On the limitations of barriers: Social visibility and weight management in Cuba and Samoa.

Obesity is an enduring global health challenge. Researchers have struggled to understand the barriers and facilitators of weight loss. Using a cross-cultural comparative approach, we move away from a barriers approach to analyze obesity and overweight through the lens of social visibility to understand the persistent failure of most obesity interventions. Drawing on ethnographic data from Cuba and Samoa collected between 2010 and 2017, we argue that social visibility is a framework for analyzing some of the reasons why people do not participate in weight management programs when they have high rates of health literacy and access to free or low-cost programming. Comparing these two places with very different histories of obesity interventions, we trace how weight management practices make people socially visible (in positive and negative ways), specifically analyzing how gender and economic inequalities shape the sociality of obesity. Our findings show that regardless of barriers and facilitators of weight loss at an individual and population level, the ways weight loss activities are incorporated into or conflict with the social dynamics of everyday life can have a profound effect on weight management. Employing visibility as a analytic framework de-individualizes weight responsibility, providing a contextual way to understand the difficulties people face when they manage their weight.

Early frailty transition predicts 15-year mortality among nondisabled older Mexican Americans.

PURPOSE: To investigate the effect of early frailty transitions on 15-year mortality risk. METHODS: Longitudinal data analysis of the Hispanic Established Populations for the Epidemiological Study of the Elderly involving 1171 community-dwelling Mexican Americans aged ≥67 years and older. Frailty was determined using the modified frailty phenotype, including unintentional weight loss, weakness, self-reported exhaustion, and slow walking speed. Participants were defined at baseline as nonfrail, prefrail, or frail and divided into nine transition groups, during a 3-year observation period. RESULTS: Mean age was 77.0 years (standard deviation [SD] = 5.3) and 59.1% were female. Participants who transitioned from prefrail to frail (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.23-2.28), frail to prefrail (HR = 1.54, 95% CI = 1.05-2.28); or who remained frail (HR = 1.72, 95% CI = 1.21-2.44), had significant higher 15-year mortality risk than those who remained nonfrail. Participants transitioning from frail to nonfrail had a similar 15-year mortality risk as those who remained nonfrail (HR = 0.96, 95% CI = 0.53-1.72). Weight loss and slow walking speed were associated with transitions to frailty. CONCLUSIONS: An early transition from frail to nonfrail in older Mexican Americans was associated with a 4% decrease in mortality compared with those who remained nonfrail, although this difference was not statistically significant. Additional longitudinal research is needed to understand positive transitions in frailty.

Family Support and Family Negativity as Mediators of the Relation between Acculturation and Postpartum Weight in Low-Income Mexican-Origin Women.

BACKGROUND: Obesity presents a significant health concern among low-income, ethnic minority women of childbearing age. PURPOSE: The study investigated the influence of maternal acculturation, family negativity, and family support on postpartum weight loss among low-income Mexican-origin women. METHODS: Low-income Mexican-origin women (N=322; 14% born in the U.S.) were recruited from a prenatal clinic in an urban area of the Southwest U.S. Acculturation was assessed during a prenatal home visit (26-38 weeks gestation), and post-birth family support and general family negativity were assessed at 6 weeks postpartum. Objective maternal weight measures were obtained at five time points across the first postpartum year. RESULTS: Higher acculturation predicted higher family support and family negativity. Higher family support predicted decreasing weight across the first postpartum year, and higher family negativity predicted higher weight at 6 weeks postpartum and increasing weight across the first postpartum year. In combination, family negativity and support mediated the impact of acculturation on postpartum weight gain. CONCLUSIONS: Cultural and family-related factors play a significant role in postpartum weight gain and loss for low-income Mexican-origin women.

Weight Loss Success Among Overweight and Obese Women of Mexican-Origin Living in Mexico and the United States: A Comparison of Two National Surveys.

We assessed variations in and correlates of weight-loss success (WLS) among overweight/obese women in Mexico (WIMX) and Mexican-American women (MA). We used cross-national data from 2006 ENSANUT (Mexico) and NHANES (2001-2008) to compare 5061 WIMX with 550 MA's without known metabolic conditions. WLS was defined as losing ≥5 % of body weight over 1 year. MA's were more likely to attain WLS (OR 1.31; 95 % CI 1.01-1.70). WLS among WIMX was higher in those with at least high school, a provider screen of overweight and a lower BMI. Among MA's, an incomplete high school versus primary education reduced the odds of WLS. Among women who lost ≥10 lbs, weight-loss strategies such as eating less were higher among MA's. MA women were more likely than WIMX to attain WLS. Understanding these disparities can help design customized public health interventions that curb the obesity epidemic in these women in both countries.

