Prevalence of sarcopenic obesity in adults with end-stage knee osteoarthritis.

OBJECTIVE: To identify the prevalence of sarcopenic obesity, a phenotype of low muscle mass and high adiposity, in adults with end-stage knee osteoarthritis (OA). Various diagnostic criteria, including assessment of muscle/fat mass, muscle strength and physical function, were used to identify patients with and without sarcopenic obesity, and to compare outcomes of pain, function and quality of life. DESIGN: Cross-sectional clinical study including adults with a body mass index (BMI) ≥30 kg/m2 and knee OA. Body composition was measured by dual-energy X-ray absorptiometry (DXA). Assessments included gait speed, handgrip strength, six minute walk test, and self-reported pain, physical function, and health-related quality of life using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol Foundation (EQ-5D). RESULTS: 151 adults (59% female) aged 65.1 ± 7.9 years, mean BMI 37.1 ± 5.5 kg/m2, were included. Prevalence of sarcopenic obesity using diagnostic cut-offs of appendicular skeletal muscle mass (ASM) relevant to height2, weight and BMI varied from 1.3% (95% confidence interval (CI): 0.2-4.7%) to 14.6% (9.4-21.2%) and 27.2% (20.2-35%), respectively. A combined diagnostic approach including low ASM with either low strength or low function yielded a prevalence of 8.6% (4.7-14.3%). Sarcopenic obesity influenced walking speed, endurance, strength, and patient-reported difficulty with self-care activities, regardless of diagnostic approach. CONCLUSION: Prevalence of sarcopenic obesity varied depending on diagnostic criteria. Given the impact of this condition and OA on physical function, we suggest a combined diagnostic approach be used to clarify expected prevalence and enable early clinical identification and management of sarcopenic obesity in patients with knee OA.

Addressing weight bias and discrimination: moving beyond raising awareness to creating change.

Weight discrimination is the unjust treatment of individuals because of their weight. There have been very few interventions to address weight discrimination, due in part to the lack of consensus on key messages and strategies. The objective of the third Canadian Weight Bias Summit was to review current evidence and move towards consensus on key weight bias and obesity discrimination reduction messages and strategies. Using a modified brokered dialogue approach, participants, including researchers, health professionals, policy makers and people living with obesity, reviewed the evidence and moved towards consensus on key messages and strategies for future interventions. Participants agreed to these key messages: (1) Weight bias and obesity discrimination should not be tolerated in education, health care and public policy sectors; (2) obesity should be recognized and treated as a chronic disease in health care and policy sectors; and (3) in the education sector, weight and health need to be decoupled. Consensus on future strategies included (1) creating resources to support policy makers, (2) using personal narratives from people living with obesity to engage audiences and communicate anti-discrimination messages and (3) developing a better clinical definition for obesity. Messages and strategies should be implemented and evaluated using consistent theoretical frameworks and methodologies.

Cross-national perspectives about weight-based bullying in youth: nature, extent and remedies.

BACKGROUND: No cross-national studies have examined public perceptions about weight-based bullying in youth. OBJECTIVES: To conduct a multinational examination of public views about (i) the prevalence/seriousness of weight-based bullying in youth; (ii) the role of parents, educators, health providers and government in addressing this problem and (iii) implementing policy actions to reduce weight-based bullying. METHODS: A cross-sectional survey of adults in the United States, Canada, Iceland and Australia (N = 2866). RESULTS: Across all countries, weight-based bullying was identified as the most prevalent reason for youth bullying, by a substantial margin over other forms of bullying (race/ethnicity, sexual orientation and religion). Participants viewed parents and teachers as playing major roles in efforts to reduce weight-based bullying. Most participants across countries (77-94%) viewed healthcare providers to be important intervention agents. Participants (65-87%) supported government augmentation of anti-bullying laws to include prohibiting weight-based bullying. Women expressed higher agreement for policy actions than men, with no associations found for participants' race/ethnicity or weight. Causal beliefs about obesity were associated with policy support across countries. CONCLUSIONS: Across countries, strong recognition exists of weight-based bullying and the need to address it. These findings may inform policy-level actions and clinical practices concerning youth vulnerable to weight-based bullying.

