Obesity reduction within a generation: the dual roles of prevention and treatment

The Association Between Adolescent Obesity and Disability Incidence in Young Adulthood

PURPOSE

To evaluate the longitudinal relationship between obesity during adolescence and development of disability during young adulthood.

METHODS

A cohort of 8,032 individuals aged 11-21 years enrolled in 1994-1995 (Wave I) of the National Longitudinal Study of Adolescent to Adult Health, followed up in 1996 (Wave II) and in 2001-2002 (Wave III). Individuals were divided into four categories based on weight and height of Wave II and Wave III: (1) developing obesity; (2) persistent obesity; (3) no obesity; and (4) obesity reversal. Disability was measured in Wave III using a measure of functional limitations and the Short Form 36 physical functioning scale. Logistic regression was used to predict the probability of disability as a function of weight category.

RESULTS

Compared with their nonobese peers, adolescents developing obesity (adjusted odds ratio: 1.83 [95% confidence interval: 1.51-2.22]) and with persistent obesity (adjusted odds ratio: 2.09 [95% confidence interval: 1.64-2.67]) had a higher odds of having a functional limitation in Wave III.

CONCLUSIONS

Developing obesity and persistent obesity during adolescence were significantly associated with increased disability in young adulthood.

Fostering multiple healthy lifestyle behaviors for primary prevention of cancer

The odds of developing cancer are increased by specific lifestyle behaviors (tobacco use, excess energy and alcohol intakes, low fruit and vegetable intake, physical inactivity, risky sexual behaviors, and inadequate sun protection) that are established risk factors for developing cancer. These behaviors are largely absent in childhood, emerge and tend to cluster over the life span, and show an increased prevalence among those disadvantaged by low education, low income, or minority status. Even though these risk behaviors are modifiable, few are diminishing in the population over time. We review the prevalence and population distribution of these behaviors and apply an ecological model to describe effective or promising healthy lifestyle interventions targeted to the individual, the sociocultural context, or environmental and policy influences. We suggest that implementing multiple health behavior change interventions across these levels could substantially reduce the prevalence of cancer and the burden it places on the public and the health care system. We note important still-unresolved questions about which behaviors can be intervened upon simultaneously in order to maximize positive behavioral synergies, minimize negative ones, and effectively engage underserved populations. We conclude that interprofessional collaboration is needed to appropriately determine and convey the value of primary prevention of cancer and other chronic diseases.

Effects of Chronic Social Stress on Obesity

The prevalence of overweight and obesity has markedly increased during the past few decades. Stress has been suggested as one environmental factor that may contribute to the development of obesity. In this review, we discuss the role that exposure to chronic stress may play in the development of obesity, with particular attention to the effects of chronic psychosocial stress. Of particular importance is the effect that social stress has on dietary preference, food consumption, and regional distribution of adipose tissue. We present evidence from human and animal studies that links sympathetic nervous system and hypothalamic-pituitary-adrenal axis hyperactivity with visceral obesity, and that stress tends to alter the pattern of food consumption, and promotes craving of nutrient-dense "comfort foods." Lastly, we discuss the visible burrow system, a model of chronic social stress used in our laboratory to assess the effects of social subordination on behavioral and metabolic profile.