The relationship between changes in sitting time and mortality in post-menopausal US women.

BACKGROUND: Prolonged sitting is linked to various deleterious health outcomes. The alterability of the sitting time (ST)-health relationship is not fully established however and warrants study within populations susceptible to high ST. METHODS: We assessed the mortality rates of post-menopausal women from the Women's Health Initiative (WHI) observational study, a 15-year prospective study of post-menopausal women aged 50-79 years, according to their change in ST between baseline and year six. A total of 77 801 participants had information at both times on which to be cross-classified into the following: (i) high ST at baseline and follow-up; (ii) low ST at baseline and follow-up; (iii) increased ST and (iv) decreased ST. Cox regression was used to assess the relationship between all-cause, CVD and cancer mortality with change in ST. RESULTS: At the end of follow-up, there were 1855 deaths. Compared with high ST maintainers, low ST maintainers had a 51 and 48% lower risk of all-cause and cancer mortality, respectively. Reducing sitting also resulted in a protective rate of 29% for all-cause and 27% for cancer mortality. CONCLUSIONS: These results highlight not only the benefit of maintaining minimal ST, but also the utility of decreasing ST in older women, if current levels are high.

Effects of acute exercise on postprandial triglyceride response after a high-fat meal in overweight black and white adolescents.

OBJECTIVE: We examined the effects of acute exercise on postprandial triglyceride (TG) metabolism following a high-fat meal in overweight black vs white adolescents. DESIGN AND SUBJECTS: Twenty-one black and 17 white adolescents (12-18 yrs, body mass index 85th percentile) were evaluated twice, during control versus exercise trials, 1-4 weeks apart, in a counterbalanced randomized design. In the control trial, participants performed no exercise on day 1. In the exercise trial, participants performed a single bout of 60-min exercise (50% VO2 peak) on a cycle ergometer on day 1. On day 2 of both trials, participants consumed a high-fat breakfast (70% calories from fat) and blood was sampled for TG concentration in the fasted state and for 6 h postprandially. RESULTS: There was a significant main effect of condition on postprandial peak TG concentration (P=0.01) and TG area under the curve (AUC) (P=0.003), suggesting that independent of race, peak TG and TG-AUC was lower in the exercise trial vs control trial. Including Tanner stage, gender, total fat (kg) and visceral adipose tissue (VAT) as independent variables, stepwise multiple regression analyses revealed that in whites, VAT was the strongest (P<0.05) predictor of postprandial TG-AUC, explaining 56 and 25% of the variances in TG-AUC in the control and exercise trials, respectively. In blacks, VAT was not associated with postprandial TG-AUC, independent of trial. CONCLUSION: A single bout of aerobic exercise preceding a high-fat meal is beneficial to reduce postprandial TG concentrations in overweight white adolescents to a greater extent than black adolescents, particularly those with increased visceral adiposity.

The joint association of physical activity and glycaemic control in predicting cardiovascular death and all-cause mortality in the US population.

AIMS/HYPOTHESIS: The aim of this study was to examine the joint association of physical activity and glycaemic control as measured by HbA(1c) on all-cause and cardiovascular disease (CVD) mortality risk. METHODS: The sample included 10,352 adults from the Third National Health and Nutrition Examination Survey (NHANES III) Linked Mortality Public-use File (follow-up 13.4 ± 3.9 years; 2,463 deaths). Physical activity was assessed by questionnaire and classified into inactive and active categories based on self-reported frequency of leisure-time activity. HbA(1c) was categorised to reflect the American Diabetes Association diagnostic and treatment guidelines. RESULTS: Being physically active was associated with a decreased risk of all-cause (HR 0.74 [95% CI 0.67, 0.81]) and CVD (HR 0.71 [95% CI 0.62, 0.82]) mortality, whereas higher levels of HbA(1c) were associated with an increased mortality risk. HbA(1c) ≥ 7% (53 mmol/mol) was associated with the highest risk for all-cause (HR 1.54 [95% CI 1.30, 1.82]) and CVD (HR 1.93 [95% CI 1.52, 2.45]) mortality. Across all categories of HbA(1c), active individuals were not at increased risk for all-cause mortality compared with inactive individuals with normal glycaemic control. Similar findings were observed for CVD mortality, except that active individuals with HbA(1c) ≥ 7% (53 mmol/mol) were still at increased risk for CVD mortality. However, their risk for CVD death was substantially lower than the risk for their inactive counterparts (HR 1.38 [95% CI 1.03, 1.84] vs HR 1.98 [95% CI 1.34, 2.92]). CONCLUSIONS/INTERPRETATION: Physical activity is associated with lower all-cause and CVD mortality risk for individuals across all levels of glycaemic control. Therefore, engaging in a physically active lifestyle and achieving normal levels of glycaemic control may both be important for the prevention of early mortality.

