Revisioning Obesity in Health Care Practice and Research: New Perspectives on the Role of Body Temperature.

Obesity is a leading health problem in the United States and globally. Relatively few people with obesity achieve long-term weight control, suggesting that obesity and resistance to weight change represent functional adaption of energy homeostasis to the environment. The purpose of this article is to synthesize the literature regarding the relationship between environmental temperature and body weight and fat mass to provide a new explanation of obesity as a problem of maintaining core body temperature. Chronic exposure to cool environmental temperatures likely contributed to the obesity epidemic, and passive whole-body warming may be a promising intervention for weight control.

Academic Tenure: Perceptual Variations Among Tenured, Tenure-seeking and Non-tenure Faculty.

BACKGROUND: Tenure is a hallmark of higher education, but its value and relevance is questioned. PURPOSE: This study examined faculty perceptions of the value of tenured and non-tenured nursing faculty appointments. METHODS: A descriptive correlational design using an anonymous survey was sent to members of the American Association of College of Nursing. Participants (N = 542) from 44 states completed the survey. RESULTS: Significant differences in workload were found in teaching, administrative responsibilities, scholarship, and academic service. Compared to non-tenured faculty, tenured faculty had higher scores on Career Opportunities (p < 0.001), lower Life Balance scores (p = 0.001) and higher Academic Support scores (p = 0.014). Non-tenured faculty were less likely to agree than tenured faculty that tenure improves quality of education (χ2 = 86.48, p < 0.001) or is relevant to the modern university (χ2 = 75.20, p < 0.001). Narrative responses revealed six themes about tenure. Faculty on both tracks questioned the value of tenure. CONCLUSIONS: Faculties in schools of nursing nationwide need to re-evaluate the purpose of tenure and the tenure criteria in light of each institution's unique mission and expectations to determine how they are meeting the needs of both academic institution and nursing faculty. Although the idea of tenure is institutional, implementation is initiated at the school level. Our study revealed naivete about tenure among nursing faculty at the school level.

COVID-19: Epidemiology and clinical practice implications.

ABSTRACT: In 2019, a novel coronavirus infection was detected in humans. As coronavirus disease 2019 (COVID-19) spread around the world, often confusing and contradictory information about the disease proliferated rapidly. This article reviews what is currently known about COVID-19, including transmission, epidemiology, immunologic responses, clinical manifestations, and disease management.

Polycyclic aromatic hydrocarbons in breast milk of obese vs normal women: Infant exposure and risk assessment.

Biomonitoring of human breast milk is one of the best ways to identify body burdens of contaminants and associated risk estimation. The objectives of the current study were to evaluate milk concentrations of persistent organic pollutants (POPs), mainly polycyclic aromatic hydrocarbons (PAHs), associated exposure estimation, and the role of body mass index (BMI) in their bioaccumulation. A total of 45 breast milk samples were collected from 24 women with BMI > 30 (obese) and 21 women with BMI < 25 (18.5-24.9, normal) from 14 different counties surrounding Lubbock in west Texas/New Mexico (age range: 18-34 years). Samples were analyzed using high resolution gas chromatography coupled with mass spectrometry. A total of 31/45 (69%) of samples tested positive for PAHs. Phenanthrene was the most frequently detected PAH followed by pyrene and fluoranthene. The mean of individual PAH concentration for all samples ranged from 0 to 25.1 ng/g milk fat; the sum of all means of individual PAHs was 146.9 ng/g milk fat. The mean concentration of total PAHs in the BMI > 30 group was 224.8 ng/g milk fat, which was approximately 4 times the mean concentration of total PAHs in the BMI 18.5-24.9 group (57.9 ng/g milk fat). None of the samples from the BMI 18.5-24.9 group contained higher molecular weight (5-6 rings) PAHs, while in the BMI >30 group, a total of 11 PAHs including listed EPA priority pollutants were observed. In this study, benzo(b)fluoranthene was found to contribute the highest percentage of carcinogenic PAHs (32.08%), yet it was not detected in any samples from the BMI 18.5-24.9 group. The estimated total PAHs intakes by infants via obese and normal mothers' milk were 1.26 and 0.32 (µg/kg/day), which are 0.049 and 0.003 (µg/kg/day) B[a]P equivalent, respectively. These findings suggest that breastfed babies from obese mothers are potentially at higher risk of exposure to carcinogenic PAHs.

Biology of obesity and weight regain: Implications for clinical practice.

BACKGROUND AND PURPOSE: Weight loss is recommended as first-line therapy for many chronic illnesses, including obesity. Most patients who do successfully lose weight are unable to maintain their reduced weight. Recent research findings are reviewed and synthesized to explain the biology of obesity, adaptation to weight loss, and weight regain. FINDINGS: Weight regain is a common consequence of successful weight loss. Current obesity management strategies fail to take into consideration the underlying genetic and environmental causes of obesity. Available treatment modalities create a negative energy balance that stimulates integrated, persistent neurologic, endocrine, muscle, and adipose tissue adaptation to restore body weight and fat mass, independent of lifestyle changes. IMPLICATIONS FOR PRACTICE: Understanding the pathophysiology of obesity and weight loss alters nurse practitioners' responsibilities in caring for patients with obesity. They are responsible for expanding assessment and intervention strategies and offering people with obesity realistic expectations for weight loss and regain. They are obligated to explain weight regain when it occurs to minimize patient frustration. Nurse practitioners have the opportunity to adopt new approaches to patient advocacy, especially in the areas of public policy to improve diagnostic tools and adjunctive therapy for people with obesity.