A multinational examination of weight bias: predictors of anti-fat attitudes across four countries.

BACKGROUND/OBJECTIVES: As rates of obesity have increased throughout much of the world, so too have bias and prejudice toward people with higher body weight (that is, weight bias). Despite considerable evidence of weight bias in the United States, little work has examined its extent and antecedents across different nations. The present study conducted a multinational examination of weight bias in four Western countries with comparable prevalence rates of adult overweight and obesity. METHODS: Using comprehensive self-report measures with 2866 individuals in Canada, the United States, Iceland and Australia, the authors assessed (1) levels of explicit weight bias (using the Fat Phobia Scale and the Universal Measure of Bias) and multiple sociodemographic predictors (for example, sex, age, race/ethnicity and educational attainment) of weight-biased attitudes and (2) the extent to which weight-related variables, including participants' own body weight, personal experiences with weight bias and causal attributions of obesity, play a role in expressions of weight bias in different countries. RESULTS: The extent of weight bias was consistent across countries, and in each nation attributions of behavioral causes of obesity predicted stronger weight bias, as did beliefs that obesity is attributable to lack of willpower and personal responsibility. In addition, across all countries the magnitude of weight bias was stronger among men and among individuals without family or friends who had experienced this form of bias. CONCLUSIONS: These findings offer new insights and important implications regarding sociocultural factors that may fuel weight bias across different cultural contexts, and for targets of stigma-reduction efforts in different countries.

Diffusing obesity myths.

Misinformation or myths about obesity can lead to weight bias and obesity stigma. Counteracting myths with facts and evidence has been shown to be effective educational tools to increase an individuals' knowledge about a certain condition and to reduce stigma.The purpose of this study was to identify common obesity myths within the healthcare and public domains and to develop evidence-based counterarguments to diffuse them. An online search of grey literature, media and public health information sources was conducted to identify common obesity myths. A list of 10 obesity myths was developed and reviewed by obesity experts and key opinion leaders. Counterarguments were developed using current research evidence and validated by obesity experts. A survey of obesity experts and health professionals was conducted to determine the usability and potential effectiveness of the myth-fact messages to reduce weight bias. A total of 754 individuals responded to the request to complete the survey. Of those who responded, 464 (61.5%) completed the survey. All 10 obesity myths were identified to be deeply pervasive within Canadian healthcare and public domains. Although the myth-fact messages were endorsed, respondents also indicated that they would likely not be sufficient to reduce weight bias. Diffusing deeply pervasive obesity myths will require multilevel approaches.

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.

A systematic review of the quality of psychometric evidence supporting the use of an obesity-specific quality of life measure for use with persons who have class III obesity.

With global obesity rates at 42%, there is a need for high-quality outcome measures that capture important aspects of quality of life for persons with obesity. The aim of this paper was to systematically review and critique the psychometric properties and utility of the impact of weight on quality of life-lite (IWQOL-Lite) for use with persons who have class III obesity. Databases were searched for articles that addressed obesity-specific quality of life. A critical appraisal of the psychometric properties of the IWQOL-Lite and connection to a quality of life conceptual framework was completed. Raters used a standardized data extraction and quality appraisal form to guide evidence extraction. Two articles that reviewed obesity-specific quality of life measures were found; none were based on a systematic review. Six articles on the IWQOL-Lite met the criteria for critical appraisal using guidelines. The mean quality score for these articles was 59.2%. Concepts measured were consistent with the biopsychosocial concept of health defined by the World Health Organization. There is limited but consistent evidence that the IWQOL-Lite is a reliable, valid and responsive outcome measure that can be used to assess disease-specific quality of life in persons with class III obesity.