Exercise is associated with improved asthma control in adults.

Global asthma control levels are suboptimal. The influence of regular exercise on asthma control is unclear. We assessed the effects of a 12-week supervised exercise intervention followed by 12 weeks of self-administered exercise on adults with partially controlled asthma (n = 21) and matched controls (n = 15). Assessments were conducted at baseline and week 12 for both the exercise and control group, and again at week 24 for the exercise group. There was a significant treatment effect on asthma control in the exercise group, as measured by the Asthma Control Questionnaire (ACQ), from baseline to week 12, compared with the control group. A clinically significant improvement (0.5 increase in ACQ score) was observed for asthma quality of life and ACQ in the exercise group from baseline to week 12. There was a significant improvement in aerobic fitness from baseline to week 24 in the exercise group. In conclusion, a 12-week supervised exercise intervention led to improvements in asthma control and quality of life in partially controlled asthmatics motivated to exercise. These improvements were maintained, while aerobic fitness and perceived asthma control significantly improved over an additional 12 weeks of self-administered exercise. These findings indicate that a structured exercise intervention can improve asthma control.

Influence of sex on total and regional fat loss in overweight and obese men and women.

OBJECTIVE: To determine the influence of sex on the association between reductions in body weight (BW) and waist circumference (WC) with reductions in total (TAT), subcutaneous (SAT) and visceral adipose tissue (VAT) in response to lifestyle-based interventions. DESIGN: Changes in TAT, SAT and VAT were assessed using magnetic resonance imaging in 81 men and 72 women who had participated in various diet and/or exercise interventions at Queen's University, Ontario, Canada. RESULTS: Reductions in BW and WC were significantly (P<0.001) correlated with TAT, SAT and VAT loss in men and women. For a given weight loss, men had a significantly greater decrease in WC than women, and the sex difference in WC reduction increased with increasing weight loss (P<0.05). Similarly, for a given reduction in BW or WC, men have significantly greater reductions in VAT, but smaller reductions in total and lower body SAT than women, differences that progressively increased in magnitude with the increasing BW or WC loss (P<0.05). Accordingly, there were no sex differences in the TAT reduction for a given BW or WC reduction (P>0.05). Reductions in BW and WC were both independent predictors of VAT loss. CONCLUSIONS: These observations suggest that for a given reduction in BW or WC, men lose more VAT and less SAT than women; however, the TAT loss observed for a given reduction in BW or WC in men and women is not different.

Individuals with obesity but no other metabolic risk factors are not at significantly elevated all-cause mortality risk in men and women.

Studies have examined mortality risk for metabolically healthy obesity, defined as zero or one metabolic risk factors but not as zero risk factors. Thus, we sought to determine the independent mortality risk associated with obesity or elevated glucose, blood pressure or lipids in isolation or clustered together. The sample included 54 089 men and women from five cohort studies (follow-up = 12.8 ± 7.2 years and 4864 [9.0%] deaths). Individuals were categorized as having obesity or elevated glucose, blood pressure or lipids alone or clustered with obesity or another metabolic factor. In our study sample, 6% of individuals presented with obesity but no other metabolic abnormalities. General obesity (hazard ratios [HR], 95% CI = 1.10, 0.8-1.6) and abdominal obesity (HR = 1.24, 0.9-1.7) in the absence of metabolic risk factors were not associated with mortality risk compared to lean individuals. Conversely, diabetes, hypertension and dyslipidaemia in isolation were significantly associated with mortality risk (HR range = 1.17-1.94, P < 0.05). However, when using traditional approaches, obesity (HR = 1.12, 1.02-1.23) is independently associated with mortality risk after statistical adjustment for the other metabolic risk factors. Similarly, metabolically healthy obesity, when defined as zero or one risk factor, is also associated with increased mortality risk (HR = 1.15, 1.01-1.32) as compared to lean healthy individuals. Obesity in the absence of metabolic abnormalities may not be associated with higher risk for all-cause mortality compared to lean healthy individuals. Conversely, elevation of even a single metabolic risk factor is associated with increased mortality risk.

