Health trajectories of children with severe obesity attending a weight management program.

PURPOSE: The objective of the present study is to examine physical and mental health trajectories of change in youth with severe obesity attending a tertiary care weight management program. It was predicted that younger children would show favourable changes in body mass index (BMI), markers of cardiovascular health, quality of life, and mental health. METHODS: This 2-year longitudinal study examined health trajectories of children referred to a weight management program at a Canadian paediatric tertiary care centre from November 2010 to December 2013. Participants were 209 of 217 consecutive referred paediatric patients (families) aged 3 to 17 years who met criteria for severe obesity and consented to participate. To maximize generalizability of results, there were no exclusion criteria. Primary outcomes were children's quality of life and BMI. Secondary outcomes included anxiety, depression, and non-high-density lipoprotein cholesterol levels. RESULTS: The findings suggest an improvement in mental health, quality of life, and cardiometabolic health of children and adolescents of all ages over the 2 years of programming. These positive findings were consistent across gender, age, and distance to the program. BMI trajectory changes varied across age cohorts such that younger children showed more favourable outcomes. The retention rate over the 2 years was high at 82.9%. CONCLUSIONS: This is the first study to show improvements in both physical and mental health outcomes beyond 1 year in a tertiary care setting with a high-risk population of children and youth with severe obesity. Findings highlight the need to examine both mental and physical health outcomes beyond 1 year.

Extracurricular Activity Involvement and Body Image in Youth with Obesity: The Mediating Role of Social Life.

Background: Youth with severe obesity are vulnerable to body dissatisfaction. Extracurricular activity (ECA) involvement has been linked to positive social interactions and body image in community samples; however, these links remain to be tested in clinical samples of youth with severe obesity. The present study explored ECA involvement [both physical and nonphysical activities (PAs)] in a clinical sample of youth with obesity to determine whether ECA involvement was related to body image (appearance and weight esteem) and social life (i.e., social experiences with peers). Methods: Participants were 209 adolescents (Mean age = 15.05; 50.2% female) who completed a baseline assessment at a tertiary care weight management program. Results: Of the participants, 70.3% of youth reported participating in PAs, and 56.5% reported participating in non-PAs. As hypothesized, weight esteem and social life were higher in those who participated in PA vs. those who did not. Mediation analyses revealed that social life positively mediated the relationship between PA participation and weight esteem. Conclusions: Social life may be a mechanism by which PA participation is positively related to weight esteem in youth with severe obesity. Findings could inform weight management programs for youth with obesity who are at risk for social inclusion and body dissatisfaction.

Do obese children perceive submaximal and maximal exertion differently?

We examined how obese children perceive a maximal cardiorespiratory fitness test compared with a submaximal cardiorespiratory fitness test. Twenty-one obese children (body mass index ≥95th percentile, ages 10-17 years) completed maximal and submaximal cardiorespiratory fitness tests on 2 separate occasions. Oxygen consumption (VO2) and overall perceived exertion (Borg 15-category scale) were measured in both fitness tests. At comparable workloads, perceived exertion was rated significantly higher (P < 0.001) in the submaximal cardiorespiratory fitness test compared with the maximal cardiorespiratory fitness test. The submaximal cardiorespiratory fitness test was significantly longer than the maximal test (14:21 ± 04:04 seconds vs. 12:48 ± 03:27 seconds, P < 0.001). Our data indicate that at the same relative intensity, obese children report comparable or even higher perceived exertion during submaximal fitness testing than during maximal fitness testing. Perceived exertion in a sample of children and youth with obesity may be influenced by test duration and protocol design.

The effects of aerobic exercise on psychosocial functioning of adolescents who are overweight or obese.

OBJECTIVES: To evaluate effects of stationary cycling to music versus interactive video game cycling on psychosocial functioning in obese adolescents. METHODS: 30 obese adolescents aged 12-17 years were randomized to twice weekly laboratory-based sessions of stationary cycling to music or interactive video game cycling for a 10-week trial. Participant's self-reported measures of scholastic competence, social competence, athletic competence, body image, and self-esteem were obtained. Aerobic fitness and body composition were directly measured. RESULTS: Although no differences emerged between exercise groups over time, when collapsed across exercise modality, significant pre-post improvements were found for body image, perceived scholastic competence and social competence. Changes in aerobic fitness, but not body composition, were positively associated with psychosocial functioning. CONCLUSIONS: Aerobic exercise was associated with improvements in body image, perceived academic performance, and social competence in obese adolescents, and these psychological benefits were related to improved aerobic fitness but not changes in body composition.

An assessment of patient information channels and knowledge of physical activity and nutrition during pregnancy.

