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.

Obesogenic Toxicants in Breast Milk of Lactating Women: Investigation of a Risk Factor for Childhood Obesity.

BACKGROUND: Persistent organic pollutants (POPs), dispersed in all environmental compartments, are associated with increased adipogenesis and body weight. These lipophilic toxicants bioaccumulate in the human body and get transferred from mothers to their offspring via the placental circulation and breast milk. The current study was designed to compare polychlorinated biphenyl (PCB) and hexachlorobenzene (HCB) concentrations between obese and normal-weight lactating women. METHODS: A cross-sectional correlation design was used to compare POP concentrations in breast milk samples of 24 obese and 21 normal-weight adult lactating women at their 2- to 8-week postpartum clinic visit. Concentrations of 12 specific PCB congeners and HCB were analyzed using high-resolution gas chromatography coupled with mass spectroscopy. RESULTS: Of 12 targeted PCB congeners, 6 were detected in the breast milk samples of obese women compared to 3 in normal-weight lactating women. PCB presence was not significantly different between the obese and normal-weight groups. HCB was not detected in any of the breast milk samples for either group. CONCLUSIONS: This exploratory study revealed no statistically significant difference in the presence of PCBs in breast milk of obese mothers compared to that of normal-weight women. Therefore, fear of increased risk of transmission of these toxicants may not be a good reason to avoid breastfeeding. Results point to the need for a large-scale multicenter study that examines the effect of PCBs on breastfeeding, considering possible geographic variations of the examined phenomenon.

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.

Increasing the Registered Nursing Workforce Through a Second-Degree BSN Program Coaching Model.

The coach model is an innovative approach to clinical education in which registered nurses facilitate clinical instruction. The nursing students are assigned with a specific coach throughout the 12-month accelerated baccalaureate nursing curriculum. The purpose of this article is to share our experience using the coach model for students' clinical education including the benefits, challenges, and outcomes.

Prevention of human immunodeficiency virus breastmilk transmission with copper oxide: proof-of-concept study.

BACKGROUND: Human immunodeficiency virus type 1 (HIV-1) transmission through breastmilk is the chief modality through which HIV-1 is transmitted from HIV-1-infected mothers to their babies in developing countries, where alternative feeding options lack practical feasibility. The development of an approach to inactivate the HIV-1 virions ingested by an infant on a daily basis through breastmilk is thus of critical importance. METHODS: Copper has potent virucidal properties. Stoichiometric concentrations of copper ions inactivate the HIV-1 protease, which is essential for viral replication. Cell-free and cell-associated HIV-1 infectivity is inhibited when the virus is exposed to copper oxide in a dose-dependent manner. Passage of high titers of a wide range of HIV-1 isolates, spiked in culture medium, through filters containing copper oxide powder resulted in their deactivation. RESULTS: In the current study, we demonstrate that the infectivity of three different HIV-1 isolates, spiked in breastmilk obtained from HIV-1-seronegative donors, or of wild-type isolates found in breastmilk obtained from HIV-1-seropositive donors, is drastically reduced (>98%) when exposed to copper oxide. CONCLUSIONS: This study is proof of concept that copper oxide is efficacious against HIV-1 found in breastmilk and serves as the basis for further research aimed at determining the possible effects that copper may have on the nutritional and anti-infective properties of breastmilk. Furthermore, this supports the continuing study of the feasibility of developing a filtering device, such as an "at-the-breast" disposable shield that can be used discreetly and safely by HIV-1-infected mothers during breastfeeding.