Waist circumference at five common measurement sites in normal weight and overweight adults: which site is most optimal?

The aim of this study was to determine (i) if adults would measure their own waist circumference (WC), (ii) which WC site(s) are the most intuitive and easy to measure and (iii) if measurement accuracy and association between WC and blood pressure differs across five measurement sites. Participants (n = 198) measured their WC first with no instruction and then using visual instructions for the iliac crest, last rib, midpoint, minimal waist and umbilicus. Without instruction, men most commonly measured their WC at the umbilicus and iliac crest, while women measured their WC at the umbilicus and minimal WC. Both men and women reported the minimal waist and umbilicus to be moderately easier to self-measure compared to the other sites (P < 0.05). Prevalence of abdominal obesity varied significantly by gender and measurement site, especially for females (normal weight: 0-18%; overweight: 51-79%). Measurement site did not influence accuracy of WC self-measurement or the association between WC and blood pressure (P > 0.05). A universal WC landmark is needed. From these results, there does not appear to be a clear clinical advantage in terms of blood pressure or practical advantage of measuring one WC site over another. However, the umbilicus may be the most intuitive and easy to measure.

The associations of resting metabolic rate with chronic conditions and weight loss.

The aim of this study was to examine the associations between baseline and changes in resting metabolic rate (RMR) with chronic condition(s) and weight loss (WL). Sex stratified analysis was undertaken on 393 adults from the Wharton Weight Management Clinics. The association between baseline RMR and WL was examined adjusting for age, BMI, ethnicity and treatment time. The association between changes in RMR (ΔRMR) and WL was also examined adjusting for baseline RMR and above covariates. Models were further adjusted for high glucose, triglycerides, blood pressure, low-density lipoprotein (LDL) and low high-density lipoprotein (HDL). While men (6.0 ± 8.6 kg) and women (5.6 ± 8.3 kg) had significant WL throughout the intervention, their measured decreases in RMR (-48 ± 322 kcal and -5 ± 322 kcal, respectively) were non-significant (P > 0.05). Individuals with a high blood pressure had a higher baseline RMR and women with a high LDL had a lower baseline RMR than those without the chronic condition (P < 0.05). Regardless of sex, WL was not significantly associated with baseline RMR or ΔRMR (P > 0.05) in both models. Participants with a low baseline RMR do not appear to be at a disadvantage for WL. Further, WL can occur without decreases in RMR in populations with high levels of obesity and obesity-related comorbidities.

Differences in weight change trajectory patterns in a publicly funded adult weight management centre.

OBJECTIVE: To describe differences in weight loss (WL) trajectory patterns at a publicly funded clinical weight management centre. METHODS: Groups with differences in the attainment of a 5% total body WL and percentage WL patterns over time were identified in 7,121 patients who attended a physician lead multi-disciplinary clinical lifestyle weight management that predominantly focused on education and diet counselling. Resultant health differences were examined. RESULTS: Patients had 3.2 ± 6.3%WL with 35% of patients achieving and maintaining a 5%WL. Half of these patients achieved the 5%WL within 6 months, while the other half had a more gradual approach. Another 10% achieved 5%WL, but regained weight after 6 months. There were seven distinct WL patterns identified: LargeWL (Mean WL: 21.2 ± 8.1%; Probability of group membership (PGM): 2.4%), ModerateWL (15.1 ± 5.1%WL; 5.4%PGM), SlowWL (6.7 ± 3.2%WL; 20.1%PGM) and MinimalWL (2.4 ± 2.2%WL; 34.6%PGM), WL Regain (9.4 ± 3.5%WL; 8.2%PGM), Weight Stable (1.2 ± 3.2%WL; 28.5%PGM) and Weight Gain (18.4 ± 11.2%WG; 0.8%PGM) groups. Improvements in blood pressure, lipids and glucose were generally related to the magnitude of WL achieved more than the pattern or speed of WL. CONCLUSIONS: There are large differences in the absolute WL attained and the pattern of WL during a publicly funded weight management program. Changes in clinical health markers appear to be more strongly related with the absolute WL attained as opposed to patterns of weight change. © 2016 The Authors. Obesity Science & Practice published by John Wiley & Sons Ltd, World Obesity and The Obesity Society.