BACKGROUND: Excessive weight gain during pregnancy increases the risk for obesity in mother and child. Healthy eating and physical activity may help prevent excessive gestational weight gain and minimize offspring risk of developing obesity, diabetes and cardiovascular disease. Our goal was to determine the information channels used by pregnant women to obtain information on nutrition and exercise. METHODS: We collected information about their knowledge of physical activity and nutrition during pregnancy and assessed their satisfaction with this information to identify factors that may be improved upon when designing a behavioural intervention. An anonymous, voluntary questionnaire was completed by 147 pregnant women to identify the proportion who are currently receiving information about exercise from their care provider. RESULTS: The primarily Caucasian sample (age: 30.9 ± 4.2, weeks gestation: 21.4 ± 9.4) completed the survey. A total of 86% are willing to participate in a lifestyle intervention trial. Personal health and the health of their child were cited as top reasons for participation. Most women were not informed as to the importance of appropriate pregnancy-specific energy intake or made aware of their own personal healthy gestational weight gain targets. A total of 63% report receiving some form of information on physical activity during pregnancy. Of those who do not, almost all (93%) would like to receive this information from a care provider. Overall, 88% of women consider it safe to exercise when pregnant. DISCUSSION: Given their responses, nutrition and exercise information offered through a lifestyle intervention during pregnancy may increase healthy behaviours and warrants clinical investigation.

Effects of interactive video game cycling on overweight and obese adolescent health.

The purpose of this study was to examine the efficacy of interactive video game stationary cycling (GameBike) in comparison with stationary cycling to music on adherence, energy expenditure measures, submaximal aerobic fitness, body composition, and cardiovascular disease risk markers in overweight and obese adolescents, using a randomized controlled trial design. Thirty overweight (with at least 1 metabolic complication) or obese adolescents aged 12-17 years were stratified by gender and randomized to video game or music condition, with 4 participants (2 per group) failing to complete the twice weekly 60 min sessions of the 10-week trial. The music group had a higher rate of attendance compared with the video game group (92% vs. 86%, p < 0.05). Time spent in minutes per session at vigorous intensity (80%-100% of predicted peak heart rate) (24.9 ± 20 min vs. 13.7 ± 12.8 min, p < 0.05) and average distance (km) pedaled per session (12.5 ± 2.8 km vs. 10.2 ± 2.2 km, p < 0.05) also favoured the music group. However, both interventions produced significant improvements in submaximal indicators of aerobic fitness as measured by a graded cycle ergometer protocol. Also, when collapsed, the exercise modalities reduced body fat percentage and total cholesterol. The present study indicates that cycling to music was just as effective as stationary cycling while playing video games at improving fitness, body composition, and cholesterol profiles in overweight and obese teens, and resulted in increased attendance, vigorous intensity of physical activity, and distance pedaled. Therefore, our data support the superiority of cycling to music and indicate investing in the more expensive GameBike may not be worth the cost.

The effect of acute taurine ingestion on endurance performance and metabolism in well-trained cyclists.

This study examined whether acute taurine (T) ingestion before prolonged cycling would improve time-trial (TT) performance and alter whole-body fuel utilization compared with a control (CON) trial and a placebo (PL) trial in which participants were told they received taurine but did not. Eleven endurance-trained male cyclists (27.2 ± 1.5 yr, 74.3 ± 2.3 kg, 59.9 ± 2.3 ml · kg⁻¹ · min⁻¹; M ± SEM) completed 3 trials in a randomized, crossover, blinded design in which they consumed a noncaloric sweetened beverage with either 1.66 g of T or nothing added (CON, PL) 1 hr before exercise. Participants then cycled at 66.5% ± 1.9% VO(2max) for 90 min followed immediately by a TT (doing 5 kJ of work/kg body mass as fast as possible). Data on fluid administration, expired gas, heart rate, and ratings of perceived exertion were collected at 15-min intervals during the 90-min cycling ride, but there were no differences recorded between trials. There was no difference in TT performance between any of the 3 trials (1,500 ± 87 s). Average carbohydrate (T 2.73 ± 0.21, CON 2.88 ± 0.19, PL 2.89 ± 0.20 g/min) and fat (T 0.45 ± 0.05, CON 0.39 ± 0.04, PL 0.39 ± 0.05 g/min) oxidation rates were unaffected by T supplementation. T ingestion resulted in a 16% increase (5 g, ~84 kJ; p < .05) in total fat oxidation over the 90-min exercise period compared with CON and PL. The acute ingestion of 1.66 g of T before exercise did not enhance TT performance but did result in a small but significant increase in fat oxidation during submaximal cycling in endurance-trained cyclists.

Stress and the relative reinforcing value of food in female binge eaters.