Direct effects of fatty meals and adiposity on oxidised low-density lipoprotein.

High-fat intake and high adiposity contribute to hyperlipaemia. In a hyperlipaemic state, lipoproteins infiltrate arterial wall where they are modified and cause an immune response characteristic of atherosclerosis. A small fraction of modified lipoproteins including oxidised low-density lipoprotein (ox-LDL) returns to circulation. The present study tracked high-fat meals during four weeks as to find effects of sustained frequency change on adiposity and ox-LDL. The findings indicated that changes in frequency of consumption of high-fat eating episodes correlated directly with changes in adiposity and ox-LDL. Hence the number of fatty meals consumed by people with overweight or obesity in few weeks could affect the atherogenic process.

Sociocultural influences on strategies to lose weight, gain weight, and increase muscles among ten cultural groups.

This study determined how sociocultural messages to change one's body are perceived by adolescents from different cultural groups. In total, 4904 adolescents, including Australian, Chilean, Chinese, Indo-Fijian, Indigenous Fijian, Greek, Malaysian, Chinese Malaysian, Tongans in New Zealand, and Tongans in Tonga, were surveyed about messages from family, peers, and the media to lose weight, gain weight, and increase muscles. Groups were best differentiated by family pressure to gain weight. Girls were more likely to receive the messages from multiple sociocultural sources whereas boys were more likely to receive the messages from the family. Some participants in a cultural group indicated higher, and others lower, levels of these sociocultural messages. These findings highlight the differences in sociocultural messages across cultural groups, but also that adolescents receive contrasting messages within a cultural group. These results demonstrate the difficulty in representing a particular message as being characteristic of each cultural group.

Comparison of weight loss achieved after laparoscopic adjustable gastric banding between Afro-Caribbean, Caucasian and South Asian adult female patients in a London bariatric centre.

INTRODUCTION: It has been shown that following laparoscopic adjustable gastric banding (LAGB) procedures, Afro-Caribbeans achieve poorer weight loss compared with Caucasians. The reasons for this are multifactorial. However, studies have been based on mainly female patients from the US and none to date have been from the UK. Furthermore, South Asians have not previously been compared. The aim of this study was to compare excess weight loss percentage (%EWL) outcomes up to five years following LAGB in Afro-Caribbean, Caucasian and South Asian females in a London-based teaching hospital. METHODS: An analysis was carried out of prospectively collected data of female patients aged ≥16 years of Afro-Caribbean, Caucasian or South Asian origin who underwent LAGB between October 2000 and December 2011. Data included demographics, co-morbidities and anthropometrics. RESULTS: Overall, 596 females underwent LAGB; 316 Caucasians (53.0%), 64 Afro-Caribbeans (10.8%) and 27 South Asians (4.5%) formed the majority of those who disclosed ethnicities. Age and initial body mass index (BMI) were comparable between Afro-Caribbeans and Caucasians (mean BMI: 47.3kg/m²[standard deviation [SD]: 7.5kg/m², range: 37.0-78.3kg/m²] vs 45.8kg/m²[SD: 7.1kg/m², range: 24.7-79.8kg/m²], p=0.225). A non-significant trend suggested less %EWL in Afro-Caribbeans than in Caucasians at 6 months, and at 1, 2, 3, 4 and 5 years (21.4% vs 24.4%, p=0.26; 27.4% vs 31.3%, p=0.27; 33.0% vs 36.8%, p=0.15; 39.0% vs 45.8%, p=0.14; 34.2% vs 45.3%, p=0.16; 37.1% vs 47.6%, p=0.67). South Asians and Caucasians had a similar age and preoperative BMI (mean BMI: 43.6kg/m² [range: 32.5-59.1kg/m²] vs 45.8kg/m² [range: 24.7-79.8kg/m²], p=0.08). The %EWL was greatest at three and four years among South Asians although numbers were small (n=4 and n=3 respectively). CONCLUSIONS: A non-significant trend suggests poorer weight loss outcomes in Afro-Caribbeans compared with Caucasians in our cohort. Discussion of realistic weight loss outcomes as well as enhanced follow-up and dietary modifications are required for Afro-Caribbean patients. Low numbers prevent definitive conclusions regarding South Asians. Multicentre studies across England are required to better define any differences between ethnicities.

The impact of seasonality on changes in body weight and physical activity in Mexican-American women.