Variations in the prevalence and predictors of prevalent metabolically healthy obesity in adolescents.

BACKGROUND: Obesity is a heterogeneous condition, which includes a subset of individuals that can be classified as having metabolically healthy obesity (MHO), but there is no consensus on what constitutes MHO. Thus, the objective of the study is to examine the prevalence and predictors of prevalent MHO in adolescents using various definitions of MHO. METHODS: Cross-sectional data from the 1999-2010 National Health and Nutrition Examination Surveys were used. Participants included 316 male and 316 female adolescents aged 12-19 years with a BMI ≥ 95th percentile. Two definitions were used to define MHO. First, MHO was defined as having ≤1 metabolic syndrome criteria (excluding waist) and being free of type 2 diabetes, hypertension and dyslipidemia. Second, MHO was defined as being free of all metabolic syndrome criteria, insulin resistance and inflammation. RESULTS: The prevalence of MHO was 42% (male) and 74% (female) using the first definition and 7% (male) and 12% (female) using the second more conservative definition. Lower abdominal obesity (waist circumference) and lower insulin resistance predicted prevalent MHO in male and female adolescents for both definitions (p < 0.01). Associations between dietary components and MHO were weak and inconsistent, while physical activity and inflammation were not associated with MHO in male and female adolescents for both definitions (p > 0.05). CONCLUSIONS: The prevalence of MHO in adolescents varied across definitions, with lower levels of abdominal obesity and insulin resistance as the most consistent predictors of prevalent MHO status.

The association between obesity and self-reported sinus infection in non-smoking adults: a cross-sectional study.

The aim of this article was to examine the associations between having had a sinus infection (SI) and BMI and physical activity (PA), diet quality, stress and/or sleep. A total of 2915 adults from the National Health and Nutrition Examination Survey 2005-2006 were examined. Logistic regression analysis was used to examine the association between having had an SI with BMI and PA, diet quality, stress or sleep. As these factors are known to influence one another, a fully adjusted model with PA, diet quality, stress and sleep was also constructed to examine their independent associations with having had an SI. Overall, 15.5 ± 1.2% of the population report having had an SI in the past year. In all models, individuals with obesity were approximately twice as likely to have had an SI compared to those of normal weight (P < 0.05). While PA and diet quality were not significantly associated with having had an SI (P > 0.05), individuals with stress and sleep troubles were also twice as likely to have had an SI (P < 0.05) independent of BMI. In the fully adjusted model, only the associations for BMI and sleep troubles remained significant (P < 0.05). Results from this study suggest that obesity and sleep troubles, but not PA, quality of diet and stress, are associated with having had an SI. As interactions exist between obesity, immune system factors and exposure to infectious disease(s), more research is necessary to understand the directionality of these relationships.

Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P < 0.05). The prevalence of comorbidities was not different by surgical interest (P = 0.17). Despite the effectiveness of bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature.

Consequences of obesity and weight loss: a devil's advocate position.

Obesity is associated with multiple negative health consequences and current weight management guidelines recommend all obese persons to lose weight. However, recent evidence suggests that not all obese persons are negatively affected by their weight and that weight loss does not necessarily always improve health. The purpose of this review is not to trivialize the significant health risks associated with obesity, but to discuss subpopulations of obese people who are not adversely affected, or may even benefit from higher adiposity, and in who weight loss per se may not always be the most appropriate recommendation. More specifically, this review will take a devil's advocate position when discussing the consequences of obesity and weight loss for adults with established cardiovascular disease and type 2 diabetes, weight cyclers, metabolically healthy obese adults, youth, older adults and obese individuals who are highly fit.

Measurement site influences abdominal subcutaneous and visceral adipose tissue in obese adolescents before and after exercise.

