintentional weight loss episodes were not associated with decreased cancer risk.

CONCLUSIONS

These findings suggest that intentional weight loss might reduce risk of obesity-related cancers.

Marital status changes and body weight changes: a US longitudinal analysis

The role of spouse is associated with better health. The dynamics of spousal roles can be represented by marital trajectories that may remain stable or may change by entry into marriage, dissolution of marriage, or death of a spouse. Body weight is an important health-related characteristic that has been found to have mixed relationships with marital status. This analysis examined changes in marital status and body weight in 9043 adults in the US National Health and Nutrition Epidemiological Follow-up Survey (NHEFS), a longitudinal national study that interviewed and measured adults in a baseline assessment and reassessed them again in a follow-up approximately 10 years later. Men's and women's weights were differently associated with marital changes. Women who were unmarried at baseline and married at follow-up had greater weight change than those who were married at both times. Analysis of weight loss and weight gain separately revealed that sociodemographic variables, including marital change, were more predictive of variation in weight loss than weight gain. Unmarried women who married gained more weight than women married at both times. Men who remained divorced/separated and men who became widowed lost more weight than men married at both baseline and follow-up. These findings suggest that changes in social roles, such as entering or leaving marriage, influence physical characteristics such as body weight.

Food insecurity is associated with past and present economic disadvantage and body mass index

Fears and experiences of food restriction influence eating behavior but the association between past and present economic disadvantage, food insecurity and body size is poorly understood. Therefore, we examined these associations in a nationwide, representative sample of 25- to 64-y-old Finnish men and women (n = 6506). The respondents were classified by their body mass index (BMI) into four groups: thin, normal, overweight and obese. Economic disadvantage was assessed by three indicators including low household income, unemployment during past 5 y and long-term economic problems in childhood. Food insecurity was assessed by five separate items concerning economic fears and experiences related to sufficient supply of food during the past 12 mo, and a combined scale in which those with affirmative responses to four to five items were classified as hungry. Multivariable logistic regression analyses were conducted using both the BMI grouping and indicators of economic disadvantage as independent variables to predict food insecurity, controlling simultaneously for age, educational attainment and sex. The results showed that low household income, recent unemployment and economic problems in childhood were all predictors of food insecurity. Thin people were most likely to be hungry and showed most food insecurity in five separate items. In addition, obese people reported more buying cheaper food due to economic problems and fears or experiences of running out of money to buy food than did normal weight subjects. In conclusion, both past and present economic disadvantage is associated with various aspects of food insecurity. The association between food insecurity and BMI is curvilinear.

Oral health problems and significant weight loss among community-dwelling older adults

BACKGROUND

Studies of hospitalized and institutionalized older adults suggest a relationship between poor oral health and subsequent weight loss. Given the association between weight loss and subsequent mortality and morbidity, we evaluated how oral health problems contributed to significant weight loss over a 1-year period among a representative sample of community-dwelling older adults.

METHODS

The study population consisted of 563 adults aged 70 years and older living at home in rural and urban areas in six New England states. Baseline data included information regarding health status, functional status, physical activity, disease diagnoses, lifestyle behaviors, and cognitive and affective status. Dentists performed oral health assessments. One year later, participants were called and asked questions regarding their health and dietary practices and their current weight.

RESULTS

Over the 1-year period of follow-up, approximately one third of the sample had lost 4% or more of their previous total body weight; 6% of men and 11% of women lost 10% or more of their previous body weight. Of the subjects, 37% were edentulous; most of these individuals wore full dentures. With gender, income, advanced age, and baseline weight controlled for, edentulousness remained an independent risk factor for significant weight loss (odds ratio 1.63 for 4% weight loss and 2.03 for 10% weight loss). Individuals with increasing numbers of posterior teeth and functional units were at slightly lower risk for weight loss; however, these associations did not reach statistical significance.

CONCLUSIONS

Dentate status is an important risk factor for clinically significant weight loss among community-dwelling older adults.

Weight change and obesity after liver transplantation: incidence and risk factors

Obesity is a concern in the long-term management of patients following liver transplantation, yet the risk of obesity and the factors that influence its development have not been well defined. We evaluated posttransplantation weight change among a cohort of 774 adults who had their height and weight recorded before liver transplantation at three major centers. Obesity was defined as a body mass index (BMI) of at least 30 kg/m2. Weight at transplantation was adjusted by the amount of ascites removed. Mean BMI increased from 24.8 kg/m2 pretransplantation to 27.0 kg/m2 in the first posttransplantation year, to 28.1 kg/m2 in the second year, and very little with subsequent observation. Among 320 patients who were not obese before transplantation, 21.6% became obese within 2 years after transplantation. On evaluation of numerous potential donor and pretransplantation risk factors, greater recipient BMI, greater donor BMI, and being married were found to be predictors of subsequent obesity (P < .05). Posttransplantation predictors of obesity included absence of acute cellular rejection, higher cumulative prednisone dose in the second year, and cyclosporine-based immunosuppression, although only rejection and prednisone dose remained predictors on multivariate analysis. Despite the marked weight gain after transplantation, prevalence of obesity at 2 years was only slightly greater than in the general US population. Obesity occurred commonly after liver transplantation, sometimes with a striking gain in weight. In addition to BMI at transplantation, donor BMI, marital status, occurrence of acute rejection, and prednisone dose affected the incidence of obesity.