This 12-month, longitudinal panel study examined seasonal variability in body weight and physical activity in Mexican-American women. Fifty-nine women (20 to 63 years of age) were measured five times at intervals of three months between March 2010 and March 2011. Complete data were collected for all measures at all times on 36 women. Repeated measures multivariate analysis of variance with follow-up univariate repeated measures analysis of variance revealed that body weight increased on average by 1.36 kg (p < .01), with the greatest increase occurring during the fall (+0.80 kg). Changes in vigorous-intensity aerobic activity were statistically significant, with the greatest increase occurring in the spring (+51.99 min/week) and the greatest decline occurring in the fall (-30.11 min/week). Significant changes were observed in muscle-strengthening activity during the summer (-32.38 min/week). Moderate-intensity aerobic activity remained relatively stable. The decline in muscle-strengthening activity during the summer and subsequent decline in vigorous-intensity aerobic activity in the fall likely led to the observed increase in body weight during the fall. Thus, weight management interventions should consider the time of year when Mexican-American women's physical activity declines and include strategies specifically designed to prevent weight gain during the fall season.

Factors related to weight loss attempt among Dominican immigrants.

To assess weight loss attempt among a Latino immigrant population from the Dominican Republic we analyzed data on 585 overweight and obese Dominicans from a cross-sectional survey using Chi-square statistics, Student's t-tests, and logistic regression models. We found 58% of the overweight and obese tried to lose weight. Female gender (OR 2.28, CI 1.53-3.39), overweight perception (OR 2.37, CI 1.57-3.60) and weight loss advice from health professionals (OR 1.90, CI 1.24-2.91) were strongly associated with weight loss attempt. Individuals with diabetes were more likely to receive advice to lose weight (OR 2.58, CI 1.18-5.63; yet, they were more satisfied with their weight (40.5 vs. 27.8%, p < 0.021), and no difference in their weight loss attempt (p = 0.849) was detected compared to individuals without diabetes. We conclude a significant proportion of overweight and obese Dominican immigrants do not attempt to lose weight. Overweight perception and, except among individuals with diabetes, weight loss advice were strong inducements to weight loss attempt.

Use of alternative medicine for weight loss among Mexican-American women.

The objective of this study is to examine the use of complementary and alternative medicine (CAM) for weight loss among Mexican-American women. Cross-sectional survey of different CAM modalities, including traditional Mexican medicine therapies. The sample was drawn from women participating in a weight-loss program in Portland, Oregon. Sample consisted of 31 adult Mexican-American women. Most respondents reported using some form of CAM for weight loss, with most reporting using herbs and teas (70 %), home remedies (61 %) and massage (55 %). Mexican-American women report using a wide range of CAM therapies for weight loss. Understanding their patterns of use will enhance cultural competence of health care professionals and help address their medical needs.

Ethnic differences in self-rated overweight and association with reporting weight loss action: the SUNSET study.

AIM: To investigate ethnic differences in self-rated overweight and self-reported weight loss action. METHODS: Cross-sectional study (conducted in 2001-03) of 1441 residents (35-60 years) of Amsterdam, The Netherlands: Surinamese of South Asian (SA-Sur) and African (Afr-Sur) origin and ethnic Dutch. Self-rated overweight and self-reported weight loss action assessed by questionnaire. Height, weight and waist circumference (WC) measured in a clinic setting. RESULTS: Compared with ethnic Dutch and adjusting for BMI, Afr-Sur men [odds ratio (OR) 0.32; 95% CI 0.19-0.57] and women (OR 0.54; 95% CI 0.34-0.86) were less likely to rate themselves as overweight. However, adjustment for WC reduced differences in self-rated overweight (men: OR 0.79; 95% CI 0.46-1.35; women: OR 0.89; 95% CI 0.59-1.36). SA-Sur participants did not differ significantly from ethnic Dutch when adjusting for either BMI or WC. Surinamese participants were significantly more likely to report weight loss action independent of BMI, WC or self-rated overweight. In Afr-Sur men, elevated WC, not BMI was associated with reported weight loss action (OR 2.31; 95% CI 1.35-3.99 vs. OR 1.52, 95% CI 0.89-2.58, respectively). CONCLUSION: In this population, differences in self-rated overweight were explained by measured weight variables (BMI or WC). Our results do not support the hypothesis that Surinamese migrants would be less likely to be attempting weight loss than their Dutch peers. Further research into the reasons underlying this finding and associated weight loss behaviour seems indicated.

Predictors of trying to lose weight among overweight and obese Mexican-Americans: a signal detection analysis.