BACKGROUND/OBJECTIVES: The objective of this study was to determine if abdominal adipose tissue (AT) measurement site influences the association between baseline and change in abdominal subcutaneous (ASAT) and visceral AT (VAT), and metabolic risk factors in obese adolescents. METHODS: Fifty-five obese adolescents (14.9 ± 1.7 years; 51% male; 42% white) participated in an aerobic or resistance exercise intervention three times/week for 3 months. We compared the association between changes in abdominal AT area (spanning 5 cm below to 15 cm above L4-L5) and volume measured by magnetic resonance imaging with concomitant changes in metabolic risk. RESULTS: All AT areas were significantly (p < 0.05) correlated with the respective volume at baseline and follow-up. Baseline VAT areas at 5 and 10 cm above L4-L5 were more strongly associated with VAT volume than VAT area at L4-L5 (p < 0.05). After the intervention, changes in the area at 5 and 10 cm above L4-L5 were more strongly associated with changes in AT volumes than changes in L4-L5 (p < 0.05). Changes in abdominal AT volumes were more strongly associated with insulin area under the curve than any single-slice abdominal AT area. CONCLUSIONS: The measurement site for abdominal AT has significant influence on the relationships with total VAT or ASAT and metabolic risk factors in obese adolescents before and after an exercise intervention.

The effect of bicycling on PSA levels: a systematic review and meta-analysis.

BACKGROUND: Recent literature has suggested that bicycling may be associated with increases in serum PSA levels, a diagnostic and prognostic marker for prostate cancer. To further investigate this relationship, we conducted a systematic review and meta-analysis of current literature in this field. METHODS: MEDLINE, CENTRAL, CINAHL and SPORTDiscus were searched using MeSH terms and keywords for English publications related to bicycle riding and PSA. Studies were included if PSA was measured relative to cycling activity in healthy men who were free of any prostatic condition. Case studies were excluded. RESULTS: Eight studies met our inclusion criteria, comprising 912 participants that engaged in, or self-reported, bicycling activity. Six studies investigated the acute pre-post change in PSA following bicycling activity that ranged from a single cycling bout of 15 min to a 4-day cycling event. Following cycling activity, two studies reported total PSA increased from baseline by up to 3.3-fold, free PSA increased in one study by 0.08±0.18 ng ml(-)(1) and did not change in four studies. One study compared PSA in elite/professional cyclists versus non-cyclists and demonstrated no significant difference in PSA measurements between groups. Data from six studies were meta-analyzed and demonstrated no significant increase in PSA associated with cycling from pre to post (mean change +0.027 ng ml(-)(1), s.e.m.=0.08, P=0.74, 95% confidence interval (CI)=-0.17-0.23). CONCLUSIONS: Our findings suggest that there is no effect of cycling on PSA; however, the limited number of trials and the absence of randomized controlled trials limit the interpretation of our results. Additionally, the median sample size only consisted of 42 subjects. Therefore, our study may have low statistical power to detect a difference in PSA. Although, a higher sample size may demonstrate statistical significance, it may not be clinically significant. Studies of higher empirical quality are needed.

Tricyclic and SSRI usage influences the association between BMI and health risk factors.

To determine if selective-serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) influence the association between obesity and cardiovascular disease risk, participants from the Third National Health and Nutrition Examination Survey (NHANES III; 1988-1992) and continuous NHANES (1999-2009, n = 18 274) were used. For a given body mass index (BMI), individuals taking SSRIs (n = 219) tended to have significantly better health risk profiles with lower systolic blood pressure (P = 0.002) and higher high-density lipoprotein (P = 0.003) compared with non-users. Conversely, those who used TCAs (n = 116) had significantly worse health risk profiles with higher diastolic blood pressure (P ≤ 0.0001) and triglycerides (P = 0.023) as compared with non-users for a given BMI. Insulin resistance (HOMA-IR) was higher in TCA users and those with larger BMIs, whereby the differences in insulin resistance between TCA users and non-users was greater with higher BMIs (interaction effect: P = 0.013). Furthermore, individuals taking SSRIs were less likely to have cardiovascular disease than non-users (odds ratio, 95% confidence interval = 0.50, 0.33-0.75) for a given BMI, with no differences by TCA use (odds ratio = 0.74, 0.44-1.24). SSRI and TCA use may alter how body weight relates with cardiovascular risk. When prescribing antidepressant medications, it may be necessary to monitor and consider body weight and cardiovascular risk profile of individual patients.