The purpose of this study was to examine the independent and interactive effects of stress reactivity and binge eating (BE) status on changes in the relative reinforcing value of snack foods. The relative reinforcing value of snack foods was assessed in binge eaters and non-binge eaters across a stress-induction session (after 3-minutes of anticipation of giving a speech) or a control day (after 3-minutes of reading magazines), with order of conditions counterbalanced. Subjects were divided into four groups based on scores on the Binge Eating Scale (BES) and changes in perceived stress: Binge eaters/low stress reactivity (n=12), binge eaters/high stress reactivity (n=10), non-binge eaters/low stress reactivity (n=6), non-binge eaters/high stress reactivity (n=9). Dietary restraint, hunger, disinhibition, and hedonics were measured by self-report. Body composition was estimated by body mass index (BMI=weight in kilograms divided by height in metres squared). The relative reinforcing value of snack food was influenced differently by binge status and stress reactivity in the stress and control conditions (p<0.05). Binge eaters who reacted to stress earned more snack food points (p<0.001) in stress condition, but non-binge eaters who showed high stress reactivity earned less points for snack food in stress condition (p<0.05). This same pattern of results remained after statistically controlling for body mass index (BMI) and dietary restraint. Findings suggest that reactivity to interpersonal or ego-related stress increases the relative reinforcing value of food in binge eaters but decreases the relative reinforcing value of snack food in non-binge eaters, and these findings appear to be independent of dietary restraint and BMI.

Magnetic resonance spectroscopy in pre-eclampsia: evidence of cerebral ischaemia.

OBJECTIVE: To establish whether there are changes in the maternal brain in pre-eclampsia detectable by magnetic resonance angiography and spectroscopy. DESIGN: A prospective, observational study. SETTING: Obstetric and Radiology Departments, Queen's Medical Centre, Nottingham. SAMPLE: Fourteen healthy, nulliparous non-pregnant women, 9 healthy primiparous pregnant women and 10 women with pre-eclampsia. METHODS: Magnetic resonance angiography and proton magnetic resonance spectroscopy of the brain was performed on each woman. Non-pregnant women were each studied twice. Healthy pregnant women were studied three times during pregnancy and once postnatally. Subjects with pre-eclampsia were studied once antenatally and twice postnatally. Magnetic resonance angiograms were examined for signs of vessel narrowing. On magnetic resonance spectroscopy, the ratios of the dominant peaks of the spectrum: N-acetyl aspartate (NAA), choline, creatine and lactate were compared. MAIN OUTCOME MEASURE: Comparison of spectroscopic indices in non-pregnant, normal pregnant and pre-eclamptic women. RESULTS: On magnetic resonance angiography, there was no evidence of vessel narrowing in any of the three groups. NAA/choline ratio was higher at all stages of pregnancy compared with the non-pregnant group (P < 0.05) associated with lower choline. NAA/choline increased gradually during healthy pregnancy associated with a decrease in choline. NAA/choline was significantly lower in the pre-eclampsia group compared with the healthy pregnant women at similar gestation (P < 0.01), associated with higher choline. There were no differences between the groups postnatally. Lactate was not detected. These changes are similar to those found in patients with carotid stenosis without cerebral infarction. CONCLUSIONS: Narrowing of vessels detectable on magnetic resonance angiography does not occur commonly in pre-eclampsia. Magnetic resonance spectroscopy results suggest that there is relative cerebral ischaemia in pre-eclampsia compared with healthy pregnancy.

Warfarin dosage in postpartum women: a case-control study.

OBJECTIVE: To investigate the clinical suspicion that postpartum women are more difficult to anticoagulate with warfarin than non-pregnant women due to the physiological changes in coagulation proteins that persist into the postpartum period. DESIGN: A retrospective case-control study. SETTING: University Hospital, Nottingham, UK. SAMPLE: Twenty-three postpartum women discharged from the obstetric wards on warfarin and 23 age-matched control women discharged from the medical wards on warfarin were identified using hospital databases. METHODS: Warfarin doses and international normalised ratio values were recorded from day one to 35. The number of days and total warfarin dose to achieve therapeutic international normalised ratio were recorded. Doses were compared with those recommended by a dosing nomogram. RESULTS: The postpartum group took significantly longer and significantly larger doses of warfarin to reach therapeutic international normalised ratio (P < 0.05). The postpartum group required a persistently higher maintenance dose of warfarin. Comparing the warfarin dose given on day three with a standardised nomogram, 79% of women in the postpartum group compared with 57% in the control group were under-dosed. CONCLUSION: Postpartum women require larger doses of warfarin to reach therapeutic international normalised ratio than non-pregnant women. We would recommend the use of a dosing nomogram.