OBJECTIVE: Signal detection analysis, a form of recursive partitioning, was used to identify combinations of sociodemographic and acculturation factors that predict trying to lose weight in a community-based sample of 957 overweight and obese Mexican-American adults (ages 18-69 years). DESIGN: Data were pooled from the 2004 and 2006 Behavioral Risk Factor Surveillance System conducted in a low-income, semi-rural community in California. RESULTS: Overall, 59 % of the population reported trying to lose weight. The proportion of adults who were trying to lose weight was highly variable across the seven mutually exclusive groups identified by signal detection (range 30-79 %). Significant predictors of trying to lose weight included BMI, gender, age and income. Women who were very overweight (BMI > 28.5 kg/m2) were most likely to be trying to lose weight (79 %), followed by very overweight higher-income men and moderately overweight (BMI = 25.0-28.5 kg/m2) higher-income women (72 % and 70 %, respectively). Moderately overweight men, aged 28-69 years, were the least likely to be trying to lose weight (30 %), followed by moderately overweight lower-income women (47 %) and very overweight lower-income men (49 %). The latter group is of particular concern since they have characteristics associated with medical complications of obesity (low education and poor access to medical care). CONCLUSIONS: Our findings highlight opportunities and challenges for public health professionals working with overweight Mexican-American adults - particularly lower-income adults who were born in Mexico - who are not trying to lose weight and are therefore at high risk for obesity-related co-morbidities.

Acculturation, weight, and weight-related behaviors among Mexican Americans in the United States.

OBJECTIVE: This analysis explores the association between acculturation and body weight, self-perceptions of weight, and attempt to lose weight among Mexican Americans. METHODS: Data were analyzed from the National Health and Nutrition Examination Survey (NHANES) for 2001-2002. Indicator of acculturation used was language assimilation. Factor analysis was used to construct the acculturation measure, and descriptive and multivariable analyses were conducted using SUDAAN. RESULTS: The acculturation measure differentiated body weight, weight-related behavior, and self-perceptions about weight. Those lower on the acculturation scale were less likely to have a high BMI (> or =30) (24% vs 32%), and their perceptions of their own weight, desired weight, and recent history of trying to lose weight differed significantly from those persons high on the acculturation scale and these varied by sex. Among Mexican Americans with a BMI > or =25, those lower on the acculturation measure were significantly less likely to perceive themselves as overweight (60% vs 73%). They were also less likely to have attempted to lose weight in the past year than those who were high on the acculturation measure (OR = 0.49; 95% CI: 0.31-0.79). CONCLUSIONS: Less acculturated Mexican Americans with BMI > or =25 were less likely to perceive themselves as overweight and to have tried to lose weight. The acculturation measure provides insights into Mexican Americans' perceptions of their own weight and their recent attempt of trying to lose weight.

Weight change and mortality among older Mexican Americans.

BACKGROUND AND AIMS: Weight changes are predictors of health outcomes in older people. The purpose of this study is to examine the association between 2-year weight change and mortality in older Mexican Americans. METHODS: Seven year prospective cohort study of 1,749 non-institutionalized Mexican American men and women aged 65 and older residing in five Southwestern states. Measures include self-reports of medical conditions (heart attack, stroke, diabetes, hypertension, hip fracture or cancer), functional disability, high depressive symptoms, smoking status, a summary performance score of lower body function, hand grip muscle strength, and body mass index (BMI). Weight change was examined by comparing the baseline weight to the weight two years later to estimate the hazard of death within the following five-year period. RESULTS: Of the 1,749 subjects, 396 (22.6%) lost 5% or more weight, 984 (56.3%) had weight that remained stable, and 369 (21.1%) gained 5% or more weight between baseline and the 2-year follow-up period. Of the ones who lost 5% of weight, 28% died as compared to 19.7% and 15.2% of those whose weight remained stable and those who gained weight after 5 years, respectively. The hazard ratio (HR) of death for the group that lost 5% or more of their weight compared to the reference group (stable weight) was 1.35 (95% CI 1.06-1.70) after controlling for demographic variables, BMI, and waist circumference at baseline and 1.32 (95% CI 1.04-1.67) after controlling for all covariates. The HR of death for the group that gained 5% or more of weight was 0.78 (95% CI 0.58-1.05) after controlling for demographic variables, BMI, and waist circumference at baseline and 0.77 (95% CI 0.57-1.04) after controlling for all covariates. CONCLUSIONS: Weight loss is an independent predictor of mortality among older Mexican Americans, after controlling for relevant risk factors.