Difference in weight loss based on ethnicity, age and comorbidity status in a publicly funded adult weight management centre: 1-year results.

Limited evidence is available on the effectiveness of publicly funded weight loss (WL) clinics. We examined the 1-year WL outcomes and investigated predictors of WL and discontinuation of 1566 overweight and obese adults, who attended the Wharton Medical Clinic (WMC) weight management centre for at least 6 months. Overall, 42.7% (n = 669) of the entire sample achieved a ≥5%WL over the entire follow-up period from July 2008 to February 2012. On average, patients lost 5.6 ± 7.2 kg (5.0 ± 6.3%) of initial body weight (BW), while a subsample of patients attending the clinic for at least 1 year had a mean weight reduction of 6.6 ± 7.9 kg (5.9 ± 7.2%) of BW. Older patients were more likely to achieve a greater WL in comparison with young patients while White patients and those without type 2 diabetes (T2D) lost almost twice as much weight and %BW in comparison with Asian patients and patients with T2D, respectively (P < 0.05). Discontinuing patients did not differ in terms of sex, body mass index, education and smoking status from those who continued treatment (P > 0.05). Results of this study demonstrate that the WMC provides a practical model for clinically effective lifestyle-based treatment, accessible to a wide range of demographically diverse adults.

Relationships between insulin sensitivity, skeletal muscle mass and muscle quality in obese adolescent boys.

We examined the relationships between insulin sensitivity (IS), skeletal muscle (SM) mass and SM quality in youth. Forty obese adolescent boys (body mass index ≥ 95 th percentile, 12-18 years) participated in this study. IS and glucose tolerance was measured by a 3 h hyperinsulinemic-euglycemic clamp and a 2 h oral glucose tolerance test (OGTT), total SM mass and intermusular adipose tissue (IMAT) by whole-body magnetic resonance imaging, and muscular strength by one-repetition maximum leg and bench press. IMAT was associated (P<0.05) with IS (r=-0.53) and OGTT-insulin area under the curve (AUC; r=0.31). Similarly, muscular strength was associated (P<0.05) with both IS (r=0.39) and OGTT-insulin AUC (r=-0.32). By contrast, total SM mass was not associated with IS or any OGTT parameters (P>0.1). After accounting for race and tanner stage, IMAT and muscular strength remained significantly associated with IS, together explaining a total of 41% of the variance in IS. Our findings suggest that SM quality, but not SM mass, is associated with IS in obese adolescent boys.

Influence of weight discrimination on weight loss goals and self-selected weight loss interventions.

UNLABELLED: What is already known about this subject • There is a discrepancy between clinical and patient goals for weight loss. • Evidence suggests that some bariatric patients highly value, and are willing to endure hardships for weight loss. • Obesity is commonly framed as an easily reversed and individual problem, which in turn promotes weight discrimination. What this study adds • Patient beliefs about weight loss are in accordance with social understandings of obesity but not with current treatment options. • Patients may not be willing to endure hardships for weight loss. • Weight discrimination may relate to how patients approach weight loss. SUMMARY: Bariatric patients report weight loss goals, which are three times higher than weight loss recommended by clinicians. It is unclear which weight loss interventions patients feel are necessary to reach these goals or whether responses associate with perceptions of weight discrimination. One hundred fifteen patients (BMI = 40.0 ± 6.9 kg m(-2) , age = 47.2 ± 12.2 years, 85% female, 77% reporting weight discrimination) were surveyed from weight management clinics. Participants reported ideal weight losses of 37.6 ± 16.7 kg (33% of initial weight), and the majority felt weight loss could be achieved through lifestyle changes such as improved physical activity (80%) or diet (52%), with fewer reporting pharmacotherapy (8%), surgery (12%) or genetic modification (7%) as necessary for goal attainment. Participants selecting lifestyle changes or pharmacotherapy for weight loss reported ideal weight loss goals that would generally be achievable through surgical means (32% and 33%, respectively), and participants selecting surgical intervention reported ideal goals at the upper end of what is generally achievable with this intervention (38%). All participants selecting surgery or genetic modifications reported experiencing weight discrimination. These results indicate a disparity between weight loss goals and selected interventions, and suggest that weight discrimination is associated with the selection of potentially riskier weight loss interventions.