Before, after, & after-after: Clinical implications of weight loss recidivism.

Weight recovery among obese patients who have lost weight through lifestyle modification or bariatric surgery is a common clinical challenge that often leads to patient stigmatization and unexpected health problems. A review of the literature describes how weight loss alters energy homeostasis to limit weight loss and restore lost fat mass in patients who have successfully lost weight.

Obesity education for nurse practitioners: perspectives from nurse practitioner faculty.

PURPOSE: The purpose of the study was to investigate curriculum content and teaching practices about obesity in graduate nursing programs in the United States. METHODOLOGY: A survey of 1202 faculty members teaching in nurse practitioner (NP) programs was conducted using an investigator-created instrument with items based on the National Institutes of Health Obesity Education Initiative guidelines. Objective items were analyzed using descriptive and nonparametric statistics, and the open-ended questions were analyzed using content analysis. FINDINGS: NP faculty emphasized existing clinical practice guidelines, but revealed a large disparity between what is emphasized in schools of nursing and the state of the science regarding obesity etiology and management. Faculty place a priority on teaching obesity as a key factor in the development of comorbidities, and weight loss as a means of treating these comorbidities. Teaching about the pathophysiology of obesity, management of bariatric surgery patients, and pharmacologic therapy are de-emphasized. Four main themes about obesity teaching practices were identified from subjects' comments to open-ended items. CONCLUSIONS: Additional education and support are needed for faculty to teach about obesity in a way that advances the care of obese patients based on emerging scientific principles.

The role of impaired mitochondrial lipid oxidation in obesity.

Obesity represents a disruption in balancing fuel intake with energy expenditure in favor of energy conservation. Adiposity is known to be carefully regulated and, over time, highly resistant to major changes, raising questions about how energy homeostasis can become dysregulated in favor of fat accumulation. In obesity, the excess lipid accumulation represents a surfeit of energy, but those who are obese often experience rapid fatigue and decreased physical endurance, reflecting an energy deficiency. To develop an explanation for this apparent contradiction in energy homeostasis and the chronic overeating relative to energy used in obesity, a review of the literature was conducted. The resulting model of obesity is based on a growing body of research demonstrating that altered mitochondrial energy production, particularly in skeletal muscles, is a major anomaly capable of setting off a chain of metabolic events leading to obesity. Alterations in skeletal muscle mitochondria distribution and their oxidative and glycolytic energy capacities in obesity are described. The metabolic responses of obese and normal individuals to exercise are contrasted, and the effects of weight loss on energy production are presented. The effect of altered fat oxidation is considered in relation to energy regulation by the central nervous system and the development of major obesity comorbidities, including systemic inflammation, insulin resistance and diabetes, and cardiovascular disease. Recommendations for clinical intervention and additional research are proposed based on the model presented of impaired mitochondrial function in obesity.

Obesity, stigma, and civilized oppression.

The study was conducted to explore what it is like for individuals and family members to live with obesity as a chronic illness. An interpretive phenomenological design was used to obtain and analyze interviews of 13 obese individuals and 5 of their family members. A convenience sample was used to recruit the subjects who participated in the audiotaped interviews. The interviews used open-ended questions. Audiotapes were transcribed and analyzed for identifying the major themes within each transcript, and patterns of meaning across narratives. The major themes and patterns were described through written essays and group discussions about the transcripts. The participants revealed frequent experiences of stigmatization and discrimination on the basis of their obesity. Those who are obese are reminded through their everyday encounters with family members, peers, healthcare providers, and strangers, that their being deviates from social norms, and that they are inferior to those who are not obese. Obese subjects experience a pattern of denigration and condemnation that is so pervasive as to constitute what Harvey has called civilized oppression. A discussion of the social construction of obesity and the elements of civilized oppression, as they are experienced by those who are obese, offers new insights into interpersonal relationships that can provide a foundation for more effective care of the obese population.

The case for an immunologic cause of obesity.

The most pressing public health problem at the start of the century is the mounting prevalence of obesity. Acknowledging an interplay between genetics and the environment in the development of obesity, most experts still attribute the rising trend toward obesity to the ready availability offood and an increasingly sedentary lifestyle. With a growing body of evidence demonstrating strong links between adipose tissue and the immune system, there is good reason to ask whether the cause of the current obesity epidemic might be a less obvious disorder of immune function, perhaps even the consequence of infection. The interplay between preadipocytes and adipocytes and the immune system is examined, and recommendations for further research are offered.